Hologic: Viral load testing
Millions of people living with HIV cannot access the regular viral load testing needed to keep their treatment on track and prevent onward transmission.
From 2018 to 2022, we provided a volume guarantee to Hologic which enabled the company to set an all-inclusive ceiling price of $12 per test on its Panther® platform, increasing access to viral load testing for millions of people.
The challenge
Public health
HIV causes AIDS, which is one of the leading causes of death by infectious disease. HIV transmission can be reduced if patients start taking combinations of medicines – called antiretroviral therapy (ART) – soon after acquiring HIV. Effective ART regimens can suppress HIV viral load, which can prevent death and onward transmission and allow patients to live longer, healthier lives.
In 2014, UNAIDS launched the “90-90-90” targets, calling for 90% of people living with HIV to know their status, 90% of those diagnosed to receive treatment, and 90% of those on treatment to achieve viral suppression by 2020. Those targets were later updated to “95-95-95” by 2030. However, in 2017, the year before the MedAccess agreement, only 81% of people receiving antiretroviral therapy were virally suppressed, and millions of people with HIV lacked access to viral load testing.
Market situation
Hologic’s Panther® platform can test for HIV and viral hepatitis viral load and provide diagnosis for COVID-19 and human papillomavirus (HPV), the leading cause of cervical cancer. The Panther® platform obtained World Health Organization (WHO) pre-qualification in December 2017.
The total size of the viral load market was around $190 million a year. At the time, the two dominant suppliers in Africa offered HIV viral load testing at a wide range of prices. Procurement of products and services was fragmented, leading to untransparent pricing. As a result, access to regular viral load testing was often limited in sub-Saharan Africa. Countries that had purchased viral load testing equipment had many machines out of use due to inconsistent service and maintenance.
Impact by end-2022
By the end of the agreement:
932k
patients not virally suppressed identified
457k
patients switched to 2nd-line treatment
The product
Hologic’s Panther® platform provides fully automated molecular testing for HIV, viral hepatitis, human papillomavirus and COVID-19. Its sample-to-result automation can run 320 tests in 8 hours, providing health care professionals and patients with faster access to accurate viral load or diagnostic results to support treatment decisions.
The Panther® platform can test for a range of illnesses simultaneously. In countries with high rates of coinfections alongside HIV, it can reduce the time patients wait for test results and lead to improved care.
The partnership
MedAccess provided a volume guarantee to Hologic, agreeing to make up any shortfall in the agreed sales volumes.
Hologic agreed to register Panther® for use in 50 low- and middle-income countries, and set a multi-country, all-inclusive ceiling price of $12 per patient test (a 30% price reduction on all products and services required to generate an HIV viral load test result), including the cost of placing the instrument, consumables and reagents, staff training and instrument service and maintenance. This was the first time a company had offered an all-inclusive price for viral load testing.
The Clinton Health Access Initiative (CHAI) supported the formation of the partnership and is responsible for monitoring the implementation of the agreement.
Impact by end-2022
By the end of the agreement:
13
countries switched to all-inclusive tender process
$45m
direct savings for procurers
13
countries now have more than two suppliers of viral load testing
The impact
By the end of the agreement in 2022, our guarantee had helped bring a new level of consistency and transparency, improved platform maintenance, and a new approach to procurement by funders. This has helped to stimulate price reductions up to 50% in some countries.
The introduction of the all-inclusive pricing framework improved procurement practices in the wider market, allowing for improved price transparency for HIV viral load procurement.
Supply security also improved with Hologic registering Panther® in 13 new countries where there were previously limited competitors.
The partnership has resulted in 932,000 patients benefitting from improved clinical outcomes and $45 million savings by purchasers.
How we calculated the impact of this agreement
Lives changed
Impact was based on estimates of the total reach of guaranteed tests and the depth of impact on patients by those tests. The depth factor was derived from the proportion of people receiving a viral load test that will switch to second-line antiretroviral therapy and the HIV-related mortality and disability burdens in Africa.
Money saved
Impact was estimated based on actual price reductions achieved throughout the course of the volume guarantee.
Markets shaped
We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of our investments. To quantify change against a baseline, we used publicly available indicators as proxies for market-wide change.
