Re: 2nd line ART. A simple solution for a complex problems

[Guest guest]

Dear All,

We all know that country needs 2nd line ART since

there are patients who are failing first line ARVs.

Here is quick solution:

1. NACO needs to identify 15 best performing ART

centers in different regions of the country.

2. If one 2nd line combination needs to be provided

first, Lopinavir/ritonavir combination seems to be the

best.

3. For bulk purchase, prices can be negotiated with

Parma companies.

4. Complex problems have simple solutions.

Best wishes

Naveet Wig

Associate Professor,

Department of Medicine

AIIMS, New Delh

Naveet Wig <naveetwig@...>

[Guest guest]

Dear FORUM,

I congratulate Dr. Wig for his quick solution for complex problems and

absolutely agree that many PLHAs needed 2nd line treatment and the number will

soon rise and bound to increase. Many more will fail to the 1st regimen which is

a fact.

While thanking him for his suggestions I would like to make a few points of my

observation to his ‘Quick Solution’ and enlighten me with few more details and

excuse me for my ignorance.

1. What is the relevance of choosing 15 centers out of 110 ART centers? Are HIV

Positive patients needing 2ndline treatment locate, reside only on 15 sites or

???

As for me I would proposed that to address 2ndline Art treatment – All ART roll

out centers in India must be strengthen and equipped to handle 2nd line

treatment roll out so as all patients should access the same from the existing

sites. The ART nodal officers, SMOs, MOS, Counselors manning the Centers should

be given an upgraded education, Training, CMEs, monographs, handouts, poster,

stickers, counseling materials to be able to correctly use, prescribe, monitor

2nd line drugs.

2. I agree that Lopinavir/Ritonavir combination might be the best combination.

3. The ART drugs pricing should not be just a matter that is to be negotiated by

patients, parties, groups, drug distributors with the Pharmaceutical companies

etc. BUT the issue is absolutely important which should be brought to the

negotiation table between the GOVERNMENT OF INDIA and the PHARMACEUTICAL

companies.

The access to drugs 1st, 2nd , 3rd or 4th or whatever regimen of drugs should be

universal and to bring down the cost of this life saving drugs to everyone who

needed is the need of the hour.

4. Complex problems might have simple solutions – BUT the complex problems

regarding 2nd line ART is indeed very complex and there are not immediate simple

solutions for this complex issue.

Best regards,

Dr Chinkholal Thangsing

Asia Pacific Bureau Chief

AIDS Healthcare Foundation

S7 Panchsheel Park,

New Delhi 110017 India

+91 11 41745541[O]

+91 98 18270687[Cell]

e-mail: chinkholal.thangsing@...

www.aidshealth.org

[Guest guest]

Dear Dr Wig,

15 second line centers will not any way solve the second line problems.

The problems many ARV centers facing now – heard from various people in HIV care

in these states —including Delhi is keeping the adherence for patients from

distant places and migrants. Many of our patients need second line just because

they could not be regular in treatment because of logistic reasons including the

distance and expenses to reach the ART center / health provider (in Pre free ART

era). This can not be solved by just 15 centers.

Dr Ajithkumar.K

Trichur, Kerala

e-mail: <ajisudha@...>