■ Prelims: Current events of national importance, HIV, AIDS, WHO, Antiretroviral Therapy (ART), AZT (zidovudine), HAART, PLHIV etc
■ Mains GS Paper I & II: Development and management of social sectors/services related to Health and education etc
ARTICLE HIGHLIGHTS
- On April 1, 2004, the Indian government had launched Free Antiretroviral Therapy (ART), for Persons living with HIV (PLHIV).
INSIGHTS ON THE ISSUE
Context
HIV/AIDS:
- HIV attacks CD4, a type of White Blood Cell (T cells)in the body’s immune system. T cells are those cells that move around the body detecting anomalies and infections in cells.
- After entering body, HIV multiplies itself and destroys CD4 cells, thus severely damaging the human immune system.
- Once this virus enters the body, it can never be removed.
- CD4 count of a person infected with HIV reduces
- In a healthy body, CD4 count is between 500- 1600, but in an infected body, it can go as low as 200.
- Weak immune system makes a person prone to opportunistic infections and cancer.
- It becomes difficult for a person infected with this virus to recover from even a minor injury or sickness.
Anti-retro vial Therapy(ART):
- It is a combination of daily medications that stop the virus from reproducing.
- The therapy helps in protecting CD4 cells, keeping the immune system strong enough to fight off the disease.
- It helps in stopping its progression to AIDS (a spectrum of conditions caused by infection due to HIV).
- The first antiretroviral drug, AZT (zidovudine), was approved by the US Food and Drug Administration (US FDA) in March 1987.
The evolution to ART:
● The UN General Assembly’s Millennium Summit(2000): It issued the declaration to stop and reverse the spread of HIV.
● The Global Fund to Fight AIDS, Tuberculosis and Malaria was created in 2002 which advocated universal access to HIV prevention, treatment, care and support services.
● In 2004, the number of PLHIV in India was estimated to be 5.1 million, with a population prevalence of 0.4%.
● The ‘cocktail therapy’ or HAART (highly active antiretroviral therapy), became available starting in 1996, but costs were prohibitively high.
- In 2006, the free ART was made available for children as well.
Impact of free ART:
- ART have expanded from less than 10 to around 700 ART centers —
- 1,264 Link ART centers are providing free ART drugs to approximately 8 million PLHIV on treatment.
- The prevalence of HIV in 15-49 years has come down to 20 (confidence interval 0.17%-0.25%)
- The burden of disease in terms of estimated PLHIV has been coming down to 4 million.
- India’s share in PLHIV globally had come down to 3% (from around 10% two decades ago).
- The annual new HIV infections in India have declined by 48% against the global average of 31% (the baseline year of 2010).
- The annual AIDS-related mortalities have declined by 82% against the global average of 47% (the baseline year of 2010).
- Dolutegravir (DTG), a new drug with superior virological efficacy and minimal adverse effects was introduced in 2020.
- In 2021, India adopted a policy of rapid ART initiation in which a person was started on ART within seven days of HIV diagnosis, and in some cases, even the same day.
Other initiatives which have contributed to halting the HIV epidemic:
- Provision of free diagnostic facilities
- Attention on prevention of parent to child transmission of HIV (PPTCT) services
- Prevention, diagnosis and management of opportunistic infections including management of co-infections such as tuberculosis (TB).
Treat All’ approach(2017):
- It ensures that ART is initiated, irrespective of CD4 count.
- It has contributed to reduced virus transmission, both at the individual and the community levels.
- It is supplemented by free of cost viral load testing for all PLHIV on treatment.
- The programme adopted a patient-centric approach by providing two to three months of medicines to stable PLHIV
- which minimizes the number of patient visits to the ART centers, reducing travel time and costs for the patients.
- It increases adherence to treatment besides decongesting ART centers by reducing the average daily OPD, giving health-care workers more time to attend to other patients.
Recent steps:
- The ongoing and fifth phase of India’s National AIDS Control programme: It aims to (by 2025) reduce the annual new HIV infections by 80%,
- reduce AIDS-related mortalities by 80%
- eliminate vertical transmission of HIV and syphilis.
- The National AIDS Control Programme (NACP) phase 5 calls for the attainment of ambitious targets of 95-95-95 by 2025
- 95% of all people living with HIV know their HIV status
- 95% of all people diagnosed with HIV infection receive sustained antiretroviral therapy (ART)
- 95% of all people receiving antiretroviral therapy achieve viral suppression by 2025.
Challenges:
- The delayed enrolment to the ART facilities: In India, patients presenting with CD4 count <200 to ART centers constitute almost a third of total foot fall.
- After starting on ART and continuing, the patient starts feeling well.
- Then they start missing doses and miss medicines for months or completely drop out.
- This results in the development of resistance as well.
- This ‘loss to follow up’ needs to be addressed.
What steps need to be taken?
- The sustained supply and availability of ART needs to be ensured by the national programme, in every geography of the country and more so for tough terrain, hilly and remote areas.
- There is a need to focus on the private sector engagement in care of PLHIV.
- There is a need for constant training and capacity building of staff as science keeps evolving and should be focused more on hands-on training.
- There is a need to focus on strengthening integration with other programmes such as hepatitis, non-communicable diseases (diabetes and hypertension) and mental health
- PLHIV are living normal but have other health conditions that need to be addressed.
- A focused approach needs to be adopted to reduce preventable mortality that includes systematic death reviews and availability of advanced diagnostics.
Reasons for success of free ART:
- Political will and constant support of successive governments
- sustained and sufficient funding, regular programme reviews and field-based monitoring, a series of complementary initiatives
- Community and stakeholder engagements and participation
- People-centric modifications in the service delivery
- Bridging the policy intentions to implementation gaps, and continuous expansion of services to cover more people living with HIV.
Way Forward
- The free ART initiative paved the path for bending the HIV/AIDS epidemic curve in India.
- The 20 years of free ART and subsequent steps under the NACP have the potential to guide other public health programmes in the country.
- The learnings can and should be used to launch a nationwide free hepatitis C treatment initiative in India and accelerate progress towards hepatitis C elimination.
QUESTION FOR PRACTICE
Besides being a moral imperative of the Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze.(UPSC 2021) (200 WORDS, 10 MARKS)
