Re: Cost of basic regimen of antiretroviral drug

[Guest guest]

Dear FORUM,

In reference to the posting on the cost of " basic regimen " of antiretroviral

drugs, I also fully agree with Dr. Neeraj Raizada Dept of Community

Medicine,M.P.Shah Medical College, Jamnagar .

I am getting ARV directly from Depot of most of Pharmaceuticals & it costs less

than in market. So I pass on benefit of price to my patients.

Dr. Rajesh M. Buddhadev MD

Surat

E-mail: <buddhadev@...>

[Guest guest]

Hello to the forum,

Thanks to Dr Rajesh and others for the flag waving that is essential, If ever

there was an argument for price fixing it would be very applicable to ARV's in

India.

It shouldn't matter where the medicine is obtained. It should also be

affordable. It shouldn't be more expensive for those unfortunate enough to be

living in a low prevalence area either.

If India wants to avoid the black marketing that has already started in Kenya

where a purchaser is not even sure that what he is buying is even proper HIV

medicine, then action needs to be taken now to take all black market incentives

away from the profiteers.

Dispensing should be regulated but not necessarily in the same format for all

places. It should only be made available to people who are diagnosed as

requiring HIV medicine and that doesn't mean even all positive diagnosed

cases.

PLWA groups can be very helpful in the screening processes and in the follow up

or innovative ways of ensuring good adherence and up to date information as to

how to manage unintended side effects.

Anti Retroviral medicine is team medicine and although a doctor is integral to

the process it requires a very multi lateral team of practitioners to ensure

that best effect and more importantly, constant affordable availability exists.

It must be understood that this medicine is only effective if it is in constant

concentrations in the body on a 24/7 basis.

Interruptions that are not structured can and will lead to resistance developing

and India doesn't need the distinction of not only having the highest population

of multi drug resistant TB patients but also the highest population of multi

drug resistant HIV patients as well.

Professional and proper prescribing practices and innovative strategies for

aiding adherence will be as important as the affordable and ready availability

of medicine. Economies of scale and regulated dispensing should see prices

reduce, and better understood prevention strategies should also ensure that the

need for ARV's declines over time.

Associated costs of staying well need to be canvassed in addition to the

treatment components. This will vary from place to place. Travel concessions

will be important in some places and access to potable water and good sanitation

will be useful in others. Overall aggressive treatment for opportunistic

infections and good meditative and holistic health practices all contribute to

well managed and strong immune function in infected individuals and there is no

substitute for competent and supportive fearless home based care.

Some of the best initiatives for adherence strategies has been the co-opting of

younger siblings in reminders about taking medicine on time and being involved

in ensuring the supply of potable safe water, cordial flavoured if necessary,

and prepared in a volume regulated jug so that the consumption of fluids can be

measured daily and the efficacy of the medicine maintained.

We are well on the way to a well managed epidemic and we should be co-opting

willing members of the affected and infected communities to ensure that stigma

free attitudes to HIV abound and better prevention strategies, focus tested and

adopted, so that by the next generation of post pubescent young people sexual

health strategies will be well learned and understood.

With regular testing, minimising sexual partners, protected penetrative sex and

harm minimisation strategies around IDU activity the virus can be stopped. Of

that there is no doubt scientifically.

Better designed intervention strategies are springing up all around the country.

Unfortunately they are only targetting high prevalence areas which is a recipe

for ensuring low prevalence areas eventually become high prevalence simply

because of neglect around strategic prevention models being in place.

A lot of responsibility for outcomes rests with State Aids Control Societies.

Without co-ordination at this level the virus can easily outwit us if we are not

diligent and creative but there is now no excuse for failing to take action at

this level. The science of transmission is well understood and the trategies for

avoiding it are also understood and easy to understand providing the information

is delivered in age appropriate ways and free from the rhetoric of middle class

moral codes, patriarchy and closely controlled female sexuality. So under our

newly elected Central Government lets get on with it.

Geoffrey

E-mail: <gheaviside@...>