In what ways has the implementation of Free Antiretroviral Therapy by the Indian government demonstrated success? Conversely, what are the persisting challenges in this context? (GS3)(12 MARKS)
Starting from providing free ART for Patients Living with HIV in 2004 and extending it to children in 2006, India has made substantial strides in ensuring that essential treatment reaches a larger population
The increase in ART centers from less than 10 to around 700 over two decades, along with Link ART centers serving millions, indicates significant infrastructural development to support the delivery of ART services across the country
Comprehensive Approach - free diagnostic facilities, focused attention on preventing transmission to children, and managing opportunistic infections like tuberculosis
Evolution of ART eligibility criteria: from CD4 <200 cells/mm3 (2004) to 'Treat All' approach in 2017 + The evolution of the 'Treat All' approach in 2017 demonstrates a willingness to adapt to evolving medical understanding and guidelines
The integration of free viral load testing, providing 2-3 months of medication, and adopting a rapid ART initiation policy underscores a patient-centric approach. These initiatives aim to improve treatment adherence, reduce burdensome clinic visits, and optimize healthcare resources efficiently
The introduction of newer and more potent drugs like Dolutegravir (DTG) reflects India's commitment to incorporating advancements in medical science into its treatment protocols. This move enhances treatment efficacy while minimizing adverse effects, ultimately benefiting PLHIV
The adoption of a rapid ART initiation policy in 2021, ensuring treatment initiation within seven days of diagnosis, underscores the importance of timely interventions. Such initiatives can significantly impact disease progression and overall health outcomes for PLHIV
As of 2023, HIV prevalence in India's 15-49 age group reduced to 0.20% with around 2.4 million estimated PLHIV, down from 10% two decades ago.
India's global share in PLHIV decreased to 6.3%.
82% of PLHIV knew their status, 72% were on ART, and 68% achieved viral suppression by 2023.
Annual new HIV infections in India declined by 48% (baseline 2010), higher than the global average of 31%.
Annual AIDS-related mortalities in India declined by 82% (baseline 2010), surpassing the global average of 47%.
India's comprehensive and evolving approach towards combating HIV/AIDS, focusing on accessibility, innovation, patient-centric care, and continuous improvement in treatment strategies has proved a success.
There are few challenges which include
Delayed Enrolment to ART Facilities: Significant challenge; patients with CD4 count <200 form a large portion of clinic visits, impacting treatment effectiveness.
Treatment Adherence: Patients often become non-adherent post-starting ART, leading to resistance; addressing 'loss to follow up' is crucial.
Supply Chain Management: Ensuring continuous ART supply across geographies, especially in remote areas, is essential for program success.
Private Sector Engagement: Need for increased involvement of private healthcare in PLHIV care to enhance service reach and quality.
Staff Training: Continuous capacity building for healthcare staff is vital due to evolving medical science, emphasizing practical training.
Integration with Other Programs: Strengthening collaboration with programs like hepatitis, diabetes, and mental health is essential for holistic PLHIV care.
Preventable Mortality: A focused strategy on reducing preventable deaths through systematic reviews and advanced diagnostics is necessary for improved outcomes.
