World Bank report examines India's approach to tackling AIDS
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《英国医生杂志》
Only 2% (12 000) of the estimated 555 000 AIDS patients in India are getting antiretroviral treatment, says a new report by the World Bank.
Moreover, the report says, more than half of the patients receiving antiretrovirals are not adhering to the regimen by the end of first year, mainly because of the high cost of the drugs and tests. Most of the treatment is in "unstructured" form—in other words, it is not conforming to the treatment guidelines issued by the World Health Organization.
In the absence of strict adherence to a three drug regimen, most people develop drug resistant strains of HIV, which can spread. In Mumbai, 18% of individuals infected with HIV had resistance to at least one antiretroviral drug. As the percentage of people with resistant strains grows, inexpensive generic antiretroviral drugs currently available will cease to be effective, the report warns.
Referring to the government抯 estimate that 3.8 million Indians were HIV positive in 2002, compared with the current UNAIDS figure of 5.1 million, the report says that 30 of the 36 variables used in estimating HIV numbers are untested assumptions. Tinkering with a few of these would push the prevalence estimate to 4.8 or even 6.5 million people, it says.
The study examines three policy options for providing antiretroviral drugs. The first is a minimalist approach in which the government strengthens private sector delivery of unstructured treatment and pays for physician training and laboratory tests while the patients pay for their own drugs. This would entail an expenditure of $100 (?5; �81) per patient each year.
The second option is an intermediate policy of providing treatment to mothers who have AIDS and to their spouses. The third option is a policy of providing subsidised structured treatment to the poorest 40% of all AIDS patients.
The expenditure on both these options would be nearly $500 a patient each year for drugs and clinic visits and an additional $100 a patient each year for laboratory tests. The total annual expenditure on providing treatment to mothers and spouses would cost $60m while providing treatment to the poorest 40% would cost the government $774m annually.
The current central health budget, however, is only $300m a year.
The World Bank抯 calculations have come under scathing criticism from health activists. "Why should there be just these three options at such inflated costs?" asks Dr Amit Sengupta, co-convenor of the People抯 Health Movement-India.
"Drug prices, including antiretrovirals, are still very high in India because there is no transparent system in place for centralised bulk procurement of drugs in the public sector," said Dr Sengupta, adding: "There is great resistance to it as ad hoc drug procurement is a major way of making money by corrupt bureaucrats and politicians."(New Delhi Sanjay Kumar)
Moreover, the report says, more than half of the patients receiving antiretrovirals are not adhering to the regimen by the end of first year, mainly because of the high cost of the drugs and tests. Most of the treatment is in "unstructured" form—in other words, it is not conforming to the treatment guidelines issued by the World Health Organization.
In the absence of strict adherence to a three drug regimen, most people develop drug resistant strains of HIV, which can spread. In Mumbai, 18% of individuals infected with HIV had resistance to at least one antiretroviral drug. As the percentage of people with resistant strains grows, inexpensive generic antiretroviral drugs currently available will cease to be effective, the report warns.
Referring to the government抯 estimate that 3.8 million Indians were HIV positive in 2002, compared with the current UNAIDS figure of 5.1 million, the report says that 30 of the 36 variables used in estimating HIV numbers are untested assumptions. Tinkering with a few of these would push the prevalence estimate to 4.8 or even 6.5 million people, it says.
The study examines three policy options for providing antiretroviral drugs. The first is a minimalist approach in which the government strengthens private sector delivery of unstructured treatment and pays for physician training and laboratory tests while the patients pay for their own drugs. This would entail an expenditure of $100 (?5; �81) per patient each year.
The second option is an intermediate policy of providing treatment to mothers who have AIDS and to their spouses. The third option is a policy of providing subsidised structured treatment to the poorest 40% of all AIDS patients.
The expenditure on both these options would be nearly $500 a patient each year for drugs and clinic visits and an additional $100 a patient each year for laboratory tests. The total annual expenditure on providing treatment to mothers and spouses would cost $60m while providing treatment to the poorest 40% would cost the government $774m annually.
The current central health budget, however, is only $300m a year.
The World Bank抯 calculations have come under scathing criticism from health activists. "Why should there be just these three options at such inflated costs?" asks Dr Amit Sengupta, co-convenor of the People抯 Health Movement-India.
"Drug prices, including antiretrovirals, are still very high in India because there is no transparent system in place for centralised bulk procurement of drugs in the public sector," said Dr Sengupta, adding: "There is great resistance to it as ad hoc drug procurement is a major way of making money by corrupt bureaucrats and politicians."(New Delhi Sanjay Kumar)