Shortage of HIV drugs is a challenge to end AIDS in India

Some people living with HIV have had their diets changed due to the unavailability of some ARVs

Some people living with HIV have had their diets changed due to the unavailability of some ARVs

In June, networks of PLHIV (people living with HIV) across the country began to see a severe shortage of certain antiretroviral (ARV) drugs in antiretroviral therapy (ART) centres. Among them were pediatric formulations and dolutegravir, the backbone of HIV treatment.

In the summer heat, PLHIV have been demonstrating peacefully for 23 continuous days at the premises of the National AIDS Control Organization (NACO). The dharna draws attention to the need for an emergency supply of ARVs and the unintended consequences of a weak and inefficient supply chain.

Virus removal

People living with HIV need access to treatment with a combination of drugs known as antiretroviral therapy to suppress the virus, maintain their health, and prevent transmission of the virus to an HIV-negative partner. It is crucial to continue taking antiretroviral treatment to keep the virus suppressed.

But the virus can mutate into a resistant form if treatment delivery is poor or uneven. As treatment activists, we have seen firsthand that when antiretroviral therapy is stopped, people living with HIV develop resistance to their treatment and become vulnerable to life-threatening bacterial and fungal infections – the leading causes of hospitalization. and AIDS-related deaths in the community.

Governments such as the Government of India have made considerable progress in providing access to testing and antiretroviral therapy (ART) for people living with HIV. Although there has been a reduction in AIDS-related deaths since 2004, progress has stalled in recent years, underscoring the need to address health system challenges such as drug supply chain disruptions to put end to AIDS.

Disruptions in the supply chain of life-saving HIV drugs are not new. What is causing these widespread and recurring shortages over the past decade affecting many states is the failure of the pooled purchasing mechanism. The National AIDS Control Organization (NACO), under the Ministry of Health and Family Welfare, is the nodal body responsible for overseeing and coordinating the activities of the National AIDS Control Program (NACP). ) with the Central Medical Services Society, which is responsible for centralized tendering and pooled procurement of different HIV products, including antiretroviral drugs.

The tender for the joint purchase of life-saving antiretroviral drugs faced bureaucratic delays in 2014, 2017 and again in 2022.

Lack of treatment

A few days ago, NACO, in its public communication, affirmed that 95% of PLHIV had not faced shortages. But by his own admission, the current shortages affect 5% of the 14.5 lakh people. People living with HIV report that ART centers struggle to keep them on treatment.

PLHIV receive a minimum of “one month dose” from ART centres. Recently, they have had to make many trips in a month to get their pills, which has had a chilling effect on adherence as poorer patients lack the resources to travel frequently. Some have had their regimen changed due to the unavailability of certain ARVs and worry if these changes are based on World Health Organization guidelines and compromise their future treatment options.

Some people with HIV have been asked to take multiple doses of pediatric formulations instead of adult formulations. As a result, the pill burden increases and they fear that a child living with HIV will be deprived of their doses in the near future. And when pediatric doses aren’t available, adult pills get broken or crushed, resulting in uneven dosing and an unpleasant taste that kids don’t like to take, making compliance difficult for caregivers.

The NACO office’s peaceful dharna seeks to draw the government’s attention to the timely tendering and procurement of HIV drugs and to hold the procurement agency of the Ministry of Health accountable. health, the Central Medical Services Society, responsible for tendering ARVs to ensure an uninterrupted supply of lifesaving drugs. treatment.

Shortages of health products in the health program supply chain are not India’s only problem and are common in low- and middle-income countries. However, India has community-based and computerized surveillance tools.

Actions needed

What is urgently needed is the political will of the Ministry of Health to take the necessary steps to ensure that drug shortages, as have happened over the past decade, are not not felt by its programs, such as HIV and TB, in the future.

If ignored, the consequences impact the right to health and promote drug resistance, a significant public health challenge for the country.

( Loon Gangte is an HIV activist with the International Treatment Preparedness Coalition. Leena Menghaney is a lawyer who works on drugs, law and policy.)

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