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The COVID-19 pandemic could affect the availability and distribution of antiretroviral drugs used in treating HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said on Monday.

An analysis by the UN agency shows the potential impacts the COVID-19 pandemic could have in low- and middle-income countries around the world on supplies of the generic antiretroviral medicines used to treat HIV.

According to the analysis, the lockdowns and border closures imposed to stop COVID-19 are impacting both the production of medicines and their distribution.

This, it said, could potentially lead to increases in their cost and to supply issues, including stock-outs over the next two months.

The analysis indicates that although 24.5 million people were on antiretroviral therapy at the end of June 2019, millions of people could be at risk of harm—both to themselves and others owing to an increased risk of HIV transmission—if they cannot continue to access their treatment.

“A recent modelling exercise estimated that a six-month disruption of antiretroviral therapy in sub-Saharan Africa alone could lead to 500 000 additional AIDS-related deaths,” it said.

The UNAIDS analysis collected information from the eight generic manufacturers of antiretroviral medicines in India that together account for more than 80 per cent of generic antiretroviral medicine production worldwide.

Government departments in seven other countries that produce generic antiretroviral medicines and that account for most of the production of generic antiretroviral medicines in low- and middle-income countries domestically were also surveyed.

Price increase

The analysis shows that the production of antiretroviral medicines has been affected by several factors.

“Air and sea transport is being severely curtailed, hampering the distribution of the raw materials and other products, such as packaging material, that pharmaceutical companies need to manufacture the medicines.

“Physical distancing and lockdowns are also restricting the levels of human resources available in manufacturing facilities.

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“The combined result of shortages of materials and workforces could lead to supply issues and pressure on prices in the coming months, with some of the regimens for first-line treatment and those for children projected to be the severest hit”.

It also said an array of circumstances are conspiring to add pressure on the overall cost of finished antiretroviral medicines.

“Increased overhead and transport costs, the need for alternative sourcing of key starting materials and active pharmaceutical ingredients and currency fluctuations caused by the forecasted economic shock are combining to push up the cost of some antiretroviral regimens.”

It estimated that a 10–25 per cent increase in these could result in an annual increase in the final cost of exported antiretroviral medicines from India alone of between US$ 100 million and US$ 225 million.

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“Considering that in 2018, there was an HIV financing shortfall of more than US$ 7 billion, the world cannot afford an added burden on investments in the AIDS response,” UNAIDs said.

Measures

The Executive Director of UNAIDS, Winnie Byanyima, said measures can still be taken to mitigate the risks.

“It is vital that countries urgently make plans now to mitigate the possibility and impacts of higher costs and reduced availability of antiretroviral medicines.

“I call on countries and buyers of HIV medicines to act swiftly in order to ensure that everyone who is currently on treatment continues to be on it, saving lives and stopping new HIV infections,” she said.

UNAIDs said the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is providing immediate funding of up to US$ 1 billion to help countries to respond to COVID-19.

The procurement platform is also been expanded to non-Global Fund recipients.

The UN agency also recommends the effective management of current and future stocks of antiretroviral medicines and supply can be continued for all who need treatment.

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