Bangalore: The nodal officer at the antiretroviral treatment (ART) centre at JN Hospital in Imphal, Manipur, pleads on the phone: “Can you take my message to the National AIDS Control Organisation (Naco)? They should cut down on bureaucracy; my patients are suffering,” says K. Priyokumar Singh, a physician who has been treating patients infected with the human immunodeficiency virus (HIV) for the past 20 years.
Since the last few months, he’s been seeking stocks of an AIDS drug, Tenofovir, that he wants to substitute for two more commonly prescribed drugs—AZT (Zidovudine) and Stavudine—which cause side effects such as peripheral neuropathy (a neurological disorder) and muscle atrophy (where a 25-year-old starts looking like a 60-year-old) in some patients.
Also See Fighting The Scourge (Graphics)
“Of the 3,078 patients that come to our centre every month, a substantial number cannot be given AZT or Stavudine; but I can’t give Tenofovir either. They have to be sent to the centre of excellence. The process is so cumbersome that my patients never get the drug,” he said. Incidentally, the World Health Organization on Monday issued a new guideline that requires phasing out of Stavudine as this drug, even though most widely used, causes serious side effects in long-term use.
Drug dispensation bottlenecks such as these are a blot on the otherwise looking-to-be-successful attempt by Naco in stalling the spread of HIV. “The ongoing mid-term review shows the programme (National AIDS Control Programme-Phase III, or NACP III) is on track (of infection reduction by 2012),” said a senior Naco official who didn’t want to be named “as the review is still in progress”.
“For the first time, we have done data triangulation (synthesizing data from three sources). The analysis is not yet complete, but broadly speaking, it appears that we might have to relook at the categorization of districts (high or low prevalence),” said the official. NACP III may be on track, but AIDS managers need to factor in the reality that the economic slowdown has led to the shrinking of global funds and most countries would have to make critical choices in financing.
Of the Rs11,585 crore budget for NACP III, the Indian government’s contribution is Rs2,861 crore; the rest comes from several international agencies. The biggest chunk of this, Rs2,683 crore, comes from the UK’s department for international development and the World Bank, and Rs2,237 crore has been committed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which, incidentally, is facing a corpus shortfall of around $3 billion (Rs13,950 crore today).