The New York Times - Thursday, January 15, 2004
Celia W. Dugger

Former President Bill Clinton announced yesterday that his foundation had negotiated deals with five major medical companies to steeply discount the price of two crucial diagnostic tests for H.I.V./AIDS in Africa and the Caribbean.

Those price reductions come just three months after Mr. Clinton's foundation brokered an agreement with generic drug manufacturers to cut prices of AIDS drugs.

The two sets of agreements will cut about 70 percent of the annual cost of treating an AIDS patient in the 13 developing countries where his foundation is working -- down to $250 a year from $800, Mr. Clinton said.

"We're systematically changing the economics of AIDS treatment," he said at a press conference near his office in Harlem.

Officials in international organizations that are rapidly attempting to expand drug treatment in poor countries said the lower prices will make it possible to treat more people with the scarce resources for AIDS care.

The Clinton Foundation "has made a major contribution to the fight against H.I.V./AIDS," said Dr. Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The United Nations estimates that six million people need antiretroviral drugs. The vast majority of them live in developing countries where more than 9 out of 10 people are not getting the medications that, in richer countries, have turned a fatal disease into a chronic one.

The laboratory tests that are part of the new pricing deals are routinely used in Western countries to gauge when to start drug treatment for AIDS patients and to monitor the effectiveness of drug therapy.

Under the new agreements, the cost of each CD-4 test will drop to $3 to $5 from $8 to $10, said Edward J. Ludwig, chairman and chief executive of Becton, Dickinson & Company, one of the companies that has struck a deal with the foundation.

Robin Toft, a vice president at Roche Molecular Diagnostics, declined to specify the new lower price for the more expensive viral load tests, but said it would be 20 percent less than what the company is now charging in developing countries.

The other three medical companies involved in the deal are Bayer Diagnostics, Beckman Coulter, Inc. and bioM rieux.

Developing countries have taken different approaches to CD-4 and viral load tests, which add substantially to the cost of care. In Botswana, where more than a third of adults are infected with the H.I.V. virus, the government has routinely used the tests.

Haiti, which has the highest infection rates in the Western Hemisphere, provides a sharp contrast. There, the nonprofit group Partners in Health uses the CD-4 test only to determine when to begin treatment. Its staff members weigh patients monthly to monitor their well-being.

It is unclear how the lower prices will affect the use of such tests. The Clinton Foundation is working in Mozambique, Rwanda, South Africa and Tanzania, which together have about a third of the people with AIDS in Africa. The foundation is active in another nine countries and three territories that contain 90 percent of the people with AIDS in the Caribbean.

Mr. Clinton said yesterday that the new agreements will make it less costly for doctors to give the lab tests they believe are needed to determine when one combination of AIDS drugs is not working and to try another.

Mr. Ludwig, of Becton, Dickinson, called discounts "a direct hit to the bottom line," while Mr. Clinton said the agreements would "still allow these companies to be profitable."

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