The Coordination Committee called on the Global Fund to support the fight against HIV epidemic in Russia

The Coordination Committee for the prevention and control of HIV/AIDS in Russian Federation, responsible for oversight and coordination of the implementation of the Global Fund grants in Russia, called on the Global Fund to allocate funding to support civil society organizations in their fight against HIV epidemic in Russia for the next three years.

2019 is the year of the replenishment for the Global Fund to Fight Aids, Tuberculosis and Malaria (Global Fund) and by the end of this year, based on the results of the replenishment, the Global Fund will make a decision on the allocations for the eligible countries to address HIV, TB and Malaria for the next 3-year period.

According to the 2019 Global Fund Eligibility List, the Russian Federation has met the requirement of two consecutive years of eligibility based on income classification and disease burden and is now eligible to receive an allocation of funding to support the HIV/AIDS response for the next 3 years. Since the Russian Federation is not on the OECD-DAC List of ODA recipients, according to the Global Fund’s Eligibility Policy, the Russian Federation may only be eligible for an allocation to support the HIV response efforts by non-governmental or civil society organizations and only if the country demonstrates barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology.

According to the Global Fund’s Eligibility Policy, “the eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. As part of its assessment, the Secretariat, in consultation with UN and other partners as appropriate, will look at the overall human rights environment of the context with respect to key populations, and specifically whether there are laws or policies which influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for such populations.”

It is a well-known fact that Eastern Europe and Central Asia (EECA) is the only region in the world where the HIV epidemic continues to grow , and Russia has been considered as the “driving force” of this regional growth. According to the UNAIDS 2018 Global AIDS Update, “the HIV epidemic in Eastern Europe and Central Asia has grown by 30% since 2010, reflecting insufficient political commitment and domestic investment in national AIDS responses across much of the region. Regional trends depend a great deal on progress in the Russian Federation, which is home to 70% of people living with HIV in the region. Outside of the Russian Federation, the rate of new HIV infections is stable.

 

 

RADIAN for the EECA region

On the 10 of September the Elton John Aids Foundation with Gilead Sciences announced the launch of a new project RADIAN. This major project aims to bring support to Eastern Europe & Central Asia, where the AIDS epidemic is on the rise.

A ground-breaking initiative

The global community now has the tools to meaningfully address new HIV infections; however, HIV is on the rise in Eastern Europe and Central Asia (EECA). To address the challenges in EECA and ensure no one is left behind in the global effort to end the HIV/AIDS epidemic, the Elton John AIDS Foundation and Gilead Sciences have partnered together in a ground-breaking initiative called RADIAN.

RADIAN is a natural evolution of the existing collaboration between the Foundation and Gilead in the EECA Key Populations (EECAKP) fund, which gave the organisations a greater understanding of the urgent needs in EECA and the necessary experience to respond. The RADIAN partnership will provide investment, support and on-the-ground resources over the next five years to support interventions and drive measurable impact in EECA.

Model Cities

RADIAN consists of two programs: ‘Model Cities’ and the RADIAN ‘Unmet Need’ Fund. The programme will support innovative approaches, including new models of care and expanded prevention and healthcare programmes, led by groups who are on-the-ground and part of the community. The first RADIAN ‘Model City’ will be Almaty, Kazakhstan’s largest city. Additional ‘Model Cities’ will be announced in 2020

The Radian Unmet Need Fund

The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region and beyond the select ‘Model Cities’. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.

The project encourages local and regional organisations in EECA who share its vision of significantly improving the quality of care for PLHIV, addressing new HIV infections and AIDS deaths to apply for grant funding when the Request for Proposals opens in mid-October 2019. Best practices and learnings from the local implementation of RADIAN over the next five years will be used as a blueprint towards creating change across the region.

Peer navigators – indispensable medical assistants

Author: Marina Maximova, Kazakhstan 

Over the past three years, express HIV testing in key populations in the East Kazakhstan region of Kazakhstan increased by a third. Peer navigators play a very important role in this success.

Today among key populations, including people who use drugs, sex workers, men who have sex with me, etc. there is a major increase in infection in the country. Representatives of these groups usually don’t come to AIDS centers and medical facilities for testing, but, as experience has shown, they easily visit non-governmental public organizations (NGOs) or ask peer navigators for such services.

Peer navigators – who are they?

The term “peer navigators” is very popular among social activists. People living with HIV (PLHIV) become voluntary medical assistants and help professionals to care about patients. They do express testing for HIV infection in peri-gingival fluid, provide counseling, and, if necessary, accompany PLHIV to AIDS centers for complete testing.

“Another important work of peer navigators is to increase the motivation of PLHIV for the constant and systematic use of special antiretroviral therapy (ARVs), which is extremely necessary for our patients to improve their health, – says Marina Zhigolko, head of the East Kazakhstan Center for the Prevention and Control of AIDS. With the participation of volunteers, in recent years, PLHIV adherence to treatment has quadrupled. Today, more than 80 % of these people take rescue therapy and can work fruitfully, have families, give birth to healthy children”.

Today in the East Kazakhstan region there are 20 peer navigators. In the framework of the USAID Flagman project, they are provided with rapid tests, tablets for record-keeping, disposable syringes, lubricants, and promo materials.

Personal example and motivation

Sergey Baranyuk, a peer navigator from the Answer public foundation, packs a backpack in the morning and sets off on his route to work “in the field”. He is an ex-prisoner, has been living with HIV for many years, he used drugs. Today Sergey has a family, a job, and he helps other people to overcome the life situation he had before. His life experience helps him to convince those who, for various reasons, fall out of medical control and are not tested for HIV.

“The express test for peri-gingival fluid is convenient to use,” says Sergey. It can be done on a bench in a park, in a car, at home. After 15-20 minutes, a person already knows his HIV status. While he is waiting for the result, a peer navigator can talk to him about the risks of behaviour, ways of transmitting HIV infection and precautions. ”

Trust on the Health Route

Over three years, with the joint work of peer navigators and health visitors in the East Kazakhstan region, the number of PLHIV on follow-up has doubled. People come for medical monitoring of health, testing and medication. Peer navigator work not only in the regional center, but also in villages. For example, some villages of Glubokovsky, Shemonaikhinsky, Ulan districts, as well as Ridder-city are also under the control of public activists.

Many people prefer to come for testing at an NGO. For this, for example, the public funds “Answer” and “Kuat” have specially equipped rooms. Here people can talk frankly and do a test.

The first six months are the most important in the work of peer navigators. After some time, patients start to understand the importance of treatment themselves. But before peer navigator should find a person from the risky behaviour group and convinces him to find out his HIV status and, if necessary, start treatment.

“Navigators are our ears, eyes and foot,” says Neil Mamyrbekova, head of the treatment department at the Semey AIDS Center. «One doctor is not able to single-handedly cover patients, set them up for treatment, and convince them in the possibility to start a new life. A person must come to us prepared, therefore navigators are our main assistants. They are trusted!»

Monitoring of HIV-related stigma and discrimination

The ways in which HIV-related stigma and discrimination are manifested and experienced are complex and varied. Many different measures from different perspectives are currently used to monitor HIV-related stigma and discrimination.

To better understand the status of HIV-related stigma and discrimination and progress towards their elimination, support advocacy for addressing HIV-related stigma and discrimination and highlight data gaps, UNAIDS is coordinating the development of summary measures of HIV-related stigma and discrimination. Please see the concept note for more background information.
Starting on 19 August 2019 for a period of three weeks, various elements of the draft measures will be discussed. A few key questions will guide the moderated discussion each week. Inputs and recommendations from each week will be shared at the start of the following week and used to inform the next element of the measures to be discussed.
To participate in the consultation please read more information here.

Through the 2016 Political Declaration on HIV and AIDS, the global community committed to eliminating HIV-related stigma and discrimination by 2020 “for the equal enjoyment of all human rights and equal participation in civil, political, social, economic and cultural life, without prejudice, stigma or discrimination of any kind” of people living with, at risk of and affected by HIV.
The proposal is to develop one summary measure of HIV-related stigma and discrimination and four accompanying summary measures of stigma and discrimination experienced by sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people related to factors other than HIV. This will make it possible to capture the diverse forms of stigma and discrimination that may be experienced by key populations most affected by HIV that may not be directly due to HIV but that have important impact on the HIV response.

This virtual consultation aims to encourage broad participation, particularly of people living with and affected by HIV, gay men and other men who have sex with men, transgender people, young people, sex workers, people who use drugs and women, from all regions. Contributions through this consultation will be used to inform the development of the measure(s) and ensure they are people-centered, reflecting the lived experiences and realities of people, and meaningful to inform programmatic action.
A summary of inputs and recommendations from the consultation will be shared in September 2019. 

Facts abour EECA region

HIV epidemic status in Eastern Europe and Central Asia (UNAIDS, 2017)

Since the start of the epidemic:
• Over 76 million HIV-infected patients registered
• 35.0 million people died of AIDS-related illnesses
• The number of people living with HIV was 36.7 million, of which 2.1 million were children under the age of 15.
• 20.9 million people (28%) living with HIV received treatment
• 76% of pregnant women living with HIV had access to treatment to prevent transmission of the virus to the fetus
• In 2017, 1.8 million new HIV infections were reported worldwide.

Have you already registered your abstracts for the EECA INTERACT 2019 workshop?

Attention! Selected abstracts will get free registration. Please find here more information. 

School of MSM and TG Leaders

On August 12–16, the “School of MSM and TG Leaders” was held in Almaty, Kazakhstan.

The objectives of this training were: to mobilize and increase the visibility of the community in the country; to create cohesion of the community itself; to create a tolerant attitude of the general population towards LGBT people.

More than 20 novice activists from different parts of Kazakhstan got new knowledge and skills to create a safe environment, maintain health and to improve the quality of life of LGBT people in the country.

“This is one of the best training I attended because it is not just a lecture but real master classes and personal experience of successful people’’ says one of the participants of the School. Indeed, the presenters – Amir Shaykezhanov – editor of www.kok.team and Elena German – program director of the Eurasian Coalition on Male Health www.ecom.ngo shared their professional experience.

The world is changing rapidly and today the most creative and innovative thinking leaders are pushing forward. The training itself and the presentation of the material were very unusual. From the beginning, the group was immersed in a creative trance – the participants were declared heroes of the Game of Thrones universe. “Five houses” – five groups of participants were engaged in the development of their unique projects for implementation in their regions. “Video blog to increase visibility”, “Community centers to support the LGBT community”, “Live libraries for anti-discrimination of HIV-positive MSM within the community”, “Improving HIV literacy among the LGBT community”, “Legal protection of the LGBT community” – during “The School” all these projects have gone all the way from the origin of the idea to a completed project application for receiving funding from the event organizers – AFEW Kazakhstan.

“We could not choose the best or most relevant topic, since all topics are important for the community,” admitted Roman Dudnik, chairman of the jury, director of AFEW Kazakhstan. As a result, the jury members – representatives of AFEW Kazakhstan and the Kazakhstan Union of PLHIV – decided to finance all projects. Teams are ready and are going to start in September.

 

 

New collaboration of AFEW International

We are happy to announce that AFEW International represented by executive director Anke Van Dam became a consultant of an international project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” awarded with NIH grant.

As one of the significant contributors AFEW International will act as a liaison to the key networks, organizations, and partners in the countries in the region of Eastern Europe and Central Asia. We will help the project team access data and the best level expertise for undertaking modeling in EECA. As well as we will provide consultations and feedback on the modeling process in the EECA region.

The overarching aim of the project “Optimizing HIV prevention portfolios targeting people who inject drugs using dynamic economic modeling” is to optimize HIV prevention strategies for people who inject drugs (PWID) in 108 countries worldwide using dynamic economic modeling based on multiple large data sources.

The project will:

1) Develop an epidemic model to estimate the impact of HIV prevention portfolios among PWID for every country with available HIV prevalence data among PWID (108 countries), based on data from multiple large systematic reviews.

2) Externally validate the model in 9 key countries with the highest numbers of HIV-positive PWID (including Russia and Ukraine)

3) Develop a user-friendly and web-based multi-platform portal for dissemination of the epidemic economic model and associated data.

The research team of the project consists of:

Natasha Martin, DPhil, Associate Professor, a leading economic infectious disease modeler (University of California);

Steffanie Strathdee, PhD, Professor and a leading epidemiologist focusing on HIV among PWID with 500 publications;

Javier Cepeda, PhD, Assistant Professor, an economic modeler with expertise in cost data collection among PWID;

Peter Vickerman, DPhil, Professor, a leading modeler of HIV transmission among high-risk groups including PWID, MSM and FSWs (the University of Bristol);

Louisa Degenhardt, PhD, Professor, an epidemiologist with over a decade of experience in conducting global systematic reviews on IDU and health harms among PWID (the University of New South Wales);

Sarah Larney, PhD (the UNSW team).

 

EECA INTERACT 2019

We are pleased to announce that, on the 18-19th November 2019, the first EECA INTERACT Workshop 2019 will take place in Almaty, Kazakhstan.

The EECA INTERACT 2019 Workshop builds scientific research capacity while simultaneously strengthening clinical, prevention, and research networks across the Eastern Europe and Central Asia (EECA) region. EECA INTERACT 2019 is an abstract-driven workshop focusing on factors unique to the region’s HIV, TB, and hepatitis epidemics. Bringing young and bright researchers together with top scientists, clinicians, and policymakers, EECA INTERACT 2019 aims to ignite a conversation that will build a stronger scientific base to serve the region and connect to the world.

EECA is the only region in the world where the HIV epidemic continues to rise rapidly. UNAIDS estimates point to a 57% increase in annual new HIV infections between 2010 and 2015.1 The World Health Organization has warned of a sharp rise in rate of HIV and tuberculosis coinfection, which poses a real threat to progress.2 Significant barriers to prevention and treatment services remain for people living with and affected by HIV, TB, and hepatitis across the region. For example, although the HIV epidemic in EECA is concentrated predominantly among key populations, particularly among people who inject drugs, coverage of harm-reduction and other prevention programs is insufficient to reduce new infections. The region urgently needs more effective strategies of prevention, treatment, and care and support that are tailored to the particular circumstances of individual countries.

The Amsterdam Institute of Global Health and Development (AIGHD) has over a decade of experience delivering in-country workshops and conferences that bring young researchers and established international experts together to share original research and state-of-the-art reviews on a wide range of topics. AIGHD has co-hosted the INTEREST Conference (the International Workshop on HIV Treatment, Pathogenesis, and Prevention Research in Resource-limited Settings) since its inception in 2007. The conference has grown from a small workshop to a full conference of more than 500 attendees each year.

Building on these proven results, AIGHD will collaborate closely with AFEW International and the AFEW network (AFEW) for EECA INTERACT 2019. AFEW’s deep roots and experience in the region offer a way to build sustainability into the new workshop, placing priority on local contributions. The EECA INTERACT 2019 will bring scientists, clinicians, members of civil society, and government officials together to tackle topics facing individual countries while building capacity and strengthening research and clinical networks. The two-day conference will focus on topics that are specifically relevant to EECA and dive deeply into particularities of the host country Kazakhstan, showcasing its successes, remaining challenges and responses.

The workshop objectives are:

  • To provide cutting-edge knowledge in the fields of epidemiology (modelling), treatment, pathogenesis, and prevention of HIV, TB, and viral hepatitis as well as chronic conditions;
  • To exchange ideas on providing and supporting HIV testing services and clinical care provision to adults, adolescents, and children living with HIV to achieve 90-90-90 goals;
  • To foster new research interactions among leading investigators and those who represent the potential future scientific leadership for health care and research in the region;
  • To build research and clinical capacity across EECA.

We invite researchers from EECA to submit their abstracts in the workshop. Selected abstracts will get free registration. Please find here more information.
Interested parties who do not have abstracts, but also wish to attend the event, can fill in an application form that will be considered by the committee. Please find here more information.

The deadline for all applications is September 20, 2019.

EECA INTERACT 2019 is organized by AFEW International, Amsterdam Institute for Global Health & Development (AIGHD), AFEW Kazakhstan and the Kazakh Scientific Center of Dermatology and Infectious Diseases.

EECA INTERACT 2019 is sponsored by Johnson & Johnson and Aidsfonds.

#EECAINTRACT

If you have any further questions, please contact Helena_Arntz@AFEW.nl.

 

 

Invisible Epidemic of Hepatitis C in Russia

Irina Shestakova, chief external infectious disease specialist of the Russian Ministry of Health, photo by Oleg Kiryushin

Author: Anastasia Petrova, Russia

July 28 is the World Hepatitis Day. According to Irina Shestakova, chief external infectious disease specialist at the Russian Ministry of Health, the number of people infected with hepatitis C in the country may reach 5.8 million. Last year, only less than 0.2% of people with this disease received treatment.

Hepatitis C spreading to the “general population”

As estimated by the World Health Organization (WHO), about 71 million people globally are infected with hepatitis C. In 2015, 1.34 million of people all over the world died of hepatitis-related conditions. This is more than the number of AIDS-related deaths and is comparable only with the number of people who lost their lives to tuberculosis. The morbidity due to the consequences of hepatitis C continues to grow.

The incidence is also growing. Hepatitis C has long gone out of socially disadvantaged groups to the “general population.” The virus may be transmitted through non-sterile equipment in a dentist’s office, nail salon or during any medical surgery involving contact with blood. At the same time, affected by this severe disease, people often lack reliable information about the virus, not to mention the opportunity to receive effective treatment.

In Russia, it is difficult to access the therapy, while the regimens which are offered are not in line with the international guidelines and have side effects along with the low treatment success rates. Thus, the WHO recommends substituting pegylated interferon, which is widely used in Russia, with direct-acting antivirals (DAAs). However, the process of introducing modern treatment methods in the country is slow.

Thirteen times fewer patients treated

In 2017, only 0.2% of the total estimated number of people with hepatitis C received treatment in Russia. According to the annual report on hepatitis C drugs procurement monitoring in Russia in 2017 published by the International Treatment Preparedness Coalition in EECA, last year 9,661 people were able to access the therapy. This coverage is 13 times less than it is required to stop transmission of the disease.

“Low coverage is due to the low interest of the state. All the activities in response to hepatitis C are the initiatives of the regions. There is no targeted funding or actions to eliminate hepatitis at the national level. Another part of the problem is the pricing policy of the corporations, which are monopolists on the market. In our country, their drugs are protected by patents and they are free to set any prices they want to,” comments Sergey Golovin from the International Treatment Preparedness Coalition in EECA.

As estimated by the Coalition, the cost of therapy with DAAs varies from about 480 thousand to one million Russian roubles. In Russia, the cost of drugs is much higher than in Brazil, India, Argentina or Thailand.

“Many countries made a decision to eliminate hepatitis C. Developed countries offer treatment with modern drugs to all people who need it. In some developing countries, patent owners allowed companies to produce and sell copies of their drugs (generics) at very low prices. As for Russia, it got stuck somewhere between the developed and developing countries,” explains Sergey Golovin.

No action plan

Meeting of civil society experts in hepatitis C at EECAAС2018.

In 2016, the WHO approved the Global Health Sector Strategy (GHSS) on Viral Hepatitis for the period of 2016-2022. The Strategy is aimed at eliminating the epidemic of hepatitis by 2030 through the reduction of new cases by 90%. The document has been signed by all member states, including the Russian Federation. However, there is still no action plan at the country level.

For quite a while, representatives of patients’ organizations have been calling on the government to adopt a National Strategy on Viral Hepatitis, which should be adopted by Russia in line with the Global Health Sector Strategy on Viral Hepatitis and the World Health Assembly Resolution on Viral Hepatitis.

According to Aleksey Lakhov, Advocacy Officer of Together Against Hepatitis NGO, implementation of the Strategy will allow raising the awareness on viral hepatitis prevention and in general improving the system of epidemiological surveillance and control over hepatitis transmission in Russia.

Such Strategy should contain a set of measures aimed at improving hepatitis C diagnostics and detection as well as clear indicators of reducing hepatitis C incidence, prevalence, and mortality rates and covering patients with therapy based on the modern treatment standards.

Civil Society of Kyrgyzstan in the Fight for Availability and Affordability of Medicines

Director of the Partner Network Association Aibar Sultangaziev

Author: Olga Ochneva, Kyrgyzstan

Kyrgyzstan is gradually switching to state drug provision system. Some of the tuberculosis medicine will be purchased out of the budgetary funds this year, and some of the antiretroviral (ARV) medicines – starting from the next year. Respective financial resources are planned to be allocated in the budget. At the same time, the question regarding the national legislation remains. A number of important documents is currently under the review. We discussed how these documents consider patients’ needs as well as the results of the analysis regarding the availability of medicines for HIV, hepatitis C and tuberculosis treatment with Aibar Sultangaziev, the representative of public council at the Ministry of Health and the Director of the Partner Network Association.

– Your organization and you personally are actively researching medicine availability and affordability. What are your successes so far?

– We started our work in 2009 with the issue of intellectual property. A respective study was conducted and, on the basis of the facts of high cost on brand medicines used for hepatitis C treatment, we advocated for the amendments to the Patent Law. In 2015, the Law was adopted; it also included the flexible provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). Due to this, it became possible to bring more generic medicine into the country. To date, seven medicines have been registered. We keep the cost of hepatitis C treatment at the lowest level in the region: from 615 US dollars for a 12-week course.

Back then, the legislation lagged far behind the needs. We developed an intra-organizational strategy for ensuring the availability of medicines and started to work in several directions. In 2014, we approved the clinical guidelines for the treatment of hepatitis C that became a clinical protocol in 2016 that included a full range of medicine available within the country. Hepatitis C treatment was added to the State Program on HIV/AIDS, and from 2018 onwards, 150 people living with HIV (PLHIV) will receive it free of charge annually. We participated in the revision of protocols on HIV treatment, and now they include modern and inexpensive medicine, such as dolutegravir, darunavir, rilpivirine.

– The Essential Drugs List (EDL) is currently undergoing a revision. It is an important document related to the availability and affordability of medicines and holding public procurement. Did you participate in its elaboration?

“For the availability and affordability of hepatitis C treatment!” Campaign on amendments to the Patent Law

– In 2015, we conducted a study on five diseases: HIV, tuberculosis, hepatitis C, oncological diseases, conditions after transplantation, and found out what medicines for their treatment were registered in the country or included to the EDL and clinical protocols. We identified the differences between the WHO recommendations and the situation in the country, and then submitted a List of necessary medicines to the Ministry of Health (MoH). All of them were added to the EDL and will be approved soon after several amendments to the Law on Circulation of Medicines are introduced. By the way, the Law provides a List of medicines that can be imported and used in the country without registration. This List is used for socially significant diseases, and, as part of the working group of the MoH, we are currently working to determine the procedure for its formation.

– Will it allow the pharmacological companies not to register medicine in Kyrgyzstan?

– Registration is needed. However, in cases when the government urgently needs medicines that are not available on the market, it will be possible to legalize them by the decision of the commission without registration. Of course, there are criteria: medicine must be of high quality, prequalified by the WHO, etc. This list already exists. Last year in November, together with UNDP, (the organization manages grants of the Global Fund in the country – author’s remark), we submitted a list of 12 essential tuberculosis and antiretroviral medicines for the Ministry of Health to consider the possibility of importing them. This is a matter of political will and one commission’s meeting, but there has been no progress with the documents yet. That is why we are preparing a new regulation so that another commission could formalize it via a new procedure.

– Does it mean that practically all conditions for public procurement are in place?

Activists’ campaign to support the amendments to the Patent Law allowing the import of generic medicines to the country

– A lot has been done but the risks still remain. We have to make every effort to regulate the process by autumn. The point is that this year the state’s responsibility is to purchase 10% of second-line tuberculosis medicines, none of which has yet been registered in the country. In 2019, the state should purchase 20% of the required amount of ARV medicines, and in 2020 the share will increase up to 30%. Not all pharmacological companies enter the national small market, and those that do, inflate prices. We are determined to promote the possibility of medicine purchase through international mechanisms. For example, if Kyrgyzstan purchases medicines through UNICEF, one can expect a 5-7-fold decrease of the cost since UNICEF places a single long-term order that covers several countries with the medicine producers.

– What other plans do you have and what is the ultimate goal of your work?

– We carry out constant monitoring of procurement. Price regulation remains one of the priority tasks. We want people to have unhindered access to inexpensive and effective treatment, and the state to provide medicines for socially significant diseases.