Re: Quality of care and treatment in Antiretroviral Treatment centers – a case study

[Guest guest]

Dear FORUM,

Ref: /message/6974

At the outset I thank Dr Bharti for his feedback. I totally agree with you that

provisiong of ART has to be done carefully and scientifically by any Physician,

whether is paid or in free roll out.

The free roll out is never meant to compromise on quality of care or

sensitiveness in treating PLHAs. NACO never starts a ART centre without training

of faculty members from Medicine, paeds, gyane and dermatology departments.

Alongwith this one medical officer, one counsellor, one satff nurse and one data

manager is provided additionally to ART Centre by NACO.

The medical officer undergoes a 12 days training before centre starts. All this

is done to provide good quality care with a view to avoid drug resistance . The

staff is also sensitized on issues of stigma and discrimination. As regards

quality of drugs is concerned, only WHO prequalified or GMP companies medicines

are procured following an International Competitive Bidding process and all

drugs undergo pre supply and random post supply quality checks.

No orders have been given to use lower doses of stavudine in case 40 mg has run

short. Many a times as patients gain weight and require higher strength, there

might be sometimes shortages for which drugs are shifted from other centres. I

personally feel that doctors are hesistant to seek 2nd opinion in case they are

in some difficult situation and this happens for any disease they are treating.

We have to come out of this. ART information is available on some many websites

and we have so many experienced persons in country that getting a opinion by

email should be no problem.

I will definately look into some of cases you have given. Such a feedback is not

a crticism but helpful in increasing the levels of care to PLHAs to which all of

us at NACO are committed

Dr B.B.Rewari MD,FICP,FIACM,FIMSA

Sr.Physician,Dr RML Hospital & National Programme Officer (ART)

National AIDS Control Organistion (NACO)

New Delhi

Tel;23325343,23325335(O)

FAX : 011-23731746

e-mail: <drbbrewari@...>

[Guest guest]

Dear FORUM,

Re: /message/6975

Dr. Rewari is right that there are many physicians in India whose help can be

saught if you face a dilemma in managing your patient on ART. but, rarely

doctors take a second opinion.

I have a HIV- II patient who went to Hinduja hospital for treatment.

He was prescribed a AZT + LMV + EFV combination (CD-4 COUNT- 25 but still no

significant symptoms) The patient took all the prscribed medicines for a month.

When he was about to start the 2'nd month traement, he fortunately read the

company's product monograph leaflet and realised that Efavir has no action

against HIV II. He came to me saying that how can an MD physician (who was

taking care of Late Pramod Mahajan) has no knowledge about this very basic.

This is just one example. I have many a cases of mis- management by our doctor

friends. Help is available at al the government set ups where patients who can

afford to shell out money should be prescribed medicines and not enroled for

free ART.

Government, NGOs and individual volunteers ( who may be doctors) must promote

this concept of -- " correct counseling and diagnosis-- is to undertaken only at

recognised centers and qualified or a specially trained physician. "

This HIV-ii patient is not on ART. After, drug sensitivity test from a

recognised lab (as the patent can afford it), a PI based regimen with NRTIs

combination would be considered after discussing the strategy of the treatment

with the patient. Drug sequencing also might be a very big challange for him.

Dr. Divya Mithel,

Jyothis Care Center, Kalamboli

e-mail: <d_mithel@...>