WHO criticises GOI ARV program

[Guest guest]

BMJ 2004;328:70 (10 January), doi:10.1136/bmj.328.7431.70-f

News extra

India’s treatment programme for AIDS is premature

New Delhi Sanjay Kumar

The announcement by India’s health minister—on the eve of world AIDS day in

December—that from 1 April 2004 the government will provide free antiretroviral

drugs to 100 000 HIV positive people in six states with high prevalence of the

infection has left the bureaucracy and AIDS experts confused and in a state of

shock.

The poor infrastructure, few facilities, and lack of training have prompted

serious apprehension among those working in the field.

" We have burnt our fingers with tuberculosis, and now we will burn our fingers

with HIV, " warned Alaka Deshpande, head of medicine at the JJ Hospital in

Mumbai, where more than 15 000 people who are HIV positive have been enrolled

for treatment.

" If we don’t give the drugs properly and monitor the patients, they are going to

develop drug resistant HIV very rapidly, and that situation would be

catastrophic, " she added.

Dr Deshpande contends that most doctors are not trained to start patients on

antiretroviral treatment: " Even those who call themselves AIDS experts do not

bother about essential CD4 counts or the viral load of patients before starting

or during treatment, " she adds. There is no drug resistance surveillance

mechanism in place in India, she warned.

Manipur state, the Indian state with the highest number of people with HIV who

are also intravenous drug users, has only one CD4 counting machine in the entire

state. " Patients have to wait for months to get their CD4 counts done, " said L

Birendrajit Singh, general secretary of the non-governmental organisation Social

Awareness and Services Organisation at Imphal.

Adherence to antiretroviral treatment is a constant problem, and many patients

stop mid-course as they cannot afford it any longer, cannot sustain its toxic

effects, or just feel better, said Dr Deshpande.

" We need to learn from the experience of directly observed therapy short course

(DOTS) for tackling tuberculosis, " said Dr Jai Prakash Narain, coordinator of

HIV/AIDS and tuberculosis at the South East Asia Regional Office of the World

Health Organization. " Mechanisms have to be developed to ensure that at least

90% patients take the pills, as in tuberculosis, " he added.

Dr Narain identifies critical elements as uninterrupted drug supplies;

laboratory capacity for CD4 monitoring; expansion of voluntary counselling and

testing; training of healthcare workers; monitoring of resistance to

antiretroviral drugs; and strengthening of the health system’s capacity to

deliver the drugs.

" Unless these critical elements are in place one should not even start the

programme, " he warned, adding that a bad programme could be worse than no

programme at all.

Dr Narain said the experience of Brazil, Malawi, and Thailand shows that

antiretroviral treatment is possible, replicable, and sustainable for reducing

the burden of morbidity and mortality, making HIV a chronic manageable disease

and no longer a death sentence.

" We are in the planning stage and will scale up the programme in a staggered,

phased manner and will be on target, " Dr Pyare Lal Joshi, one of the project

directors of the National AIDS Control Organisation, told the BMJ.

http://bmj.bmjjournals.com/cgi/content/full/328/7431/70-f

[Guest guest]

Dear Forum,

Not only all this, there are many more critical elements in it. What kind of

criteria is going to take place to give ARV for 100000 people? Here also whether

influences and bribes will play much more like in any thing else?

Do the really needy and poor will atleast know about this? Govt is supposed to

do lot of things even in general hospitals. When a person with fever goes to

hospital, they are saying " No Stock of Paracetamol tablet " , if it happens with

HIV for ARV, what do you do? What are measures for all this?

I think Govt needs to think many things before starting any thing.

1. Who will get ARV?

2. Under what grounds?

3. Upto which line drugs?

4. Whether the doctors are trained in this? What about monitoring tests?

5. Like Dots centre, do they need to think of some infrastructure where it can

be monitored?

6. If it is going to be like that what would be the levels of confidentiality?

7. What about the people other than 100000 people?

I hope Govt will not make a mess of it and make the problem from pan to stove.

If it is going to take little more time also let them plan properly and go

ahead about it.

Madhuri KV

E-mail: madhurikv_99@...>