India's free antiretroviral programme gets off to slow start. The Lancet

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India's free antiretroviral programme gets off to slow start

India's HIV/AIDS programme has entered a new phase with the launch of

free antiretroviral treatment in government clinics from April 1,

2004. But the programme is a diluted version of one that was

announced by health minister Sushma Swaraj on World AIDS Day last

year.

Just one government hospital in each of six high-prevalence states

will be able to distribute the drugs. But in Delhi--a low-prevalence

state and a surprise inclusion on the list--free drugs will be

available at two hospitals. Priority will be given to women already

registered in the " prevention of parent-to-child programme " in

government antenatal clinics, children younger than 15, and patients

with full-blown AIDS who are already being treated at the eight

selected hospitals, according to the National AIDS Control

Organisation.

Public health experts criticised the plan last year saying that the

government delivery system was not prepared for it. Swaraj initiated

talks with Indian generic antiretroviral manufacturers to reduce the

costs of the drugs below prices agreed by the Clinton Foundation. But

the discussions collapsed because early general elections prevented

budgetary negotiations from being finalised. As a result, the future

sustainability of the free drug supplies remains uncertain.

" We should have done proper homework before launching such a

programme " , comments Radium Bhattacharya, a spokesperson for the

Indian Network of non-governmental organisations (NGOs) on

HIV/AIDS. " For enrolment of patients, referral, and follow-up, each

state should have a nodal network of NGOs. This has been done only in

Tamil Nadu state. "

Bhattacharya believes that without such an arrangement, patient

recruitment will be poor. In the first week, the programme has

enrolled just 10 patients in Manipur and 25 in Andhra Pradesh--both

of which are high-prevalence states. The aim is to provide treatment

to 100 000 people in the first year.

Dinesh C Sharma

The Lancet. Volume 363, Number 9416.10 April 2004