Objective="Providing free treatment to people living with HIV/AIDS."
Details for Reform Option "Anti-retroviral Therapy for HIV/AIDS patients, Manipur"
According to the WHO estimates, of the 40 million People Living with HIV/AIDS (PLHA) in the world, 95% are in developing countries and of the 6 million people currently in urgent need of anti-retroviral therapy (ART), less than 8% receive it.
Government of India (GOI) announced a policy commitment to provide free ART on 30th November 2003 with implementation starting from 1st April 2004, in the six high prevalence states - Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland. Later, the Government also added the low prevalence state of Delhi due to its ‘high vulnerability’. The GOI plans to provide free ART to 100,000 patients by the year 2007 and 180,000 patients by 2010. This policy development is in line with the declaration of the AIDS treatment gap as a global health emergency and the launch of the WHO/UNAIDS initiatives to provide 3 million people with ART by the end of 2005.
Anti-retroviral therapy is no cure to HIV/AIDS. But effective anti retroviral regimens inhibits the efficient replication of HIV virus. Lower frequency of opportunistic infections significantly reduces the cost of management of HIV/AIDS. This helps people lead more productive lives with perceptibly reduced stigma and discrimination. Success achieved in terms of ART delaying the onset of AIDS, has helped in transforming the common perception about HIV from being an immediate fatal disease to somewhat more manageable chronic illness.
The number of PLHA in Manipur is 23,086 (May 2006). The first ART Unit was launched in April, 2004 at RIMS hospital with a provision for 300 patients. Lots of problems were faced in dealing with PLWHA who demanded more Anti Retro-Viral (ARV) drugs for the needy AIDS patients who were in the waiting list. This was to some extents, relieved after the opening of the second ART Unit at J.N. Hospital on 1st December 2004 with a capacity of 200 patients especially for infected pregnant women their children and spouses. Subsequently, the third and the fourth ART Units were established at District hospital, UKhrul on 1st December 2005 and District Hospital Churachanpur on 15th March 2006. National AIDS Control Organization (NACO) has selected a Regional Paediatrics ART centre at JN Hospital out of the six centres in India as a referral centre for North East. One more ART centre is to be established before March 2007 at District Hospital, Thoubal with a target of 200 patients.
The main targeted sub-groups given priority for free ART are: (a) seropositive mothers who have participated in the Prevention of Parent-to-Child Transmission Programme (PPTCT); (b) seropositive children < 15 years; and (c) people with AIDS who seek treatment at the designated hospitals.
The centres are providing:
i) ARV drug therapy, follow up and strict maintenance of adherence to treatment to avoid ARV drug resistance.
ii) Pre ART cares for Opportunistic Infection (OI), to change the high-risk behaviour and preparation for ART by a team of ART centre.
iii) Strengthening of linkages and referral systems with other service providers.
Free paediatrics ARV drug formulation is available at ART centres of RIMS and JN Hospital. Paediatrics ARV initiative was launched on Children’s Day in 2006.
The cumulative numbers ever enrolled in the HIV care (till the end of October 2006) are: Males Females Children Total
1. ART RIMS 1,525 796 145 2,466
2. ART J.N. Hospital 1143 746 232 2,121
3. ART, Churachandpur 305 277 85 667
4. ART, Ukhrul 70 55 11 136
The cumulative number of patients who were lost to follow up was 108 at the end of October 2006 and 69 patients transferred out. 118 deaths were reported and the total number of patients alive and both on ART and DOTS treatment is 114. As on 31st October 2006 the number of patients with more than 95% adherence to ART is 2627 patients.
Approximately 4 months to start the 1st ART centre.
Comprehensive programme to combat HIV/AIDS: Access to treatment is now perceived as an important component to combat HIV/AIDS.
Prolongs the life of patients: By preventing opportunistic infections ART dramatically improves the quality of life and prolongs the life of AIDS patients.
Reduction in stigma and discrimination: As treatment options become available, it will help in reducing stigma and discrimination attached to HIV/AIDS.
Adherence to ART: Failure to comply with therapy results in the rapid recurrence of viral replications.
Limited coverage: The government’s programme makes a commitment to cover only a very small percentage of the suffering PLHA, and thus deliberately leaving out a vast number simply because the system cannot afford it.
Cost of ART drugs. The price of ART drugs have come down but not enough to be within the buying capacity of people infected with HIV. The need for subsidizing the rates of ART is strongly felt as the existing health care set ups have not been able to incorporate free ART for all the people living with HIV/AIDS.
* Legal agreement between partners.
Who needs to be consulted
Manipur State AIDS Control Society.
The programme is sustainable as there are funds available under MSACS, though the ART programme is not covering all the PLHA.
Chances of Replication
The programme is running in Delhi and other states like Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland.
Prabha Sati, Research Consultant, European Commission Technical Assistance, New Delhi and
Mr. S.Sahoo, Deputy Director, Field Survey Unit, CBHI, Bhuvneshwar, Orissa, March 2007.