Centre plans easier HIV care at patients' doorsteps, digital data management and patient tracing on the cards
The Union health ministry is working on a "person-centered approach" instead of a uniform plan for everyone. This major overhaul, incorporated in the "Operational Guidelines for Care and Support Centres" by the National AIDS Control Organisation (NACO), aims to eradicate AIDS as a public health threat by 2030.
According to the 'India HIV Estimation 2023' report, an estimated 2.54 million people were living with HIV in India. The report said that in 2023, approximately 35,870 people in India died due to causes related to AIDS.
To be sure, not everyone with HIV develops AIDS, and anti- retroviral or ARV drugs have made living with the disease as manageable as any other condition.
Furthermore, the government is looking to roll out new mobile applications such as the NACO-CSC app for tracking and monitoring HIV patients. This initiative aims to digitize data and improve efficiency.
A significant change in this new strategy is the widespread adoption of community-based link ART centres (LACs), which will enable HIV patients to pick up their vital antiretroviral (ARV) medicines at local care and support centres, rather than having to travel long distances to bigger hospitals.
This "decentralized approach" aims to make treatment much easier to access, especially for those facing travel difficulties, financial strain or other personal challenges.
Beyond easier ARV access, the government is also leveraging a major technological leap: digital record-keeping and patient tracking through a new "NACO-CSC mobile application".
This initiative will replace the older, time-consuming paper-based system, allowing for real-time updates and seamless coordination between HIV testing centres (ICTC), treatment centres (ARTCs), and the care and support centres (CSCs).
This digital shift is expected to save time, speed up patient care, and make the entire process more transparent and efficient. Importantly, patient confidentiality will be strictly maintained as per government data policies.
The new treatment guidelines prioritize crucial areas like the Elimination of Vertical Transmission of HIV & Syphilis (EVTHS). This is a vital step to prevent HIV and syphilis from being passed from mothers to their children during pregnancy, childbirth or breastfeeding.
This focus is particularly urgent given that an estimated 2,350 new pediatric HIV infections in India in 2023 were due to such vertical transmission. The aim is to ensure that 95% of pregnant and breastfeeding women living with HIV achieve a suppressed viral load, a key factor in preventing transmission to their babies.
'Care and Support Centres (CSCs) will play a crucial role in this by proactively following up with pregnant women living with HIV to ensure they adhere to their treatment, get regular viral load tests, and that their babies receive necessary preventive medicines and early diagnosis," said an official aware of the matter.
'CSCs will help bridge the gaps in linking newly diagnosed individuals to treatment, improve how well patients stick to their medicine plans, and track those who might interrupt treatment or have a high viral load. CSCs also play a critical role in connecting patients to various social welfare schemes and actively work to reduce the stigma and discrimination that people living with HIV often face," the official added.
Another focus of the new protocol is the comprehensive management of HIV-related co-morbidities and advanced HIV disease. This means addressing other health conditions that people living with HIV might develop, ensuring they receive holistic care.
Indian pharmaceutical companies, including Cipla, Aurobindo Pharma, Zydus Lifesciences and Lupin, are key manufacturers of ARV drugs essential for HIV treatment. The market for HIV drugs is substantial, estimated at $250.23 million in 2022, with projections to grow to $389.90 million by 2030.
Queries sent to the above mentioned companies remained unanswered.
Raman Gangakhedkar, distinguished professor, Symbiosis International University, Pune and former C.G. Pandit national chair at the Indian Council on Medical Research (ICMR),said that though the National AIDS Control Programme continues to be one of the most successful nationally and internationally, it faces the challenge of linking 95% of HIV infected Individuals to ART services and ensure lifelong treatment adherence for the 2030 elimination goal.
'Vast number of People Living with HIV (PLHIV) cannot be followed up for the treatment and get missed, migration, opt out for treatment from closest clinics and social stigma are some of the key challenges for linkage as well continuation of antiretroviral therapy that has ensured that one can live as long as others who are not infected. Tracking individuals detected to be infected from detection to maintenance of suppressed viral load is critical," Dr. Gangakhedkar said.
He said that to combat this, community involvement is paramount in the fight to eliminate HIV.
'The government now plans to establish more Care and Support Centres across the country in most of the districts and will not only track the person to ensure quality treatment against HIV disease but also monitor TB and other non-communicable diseases as a component of comprehensive care. The current guidelines cover objective parameters to be an agency to implement CSC related services, parameters used for rigorous monitoring and evaluation based on their performance. The HIV infected individuals will soon be able to get their medicines and refills directly from these local CSCs, eliminating the need to travel long distances to ART centres and when they are unable to travel due to sickness. The CSC will also counsel them comprehensively and also ensure measures related social stigma are handled well."
He said that some of the patients on ART may prefer private healthcare to begin with and also during treatment from ART Centres. In such circumstances, the government often lacks crucial data on whether they're actually receiving treatment.
'To address this, all newly diagnosed HIV-positive individuals will now be linked to an ART centre. Furthermore, a digital mobile application will be instrumental in tracing patients anywhere in the country. Our major goal is to monitor active HIV cases and their treatment in India," said Dr. Gangakhedkar.
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