Tido von Schoen-Angerer and colleagues discuss the new Affordable Medicines Facility for malaria (AMFm), which subsidizes and facilitates access to artemisinin-based combination therapy, and what mechanisms are needed to ensure it stays focused on quality patient care.
Despite significant progress in paediatric HIV treatment, optimal antiretroviral formulations for infants, children and adolescents remain limited. The paediatric antiretroviral drug optimization group regularly reviews medium-and long-term priorities for antiretroviral drug development, to guide industry and other stakeholders on formulations most needed for low-and middle-income countries. Ongoing medium-term priorities include a scored dispersible dolutegravir tablet (10mg), a dolutegravir-containing fixed-dose combination, and fixed-dose combinations containing tenofovir alafenamide. Darunavir/ritonavir combination tablet remain a priority for second-line treatment. Future treatment options of potential interest for paediatrics include broadly neutralizing antibodies, long acting/extended release formulations, and novel technologies. Issues specific to neonatal prophylaxis and treatment, and to the investigation of novel antiretrovirals in adolescents and pregnant and lactating women are also discussed. Continued focus on identifying, prioritizing and ensuring access to optimal formulations suitable for infants, children and adolescents is key to ensuring that global HIV treatment targets can be met.
Corresponding author: W D F Venter (fventer@wrhi.ac.za)Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.
Long-acting antiretroviral drugs have emerged as exciting treatment and preexposure prophylaxis (PrEP) options for people with HIV and at risk of HIV. Long-acting regimens may improve dosing convenience, tolerability and cost compared with current dailybased oral therapy. They can also circumvent stigma associated with oral therapy for both treatment and PrEP, thereby improving adherence and outcomes. Yet, multiple challenges remain, many specific to low-income and middle-income countries (LMICs), where the epidemic is most concentrated and HIV prevention and treatment options are limited. To optimize the use of long-acting formulations, key outstanding questions must be addressed. Uncertain costing, scale-up manufacturing, complex delivery systems and implementation challenges are potential barriers when considering the scalability of long-acting ARVs for global use.
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