1. www.aids2014.org Getting from Point A to Point B: What it means to bring HIVST to market Petra Stankard Technical Advisor 22 July 2014

2. www.aids2014.org Presentation Outline Current HIVST Market Inefficiencies in the HIVST Market Catalyzing the HIVST Market

3. www.aids2014.org What is a market?

4. www.aids2014.org Current HIVST Market

5. www.aids2014.org A Framework for Market Analysis Desired Outcomes Evaluate Current Market Identify Inefficiencies and Barriers to Resolution Options to Address Barriers

6. www.aids2014.org Desired Outcomes Evaluate Current Market Identify Inefficiencies and Barriers to Resolution Options to Address Barriers Appropriate product design Secure Supply Quality Products Affordable Prices Availability to the End User Demand among End User Lack of incentives to enter the market Volume/revenues do not cover costs Alternate markets are more lucrative Risk of investment perceived as too high Lack of incentives to meet strict regulatory authority (SRA)/pre-qualification(PQ) requirements Information and data gaps Distribution and delivery issues Limited demand predictability Lack of insight into user needs and awareness Adapted from Dalberg & Reproductive Health Supplies Coaltion, “Market Shaping for Family Planning”, 2014.

7. www.aids2014.org Inefficiencies in the HIVST Market Manufacturers No normative guidance In few national strategies Not reflected in testing algorithms Complex product registration Policy Environment Variable product quality One product with SRA approval Current product retails at USD$40 Unknown willingness to enter an undefined market Distributors No policy framework for distribution Preferred channel among the target population (TP) unknown Implications for supply chain Consumers Low awareness of HIVST among potential TPs Unknown demand/desire for the product in TP

8. www.aids2014.org Potentially Large Market for HIVST Over 100 million HIV testing episodes annually Increasing demand for HIV testing expected WHO 2013 ART Guidelines Regular HIV re-testing Prior to VMMC Sexual partners of those on ART Median reporting tested in last 12 months: Women = 20% Men = 20% Median reporting ever tested: Women = 51% Men = 37% Staveteig et al, Measure DHS, 2013

9. www.aids2014.org In the current market, first mover risk outweighs first mover opportunity.

10. www.aids2014.org A Framework to Catalyze the Market 50% PLHIV unaware of status; limited access to confidential HTC High price of HIVST kits; limited demand; lack of competition; unsupportive policies Establish policy framework; demonstrate demand & supply; quantify market size Lower market barriers achieve intended market effects Greater coverage of HTC & more people tested in vulnerable and remote communities Case for interventionPathway from market to public health impact Intended market effects Increased product availability Product quality improvement Price reductionImproved product delivery Barnighausen et al. Health policy and Planning 2011

11. www.aids2014.org Research to Inform Policy Policy Development Demonstration of Potential Market Demonstration of Potential Market Articulate Market Size and Quantify Demand (consumers, govt., donors) Articulate Market Size and Quantify Demand (consumers, govt., donors) New Market Entrants Volume Price Agreements Catalyzing the HIVST Market

12. www.aids2014.org Desired Outcomes Evaluate Current Market Identify Inefficiencies and Barriers to Resolution Options to Address Barriers Appropriate product design Secure Supply Quality Products Affordable Prices Availability to the End User Demand among End User

13. www.aids2014.org Acknowledgments Dr. Liz Corbett –London School of Hygiene and Tropical Medicine Dr. Hendramoorthy Maheswaran –University of Warwick Medical School Dr. Krishna Jafa, Olivier LeTouze and Anabel Gomez –PSI

14. www.aids2014.org Thank you! Questions? pstankard@psi.org