Drug scarcity hits AIDS Program in New Delhi

[Guest guest]

Drug scarcity hits AIDS programme

ToI, 17th OCT.2007. New Delhi: Three years after the free ART (anti-retroviral

therapy) programme for AIDS patients was launched, the nine ART centres in the

city are plagued by long waiting lists, a result, according to officials, of the

shortage of drugs.

Antiretroviral drugs are medications for the treatment of infections by

retroviruses, primarily HIV. Three to four drugs are used in combination to slow

down the replication process of the virus inside the body and is believed to be

the most effective option available for AIDS patients.

Through health officials are loathe to use the word waiting list, all the nine

centres in Delhi that include premier hospitals like AIIMS and RML, show

Huge gaps between the number of patients who have registered for ART and the

number of people who have actually been started on the regimen. Which

essentially means that these people are still waiting for the therapy to start.

Ram Monohar Lohia tops the list of waiting patients with 2,166 of its

4,281registered people still waiting for the therapy to start, followed by AIIMS

at 1,506 patients. The dropout rates too are quite alarming, with nearly 50%

discontinuing the treatment at RML and more than 30 % at AIIMS and Lala Ram

Swarup Hospital.

Health official say that shortage of drugs is the main reason for the long

waiting lists. ¡°The dropout rate is not as alarming as it sounds because

Cause the figure also includes patients who were started on the therapy but died

later,¡± explained a doctor at Lok Nayak Hospital.

A health department official said: ¡°There may be many patients waiting for the

therapy but we take all precautions to ensure that those in the more advanced

stages of the disease are not left waiting for too long for the therapy to

start. We cannot really do anything about the availability of the drugs because

the project itself is under the aegis of NACO, we just act as managers.¡±

As per the estimation of the 9th Annual Sentinel Surveillance conducted in 2006,

Delhi has 26,653 people living with HIV, many of whom are full blown AIDS cases.

Abantika.ghosh@...

Dr.Chinkholal Thangsing

e-mail: <chinkholal.thangsing@...>

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]

chinkholal.thangsing@...

www.aidshealth.org

[Guest guest]

Dear all,

Re: /message/7969

The report is factually incorrect as all patients registered at ART centres do

not need ART. There are clinical and laboratory parameters that determine

initiation of treatment.

The following rejoinder has been carried by THE TIMES OF INDIA , Delhi Edition

on 18th October 2007 on page 6

Whenever a person is found to be HIV positive, he is referred to an ART centre

where he is “registered " in Pre ART Care.

Following " registration " he undergoes different investigations including a

marker called CD4 cell count which determines whether person is to be started on

ART or not. If CD4 cell count (blood test) is less than 200 cells/cmm, only then

person is to be started on ART as per national & WHO treatment protocols. Those

with CD4 count more than 200 are kept on follow up and CD4 count is repeated

every 6 months to determine his requirement of ART. HIV infected persons with

CD4 count less 200 are treated as AIDS patients. Those with CD4 count more than

200 do not require ART though they are " registered " for ART.

Since launch of ART services in the 9 hospitals referred to in the report, of

the 5478 patients ever started on treatment with ARV only 448 have died, 406

have been transferred out to centres nearer to their residences and 705 patients

are actually lost to follow up.

Delhi has been given ARV drugs for 5,710 patients for year 2007-08. There are at

present 3,611 patients receiving ART. Hence there is no Drug scarcity as

reported. Nationally 2,80,000 patients are " registered " of whom 1,05,000

patients on ART. All patients who require ART as per treatment protocols are

getting it and there is no waiting for ART drugs.

I hope this clarifies the issue raised

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

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

National AIDS Control Organistion

New Delhi

Tel;23325343,23325335(O)

FAX : 011-23731746

e-mail: <drbbrewari@...>

[Guest guest]

Dear Forum,

Re: /message/7969

For the last 2 years DNP+ has been closely monitoring " drug supplies

interuption " in all the ART clinic in Delhi.

Our staff are on the move everyday at most of the ART clinic, giving adherence

support et al, but also always observing the drug supplies.

In the past 2 years we have document at least 5 incidence of supply

interuption of various drug/s in various ART Clinic.

For these reasons we have been at loggerhead with NACO on many occasion.

But i would like to say these report about people who are register doesn't mean

they need treatment. As many people who register are having a good CD4 count and

no clinical indication to start ARV. We also observed that some people whose CD4

count is more then 200 are

also on put on ARV as they are clinically indicated.

No doubt, NACO needs to urgently look into more efficient way to disburse ARV at

all the ART clinic in the country, to avoid this (periodic) drug supply

interuption.

I want to inform the Forum that Registering at ART Clinic doesn't mean you need

or you have to take ARV.

However, irrespective of their CD4 count, if we came across any persons who

needs ARV treatment it's our duty to refer them to ART clinic and ensure that

they get their treatment.

To the best of my knowledge people who needs 1st line ARV in Delhi gets it. If

you come across any people who needs treatment but don't get, let us know, we

will be happy to assist him/her.

Yes, drop out rate is very alarming and its a concern for us.

So far DNP+ tried to trace back approx. 40 people who drop out, but our success

rate is very low.

Out of 40 we follow up, we manage to put back only 3 people on Treatment. Most

of the people whom we follow up, when we visit at their given address many are

already death or wrong address or no further information or.?.

To trace back this drop out case, we had discuss with the treating Doctors and

DSACS, but not concrete strategy has come out so far.We simple got the list and

address of the drop out people, but this system is not so fruitful.

DNP+ would be happy to join hands with ART doctors and SACS to strategise to do

follow up of defaulter case.

For this, i believe the network should be involve from day one, verification of

their address and so on.

Otherwise we are given the address of a drop client to trace back after a year

or so, doesn't bear much fruits.

Further, i suggest that NACO must start a Treatment iteracy/education initiative

for the PLHA as well as Doctors, health care worker, drug supplier and other

stakeholder who are directly or indirectly

involved. Had the policy makers,the Doctors, the supplier, the PLHA, SACS knows

how important it is to achieved atleast 95% adherence, and had we all know the

consequence of non-adherence, i believe it will be

much better. Isn't it?

Loon Gangte

e-mail: <dnpplus@...>

[Guest guest]

Dear FORUM,

We read the reply from Dr. Rewari, with interest.

Re: /message/7981

I sat with Dr. Rewari and Mrs. Rao in her office for an over an hour during the

third week of November of 2006, and you are witness to the fact that she told

myself and Eugene Schiff that she was " hoping " for 2nd line medications in

January, but that, " at the latest, " this would occur in April, of 2007.

Yet, as of today, my understanding is that the public health care system in

India is still not providing 2nd line treatment.

Would you call this description above, " factually incorrect? "

I think it is highly unfortunate that the highest level of decision makers are

willing to make untrue statements that are perhaps designed to placate people in

the activist community.

Sincerely,

e-mail: <rastern@...>