The Joint United Nations Programme on HIV/AIDS 95–95–95 targets: worldwide clinical and cost benefits of generic manufacture

TLDR

The Joint United Nations Programme on HIV/AIDS aims for 95–95–95 testing, treatment, and viral suppression rates by 2025, but patented drug prices remain a barrier to treatment. We collated export records of active pharmaceutical ingredient for HIV drugs, used epidemiological data to estimate treatment costs for 164 countries at 95–95–95, and applied weighted log-linear regression models to estimate preventable MTCTs, deaths, and new infections, finding that TDF/3TC/DTG could be produced for $59 per person per year. Treating 164 countries at 95–95–95 for $2 billion per year would prevent 66 308 MTCTs, 241 811 HIV-related deaths, and 631 398 new infections annually—about the cost of 4 weeks of current global HIV pharmaceutical spending—and global access to generics could reduce expenditure and improve clinical outcomes.

Abstract

The Joint United Nations Programme on HIV/AIDS aims for HIV testing, treatment and viral suppression rates to be 95%--95%--95% by 2025. Patented drug prices remain a barrier to HIV treatment. Generic alternatives are being produced and exported from countries without patent barriers at a fraction of the cost.We collated export records of active pharmaceutical ingredient for HIV drugs to estimate the minimum costs of production. Using epidemiological data describing national HIV epidemics, we calculated the cost to treat 164 countries at 95%--95%-95%. Using weighted log-linear regression models, we estimated the mother-to-child transmissions (MTCTs), HIV-related deaths and new HIV infections preventable every year by increased treatment.We estimated that TDF/3TC/DTG could be produced for $59 per person per year. At this price, the 164 countries in our analysis could be treated at 95%--95%--95% for $2 billion a year, preventing 66 308 MTCTs, 241 811 HIV-related deaths and 631 398 new HIV infections every year. In comparison, global expenditure on HIV pharmaceuticals in 2019 was $28 billion.At $2 billion/year, the 164 countries in our analysis could be treated for the price of 4 weeks of current global sales. Global access to generic alternatives could reduce expenditure and improve clinical outcomes.