Antiretroviral medicines in low- and middle-income countries: Forecasts of global and regional demand for 2012–2015
The global effort to scale up HIV treatment in low- and middle-income countries continues to move closer towards achieving the goal of 15 million people receiving treatment by 2015. By the end of 2011, more than 8 million people in low- and middle-income countries were receiving antiretroviral therapy, which represents a 20-fold increase since 2003.
Objectives of the report
- to improve information about the demand for antiretroviral therapy and antiretroviral medicines;
- to update the forecasts of demand for antiretroviral drugs prepared in 2011; and
- to forecast the global and regional demand for antiretroviral drugs from 2012 to 2015.
Three forecasting approaches inform the consolidated results presented in this report. The linear regression forecast extrapolates from historical trends in the number of people receiving antiretroviral drugs; the country target model reflects the reported programme goals of national programmes; and the approach of the Clinton Health Access Initiative focuses on the experience of the countries with a high burden of HIV infection. The three approaches use data from the 2012 WHO survey on antiretroviral use, augmented in the Clinton Health Access Initiative model with data from the progress report towards universal access and country information.
This report utilizes data compiled by the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Clinton Health Access Initiative and the Supply Chain Management System Project to project the demand for antiretroviral drugs from 2012 to 2015. The numbers of people receiving antiretroviral therapy for the projected years are forecast using three approaches: linear projection of historical numbers of people receiving antiretroviral therapy by country; country target projection (based on planning targets submitted by national programmes); and projections by the Clinton Health Access Initiative. In general, forecasting the number of people receiving treatment involved the following steps:
- project the total number of people receiving antiretroviral therapy.
- determine the number of people receiving first-line and second- line therapy, using the average of proportions from three sources of data: (1) linear regression based on the WHO surveys of antiretroviral drug use in 2009, 2010 and 2011; linear extrapolation of the relative market share of PIs for 2009–2011 from GPRM procurement data; and (3) the Clinton Health Access Initiative projection for second-line therapy by 2015.
- determine the distribution of regimens for adults receiving first- and second-line therapy and children receiving treatment.
- calculate the number of person-years of treatment for each regimen and thus for each antiretroviral drug.
- calculate the total volume of APIs required to meet the forecast demand for each antiretroviral drug.
The averages of the results of the three approaches, in terms of numbers of people receiving antiretroviral drugs, the breakdown of first-line and second-line therapy and regimen use, were calculated and used as the basis to determine the final estimates of the demand for APIs for 2012–2015.