Shortage of antiretroviral (ARV) therapy drugs for HIV patients is looming large over the State as there seems to be no immediate resolution of the national-level supply shortage of ARV drugs, the impact of which is beginning to be felt across many States.
While Kerala has been lucky enough to ensure that there never has been a total stock-out of ARV drugs so far, it is now walking the tightrope as the current stocks are barely enough to last a month.
India offers free antiretroviral therapy (ART) for people living with HIV/AIDS and the mainstay drugs of all ART regimens are procured centrally by National AIDS Control Organisation (NACO) for all States.
‘Very expensive drugs’
The possibility of supply shortage of ARV drugs was being hinted at since February. “We anticipated that there could be problems in supply down the line, which was confirmed when NACO announced that States may be allowed to make local purchases. We started procurement through Kerala Medical Services Corporation Ltd. in March-April. However, ARV drugs are very expensive and we did not have the funds to procure for more than three months,” says Yamini Thankachy, Deputy Director ( Care, Support and Treatment), Kerala State AIDS Control Society (KSACS).
The first lot of drugs procured in April is now nearly over. With NACO remaining non-committal about when the regular drug supply might be restored, the KSACS has approached KMSCL for procurement of ARV drugs again. However, an already beleaguered KMSCL seems to be struggling to meet the requirement of KSACS.
15,500 persons being treated
Close to 15,500 persons living with HIV are currently on various ART regimens in the State. In 2020, following the recommendation of WHO, NACO had made the transition from TLE regimen (a fixed combination of Tenofovir, Lamivudine and Efavirenz) to the TLD regimen (a combination with a new drug Dolutegravir, in place of Efavirenz) as the first line ART regimen.
About 85% of the HIV patients in Kerala have been moved to the new TLD regimen and it is these mainstay ART drugs which have now fallen short. This has forced KSACS now to tweak drug regimens so that some patients are asked to continue on the old regimen, while some others are put on substitution drugs.
Adherence to drug therapy is crucial for HIV patients and this juggling around with alternatives could lead to some confusion and patients not following instructions correctly.
“Earlier, ART centres in districts could give drugs for 2-3 months together. We can no longer do that as we have to stretch our supply. So now drugs are being given only for 15 days or a month. This has put patients to difficulty as they will have to make more trips to the ART centres to get their medicine,” Dr. Thankachi points out. It is possible that a patient might choose to skip a drug than make multiple trips.
“Drugs are being relocated in between various ART centres now to meet patient demand. At times, the patient might be required to buy the drug from outside, to be reimbursed later. But many, who do not have the money, will stop taking the drug. We fear that drug adherence could go down during the current stalemate,” says Joseph Mathew, president of Council of People living with HIV in Kerala.
NACO might be able to relocate drugs from States which have excess medicines to Kerala even as it waits for KMSCL to procure ART drugs, it is hoped.