July 25, 2021

Innovative agreement launches affordable, optimal second-line HIV treatment in low- and middle-income countries

Unitaid and CHAI logos side by side. Unitaid spelled in red with subtext 'Innovation in Global Health'. Clinton Health Access Initiative spelled out with a circle of increasing sized stars surrounding it.

  • Unitaid and the Clinton Health Access Initiative, Inc. (CHAI) announce pricing agreement with pharmaceutical company Hetero Labs LTD to make available generic version of best-in-class second-line therapy for people living with HIV.

July 26, 2021 – Unitaid and CHAI today announced a groundbreaking pricing agreement with pharmaceutical company Hetero Labs LTD to make darunavir boosted with ritonavir (DRV/r) available as a second-line therapy for people living with HIV in low- and middle-income countries for US$210 per patient, per year.

Darunavir (DRV) in combination with ritonavir is a best-in-class protease inhibitor, proven to be effective both in patients who have never been treated for HIV and those who have experienced multi-drug resistance. DRV is easier to take and less toxic than existing protease inhibitors used in second-line treatment.

Despite being available in the United States and other high-income countries for over a decade, low- and middle-income countries still lack access to an affordable, quality generic version of the drug. Through this agreement, Hetero Labs LTD’s World Health Organization (WHO) prequalified DRV/r will be available in low- and middle-income countries for US$210 per patient per year, or US$17.50/pack (plus shipping and insurance). This price is cheaper than the well-established but suboptimal alternative option, lopinavir/ritonavir (LPV/r).

Kenly Sikwese, HIV advocate and head of the African Community Advisory Board (AfroCAB) stated, “It is fantastic to finally have a robust more efficacious protease inhibitor for the treatment of HIV. Since 2011, the community has been advocating for the use of DRV in second-line, and this milestone is a critical step to addressing the longstanding inequity in access to this optimal HIV treatment in low- and middle-income countries. We look forward to seeing policymakers across the globe move expeditiously forward to accelerate access to this very important drug for communities.”

Second- and third-line therapies are critical for people living with HIV where first-line treatment may not be an option, due to medication resistance or intolerance. However, there are barriers to commercializing DRV/r in low-resource settings, including the higher cost of producing the DRV active pharmaceutical ingredient in comparison to that of other protease inhibitors, as well as availability of DRV in a fixed-dose combination with ritonavir. Until now, this made the product too expensive for national treatment programs in low- and middle-income countries to afford, relying instead on sub-optimal products like LPV/r.

To address these barriers and others like them, Unitaid has invested in CHAI since 2016 to bring the best HIV medications to market more quickly and integrate them into treatment programs in the low- and middle-income countries that need them most.

Unitaid Executive Director Dr Philippe Duneton said, “Ensuring equitable access to the best HIV treatments is at the heart of what Unitaid does. This agreement with Hetero marks an important moment in accelerating the development and availability of a long-awaited generic formulation of darunavir/ritonavir. It is vital that all those living with HIV who cannot stay on first-line treatment have access to a quality second-line product, and we are proud of our work with CHAI to make this happen.”

Joy Phumaphi, CHAI Interim Co-CEO, stated, “Access to this best-in-class second-line HIV treatment is long overdue. We are grateful that through our partnership with Unitaid, patients in low- and middle-income countries will now be able to access the same high-quality second- line medication as those in high-income countries, enabling more patients to remain on treatment and save lives. We look forward to working with our government and community partners to quickly deliver this medication to patients.”

The agreement not only ensures a groundbreaking price, but that the product will be registered widely in low- and middle-income countries using the WHO Collaborative Registration Procedure (CRP) for prequalified products. The CRP accelerates registration through information sharing between the WHO Prequalification of Medicines Programme (PQP) and national medicines regulatory authorities.

To reach the milestone announced today, CHAI and Unitaid drew on years of experience on both the supply and demand side of the HIV therapy market. CHAI engaged with the originator company, Janssen, and generic drug manufacturers to encourage data sharing, and ensure a generic product was quickly developed and filed with stringent regulatory and national drug regulatory authorities. Unitaid provided an innovative financial incentive to secure a highly competitive yet sustainable price, that is designed to partially offset the high costs of manufacturing until economies of scale are achieved. These efforts helped ensure that affordable pricing was available in low- and middle-income countries from day one, thereby paving the way for adoption of the product.


About Unitaid | Unitaid is a global health agency engaged in finding innovative solutions to prevent, diagnose and treat diseases more quickly, cheaply and effectively, in low- and middle-income countries. Its work includes funding initiatives to address major diseases such as HIV/AIDS, malaria and tuberculosis, as well as HIV co-infections and co-morbidities such as cervical cancer and hepatitis C, and cross-cutting areas, such as fever management. Unitaid is now applying its expertise to address challenges in advancing new therapies and diagnostics for the COVID-19 pandemic, serving as a key member of the Access to COVID Tools Accelerator. Unitaid is hosted by the World Health Organization.

About CHAI | The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low-and middle-income countries. We work with our partners to strengthen the capabilities of governments and the private sector to create and sustain high-quality health systems that can succeed without our assistance. For more information, please visit: www.clintonhealthaccess.org.

For further information contact:

Thalia Bayle, Unitaid, Geneva – tel. +41 79 660 56 37 baylet@unitaid.who.int

Regan Lachapelle, CHAI, Chicago – tel. +1 857-208-2788 rlachapelle@clintonhealthaccess.org


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