Public health

HIV causes AIDS, which is one of the leading causes of death by infectious disease. In 2022, more than 5 million people living with HIV did not know their HIV status, meaning they are not on treatment and are at risk of developing AIDS-related illnesses and unknowingly passing the virus on. Testing is the gateway to accessing HIV prevention, treatment, and care.

Current HIV testing strategies are not effectively reaching priority populations, such as people who use drugs, sex workers and LGBTI people. People from these groups often face stigma, discrimination, and even criminalisation if they seek an HIV test at a clinic. The World Health Organization (WHO) recommends countries implement self-testing as part of HIV testing services.

Market situation

WHO prequalified HIV self-tests have been available since 2016. They are not widely used in lower-income countries because of their historically higher costs compared to professional-use tests offered in health facilities.

Global health organisations have provided a lot of support to introduce and scale-up HIV self-testing, with six suppliers now providing WHO-prequalified tests. However, the market remains dominated by a single company, leading to higher prices and limited use as donors and countries face pressure on HIV budgets.

Lives changed

Estimates for test uptake and linkage to care are based on a meta-analysis by Njau et al. Average HIV positivity rates for Africa reported by UNAIDS were applied to estimate people living with HIV identified through testing.

Money saved

Impact is based on comparing the negotiated price to the expected lowest priced equivalent HIV self-test.

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 impact.

Lives changed

Estimates for additional women receiving access to syphilis testing were based on 2020 antenatal testing coverage for syphilis in African countries. Downstream patient outcomes were estimated based on 2020 seroprevalence and treatment rates in African countries, and a meta-analysis of risk for adverse outcomes of pregnancy by Gomez et. al.

Money saved

Impact was based on comparing the negotiated price to the expected weighted average market price of HIV-syphilis dual tests, including expected distributor mark-up where relevant.

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 impact.

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.

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.