New Delhi: The health ministry could be looking at a crisis situation as government-owned antiretroviral therapy (ART) centres in some states could soon run out of HIV medicine since no fresh stocks are coming in, according to activist groups.

These drugs, which include a combination of Tenofovir and Lamivudine for adults and a combination syrup of Lopinavir and Ritonavir for children, are critical for HIV patients. The dose for adults has to be taken every day or twice a day based on the patient’s condition. At present, the state-run centres are running on buffer stocks.

“Next month, over 200,000 people living with HIV on the Tenofovir-based first line regimen could face stock-outs of their medicine at the facility level which are ART centres. It’s time for the ministry of health to take emergency action. We have no time to wait," said Loon Gangte, regional coordinator, South Asia, International Treatment Preparedness Coalition (ITPC).

In India, treatment and control of HIV is handled by government-run public health programmes. For this, the National AIDS Control Organisation (Naco), a unit of the health ministry, procures antiretroviral drugs from companies through a tender process and supplies the drugs to healthcare providers across the country.

These centres could run out of stock as Naco has yet to appoint a pharmaceutical company for manufacturing these drugs, said an activist who did not want to be named.

“Naco tenders for antiretroviral drugs for the year 2014-15 were opened on 19 May. The last day of receiving bids was 20 June. The bid evaluation report on the procurement of first line HIV medicines for adults has been completed by the procurement agent, but the notification of award (NoA) to the company who has won the tender has not happened," the person cited above said.

Because of the delay, even if a pharmaceutical company that has won the tender is asked to supply 200,000 packs—a month’s supply—it will take time for it to start the process of bulk drug procurement and manufacture the drugs.

There is also an acute shortage of nevirapine syrup, which is given to newborn children born to HIV positive mothers and viral load kits used for testing patients for first line, second line or third line regimens in many states.

“It’s not just HIV medicines, viral load kits have not been available in Mumbai, Delhi and other centres for months", said Daxa Patel, general secretary of the National Coalition of People Living With HIV.

To address this, the Delhi Network of Positive People sent a legal notice to the health ministry on 22 August, asking for emergency procurement and supply of stock at government centres, strengthen drug forecasting and set up an emergency procurement system for all state governments. Mint has reviewed a copy of the legal notice.

According to Vikas Ahuja, president of the Delhi network, the ministry has yet to reply to the notice.

“I think there is a shortage of will to address these issues. There is no shortage on manpower or infrastructure," Ahuja said.

Calls and emails sent to the office of R.K. Jain, additional secretary, ministry of health, went unanswered.

According to activists, Naco urgently needs 6 million tablets of Tenofovir 300mg and Lamivudine 300mg to prevent a stock-out of the first-line regimens in the ART centres in the coming month.

This is not the first time that Naco has had a run in with HIV activist bodies. Last year, because the health ministry did not deploy a $187 million international grant offered by the Global Fund to Fight AIDS, Tuberculosis and Malaria to the National AIDS Control Programme, there were drug shortages that left 1 million HIV-positive Indians without medicines and testing kits for at least five months, Mint reported on 25 November.

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