Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

IndiaBy Abraham KK, Celina D’Costa, Bobby Jayanta,Murali Shunmugam, Dr. Venkatesan ChakrapaniIndian Network for People living with HIV (INP+)Stock-outs in ManipurStock-outs of ARVs have been reported by PLWHA activists from several differentregions of India. However, the reasons behind the stock-outs and the follow-upactions taken are relatively unique in Manipur, a state in northeast India where,unlike the rest of the country, the HIV/AIDS epidemic is predominantly affectinginjecting drug users (IDUs).There are government-run ART centers in just five of Manipur’s nine districts.PLWHA from the other four districts must travel six to eight hours to reach thenearest ART center. Even PLWHA living in a district that has a center face very longtravel times. The hilly landscape makes travel even more difficult for many PLWHA.IDUs living with HIV/AIDS usually also have liver complications, often due tohepatitis-B and -C co-infections, as well as due to alcohol-related liver damage.In such cases, the ARV nevirapine (NVP) cannot be used; doctors in Manipur andelsewhere often prescribe an efavirenz (EFV)-based ART regimen instead.In August 2007, acute shortages of efavirenz were reported in some ART centers inManipur. The shortages occurred because only about 20 percent of the expectednumber of first-line regimens were allocated as efavirenz-based. The crisis ledBobby Jayanta, the general secretary of Manipur Network of People living withHIV (MNP+), and some other activists to approach the National AIDS ControlOrganization (NACO) and the Manipur State AIDS Control Society (SACS) todemand action to fix the problem. Manipur SACS’s immediate short-term solutionwas to transfer efavirenz tablets from nearby ART centers to those experiencingefavirenz shortfalls. However, because of the shortage, PLWHA were only givenenough efavirenz to last for 10 or 15 days (instead of a month’s supply), a solutionthat necessitated traveling to ART centers twice or three times per month. Inaddition to the additional travel costs, many PLWHA had to bear accommodationcosts since long distances meant overnight stays became necessary.Thus, the short-term solution of transferring efavirenz from other ART centers inManipur or from those in the neighboring state of Assam was not convenient orhelpful for the affected PLWHA. Although no data have yet been obtained aboutthe impact of the efavirenz shortfall on treatment adherence, it is thought that some75