Urgent need to introduce second-line ARVs in government-supported ART centers

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An Open-letter to NACO to urgently introduce second-line ARVs. (Note: We also

invite the forum members to send their suggestions for making second-line ARVs

available in government-supported ART centers)

Ms. Sujatha Rao

Director General, NACO.

Sub: Urgent need to introduce second-line ARVs in government-supported ART

centers

Dear Ms. Sujatha Rao,

INP+ appreciates the initiatives by NACO to provide first-line ARVs in various

parts of India. With about 50000 PLHA getting first-line ARVs in India by the

end of October 2006, we have the challenge of rapidly scaling-up first-line ARVs

to men, women and children and also ensure equity in ARV access to various

marginalized populations.

However, it is also time to consider the urgent need to introduce second-line

ARVs in national ARV rollout program. We are sure that NACO is committed to

provide second-line ARVs in national ART program but we need to make urgent and

crucial decisions on this.

INP+ has been following up the progress in ARV access in India through periodic

reports ('Missing the target' series) that are available in

www.aidstreatmentaccess.org. One of the recommendations that have been

consistently made in all these reports as well as in the various consultations

during formulation of NACP-3 strategy, and one in which not much progress has

been made is the urgent need to introduce second-line ARVs in

government-supported ART centers. To assist NACO and other stakeholders in

making decisions on introducing second-line ARVs INP+ is also preparing a

discussion paper on introducing second-line ARVs in government ART centers.

Various state and district level PLHA networks of INP+ are witnessing deaths of

PLHA because they could not afford second-line ARVs. We feel this is not

ethically correct in this period of rapid progress made in economy and health

sector in India. We need to think creatively and devise mechanisms to raise

resources and make second-line ARVs available as soon as possible.

The following simple steps can be considered if we want to introduce second-line

ARVs in government-supported ART centers.

1. Estimation of those PLHA who need second-line ARVs:

Estimation of the number of PLHA who are coming to government-supported ART

centers and who now need second-line ARV regimens.

Estimation of what proportion of PLHA at any point in time might need

second-line ARVs so that this will be useful if we plan to use the available

resources to buy first-line and second-line ARVs.

2. Reallocation of resources and negotiation with pharma companies:

Possibility of reallocating resources from the round-4 and round-6 grants to buy

second-line ARVs.

Negotiation with pharmaceutical companies to bring down the prices of

second-line ARVs.

3. Mobilising new resources:

Asking major donors and international agencies like Bill and Melinda Gates

Foundation and Clinton Foundation to support for introduction of second-line

ARVs in government-supported ART centers.

Asking Indian government to support for second-line ARVs when budgeting for

NACP-3.

Asking state governments to support for both first-line and second-line ARVs in

their respective states.

Proposing in the global fund round-7 grant application to introduce second-line

ARVs.

4. Setting-up interim mechanisms:

Since introduction of second-line ARVs in government ART centers may take some

time and we do not want to loose lives because of the delay in this process, we

suggest to setup interim mechanisms to support those who urgently need

second-line ARVs.

Some of those interim mechanisms could be - introducing reimbursement system to

reimburse the costs of second-line ARVs purchased by PLHA who come to the

government-supported ART centers; and funding the 'Positive support fund' setup

by INP+ to support those PLHA who need second-line ARVs.

Three years ago, NACO felt that introducing first-line ARVs was not possible

because it was afraid that the costs might be quite huge. We guess NACO is now

in a similar thinking mode when it comes to introducing second-line ARVs. But we

hope we can devise ways to move forward and introduce second-line ARVs as soon

as possible.

Sincerely

K.K. Abraham

General Secretary,

Indian Network for People Living with HIV/AIDS (INP+)

INP Secretariat

e-mail:<inp@...>