HIV TREATMENT
2020
Action 27. Mobilize their networks and work with communities to help build treatment literacy, generate demand, and expand access to ARVs among children.
Action 34. Increase efforts to share information on the roll-out of new paediatric formulations, including lessons learned.
Paediatric HIV & TB : Rome Action Plan
20. Develop ALD pediatric formulation by end of 2021.
43. Through PENTA and IAS CIPHER, work together to develop an enhanced monitoring and safety data platform for new and existing paediatric ARV drugs.
44. Convene or participate in a series of virtual consultations of key stakeholders in 2020-2021 to develop a model and mobilize resources for the platform.
47. Rapidly scale up the manufacture of new PADO priority pediatric ARV products (4-in-1 and DTG 10mg dispersible tablets) at a scale that will fully meet market demand as forecast by GAP-f partners and procurement agencies within 6 months of approval.
63. Work with ARV Procurement Working Group to ensure coordination of demand and supply of 4-in-1 and LPV/r pellets.
64. Once 4-in-1 is approved by FDA, ensure it is widely available and rapidly scale up production.
65. Move towards 4-in-1 at $15 per pack of 120’s.
Commitment 20:
April 2021
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Product is under development at Cipla
Commitment 43:
April 2021
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We would appreciate more information to get in contact with the concerned stakeholder to take it ahead.
Commitment 44:
April 2021
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We look forward to receive the links for these sessions
Commitment 47:
April 2021
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4 in 1 sprinkle will be manufactured at full capacity to meet the market demand once approved by FDA
Commitment 63:
April 2021
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Cipla is in continuous discussion with APWG on Lopi/Rito Pellets where the demand has seen a sudden downward trend. We have finished stocks and API to service the demand at short notice
Commitment 64:
April 2021
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Post Approval, the product will be supplied across the countries through various agencies.
Commitment 65:
April 2021
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Current focus is towards getting the Goa inspections cleared from FDA to enhance faster approval of the product and having it accessible and affordable to the patients. Over the last year, there has been a huge increase in the API cost as well as an increase in the internal operation cost.
Commitment 65:
April 2021
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Current focus is towards getting the Goa inspections cleared from FDA to enhance faster approval of the product and having it accessible and affordable to the patients. Over the last year, there has been a huge increase in the API cost as well as an increase in the internal operation cost.
23. Jointly agree upon and execute next steps to optimize the availability and delivery of these formulations in 2019 including:
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Timely and regular information sharing (including orders placed and timelines for deliveries)
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Providing best possible demand forecasts
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Collaborate on the optimization of limited supply within and among countries and joint prioritization among orders to ensure sustainable supplies to children once initiated
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Support product uptake at country level
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Regulatory filings as needed to support scale-up, timely responses to queries raised during the review, and implementation (re-validation as required) of post approval changes at risk during the review period.
36. Bring RTV 25 mg to the market, producing first batch beginning in June 2019.
Commitment 23: More than doubled output compared to the end of 2018 and will continue to increase in line with demand expressed by APWG. The 4-in-1 dossier is currently under FDA review.
Pharmaceutical companies, SRAs, WHO Prequalification Programme (PQ) and NRAs commit to:
1. Accelerate the national drug registration process to enable registration of any ARV listed by WHO EOI in around 40 participating countries within 1 year by ensuring that:
FOR PRODUCTS WITH PQ APPROVAL:
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Company submits for registration in countries requesting use of the CRP (based on PQ approval) and process completed within around 4-5 months (country decisions within 3 months, plus submission processing time)
FOR PRODUCTS THAT HAVE NOT YET RECEIVED PQ APPROVAL:
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Company submits with USFDA for full approval or tentative approval and process completed within 6 months;
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USFDA approval or tentative approval review shared with WHO for Collaborative Registration
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Procedure-lite (CRP-lite), a pilot program at first allowing FDA to share up to 5 minimally redacted reviews.
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Company submits for registration in countries requesting use of the CRP (based on WHO PQ, FDA (CRP-lite) or other SRA review) and process completed in around 4-5 months (country decisions within 3 months, plus submission processing time)
13. Share their methodological approaches to acceptability studies (including palatability and ease of administration) and contribute to a repository held by GAP-f partners to guide future investigation of acceptability for paediatric products.
14. Consider the use of the CRP for national registration of pediatric ARV products on PADO, Optimal formulary and Limited use lists.
15. Ensure all drug registration dossiers meet minimum requirements at the time of filing and that responses to specific queries are complete and provided in a timely manner
20. Manufacture new PADO priority pediatric ARV products “at risk” such that the new product is available for supply at time of approval/tentative approval/prequalification, including validation of manufacturing process during regulatory review.
Cipla is now scaling up production capacity of LPV/r pellets, with support from PEPFAR and the Global Fund. Alongside Mylan, capacity is expected to meet demand by Q2 2020.
44. Develop pediatric ARV products at a scale that will meet ultimate market demand as provided by GAP-f partners.
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Action 6: Prioritize PADO products in research and development plans.
Action 13: In pre-clinical and clinical development, initiate paediatric formulation development as soon as a given drug shows potential public health impact in adults, soon after Phase II trials are completed.
Action 14: Include adolescents when conducting initial adult efficacy trials, where possible and practical, or conduct parallel trials with the goal of providing information to support licencing for adolescents at the same time as adults.
Action 15: In the design of paediatric PK and safety studies, use weight-based dosing and enroll all children above 4 weeks concurrently, unless a strong rationale exists for not doing so.
Action 16: Assess acceptability and palatability of formulations for low-resource settings at early stages of the formulations development.
Action 17: Engage in early and regular consultations with the PAWG on PIP/PSPs, as well as recommended dosing and ratios for FDC development.
Action 18: Take all possible measures to rapidly complete development of priority paediatric drugs and formulations in the pipeline, with the goal of providing the maximum number of new formulations by end of 2018, especially for infants and young children.
Action 30: Strengthen and expand collaboration to overcome intellectual property challenges and otherwise facilitate technology transfer and knowledge sharing that can promote faster paediatric formulation development, including on challenges like taste-masking.
8. (individual commitment) Cipla committed to scale-up production of Lopinavir/Ritonavir (LPVr) pellets to 30,000 bottles per month in 2018 and to submitting the new “4-in-1” (ABC/3TC/LPV/r) pellets in 2018.
Request filed and approved. Moving to scale up production to 60,000/month.
4 in 1 granules now under FDA review.