Role of pharmacists in improving accessibility of antiretrovirals to support the United States President's Emergency Plan for AIDS Relief: Impact on the patient, program, and market

Abstract

The United States President's Emergency Plan for AIDS Relief (PEPFAR) is the largest commitment by any nation to combat a single disease through prevention and treatment initiatives; pharmacists play a critical role in improving the accessibility of antiretrovirals (ARVs). When determining the potential use of a medication for a human immunodeficiency virus (HIV) program, it is helpful to consider decisions through the (a) Perspective of a patient, (b) Perspective of the overarching HIV program providing care, and (c) Perspective of the ARV market. Pharmacists are uniquely positioned to contribute to decisions from these three perspectives. At the beginning of PEPFAR, the price of ARVs was cost prohibitive; however, after 17 years since its inception, through the work of pharmacists and other public health professionals, the price to treat one patient for one year is currently 63 USD. This article describes the impact of pharmacists at the U.S. Agency for International Development (USAID) and the Food and Drug Administration (FDA) in facilitating a dramatic reduction in the cost of ARVs, through the use of an expedited approval process and through pooling procurement of ARVs from a limited formulary.

Implementation of a Global Health Equity fellowship established in partnership between an academic institution and governmental agency

“…While this fellowship is new in structure, it was built on the strong foundations of both the PKP and USAID, who have been working for decades to address health inequities through engagement in global communities. 16,19 In identifying the guiding tenets, the fellowship relied on past experiences of developing ethical and sustainable programs in global health and the concept of reciprocal innovation, which has recently been adopted in global health. Reciprocal innovation challenges the notion that only higher income settings will produce groundbreaking solutions and highlights the ability to utilize concepts, innovations, and research from lower income settings for application in higher income settings.…”

“…While this fellowship is new in structure, it was built on the strong foundations of both the PKP and USAID, who have been working for decades to address health inequities through engagement in global communities 16,19 . In identifying the guiding tenets, the fellowship relied on past experiences of developing ethical and sustainable programs in global health and the concept of reciprocal innovation, which has recently been adopted in global health.…”

“…At USAID, pharmacists are specifically hired into roles within policy drafting, supply chain management, and planning, and as liaisons to the Food and Drug Administration (FDA), WHO, and various manufacturers. 19 Roles within this type of global health work are less commonly associated with a pharmacy career path and as such, in 2017, USAID created work share programs for pharmacists, an internship for student pharmacists, and various fellowship opportunities.…”

“…At the policy level, the U.S. Agency for International Development (USAID) has robust programs addressing multiple diseases and conditions in over 80 countries, and pharmacists are involved in many layers of these programs. At USAID, pharmacists are specifically hired into roles within policy drafting, supply chain management, and planning, and as liaisons to the Food and Drug Administration (FDA), WHO, and various manufacturers 19 . Roles within this type of global health work are less commonly associated with a pharmacy career path and as such, in 2017, USAID created work share programs for pharmacists, an internship for student pharmacists, and various fellowship opportunities.…”

“…USAID maintains strong collaborations with other international agencies, non-governmental organizations (NGO), and supply chain entities to ensure a coordinated approach to achieving its international policies. As a part of the experiential rotation at USAID, fellows would have mentored opportunities to work across international agencies, such as the WHO and Centers for Disease Control and Prevention (CDC) 19. To aid in the development of the fellowship, USAID utilized the Sustaining Technical and Analytical Resources (STAR) program implemented by the Public Health Institute to further sought experiences in engagement that addressed SDOH in innovative ways through community engagement, clinical care, and policy development.…”