Multi-month prescription, home delivery for uninterrupted AIDS drugs in times of Covid-19

Within days of China locking down Wuhan and different cities in coronavirus illness (Covid-19) -hit Hubei province on January 23, and India confirming its first case in Kerala on January 30, officers from UNAIDS and National AIDS Control Organisation (NACO) went right into a huddle in New Delhi to make sure an uninterrupted provide of HIV companies, that are provided free to everybody who wants them underneath the nationwide Aids management programme.

Antiretroviral remedy (ART) given to folks dwelling with HIV (PLHIV) works in two essential methods — it slows illness development and helps PLHIVs lead productive lives, and reduces the viral load to decrease illness transmission and stop new an infection.

“When Covid-19 was first reported in India, we put our heads together with NACO, civil society and PLHIVs to plan for contingencies such as the Wuhan lockdown , to mitigate the impact on critical HIV services, including ART delivery and harm reduction,” mentioned Dr Bilali Camara, Unaids Country Director for India, who’s a medical epidemiologist by coaching. Unaids is the Joint United Nations Programme on HIV and AIDS.

By March, month-to-month dispensation of ART medicine was changed with a 3 to 6 months provide throughout states. “Instead of monthly, we began giving six months provisions to people so they didn’t have to come back to a facility and risk exposure to Covid-19, or spent money on transportation etc. This was introduced by state Aids control societies across India very quickly. With treatment saturation, we can achieve a lot in terms of keeping PLHIVs health and preventing new infection,” mentioned Dr Camara.

What additionally helped was the introduction of a brand new antiretroviral drug with fewer side-effects known as dolutegravir. “At the beginning of the pandemic, there was a very good policy change, when NACO introduced a much safer, less toxic drug on Unaids advice. That medication really helped people stay on treatment course, which will improve outcomes and lower their risk of developing drug resistance,” he mentioned.

There are 2.1 million folks dwelling with HIV in India, with new infections rising in Assam, Mizoram, Meghalaya and Uttarakhand, and declining in Nagaland, Manipur, Delhi and Chhattisgarh. Just eight states accounted for two-thirds of the estimated 87,580 annual new HIV infections in India in 2018.

In absolute numbers, India has the third highest variety of folks dwelling with HIV (PLHIV) on the earth after South Africa and Mozambique, however circumstances have hovered round 2.1 million for the previous decade regardless of folks dwelling longer with improved entry to testing and ART. Since 2010, India has diminished new an infection by 37%.

Delhi resident Saurabh, 41, who doesn’t need to share his second identify, is amongst those that benefited from the multi-month dispensation of ART medicine simply earlier than the lockdown. “I was surprised when I was given medicines for several months in March but within a week, the lockdown was announced, which meant I couldn’t step out. It was a big relief as I could continue treatment without a break,” mentioned Saurabh, who was recognized with HIV in 2012.

“India has accomplished reductions in new HIV infections, important reduction in AIDS-related deaths, and an increase in the number of pregnant women living with HIV on treatment, with a 66% ART coverage in 2018. This has resulted in 79% people knowing their status, and 82% of them being on treatment,” mentioned Camara. Testing and therapy is offered free within the public sector, and prices the federal government US$ 70-80 per affected person per yr.

The lockdown additionally invigorated the community-based dispensation medicine. “We have volunteers collect the ART drugs from the government and distribute them on motorbikes, bikes, carts, and on foot to ensure people get medicines at their doorsteps. I really have to thank all the networks of HIV and Aids in India, all of them have participated,” mentioned Dr Camara.

Opportunities to quick monitor the AIDS response embody specializing in excessive burden districts for the elimination of mother-to-child transmission of HIV primarily based on the final ANC survey knowledge which has proven a prevalence of 0.2%., and intensifying prevention programmes, together with focused interventions for key populations similar to feminine intercourse employees, (1.56% HIV prevalence), the jail populations with 2.04%, transgender (3.14%), and individuals who inject medicine (6.26%), based on NACO knowledge.

“Covid-19 has been a huge challenge but it has forced us to think differently. UNAIDS has worked with NACO and ministry of health to take oral substitution therapy to injecting drug users in prescribed doses for two to three months,” mentioned Camara. Since this once more was community- led, the oral substitution remedy utilizing buprenorphine (opioid) reached injecting drug customers at residence in addition to the homeless.

“The unexpected outcome was that more and more people moved from injecting drug use to oral drug use, which is preferred because HIV infections occur from injecting drug use. So we have an opportunity to reduce risk as injecting drug use is a serious problem is in the north eastern states, and some pockets in Punjab and Uttar Pradesh,” mentioned Dr Camara.

At least 82 nations criminalise some type of HIV transmission, publicity or non-disclosure, intercourse work is criminalised in at the very least 103 nations and at the very least 108 nations criminalize the consumption or possession of medication for private use, based on UNAIDS.

“There are instances drug users being put in jail, NACO data collected for the first time from jails for 2019 shows 2.04% prevalence rate which is 10 times more than the general population. Jailing drug users like criminals is not addressing the problem of drug use and Covid-19 has helped establish that overcrowded jails are not practical. Jails should be an instrument to educate and rehabilitate people,” he mentioned.

Working carefully with the neighborhood for HIV service supply and interesting them within the nationwide AIDS response is vital. “Community empowerment is essential to reduce stigma, deliver medicines and and tools for prevention, which has gone down. The increasing emphasis in treatment is needed, but not at the cost of prevention in vulnerable populations, who still account 62% of new infections in India,” mentioned JVR Prasada Rao, former well being secretary, and founder director of NACO, and particular envoy at Unaids.