Closing the Affordability Gap for Drugs in Low-Income Countries

The cost of treating human immunodeficiency virus (HIV) infection is decreasing. Nonetheless, tenofovir–emtricitabine–efavirenz, the standard first-line treatment in North America and Europe, is prescribed rarely in low- and middle-income countries. The lowest annual cost for a generic formulation of this regimen is still hundreds of dollars more than the $100 annual cost of generic stavudine–lamivudine–nevirapine, an effective but less safe alternative that has been largely abandoned in Western countries (see Figure 1).1 Unfortunately, many medications remain unaffordable in low- and middle-income countries. In the public sector, medicines are often provided free of charge, but essential drugs may be unavailable.2 If they . . .