Time-lags in HIV medicine deliverance can lead to Drug-resistance

 

 

In case of a drug shortage or treatment interruption-people living with HIV may develop drug resistance that is difficult to treat

 

 

 

 

 

 

 

 

Kadhar has had been on antiretroviral medication for twenty years. The past few months have been difficult for him. The 48-year-old resident of Pallavaram, Chennai has been living with HIV or the human immunodeficiency virus (HIV), for which there is no cure or vaccine.

 

 

 

Kadhar, is one of like most HIV patients i.e 1.25 lakh of HIV positive people in Tamil Nadu- and depends on ART medication regimens to manage the viral load in the blood. ART (Antiretroviral therapy) is a lifelong treatment that people living with HIV follow to manage the progression of any infection leading to immunodeficiency syndrome (AIDS).

 

 

 

 Kadhar collects his daily medication from the ART (antiretroviral therapy) center at Government Kilpauk Medical Hospital in Tambaram which is 20 mins away from his home. The center provides him with his routine checkup and daily medication.

 

 

 Kadhar had been ill with a high fever and was further directed to the Sembium Corporation Dispensary (ICTC) which is closer to his home- to collect his daily medication. Chennai has a systematic chain of ICTC centers to deliver medicines and tracks opportunistic infections in HIV patients.  Kadhar questions the working of this system “This is confusing to me, I didn't know that there was a facility near my home where I can collect medicines, only when my health got worse they send me here, and I had to travel to the ART center all these years” he said.

 

 

He opens up about the issues he faces in the medical system, “There was a time when I did not get my three months medicine dispensation, they say one-month dispensation is enough as I will have to come for the routine medication anyhow”. As advised by his doctor, Kadhar’s conditions are stable and he has to report monthly. “I do my part correctly and yet if I am pulled down to a situation to travel long for medicines; it affects my livelihood interrupting my life. I live alone,” he added, while also talking about the stigma he faces.

 

 

There were reports of a limited stock of antiretroviral drugs in the state that concerns the possibility of drug resistance in patients like Kadhar. The Tamil Nadu state AIDS control society (TANSACS) confirms that limited stock of drugs is dealt with pre-fixed procurement system.  “The state and its functionaries have the authority to procure medicines if the stock is limited, as a last resort we have maintained a list of suppliers to get medicines from,” said TANSACS director, Dr.Babi.

 

 

Full adherence to the HIV treatment regimens is advised by the UNAIDS (Joint united nations program on AIDS/HIV) as treatment interruptions can cause resistance to drugs- which means fewer options for treatment. TANSACS, therefore, keep a track of all opportunistic infections that can indicate any symptoms of drug resistance. CD4(to check the health of your immune system) testing and culture testing are the diagnostics followed to track this. “We keep track of immunological failures, as we have departments assigned to track drug response, this is done on a routine basis,” said Dr. Janakiravan TANSACS.

 

 

TANSACS work as per the guidelines from the national AIDS control organization (NACO) to ensure the functioning of diagnostics and deliverance of ART. Antiretroviral therapy for people living with HIV is delivered through a single-window system followed by district prevention and control units (DAPCO) and ART centers in all districts and zones.

 

 

 A fully functioning 55 ART centers are available in the state. Dr. Babi at TANSACS explains, “we take instructions from the apex body- NACO, we have a chain of systems from UNAIDS to the ICTC(Integrated counseling and testing center- MAMBIKAI MAIYAM in Tamil) which ensures services to diagnostics and lifelong treatment”.

 

 

TANSACS works as a medicine-delivering agency also that functions according to the NACO’s treatment protocols, so in case of a drug shortage, NACO is in charge of the procurement. The national functionaries work as per the UNAIDS guidelines, and NACO’s team of experts decides the regimen, and district functionaries follow that. However, the provisions available still do not reach everyone. For patients like Kadhar, limited stock of medicines, and travelling far for daily medicines are difficult to manage amidst the illness.

 

 

Comments:

 

This is a fairly good story, but it needs to be reported better.

 

First of all, you can’t build your entire story on just one person. You should have spoken to more patients. Even that one person, you haven’t used the info well. He’s mentioned adverse impact on livelihood, but story doesn’t say how. Also, 20 minutes travel is really not a problem unless someone has a health condition, or a disability or something. So that actually makes him (and therefore you) look silly.

 

Second you missed a crucial part of the story. You mention drug resistance, but you didn’t explore it even when there was an opportunity to do so in that conversation with Janakiravan.. This angle could have been explored more, and you could have also asked for or looked for research on HIV/AIDs drug resistance in india and globally.

 

And there are just three people quoted here, two of whom are officials. For some of the things that they said, no quotes are required. Quotes should ideally be for things that someone says memorably, or if you’re quoting a govt official’s response to an issue etc. That part about taking instructions from NACO… that need not have been a quote.

 

The story ended up being more about the infrastructural set up than about the lives of people who live with HIV.