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Lancet Public Health ; 7(2):E169-E176, 2022.
Article in English | Web of Science | ID: covidwho-1751538


Background Non-exclusive voluntary licensing that is access-oriented has been suggested as an option to increase access to medicines to address the COVID-19 pandemic. To date, there has been little research on the effect of licensing, mainly focused on economic and supply chain considerations, and not on the benefits in terms of health outcomes. We aimed to study the economic and health effect of voluntary licensing for medicines for HIV and hepatitis C virus (HCV) in low-income and middle-income countries (LMICs). Methods A robust modelling framework was created to examine the difference between scenarios, with (factual) and without (counterfactual) a Medicines Patent Pool (MPP) licence for two medicines, dolutegravir and daclatasvir. Data were obtained from MPP licensees, as well as a large number of external sources. The primary outcomes were the cost savings and health impact between scenarios with and without MPP licences across all LMICs. Through its licences, MPP had access to the volumes and prices of licensed generic products sold in all covered countries on a quarterly basis. These data informed the volumes, prices, and uptake for the past factual scenarios and were the basis for modelling the future factual scenarios. These scenarios were then compared with a set of counterfactual scenarios in the absence of the studied licences. Findings Cumulatively, between 2017 and 2032, the model's central assumptions predicted an additional uptake of 15.494 (range 14.406-15.494) million patient-years of dolutegravir-based HIV treatments, 151 839 (34 575-312 973) deaths averted, and US$3.074 (1.837-5.617) billion saved through the MPP licence compared with the counterfactual scenario. For daclatasvir-based HCV treatments, the cumulative effect from 2015 to 2026 was predicted to be an additional uptake of 428 244 (127 584-636 270) patients treated with daclatasvir, 4070 (225-6323) deaths averted, and $107.593 (30.377-121.284) million saved with the licence compared with the counterfactual scenario. Interpretation The chain of effects linking upstream licensing to downstream outcomes can be modelled. Accordingly, credible quantitative estimates of economic and health effects arising from access-oriented voluntary licensing were obtained based on assumptions that early generic competition leads to price reductions that influence procurement decisions and enable the faster and broader uptake of recommended medicines, with beneficial economic and health effects. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

Hepatology ; 74(SUPPL 1):449A-450A, 2021.
Article in English | EMBASE | ID: covidwho-1508742


Background: African migrant populations living in Europe are disproportionately affected by HBV infection. Chronic HBV infection is a major public health threat for African migrant populations living in Spain who use health services at lower rates due to structural and/or cultural/linguistic barriers. Efforts to scale up prevention, testing and treatment are needed to reach the 2030 hepatitis elimination targets set by the WHO. TheHBV-COMSAVA study aims to use pointof-care testing and simplified diagnostic tools in community settings to identify and link to care or vaccinate west African migrants in the greater Barcelona area during the ongoing COVID-19 pandemic. Methods: 280 study participants were offered HBV screening in a pop-up clinic in a community setting from 21/11/20- 6/6/21 Rapid tests to screen for the presence of HBsAg were used and a blood sample was collected using plasma separation cards and analyzed in a laboratory. Patients received their results during a second visit and were offered: a) linkage to specialist care);b) posttest counselling;or c) vaccination of the first dose of the HBV vaccine in situ. Sociodemographic and clinical history were collected and basic standard descriptive statistics were utilized using STATA software. Participants who did not already have Catalonia's CatSalut health card were offered an expedited processing system to acquire one. Results: Five participants were excluded and 275 were included for analysis. The overall HBsAg prevalence was 12.7% (n=35). Of those included, laboratory results are available for 229 (83.3%). Of these, anti-HBc positivity was detected in 31.9% (n=73). The majority (44.4%, n=122) required vaccination against HBV followed by post-test counselling (30.9%, n=85) and referral to a specialist (12.7%, n=35). Of those who received their results (n=243), 75.7% returned and either received post-test counselling, linkage to specialist care, or the first dose of the HBV vaccine (figure 1). The HBV vaccination acceptance rate was 86.4%. Eight participants did not have access to the public health system and requested CatSalut cards and all were provided with one Conclusion: Despite the COVID-19 pandemic, by employing a community-based model of care utilizing novel simplified diagnostic tools the HBV-COMSAVA study demonstrated the possibility to screen, diagnose, link to care, and vaccinate African migrants who may otherwise not have received care.