Three months after the second line of drugs for HIV-positive patients was successfully rolled out in JJ Hospital, it is now being extended to the three Brihanmumbai Municipal Corporation hospitals that have Anti-Retroviral Treatment (ART) clinics.
From now on, HIV-positive persons registered with the King Edward Memorial Hospital, Parel; the B Y L Nair Hospital, Mumbai Central and the Lokmanya Tilak Municipal General Hospital, Sion who require the second line of drugs will be referred to JJ Hospital.
A decision to this effect was taken by the National AIDS Control Organisation recently, kickstarting Phase Two of the drug rollout.
Chennai’s Government Hospital for Thoracic Medicine in Tambaram, which also launched the second line of drugs earlier this year, will similarly be linked with four local ART centres.
A team of NACO officials currently visiting Mumbai is reviewing the work at JJ Hospital as well as finalising details at the three civic hospitals for the expansion programme.
Patients referred from these hospitals will be evaluated by the State AIDS Clinical Expert Panel (SACEP) — the special panel of experts constituted by NACO – before being put on the second regime. A nodal officer from the BMC hospitals will also be on the SACEP.
Candidates are patients whose CD4 count falls below the base line after a high or persistently remains less than 100. Those who develop opportunistic infections and whose viral load count is 1,000 copies/ ml are also eligible. “Patients from the three other centres which are offering ART will be referred to the JJ Hospital. Here, the SACEP will evaluate them and after a viral load test along with their CD4 count, they will be given the second line of drugs,” said Dr B B Rewari, National Programme Officer (ART), NACO, who is in Mumbai with his team.
These patients will continue getting treatment from JJ Hospital for six months, after which they will be followed up at the BMC hospitals.
In Phase Three of the drug rollout, the drugs will be available at all 27 ART centers in the state. Currently, the Clinton Foundation is providing the drugs, which cost Rs 8,000 per month per patient – a sum that can cover the yearly cost of the first line of drugs. NACO estimates that close to 3,000 persons on ART treatment have developed resistance and need to be moved to the second line.
“There has to be a feedback system established, a two-way mechanism. The state-wide expansion in the third phase will begin only after the linkages and referral mechanisms have been established,” said Rewari.
In Mumbai, the team of NACO officials on Friday interacted with 20 of the 24 patients who have been put on the second line of drugs at JJ Hospital. Four teams, including a counselor, are paying home visits to patients and interacting with their family members. Patients are administered a structured questionnaire that gauges the adherence level, the knowledge about the second line of drugs and the reasons for leaving medication in case they do.
Three patients on the second line of drugs have been hospitalised, while one person died. Among the rest, eight to nine patients who had a low CD4 count but showed no viral load, have been put on the first line of drugs.
“We are following the guidelines for selection, the operation is stringent. Some people may have complained, but we cannot override the rules. At this moment, we have medicines stocked to give to 300 patients at JJ. We have to be careful as there is no third line,” said Dr Rewari.
swatee.kher@expressindia.com