[e-drug] MSF on FDCs (5)

e-drug
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E-DRUG: MSF on FDCs (5)
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Hi e-druggers

I am Michel Lotrowska, Access Campaign Representative for MSF in Brazil,
Economist and Master in Public Health. As I did my master thesis on
access to ARVs in Brazil, I would like to contribute a bit to the
discussion.

You are right that in any pilot project, there is a need to show results
and that means a selection of the "best"patient can be made, with all
the bias it gives by improving adherence more than in a general
population. On the other hand, there is a huge need to prove that ARVs
and now FDCs are effective in poor-resource settings. Brazil doesn't
have such good results, probably because as a public programme
accessible to the whole population, there is no way you can choose the
best patients. That means you treat people who are drug-users, alcohol
users, who don't disclose their status to others. But that reduction of
adherence only happens because there is a very wide coverage of the
population treated. While this is not the case in most developing
countries, I don't think we should worry about this bias. The deficit
of treatment is so huge that it will take years before universal
coverage is implemented. In the meantime, criterias will need to be put
into place based primarily on public health choices and that might mean
some limitation of "universal" criteria. There will be some tension as
to how to implement these criterias but with participation of the
community-based groups in the criteria decision process, you actually
solve the "government" responsibility on some of these criteria. This
community-based decision process has been the key factor of success for
criteria implementation everywhere.

Best regards

Michel Lotrowska
MSF
Brazil
access@msf.org.br

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