While HIV programmes have focussed on sustaining patients on anti-retroviral therapy to combat the AIDS epidemic, data from Maharashtra State AIDS Control Society (MSACS), ahead of World AIDS Day (Dec 1)m indicates that more than 18,000 have been lost to follow-ups. Of the estimated 4 lakh HIV patients in Maharashtra, about half (2.36 lakh) are on anti-retroviral therapy while 18,321 persons are lost to the follow-up.
What is of concern is that the number of patients on second-line ART has doubled in the last five years. From 10,106 persons with HIV who were on the second line of treatment against the disease in 2018, the number has gone up to 21,920 this year.
Once detected with HIV, a person undergoes six months of treatment following which the first test is conducted to test the viral load, as the test indicates whether the patient is taking medication properly or not. MSACS officials said that rigorous counselling is done to ensure adherence to medication. After other tests, and on the basis of clinical parameters, the treatment regimen is then changed. “However this data implies the possibility of the patient not adhering to treatment, which is a concern,” an official said.
Meanwhile, there are several reasons why patients are no longer seen in HIV treatment programmes. It could be transfer to other facilities, death, migratory population and withdrawal of care and so on. However, tracking patients every month is MSACS’s ambitious programme ‘Vihaan’ where at the district level, 40 care support centres (CSC)in Maharashtra have been selected to provide care and support services to persons living with HIV.
“If the patient does not report to the ART centre for three consecutive months then the Vihaan outreach team visits patients at their homes. At times the doors are locked, but still our team makes repeated checks every month,” an official with MSACS told The Indian Express. The Vihaan team conducts counselling sessions at CSC apart from periodic meetings with various groups and even setting up discrimination response teams. While there are 78 ART centres which provide free-of-cost medication, to ensure increased adherence to ART and minimise time and cost of travel, there are at least 177 Link ART centres across 34 districts.
PrEP regimen
Dr Vinay Kulkarni, Coordinator and Medical Director of Prayas (Health Group), Punewho has been practicing HIV medicine since 1989, said that although newer medicines have effectively converted a once invariably fatal disease into a chronic, manageable medical disorder, prevention remains an important agenda.
Among these attempts to prevent HIV, one such paradigm shift has been to scale up pre-exposure prophylaxis (PrEP)- to reduce HIV transmission. Medications are quite effective for people at higher risk of acquiring HIV, such as those who are injection drug users, who have multiple sexual partners, men who have sex with men (MSM), transgender communities, and people who have partners who are HIV-infected (serodiscordant couples).
One needs to remember that PREP is only protective against HIV and not other sexually transmitted infections. People who are at high risk of HIV should continue taking precautions against other sexually transmitted infections. These novel prevention strategies like PrEP can help to control the HIV epidemic in India,” Dr Kulkarni said.
Progress not fast enough
We are progressing but not fast enough, to end AIDS by 2030. An array of ‘missed opportunities’ is plaguing the AIDS response globally,” Dr Ishwar Gilada, President Emeritus, AIDS Society of India, who had started India’s first AIDS awareness campaign in 1985 and first AIDS clinic in 1986.
“There are new targets—Zero New Infections, Zero Deaths and Zero Discrimination against PLHIV by 2030; all persons living with HIV must have access to HIV testing and treatment; laws and policies should help end stigma and discrimination faced by people living with HIV,; and by key and marginalised populations. However we are a little far from achieving the targets,” Dr Gilada observed. “We know how to prevent HIV, diagnose HIV, treat and support PLHIV. But the gap between where we are and where we need to be is a chasm we can’t afford to have anymore. Bridge the gap to end AIDS,” he added.
