Macleods: 3HP latent TB treatment

In July 2021, MedAccess, in partnership with CHAI and Unitaid, executed a volume guarantee agreement with Macleods Pharmaceutical Limited to catalyse access to 3HP, a short-course (3-month) tuberculosis preventive therapy (TPT) that improves completion rates over the standard of care in people living with HIV and their household contacts.

The partnership

The volume guarantee agreement complements a broader set of interventions provided by the Clinton Health Access Initiative (CHAI) and Unitaid to support the commercialisation and roll-out of the 3HP product. In this transaction:

  • MedAccess has provided a volume guarantee to Macleods, meaning that we will make up any shortfall in sales
  • Macleods will continue to produce and supply 3HP, scaling up capacity to meet increasing demand

Through this partnership, Macleods has also agreed to extend its commitment to make 3HP available at $15 per patient course for 138 low- and middle-income countries.

A lady at a pharmacy

Development impact

We project that up to an additional 2.5 million people living with HIV and their household contacts will receive 3HP across sub-Saharan Africa as a result of these partnerships.

3HP is superior to the alternative TPT treatment, isoniazid preventive therapy (IPT). 3HP has a shorter treatment duration, taken once weekly for 3 months vs. IPT which is taken daily for 6 to 9 months. In addition to its shorter duration, 3HP also presents a reduced pill burden, higher completion rates (90% on 3HP vs. 50% for patients treated with IPT) and fewer hospitalising adverse events.

The volume guarantee will contribute to 500,000 additional patients completing treatment and would thereby prevent 126,000 hospitalisations in comparison to the current standard-of-care.

The transaction also extends Macleods’ commitment to make 3HP available at $15 per patient course leading to savings for procurers of up to $22m over the volume guarantee period.

How we calculate the impact of this guarantee

Lives changed: Downstream patient outcomes were estimated based on the pooled risk analysis developed for the 2020 update of the WHO Latent Tuberculosis Infection Guidelines, and represent relative risk for people living with HIV when comparing 3HP to the current standard-of-care, isoniazid preventive therapy.

Money saved: Impact is estimated based on actual price reductions for 3HP over 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 impact.

Nurse checks young patient

The product

3HP is a fixed dose combination therapy that combines two antibiotics for the treatment of latent tuberculosis infection – Isoniazid and Rifapentine. 3HP is a short course regimen, taken once a week for 3 months. It has been found to be as effective as Isoniazid Preventive Therapy – a longer daily 6- to 9-month treatment, but with fewer side effects, and better completion rates (as published by Churchyard et al. 2021)  due to less frequent dosing and a reduced treatment duration.

Why we acted

TB is the world’s leading cause of death from an infectious disease, claiming 1.4 million lives in 2019. Latent TB Infection (LTBI) occurs when someone is infected with TB-causing bacteria but is asymptomatic and non-infectious. About a quarter of the world’s population – 1.7 billion people – are estimated to have LTBI. In 2019, an estimated 10 million people went on to develop active TB. Over a lifetime, the chance of LTBI activating to TB is much higher in people living with HIV and household contacts.

3HP provides an opportunity to increase treatment uptake and improve outcomes for LTBI patients. However, demand has been largely unmet due to high prices and supply constraints. This partnership will improve supply security, secure the previously negotiated $15 price, and create a pathway for increased availability and access to the product over time.