[639] COMPREHENSIVE COST-EFFICIENT MODEL OF HIV CARE FROM INDIA MOST SUITABLE FOR RESOURCE-POOR SETTINGS

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] COMPREHENSIVE COST-EFFICIENT MODEL OF HIV CARE FROM INDIA MOST SUITABLE FOR RESOURCE-POOR SETTINGS

[AUTHOR(S):] I Gilada
Unison Medicare and Research Centre, Mumbai, India

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 639
Antiviral Therapy 2003; 8(Suppl. 1):S360

[ABSTRACT:] Purpose of the study: India can provide leadership to the resourcepoor settings with its assets to provide low-cost ARVs and patient-care skills. Our PLWHAs envy ART with frustration as costs on ART and follow-up tests is prohibitive due to rigid CDC criteria. ‘Hit Early, Hit Hard’ to start ART at <500 CD4 and >10,000 copies/ml viral load will make almost 80% eligible for ART and will bankrupt us. Study focused on modifying protocol for treatment, dosages, combinations and follow-up to increase affordability, adherence and survival.

Methods: Of the 4,100 PLWHA managed prospectively from 1995–2002, 23% were found eligible for ARV using local criteria, but only 570 could afford generic ART: 7% 2NRTI+1 PI; 93% 2NRTI+NNRTI, at 93% less cost than patented ARVs; others given supportive, symptomatic and OI treatment. CD4 count, clinical status, incidence of OI were studied, but VL was dispensed with. Follow-up interval was widened (av 3.7 months); dosages reduced by 25–50% in 80% patients commensurate to body weight.

Summary of results: There was no significant difference in weight, incidence of OI, survival and gain in CD4 count at three years. Access to ART was increased from 5% in 1998 to 14% in 2000 and 54% in 2002 among eligible PLWHAs.

Conclusions: Proper selection, modifying ARV, dose reduction, combo-ARVs and longer follow-up intervals improves access. PLWHAs need not be in despair, thanks to generics that survived onslaught of powerful pharma lobby. Despite low-cost ($30 pm), PI-free regime, results were similar. Generics proved to be the boon and even patented drugs became cheaper. Preferential pricing of ARV, reducing follow-up costs, simplifying patient care protocols may increase access.

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