Immediate-release flucytosine & liposomal amphotericin B access

DNDi joined the Improved Access to AHD Care and Treatment for HIV (IMPAACT4HIV) project consortium as an implementing partner in the Democratic Republic of the Congo (DRC), where the consortium aims to enhance access to optimal diagnosis, prevention, treatment, and innovative delivery mechanisms for patients with advanced HIV disease (AHD). This project will work closely with PNLS, the national HIV programme within the DRC Ministry of Health, to implement an AHD package of care in nine health centres in Kinshasa. It will provide access to treatment for opportunistic infections including histoplasmosis, cryptococcal meningitis, and tuberculosis.

In May 2024, DNDi co-organized a meeting on AHD in Nairobi, Kenya, together with the AHD Alliance; End AIDS Action Group; Fight AIDS Coalition; Infectious Diseases Institute, Makerere University; Médecins Sans Frontières (MSF); Partners in Hope; and St. George’s, University of London. The meeting focused on driving demand creation and scaling up access to AHD services and medical commodities in Africa. The Nairobi Declaration on access to CD4 testing was one result of the meeting, bringing attention to the problem of declining CD4 testing in its call to action for global, regional, and local stakeholders to make concerted efforts to support the development, production, introduction, and scale-up of new effective CD4 technologies.

DNDi and the HIV Policy Lab completed development of the Advanced HIV Disease (AHD) Dashboard,  an online resource that maps national guidelines for AHD and cryptococcal meningitis across 35 African countries. The dashboard serves to monitor progress and encourage countries to fast-track full adoption of life-saving interventions against AHD. It also aims to reduce the time lag between the generation of scientific evidence and adoption of revised policies by national health authorities. The AHD dashboard and an accompanying policy brief were launched at the 22nd International Conference on AIDS and STIs in Africa (ICASA) in December 2023.

With the Clinton Health Access Initiative (CHAI) and St George’s, University of London, DNDi co-convened a multi-country meeting on access to therapeutics and diagnostics for advanced HIV disease (AHD) in December 2022. Attended by representatives from ministries of health, expert clinicians, supply chain specialists, civil society, patient representatives, and donors, the 3-day meeting in Nairobi, Kenya, sought to share best practices and address barriers to treatment in 13 countries with a high disease burden.

A request for proposals to produce generic liposomal amphotericin B (LAmB) was launched in collaboration with CHAI and Unitaid, with the aim of securing at least one affordable, quality-assured generic product in 2023/2024. Access activities related to immediate-release flucytosine continued throughout the year, with several countries adopting the updated WHO treatment guidelines released in April 2022.

Together with St George’s, University of London; WHO; and CDC Foundation, DNDi co-hosted two satellite sessions on advanced HIV disease and cryptococcal meningitis at the 11th IAS Conference on HIV Science held in July 2021. The sessions, a call to action to address access barriers for the management of cryptococcal meningitis, brought together multiple stakeholders, including global policy making institutions, donors, ministries of health, country implementing partners, civil society, and patient advocates.

DNDi also collaborated with the Clinton Health Access Initiative on a LAmB landscape and gap analysis, including a technical assessment of potential alternative suppliers, market analyses of the cost of goods, and commercial discussions. Follow-up activities were identified for action.