GUARANTEE PORTFOLIO

3HP latent TB treatment

Since July 2021, we have partnered with the Clinton Health Access Initiative (CHAI), Unitaid and 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 agreed to extend its commitment to make 3HP available at $15 per patient course for 138 low- and middle-income countries. In August 2022, a new ceiling price of $14.25 was agreed.

A lady at a pharmacy

Development impact

We projected 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. 
  • 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 $14.25 per patient course leading to savings for procurers of up to $21.5m over the volume guarantee period. 

Impact by end of 2021:

  • 101,000 additional people living with HIV will complete treatment with 3HP, when compared to the current standard of care. 
  • 25,500 hospitalisations of people living with HIV experiencing side effects of latent TB treatment will be prevented. 
  • 213,000 (approximate) cases of latent TB averted in household contacts.
  • 6 countries newly registered for 3HP. 
  • 32% average price reduction. 
  • $11.7m in procurement savings. 

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.  

It is a short course regimen, taken once a week for 3 months. It has been found to be as effective as, and superior to, Isoniazid Preventive Therapy – a longer daily 6- to 9-month treatment.  

Because of its shorter treatment duration and reduced pill burden, 3HP has fewer side effects and better completion rates (90% on 3HP vs. 50% for patients treated with IPT as published by Churchyard et al. 2021). It also has fewer hospitalising adverse events due to less frequent dosing and a reduced treatment duration.  

Why we acted

TB is the world’s second leading cause of death from an infectious disease, claiming 1.5 million lives in 2020. 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 2020, 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 negotiated $14.25 price, and create a pathway for increased availability and access to the product over time.