projected demand for antiretroviral therapy (ART) will increase to 16.8 million person-years by the end
of 2016 in low- and middle-income countries, including 15.7 million
person-years of adult and 1.1 million person-years of paediatric formulation,
according to a study presented on behalf of the global ARV Forecasting
Technical Working Group at the 20th International AIDS Conference (AIDS 2014) in
projected demand for ART will increase from 11.5 million person-years by the
end of 2013 to 15 million person-years by the end of 2015 and 16.8 million person-years
by the end of 2016. Person-years represent the product of the
number of years times the number of members of a population that will need ART.
ART supply security is an issue,
as witnessed in the 2013 shortages of tenofovir and efavirenz. There has also
been a global supply outage of stavudine/lamivudine paediatric
formulation and a shortage of zidovudine.
be able to supply the right ARVs on time, manufacturers need independent
assessment of what and how much to produce two to three years ahead of time,
certainly when they need to bring new formulations to the market,” said Jos
Perriëns, of the World Health Organization (WHO), who was presenting the study.
that enough ARVs are produced globally, WHO convened a global ARV Forecasting
Technical Working Group in 2013, with UNAIDS, the Clinton Health Access
Initiative (CHAI), UNICEF, the Global Fund to Fight AIDS, TB and Malaria (GFATM), PEPFAR,
and Futures Institute to develop annual three-year forecasts of the demand of ARVs. Forecasts are based on the annual WHO survey on ARV use, the volume
of individual ARVs in the global procurement reporting mechanism, CHAI
projections for 22 high-volume countries, GFATM and PEPFAR’s Supply Chain
Management System quantification data, and projected evolution of ART needs from
UNAIDS and the Futures Institute.
According to the study, the market share of tenofovir
will increase from 50% in 2013 to reach 62% in 2016, that of zidovudine will
decrease from 40% to 34% and that of stavudine will decrease from 8% to 2%.
The market share of efavirenz will increase from 48% in 2013 to 63%, and
nevirapine will gradually lose market share. Second-line ART uptake will
increase slowly from 4.4% currently to 5.0% in 2016. Insufficient data were
available to project the uptake of third-line drugs. The study
limited the number treated in each country to 80% of those eligible for
treatment using WHO 2013 criteria. Three forecast scenarios were
used and averaged arithmetically to generate the projected demand. Forecasts
were broken down by active ingredient and adults versus children.
The average estimate for end of 2013 was 11.5 million – when in reality
11.7 million were reached. In the six
years in which the WHO produced their forecasts, they have consistently
underestimated the future treatment uptake by about 2%. “We therefore believe that the 15 by 15
target will be met, and think that it will in fact be exceeded,” said Perriëns.
the limitations of the study is that there may be overlap between the data
sets. The time horizon is also limited, but will be expanded to five to seven
years in future analyses. The analysis also excluded novel molecules that may
become available to treat HIV and has no insight on formulation use.