Introducing new anti-HIV drugs into Thailand and health fund benefit packages

Abstract

Current care for people living with HIV (PLHIV) is with anti-HIV drugs, which must be taken continuously throughout their lives. However, current anti-HIV drugs cause a large number of adverse reactions in HIV-infected people, such as hallucinations, anxiety, insomnia, resulting in a discontinuity in taking medication and failure to suppress the virus. The World Health Organization recommends a new anti-HIV drug with fewer side effects, efficient viral load suppression, and a low incidence of drug resistance. However, this new recommended anti-HIV drug is available in Thailand only through one company and has not yet been registered on the national essential drug list in Thailand. Additionally, it has not been included in various health fund benefit packages. As a result, the service unit has not changed the drug formula. This performance report aims to summarize management approaches for introducing new anti-HIV drug formulations into Thailand, addressing the health fund benefits package, and outlining the challenges encountered during implementation. The data utilized for performance analysis includes the following: (1) operational guidelines for introducing anti-HIV medicines into Thailand and health fund benefit packages as discussed in the working group meetings, (2) information regarding both old and new PLHIV who are receiving the new anti-HIV medicines, sourced from the National AIDS Program, and (3) details about operational challenges were obtained from information on problems encountered during operations, gathered from progress monitoring meetings and reports provided by personnel in various hospitals in Thailand. This information was collected through the LINE application group that was specifically established. The results of the efforts to advocate for new formulations of anti-HIV drugs to be registered on the National Essential Drug List and included in the health fund’s benefit package in 2021 revealed that, in the change to Thailand’s new drug regimen in 2021 and 2022, old cases of PLHIV transitioned from efavirenz-based (EFV-based) to dolutegravir-based (DTG-based) regimens at rates of 54.4% and 75.5%, respectively. New cases of PLHIV were able to initiate DTG-based regimens at rates of 89.9% and 94.3%. The primary issue faced was the procurement process for new anti-HIV drugs within service units. The supply inadequately meets the demand, and the
procurement of these drugs does not align consistently with the drug procurement plan. The lengthy procurement duration poses a challenge. Therefore, it is essential for the National Health Security Office, Social Security Office, and the Government Pharmaceutical Organization to assess the demand for new drug formulations, ensure comprehensive drug procurement planning, and implement continuous monitoring and evaluation.