HIV drug shortage is India’s challenge to ending AIDS

In June, the national PLHIV (People Living with HIV) network began seeing a severe shortage of certain antiretroviral (ARV) drugs at antiretroviral therapy (ART) centers. These included a pediatric formulation and dolutegravir, a cornerstone of HIV treatment.

In the heat of the summer, PLHIV has been peacefully protesting inside the National AIDS Control Organization (NACO) premises for the past 23 days.of Darna calls attention to the need for urgent procurement of ARVs and the unintended consequences of weak and ineffective supply chains.

virus suppression

People living with HIV need to be treated with a combination of drugs known as antiretroviral therapy to keep the virus under control, stay healthy, and prevent transmission of the virus to HIV-negative partners. Continuous antiretroviral therapy is very important to keep the virus under control.

However, if treatment delivery is inadequate or patchy, the virus can mutate into resistant forms. We have seen first-hand the development of resistance to regimens and increased susceptibility to life-threatening bacterial and fungal infections.

Governments such as the Indian government have made considerable progress in providing access to testing and antiretroviral therapy (ART) for people living with HIV. Although the number of AIDS-related deaths has declined since 2004, progress has stalled in recent years, highlighting the need to address health system challenges such as disrupted drug supply chains to end AIDS. has become

Disruptions in the supply chain of life-saving HIV drugs are nothing new. It is the failure of the pooled procurement mechanism that has caused widespread recurrent shortages over the past decade that have affected many states. The National AIDS Control Organization (NACO) under the Ministry of Health and Family Welfare is the key agency responsible for monitoring and coordinating the activities of the National AIDS Control Program (NACP), and the Central Medical Services Association is responsible for centralized bidding and management. I am in charge of Joint procurement of various HIV products, including antiretroviral drugs.

Tenders for joint procurement of life-saving antiretroviral drugs faced bureaucratic delays in 2014, 2017 and again in 2022.

lack of treatment

A few days ago, NACO claimed in a public communication that 95% of PLHIV are not facing shortages. But, by its own admission, the current shortage affects 5% of his 14.5 million. People living with HIV report that ART centers struggle to keep up with treatment.

PLHIV receives a minimum “monthly dose” from the ART center. These days, they have to travel multiple times a month to get their pills, and poor patients don’t have the resources to travel often, which has a chilling effect on adherence. Some patients have changed regimens because of the unavailability of certain ARVs and are concerned that these changes are based on World Health Organization guidelines and may compromise future treatment options. increase.

Some people with PLHIV have been asked to take multiple doses of the pediatric formulation instead of the adult formulation. As a result, the burden of the pill has increased, and I fear that in the near future children living with HIV will be unable to take medication. Also, if pediatric doses are not available, adult tablets may break or crush, resulting in uneven dosages or an unpleasant taste that children do not like, making it difficult for caregivers to take medication. compliance becomes difficult.

The peaceful Darna of the NACO office has drawn government attention to the timely bidding and procurement of HIV drugs, holding accountable the Central Medical Services Association, the Ministry of Health’s procurement agency responsible for bidding on ARVs, and saving lives. aims to ensure an uninterrupted supply of medicines that save process.

The shortage of health products in health program supply chains is not unique to India, but is commonly experienced in lower and middle income settings. However, India has IT-enabled community monitoring tools that are free to use.

action required

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

If ignored, the consequences affect right to health and promote drug resistance. This is a major public health challenge for the country.

( Loon Gangte is an HIV activist for the International Treatment Readiness Coalition. Leena Menghaney is a pharmaceutical, legal and policy attorney..)