THE SDUTHHlN AFRICAN JOURNAL OF HIV MEDICINE ----------- FEBRUARY 200 I

HORIZONS

FREE DIFLUCAN HERE!

The Southern Africa Regional Dffice of IAPAC (The Inter-
national Association of Physicians in AIDS Care) has been
given the responsibility to facilitate the training of health
care workers on the best practices relating to using Diflucan
and for managing CM and Oc. This training will take place
in a phased approach that initially targets the institutions
in each province where the drug is to be made available.

Fact Sheets that summarise these best practices have
been published. In addition, modular training materials for
nurses, doctors and patients are being developed and will
be available from IAPAC.

IAPAC's 'AIDS Care Faculty', a network of experienced health
professionals through which ongoing training activities
will take place, is seen as a regional asset that will facilitate
the cascade of information fiow and professional education
relating to HIV/AIDS best practices and lead to a growth in
both the numbers and capacity of trained health care work-
ers managing the disease appropriately.

Careful procedures have been put in place to regulate the
dispensing of donation stock to ensure that it is used only
for the indications allowed and to prevent stock diversion,
although the Ministry of Health has confirmed that no
patient will be refused access to this treatment, even if
they are referred from the private sector.

Patients presenting with CM have a poor longer-term
survival prognosis and here are particular challenges to
managing AIDS patients with CM and also important
opportunities not to be missed in identifying vulnerable
households of patients that will benefit from social inter-
ventions, such as planning for orphan care.

Clinicians are encouraged to actively participate in train-
ing activities where these are offered and to ensure that
patients are identified early and referred to participating
institutions to make the most of this intervention.

The Diflucan Parnership Programme offers an important
opportunity to impact on the care of AIDS patients, but its
success will depend on how well the drug is used and how
many patients are identified and referred for treatment.

IAPAC is facilitating a toll-free Difiucan Hotline on the
number 08003435821 for any enquiries relating to where
the drug is available, how it should be used and how to
access training and other resources.
The Diflucan Partnership Programme website
(www.dpp.org.zo) is on additional source of resources,
information and training materials.

The Diflucan Partnership Programme is therefore seen as
an important catalyst for improving how AIDS patients
are treated and cared for.

World AIDS Day (December 1st) at the end of last year saw
the signing of a groundbreaking public-private partner-
ship agreement between Pfizer Pharmaceuticals and
the South African Ministry of Health. The Memorandum of
Understanding that defines the conditions of Pfizer's 2-year
donation of free Difiucan to South Africa (estimated at a
market value of R375 million) was the culmination of
months of negotiations to ensure that South Africa benefits
appropriately from the offer.

Pfizer has made a significant additional commitment
to support the development of knowledge and skills in
implementing the Diflucan Partnership Programme
through funding professional training that is part of
the Department of Health's broader strategy to build
the capacity of all healthcare workers managing the
epidemic, providing training for guideline-supported best
practices.

Through this process, which has been severely criticised
by the Treatment Action Campaign as creating unaccep-
table delays to making this treatment accessible, the
Department of Health has achieved agreement on
expanding the indications for using the donated drug to
include both cryptococcal meningitis and oesophageal
candidiasis. Pfizer also committed to making the offer
available to other SADC countries, in compliance with the
SADC Health Ministers' stated strategy for taking on
international pharmaceutical offers as part of a regional
response.

The implementation of this initiative is being overseen at
a top level by a Ministerial Working Group, which has
already held a number of strategy meetings to ensure that
the intervention is made widely available as soon as
possible.

The agreement has been cited as an important example of
what can be achieved through enabling partnerships that
add value and scope to the care that is delivered to HIV-
affected populations. It is hoped that this will encourage
similar initiatives that are able to bring more hope to AIDS
sufferers in the region. For South Africa, this is important
as the first treatment access programme to result from
challenging the pharmaceutical multinationals to make
HIV medications more generally available to HIV-affected
populations in developing countries.

In mid February, the MCC fast-tracked its registration of
the donation formulation (which differs from the com-
mercially available capsule in that it is a blue 200 mg
tablet), and it is anticipated that institutions should have
stock available for prescription before the end of March.