MerckMerck announced the Merck Company Foundation and the Bill & Melinda Gates Foundation are committing an additional $60 million to support Botswana's African Comprehensive HIV/AIDS Partnerships (ACHAP). Merck is known as MSD outside the US and Canada. A unique program developed with and led by the Government of Botswana, ACHAP is one of sub-Saharan Africa's oldest, most successful public-private partnerships. With today's pledge, the Merck Foundation and the Gates Foundation's total cash contributions now amount to $166.5 million. Merck will also continue the donation of its HIV medicines.

Building on the successes created by its initial investment of $56.5 million nine years ago, Merck will contribute an additional $30 million over the next five years. The new funding will continue the program's original efforts in treatment and care but also will support the second phase initiatives to meet the current treatment needs of the 137,000 Batswana (people from Botswana) living with HIV and new patients enrolled in the second phase. The second phase initiatives include: the prevention of HIV, the critical need to treat people living with HIV for tuberculosis (TB) and the sustainability of the program to allow Botswana to successfully address HIV/AIDS within its own borders.

"For nearly 10 years, Merck has been a partner in helping the Government of Botswana save the lives of thousands of people living with HIV and AIDS and we are confident our new funding will continue to contribute to the well-being of the country," said Richard T. Clark, chairman and CEO of Merck. "This collaboration is a great success story on many levels, and has become a model for many countries both on and off the African continent."

ACHAP has helped demonstrate how public-private partnerships might work to save the lives of the world's poorest people infected with HIV. Between 2001 and 2007, the partnership has supported Botswana in preventing the estimated deaths of more than 53,000 Batswana living with HIV. Today about 90 percent of Batswana living with HIV receive treatment, compared to less than 5 percent when the program began in 2001.

"Our partners' contributions, through funding, antiretroviral (ARV) medicine donations and medical expertise, have been absolutely essential to our ability to address the needs of Batswana living with HIV and AIDS," said Themba Moeti, M.D., managing director of ACHAP. "We look forward to strengthening our partnership as we enter our second phase and enhancing the successes of our first decade while responding to the challenges that remain and retaining the flexibility to address emerging issues."

ACHAP's New Initiatives Focus on Prevention, Integration and Sustainability
Merck and the Gates Foundation recognized that in order to build upon the successes of the program's first phase and not have the progress lapse, a second phase of funding was necessary. In addition to staying focused on its original commitment to treatment and care, ACHAP's new initiatives will expand efforts to improve the prevention of HIV, address the link to treatment of TB for people with HIV, and create greater sustainability through the transfer of key services to the Government of Botswana and local organizations.

These new commitments come as the World Health Organization's (WHO) newly revised guidelines now recommend starting HIV treatment earlier, effectively doubling the number of people worldwide in need of treatment and not receiving it to 10 million. At the same time, global funding is on the decline. In addition to the funding necessary to meet WHO’s new guidelines, the Global Fund to Fight AIDS, TB and Malaria, which pays for one-fourth of the ARV treatment needs in developing countries, faces a deficit of at least $20 billion over the next three years in meeting the current treatment need.

From 2001 to 2009, Merck and the foundation contributed $106.5 million to the partnership. Additionally, Merck donates its ARV medicines - CRIXIVAN® (indinavir sulfate), STOCRIN® (efavirenz), ATRIPLA® (efavirenz 600mg/emtricitabine 200mg, tenofovir disoprixil fumarate 300mg) and ISENTRESS® (raltegravir) - to Botswana's national treatment program and will continue to do so for the duration of the partnership's second phase through 2014. As the donation is scaled down, the Government of Botswana will increase its investments to ensure long-term sustainability of access to these medicines beyond the life of the partnership.

ACHAP Helps Botswana Achieve 90 Percent Treatment Rates, Supports Scale-Up of Prevention
Today, through ACHAP's help, 32 ARV treatment sites and more than 170 clinics throughout the country provide treatment and care to Batswana in need. As a result, about 90 percent of Batswana living with HIV receive treatment, which is among the highest treatment rates in all of sub-Saharan Africa. Additionally, more than 90 percent of pregnant women living with HIV receive treatment for the prevention of mother to child transmission (MTCT) of HIV, bringing down MTCT rates from more than 20 percent to less than 4 percent.

However, with nearly 25 percent of its people aged 15 to 49 living with HIV - the second highest rate in the world next to Swaziland - Botswana remains seriously impacted by the HIV epidemic.

New prevention programs, particularly among young people aged 15 to 29, are critical to curbing the spread of HIV in Botswana in support of the government's ambitious goal of zero new infections by 2016. The new funding will support the government in expanding new prevention efforts like safe male circumcision, while also supporting the inclusion of TB treatment with HIV services. TB is a leading cause of death for people with AIDS in Botswana.

Without a continued reduction in new HIV infections, Botswana's treatment successes will become much more challenging to maintain. ACHAP's second phase will support the expansion of key services to ensure the long-term sustainability of the important gains made in the last decade. The goal is for Botswana to become self-sustaining in its efforts to combat the HIV epidemic within its borders.

Merck's Commitment to Sustainable Partnerships to Advance Global Health
Merck's past experiences in the developing world and creating greater access to medicines - including the MECTIZAN® Donation Program for onchocerciases, or river blindness, and the Enhancing Care Initiative for HIV/AIDS in partnership with the Harvard AIDS Institute - informed the company's approach with ACHAP. Through these and other initiatives, Merck has learned that the donation of medicines alone is not enough to create sustainable progress against disease without also improving healthcare infrastructure, ensuring adequate funding for healthcare and providing training to local medical workers.

Through highly collaborative programs and partnerships like ACHAP, Merck works to address specific health challenges beyond the donation of its medicines. Merck collaborates with national governments, local institutions, and nongovernmental organizations to promote sustainable prevention, treatment, care and support for those in need.

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