On Monday, when Krithika*, a resident of Ambattur when to the Tambaram sanatorium to pick up her second-line anti-retroviral therapy (ART) drugs, she was only given enough for a few days, and asked to come back on Friday for more.
“I was told that they didn’t have any more drugs to give me,” said the 42-year-old. Her daughter, who also takes second-line ART drugs, said she too was given only enough for 10 days.
For the last few weeks, people living with HIV/AIDS and activists have been complaining about a shortage of second-line ART drugs at some centres in the State, leading to drugs being provided for only a few days instead of a month. They have even alleged that some patients, on whom the first-line drugs have failed, are not being started on second-line drugs due to the stock-out position.
A total of 88,168 patients are on ART drugs at the 52 centres in Tamil Nadu. Those who have failed first-line ART drugs are started on second-line drugs. Four nodal centres – in Chennai (Tambaram), Madurai, Tirunelveli and Salem — identify patients in need of second-line ART. The drugs are then given at the nodal centre or the patient’s own ART centre. In Tamabaram alone, 1,082 second-line cases have been identified.
“We have raised the issue of drug stock-outs repeatedly but it continues to be a problem. Many patients go to the centres travelling long distances, taking a day off work, to get their medication. Going there more than once a month is extremely difficult for them, especially for daily wage workers. This can lead to problems with drug adherence,” said Daisy David, an advocacy officer with World Vision India, an NGO.
It takes Jeyarani* an hour to travel from her home in Poonamallee to her centre at Government Kilpauk Hospital, where she was given her drugs for 15 days. “The last time I came, I was given only a week’s supply. I was told stocks have not yet come,” she said.
The problem is acute at centres where a lot of patients go such as Tambaram and Palani, said A. Paulraj, president, Dindigul Network of Positive People. “In fact, in Palani, some patients were sent away without drugs. We have held meetings with officials and informed them about the problem and they assured us it would be taken care of,” he said.
Tamil Nadu State AIDS Control Society officials however maintained that there was no problem now. “New stocks of the drugs have arrived on Tuesday and the allocation has already been done. In any case, if there is a problem at one centre, drugs are diverted there from centres that have excess,” an official said. The issue, another official explained, was that every month, there are new cases and the demand increases. This time, it was more than what was predicted.
Drug supply problems have plagued the ART programme in several States across the country for over a year now, leading health experts to worry about the effect this will have on patients.
*Names of patients have been changed
In 1986, the first HIV positive case was detected in Tamil Nadu. In 1993, the State AIDS Cell was formed, which in 1994, became TANSACS
Tamil Nadu has 52 ART centres. Of these, 21 are in medical college Institutions, 27 in government hospitals and 1 in a private institution. There are also 105 link ART centres which function as drug dispensing units.
On November 30, 2003, the government of India announced a plan to provide ART through public hospitals in the country from April 1, 2004.
Second-line ART was launched in Tamil Nadu in January 2008 at the Government Hospital for Thoracic Medicine in Tambaram. Subsequently three other centres in Salem, Madurai and Tirunelveli too provided the treatment.
At present, according to a TANSACS official, while patients are admitted and assessed at these four centres by an expert team to decide whether they need second-line ART, the drugs can be picked up by the patients at any one of the ART centres.
A total of 88,168 patients are on ART drugs at 52 centres in Tamil Nadu. Those who have failed first-line ART drugs are started on second-line drugs. In Tamabaram alone, 1,082 second-line cases have been identified.
According to the National AIDS Control Organisation’s March 2014 fact sheet for Tamil Nadu:
The number of people living with HIV/AIDS is estimated to be 1,32,590. Of these, males form 91,705 and females 40,885 |
The adult HIV prevalence is estimated to be 0.28 per cent. Males form 0.39 per cent and females 0.18 per cent |
The number of children living with HIV/AIDS is estimated to be 6,504 |
Sources: NACO, TANSACS websites
According to the National AIDS Control Organisation’s March 2014 fact sheet for Tamil Nadu:
Adult HIV prevalence is estimated to be 0.28 per cent.
Prevalence in females: | 0.18 per cent |
Prevalence in males: | 0.39 per cent |
Number of people living with HIV/AIDS: | 1,32,590. |
Males: | 91,705 |
females: | 40,885 |
Number of children living with HIV/AIDS: | 6,504 |
Extensive Network
1986: First HIV positive case was detected in Tamil Nadu.
1993: State AIDS Cell was formed, which in 1994, became TANSACS
November 2003: Government of India announces a plan to provide ART through public hospitals in the country from April 1, 2004.
January 2008: Second-line ART was launched in Tamil Nadu at the Government Hospital for Thoracic Medicine in Tambaram. Subsequently, three other centres in Salem, Madurai and Tirunelveli too provided the treatment.
No. of ART centres in Tamil Nadu: 52
No. of centres in medical college institutions: 21
No. of centres in government hospitals: 27 in government hospitals
No. of centres in a private institution: 1
Link ART centres which function as drug dispensing units: 105.
No. of patients on ART drugs at 52 centres: 88,168 patients
Those who have failed first-line ART drugs are started on second-line drugs.
Patients are admitted and assessed at the four Second-Line ART centres by an expert team to decide whether they need the treatment. The drugs can be picked up by the patients at any one of the ART centres
In Tamabaram alone, 1,082 second-line cases have been identified.
Sources: NACO, TANSACS websites
