Private sector ARV schemes in Africa report progress

Two companies reported today on the efforts they are making to provide antiretrovirals to their employees in Africa, at the XIV International AIDS Conference in Barcelona.

The brewer Heineken is providing triple therapy to all employees who need it if they have symptomatic HIV disease or a CD4 cell count below 200 cells/mm³. The company is treating employees in Rwanda, Burundi, Nigeria, Congo and Democratic Republic of Congo. Workers will continue to receive antiretroviral therapy if they are laid off or if they move to another job as log as alternative supplies are not available.

How has the company been able to achieve this? Stefaan van der Borght of Heineken described the factors that had made it possible to launch one of the first ARV programmes in the private sector.

Van der Borght said that Heineken’s emphasis on business sustainability rather than a quick profit had made the decision easier, but another key factor was the affinity that board members felt for the company’s business in Africa. Nearly every board member had worked in Africa and had personal knowledge of a colleague who had died.

Affordability was also critical. When reduced price drugs became available through the Accelerating Access Initiative, treatment became affordable, and is currently estimated to cost $220 for each employee, assuming an HIV prevalence of 7.5% among the workforce across the company’s African operations. This is the equivalent of one to two months of an employee’s average salary (although the company estimates it is currently treating only 1% due to the low rate of HIV testing).

Obstacles for any multinational that is attempting to roll out common regimens for its employees across several countries is the differing registration status of agents that are available through the AAI. In some cases unregistered agents cannot be imported, whilst others face a 20% import tax. Whilst governments have approved Heineken’s efforts in principle, they have done little in practice to facilitate the scheme and international agencies and donors have also given little assistance on the ground. As countries move forward with country coordinating mechanisms for ARV access, they need to look at how multinationals can be engaged and involved in the process – at present business is operating in a parallel universe from the NGO sector and the state sector.

In Botswana, the diamond mining company Debswana began providing antiretroviral therapy in 2001 after a company-wide anonymised seroprevalence survey found that 28.8% of the 75% of the workforce who participated were already HIV-positive. By June 2001 the proportion had fallen to 22.6%, a reflection of both employee turnover and a high level of deaths in service and AIDS-related ill health retirements.

The company decided to set up a managed care scheme with Aid for AIDS, based in Cape Town, to provide regimens similar to the WHO recommended regimens, together with viral load and CD4 monitoring. The company provides treatment and monitoring for employees with symptomatic HIV disease or with CD4 counts below 350, and pays 90% of the cost once the employee’s health insurance entitlement of 10,000 pula per year for AIDS care has been exhausted. The benefit is extended to the employee’s spouse, but does not cover children because the Botswana government will provide treatment.

The average cost of the regimens is around $160 a month, and the usual first line regimen used is AZT/3TC and efavirenz. So far, 209 people have entered the scheme and 168 are already receiving treatment (including 46 spouses). Adherence is supported by a nurse counsellor at each mine who monitors adherence and side effects and advises on how to manage any problems.

Voluntary counselling and testing is available at all Debswana company sites and has increased five fold since the treatment scheme began in May 2001. The company also supports HIV peer education teams and has developed a peer education training manual based on research amongst the workforce.

Both companies stressed that they wanted to see others follow them. Dr Dudley Wang told aidsmap that Debswana saw its treatment programme as a model that could be followed by other companies, but stressed that “we are going into the unknown here. We had to do something, but we don’t know what the outcome will be. We currently have 12.6% of employees being provided with ART through medical benefits, compared with an average of 5% across Southern Africa.”