South-East Asia Regional Conference on Epidemiology

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<strong>South</strong>-<strong>East</strong> <strong>Asia</strong> <strong>Regional</strong> <strong>Conference</strong> on Epidemiology | 231
Fig. 6: Treatment status of all patients ever started on ART as on April 2009
Source: ART Centre Monthly Report, NACO
Total ever started as on April 2009: 328,848 patients
38,740 (11.8%)
20,440 (6.2%)
45,473 (13.8%)
Died
224,195 (68.2%)
1
Lost to follow up
Stopped/MIS/
Transferred out
On Treatment
Many countries have committed themselves to universal access to HIV prevention, care and
treatment by 2010. There are challenges to universal access in India. Universal access in a country
that has low prevalence of HIV is a challenge. Consider PPTCT: there are 27 million pregnancies
every year in India; about 70 000 of pregnant women are infected with HIV. The coverage of over 80%
pregnant women is what WHO considers as universal. Another challenge is the need to move to more
expensive second-line ART. Failing first line, patients need the second-line treatment, of which the
cost is going up. Two thirds of the budget is allocated for prevention and one third for treatment. How
is that going to be maintained when actually national budgets are not increasing? The main emphasis
from the public health point of view in an HIV programme should be to improve prevention rather
than having to treat. WHO has introduced new global guidelines which recommend earlier start and
more expensive and slightly more tolerable regimens. If these guidelines are going to be implemented,
more people will need to start the treatment early and will need to use more expensive drugs.
The HIV programme in India is relatively effective and is delivering impressive but hard-won gains
that include maintaining the slow but steady drop in HIV prevalence. This may lead to less spending
on prevention because it is working quite well. Complacency can be dangerous because although
the programme is doing quite well in covering people in the most-risk groups with services, it has
done very little in altering the structural drivers of the epidemic. If there is any significant cut-back in
prevention interventions now, there would be a major rebound in the number of cases. One needs to
advocate and make sure that this message is understood by policy-makers, health professionals and
the infected and affected communities.