MedAccess: Transforming Access to Dual HIV and Syphilis Testing

MedAccess is a social enterprise using innovative finance solutions to address healthcare market inefficiencies and expand access to life-saving health products in low- and middle-income countries (LMICs). To address low testing rates for syphilis in pregnant women in LMICs (at around half of HIV testing rates), MedAccess provided a volume guarantee to the manufacturer SD Biosensor, enabling dual HIV/syphilis rapid testing for less than $1 per test--the lowest price ever achieved, and remarkably close to single HIV test pricing.

The Silent Crisis of Maternal Syphilis

Syphilis remains a silent threat during pregnancy, with untreated cases 52% more likely to result in adverse birth outcomes. Mother-to-child transmission of syphilis stands as the second leading cause of stillbirth globally, with surviving infants potentially suffering from lifelong health problems.

While years of global investment and awareness campaigns have established robust HIV testing programs, reaching 70-100% of pregnant women in many LMICs, syphilis testing rates remain at just 40-60%. This disparity persists despite the existence of dual rapid diagnostic tests that can detect both infections simultaneously in minutes while reducing training requirements, storage needs, and transportation costs. However, prior to MedAccess' intervention, widespread adoption of dual testing faced significant obstacles --including price. The cost difference between single HIV tests and dual tests made procurement decisions difficult for health ministries working with limited budgets. Manufacturers, faced with this tepid demand, lacked incentives to scale production or reduce prices.

Innovative Financing: How Volume Guarantees De-risk Markets and Drive Access

The volume guarantee mechanism addressed both sides of this market impasse. By contracting with the dual test manufacturer, SD Biosensor, and assuring minimum sales volumes over a defined period, MedAccess created the market certainty for the manufacturer to commit to a sub-$1 price ceiling across more than 100 LMICs--bringing the dual test closer to the cost of single HIV tests. Indeed, the guarantee effectively creates a safety net for the manufacturer: if actual sales volumes fall below guaranteed thresholds, MedAccess makes a shortfall payment to SD Biosensor.

The price breakthrough enabled by this risk-sharing approach generated cascading benefits: procurement agencies gained both affordability and supply predictability; health ministries could confidently incorporate dual testing into long-term programs without supply concerns; and millions more pregnant women gained access to life-saving syphilis screening alongside established HIV testing. 

A Collaborative Public-Private Partnership Structure

MedAccess emerged from a recognition by global health leaders--including the Clinton Health Access Initiative (CHAI), Gates Foundation, and UK's Department for International Development--that unpredictable healthcare markets create major access barriers. As such, this unique origin positioned MedAccess at the critical intersection of public procurement and private manufacturing.

The organization operates through a blended finance model, combining $170 million capital from British International Investment with grants, including £17 million in from the UK's Foreign, Commonwealth & Development Office since 2021. MedAccess also charges manufacturers a risk-reflective fee when it provides a guarantee. This financial structure enables MedAccess to pursue maximum impact while maintaining operational sustainability.

The volume guarantee's success relied on complementary partnerships: CHAI provided implementation support and country-level data to validate market assumptions; SD Biosensor collaborated closely to address "landed costs" challenges and supply chain bottlenecks that threatened the sub-$1 price point; and ongoing dialogue with major donors like PEPFAR and the Global Fund ensured alignment with broader procurement strategies. This ecosystem approach enabled MedAccess to navigate complex market dynamics while maintaining both affordability and sustainability.

Measurable Impact across Three Dimensions

MedAccess employs a sophisticated impact framework to identify high-potential partnerships and rigorously track outcomes across three interconnected dimensions:

Lives Changed: Using WHO data on 2020 antenatal testing in Africa, MedAccess projected that an additional 4.4 million women would gain access to syphilis testing through the SD Biosensor dual test guarantee. By the end of 2025, the partnership had led to an estimated 770,000 pregnant women with syphilis being identified and treated, averting 162,000 stillbirths and preventing 119,000 cases of congenital syphilis across 43 countries in Africa, Asia, and Latin America.

Money Saved: Financial impact was measured by comparing the negotiated sub-$1 price to the expected weighted average market price of dual tests. By the end of 2025 the initiative had secured $13.6 million in direct procurement savings while enabling countries to extend testing coverage with existing budgets. 

Markets Shaped: Working with donors, procurers and health ministries, MedAccess tracks changes in policy adoption, procurement practices, and supplier movement. Market effects were substantial, as the partnership drove a 21% reduction in average market prices for dual tests, increased supplier competition as SD Biosensor became the third WHO-prequalified supplier to enter the dual test market in LMICs, and catalyzed wider adoption of dual testing protocols. Healthcare workers are now being trained on how to administer and read these tests, and more LMICs are looking to adopt and roll-out the dual test for HIV and syphilis.

Expanding the Model towards Stronger Systemic Impact

The dual test partnership yielded surprising insights that have directly shaped MedAccess' strategy. While projections assumed that high-burden HIV countries would drive adoption, smaller countries with lower HIV prevalence also emerged as significant purchasers. This pattern revealed broader global interest in dual testing than initially anticipated, reinforcing for MedAccess the importance of wide geographic scope in agreements.

As MedAccess' first intervention in both rapid diagnostics and maternal health, the partnership also built specialized expertise now powering new initiatives. Knowledge gained on screening directly informed a subsequent partnership with Wondfo on HIV self-testing, while insights into maternal health have strengthened MedAccess' women's health portfolio. The relationship with SD Biosensor also evolved, with a second volume guarantee in 2022 for G6PD testing, supporting efforts towards P. vivax malaria elimination. To date, MedAccess has executed 16 agreements across diverse health priorities from tuberculosis treatment to COVID-19 supplies.

Looking forward, MedAccess is seeking to apply these learnings to support regional manufacturing in Africa across four strategic areas: antiretroviral treatments, malaria diagnostics, vaccines, and pharmaceutical raw materials. Each partnership would be tailored to manufacturer capabilities-whether supporting fill-finish capacity development or end-to-end production.

MedAccess has documented the implementation of the guarantee via a visit to Nigeria in 2022 to gather stories from pregnant women, healthcare workers and officials about the positive impact of increased testing for syphilis. By working with partners presenting at venues like the International AIDS Society's 2022 conference and measuring how market improvements persist after guarantees end, MedAccess demonstrates how innovative financing can address healthcare market failures when standard business incentives fall short, creating sustainable pathways to health equity. With all operational surpluses reinvested into new agreements, this creates a continuously expanding cycle of impact.