Supreme Court directs Universal Access to Second Line ART in a phased manner

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Update: Sahara House

v. UOI W.P. © 535/1998 &

Sankalp

Rehabilitation Trust v. UOI W.P © 512/1999

Sankalp Rehabilitation

Trust had filed an application in the above petition in the Supreme Court

challenging the constitutionality of NACO’s criteria for second line ART

and seeking a direction that second line be made available to all those who need

it, irrespective of any other criteria.

Under

Indian law, commenting on the merits of a case which is pending before a court

amounts to contempt. The update below is a fair reporting of the proceedings

before the Supreme Court in this matter.

The Petitioner

argued that limiting access to 2nd line was violative of fundamental

right to life of PLHIV. Taking a serious view of the situation, the

Hon’ble Supreme Court made it clear to the government that access to

second line must be universalized. On 16th December, the following

statement, appended below, was endorsed as an order of the Hon’ble

Supreme Court.

As per

the order, second line ART will be provided to all PLHIV who need it, whether

they were in the private or public sector or on rational or irrational

treatment. In

the first phase (3 months), universal access to second line treatment would be

started at four Centres of Excellence (JJ Hospital in Mumbai, GHTM Tambaram,

Maulana Azad Medical College (MAMC), New Delhi and Calcutta School of Tropical Medicines,

Kolkata) with immediate effect. This pilot initiative would be studied over a

period of three months, after which it will be scaled up to more ART Centres.

Lawyers

Collective HIV/AIDS Unit will organize a meeting in January 2011 with PLHIV and

NACO to further explain the order and discuss the remaining issues in the ART

Rollout Programme.

Statement/Minutes

of Meeting for bringing about Universal Access to Second

line treatment

SAHARA

HOUSE vs. UNION OF INDIA,

WRIT

PETITION © No. 535 of 1998

SANKALP

REHABILITATION TRUST & ANR. V. UNION OF INDIA

WRIT

PETITION © No.512/1999

VOLUNTARY

HEALTH ASSOCIATION OF PUNJAB vs UNION OF INDIA

WRIT

PETITION No. (C ) No. 311/2003

COMMON

CAUSE Vs. UNION OF INDIA WRIT PETITION © No. 61/2003

One of

the issues that has arisen in the above-referenced Writ Petitions concerns the

criteria currently being employed by the National AIDS Control Organization

(NACO) for administering second line treatment to persons suffering from HIV /

AIDS. Specifically, the Petitioners have sought extension of second line

treatment to all persons in need of it - whether they underwent first line

treatment in government or private sector, and irrespective of whether they were

put on a rational regimen for first line treatment. The NACO has consistently

maintained that the ultimate goal is to have universal access to second line

treatment, but there were various capacity-related and other

constraints on doing so, and this was therefore sought to be achieved in a

phased manner. In proceedings before this Hon'ble Court, the parties undertook

to hold a review meeting to discuss the modalities for bringing about universal

access to second line treatment to all those in need of it. A meeting was held

on 13.12.10, where the following decisions were taken:

1. The

private practitioners are required to follow the ART guidelines out lined in

the OM no. T-11020/29/1998 (Admn.-ART) dated 9th September 2010 and

earlier OM no. T-11020/29/1998 (Admn.-ART) dated 26th August 2008

approved by Hon’ble Supreme Court of India in its order dated 1st

October 2008.

2 NACO

commits to making second line treatment available to all those in need of it -

whether they underwent first line treatment in the government sector or private

sector, and irrespective of whether they were put on rational / irrational

treatment regimen.

3. However,

there are some immediate constraints that need to be addressed, before second

line treatment can be universally available. The process for drug procurement

(through international competitive bidding) is likely to take at least six to

eight months, and some lead-up time is also required for strengthening viral

load capacity and trained personnel.

4. Further,

complete data on the number of persons who would seek second line treatment in

the government sector is presently unavailable. Without such data, it is

difficult for NACO to gauge the nature and extent of capacity addition that is

required to handle the additional inflow of persons in need of treatment

without compromising on quality of care.

5. Therefore,

it is proposed that in the first phase, universal access to second line

treatment would be started at four Centres of Excellence (JJ Hospital in Mumbai,

GHTM Tambaram, Maulana Azad Medical College(MAMC), New Delhi and Calcutta

School of Tropical Medicines, Kolkata) with immediate effect. This pilot

initiative would be studied over a period of three months, which would give an

indication of the numbers of additional persons seeking second line treatment,

thus enabling capacity addition to proceed in a planned and phased manner. A

Status Report would be presented to this Hon'ble Court after three months,

along with a plan for Phase II (where such treatment is likely to be made

universally available at some more Centres of Excellence).

6. By

way of clarification, it is submitted that persons from anywhere in

the country (in need of second line treatment) may be referred to these four

Centres of Excellence presently.

7. As

a matter of procedure, person in need of second line treatment will register at

the local ART centre. This could be a person who suspects treatment failure, or

a person already on second line treatment. The local ART centre will then refer

the person to the State AIDS Clinical Expert Panel (SACEP) in the Centre

of Excellence, as per existing operational guidelines and prior appointment

shall be given. The person shall then report to SACEP where further

viral load tests etc. will be conducted as required, and a decision would

be taken on whether there is genuine treatment failure necessitating second

line treatment.

8. The

precise progression of phases depends, in large part, on the number of

persons requiring treatment once access to such treatment is universalized

and patients are referred by the practitioners / information provided by

networks. NACO shall make its best efforts to ensure that such treatment

is universally available at the earliest.

In

Solidarity,

Shivangi

Rai

Legal Officer

Lawyers

Collective HIV/AIDS Unit