Pharmaceutical industry's corporate social responsibility towards HIV/AIDSArun Kumar Khanna
Emcure Pharmaceuticals Ltd., Survey No.255/2, Phase-1, Rajiv Gandhi IT Park, M.I.D.C., Hinjwadi, Pune - 411 057, India
The pharmaceutical industry has a corporate social responsibility (CSR) towards HIV/AIDS. Measures taken to increase awareness of HIV/AIDS, availability and accessibility of potent and patient-friendly FDCs / Kits for adults and children will go a long way in increasing awareness and acceptance of this disease and its therapy. This will improve adherence, lower resistance and facilitate better disease management. This article discusses some of the CSR initiatives and their scope.
Keywords: HIV, corporate social responsibility
HIV treatment strategy has transformed greatly from monotherapy to high activity antiretroviral therapy (HAART) that includes three or four drugs of one or two or three different classes. However, various factors affect outcome of HAART. These are access to and availability of medicines and healthcare facilities, financial condition of the patient, benefits versus risks of starting therapy, level of motivation of patient to begin therapy, adherence to therapy, acceptance and support by society/family etc. There is an increasing realization in the corporate world and especially among the pharmaceutical industry that programs to sensitize the society along with developing patient-friendly drug regimens are keys to better outcome against HIV/AIDS. This article discusses some of the initiatives taken by the pharmaceutical industry in this respect as part of corporate social responsibility. This article is based on the presentation by the author at the national consultation on drug resistance in malaria, tuberculosis and HIV / AIDS organized by Seth G. S. Medical College and K. E. M. Hospital, Mumbai during 19th to 21st September, 2005.
Definition of corporate social responsibility (CSR)
Although a universally accepted definition of CSR is yet to emerge, CSR can be defined as a business commitment to contribute to sustainable economic development, working with employees, their families, the local community and society at large to improve their quality of life. Corporate social responsibility can thus be understood as the socio-economic product of the organizational division of labor in a complex modern society. Here we discuss CSR in the context of Indian pharmaceutical industry's responsibility towards AIDS management.
Importance of adherence in HIV/AIDS
"Drugs don't work in patients who don't take them" and in the management of HIV/AIDS it is a well-established fact that poor adherence by patients is an important predictor of the outcome of antiretroviral therapy. Studies have indicated that at least 95% adherence to ART regimen is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The regimen's pill burden, dosing frequency, food requirements, inconvenience, toxicity and drug interaction profile, lack of patient education and inability of patients to identify their medications, lack of reliable access to healthcare or medication are considered to be predictors of inadequate adherence. Although combination antiretroviral therapy is indicated for all infants, children and adolescents, such therapies are still unavailable to millions of HIV infected children in developing countries. The limited availability and poor adherence to HIV medications act as barriers to treatment in children too. These issues can be addressed through greater commitment of the pharmaceutical industry with innovative solutions in partnership with clinicians.
Increasing development of FDCs and kits for adults as well as pediatric patients
Studies have shown that patient adherence to antiretroviral therapy is more with a reduced frequency of doses. As recommended by WHO, ARVs in fixed-dose combinations (FDCs) have potential advantages over conventional drug regimens: they are helpful tools for simplifying treatment and promote adherence. Moreover, they can minimize prescription errors, improve adherence of health care workers to treatment standards, decrease errors in drug administration, improve drug management (because of fewer items and a single date of expiry) and reduce the risk of misuse of single drugs. According to DHHS, to the extent possible, regimens should be simplified with respect to the number of pills/ frequency of therapy etc. DHHS also recommends choosing the best-tasting liquid medicine possible or formulations suitable for mixing with formula or food for administration of oral drugs to young children., Therefore, in order to improve adherence and clinical outcome, pharmaceutical industry is bringing in patient-friendly simplified regimens in the form of fixed-dose combinations (FDCs)/Kits for adults as well as children. Some examples of FDCs/Kits are listed in [Table - 1].
Society sensitization programs
Awareness of HIV/AIDS is poor in India. This, along with cultural differences, taboos and stigma further reduces the acceptance of HIV/AIDS patients in the community. These factors contribute to low adherence and higher resistance and greatly impact the overall outcome of ART. Interventions to improve overall social acceptance of HIV/AIDS and its therapy have become essential for better outcome. Industry's initiatives such as disease awareness campaigns by means of mass communication activities, multilingual posters, HIV/AIDS patient education books, patient counseling/help-lines and online information resource are expected to improve awareness of HIV/AIDS. The pharmaceutical industry's proximity to doctors enable it to learn and interact with them to refine and improve its CSR activities. In fact, initiatives on training of doctors by doctors with the collaboration of industry have been welcomed and have been conducted successfully in the past.
Improving access to medicines
Pharmaceutical industry is also trying to improve access to therapy and healthcare by setting up exclusive ARV pharmacies, donation of ARV drugs in special situations and by establishing exclusive HIV/AIDS care hospitals. Multinational pharmaceutical companies have also contributed by offering their patented molecules to Indian companies without royalty and with technical support.
Lowering the daily cost of therapy can improve adherence to therapy and should also be part of CSR. To this end, initiatives like technology transfer without royalty, abolition of excise duties by government, financial incentives for R&D will definitely help., Formulation of FDC combinations can lower the cost of distribution and improve inventory management. In many cases it has allowed medicines to become more affordable.
It is also important to note some of the criticisms that pharmaceutical companies may need to take care of. These include, but are not limited to, an alleged pursuit of more profits and using CSR as a means to popularize products and companies. CSR activities are not revenue generators for any particular pharmaceutical company. Society sensitization programmes do not promote pharmaceutical brands to patients. The increased visibility (or popularity) of organizations involved in social work, increases their responsibility and accountability to society; and not the opposite. Improving access to medicines, offering training and HIV-exclusive pharmacies may benefit society in terms of employment of service providers and counselors. Improved access and patient-friendly medicines should lead to increased consumption of medicines (prices of which are controlled by market forces and the government); however, in the process, the scourge of HIV/AIDS would have been better tackled, with better treatment outcome. The alternative is not thinkable.
The pharmaceutical industry has a corporate social responsibility towards HIV/AIDS. Measures taken to increase awareness of HIV/AIDS, availability and accessibility of potent and patient-friendly FDCs/Kits for adults and children will go a long way in increasing awareness and acceptance of this disease and its therapy. This will improve adherence, lower resistance and facilitate better disease management.
[Table - 1]