UNAIDS HIV Drug Access Initiative: Providing Wider Access to HIV-related Drugs in Developing Countries, Pilot Phase

access to drugs at the subsidized prices after the completion of the pilot
phase. The National Authorities are also expected to ensure sustainability of
the programme for these patients.
Evaluation and Expansion
Ongoing evaluation is a key component of the Drug Access Initiative. A
UNAIDS evaluation team provides continuous monitoring and assessment of
the Initiative's pilot phases. As new problems are identified, new strategies
are designed to overcome the obstacles.
At the end of Year 1, a detailed review of the structure and administration of
the Initiative evaluates the fit between the Initiative's theoretical design and its
practical implementation. A further evaluation at the end of Year 2 provides
the first concrete results with regard to the real impact of the Initiative in
participating countries. An action plan for expanding the Initiative, within
currently participating countries as well as to other countries, is established
on the basis of the second year evaluation.
Aspects of the Initiative to be evaluated include:
* Economic and pharmacoeconomic: The evaluation will determine potential
savings achieved through avoided illness, as well as increases in survival
and productivity. This economic evaluation will include a review of the
overall economic picture of the country, and a qualitative assessment of
the economic constraints on individuals, households, and families
regarding both ability to pay for treatment and the impact on individual and
family financial resources.
* Clinical: The evaluation will include a review of the clinical effect of
antiretroviral treatments and drugs for the prevention and treatment of
opportunistic infections and STDs, with respect to survival of patients,
immune status improvement, and reduction in HIV-related illnesses.
* Epidemiological: A crucial public health issue is the emergence of drug
resistant strains of HIV, which can proliferate when patients do not take
their drugs properly. Itis critically important to evaluate patient
compliance by monitoring drug supply through the local medical centre
pharmacy, and by testing blood samples for viral load and the emergence
of resistant viral strains.
* Social and behavioural: A qualitative study will be undertaken to shape an
epidemiological survey on compliance. The role of social support in
treatment compliance will be also be assessed, as will the impact of
treatment on prevention messages and behaviour.
* Logistical: The logistical evaluation will include needs assessments,

procurement procedures, distribution to the clinics, stock management at
the clinics, laboratory procedure, and delivery of test results.

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