The Parliamentary Standing Committee on Health and Family Welfare has asked the National AIDS Control Organisation (NACO) to immediately reform the pharmaceutical supply management system for HIV medicines, in the wake of wide-spread stock-outs of medicines for the patients across the country in the recent past.

The committee also took objection to the claim by the Department of AIDS Control that the performance of the procurement agency – Rail India Technical and Economic Services (RITES)—was satisfactory after one year of service.

“The Committee notes that stock outs of ART medicines were reposted throughout 2011 in many States including UP, Bihar, Maharashtra, Manipur etc. The Committee fails to understand that how performance of RITES has been called satisfactory in such circumstances. The Committee recommends that the Department take a more serious note of such lapses and have closer monitoring mechanism in place since such gaps in supply only add to drug resistance apart from the obvious inconvenience,” a recent report of the panel said.

The Committee has noted that throughout 2011, there were regular interruptions of stock outs of HIV drugs (first, second and paediatric doses) in different States and the instances were reported by different PLHIV networks. “The Committee feels that this is serious issue since, stock outs mean drug interruptions which can lead to increased public health risks of HIV drug resistance. The Committee recommends that an investigation and report be undertaken to list the numbers of stock outs and to document the reasons for the stock outs. NACO should also outline to this Committee what measures have been planned to prevent and to deal with incidents of stock outs,” the panel said.

The role of the PLHIV Networks should be to continue this good work of monitoring HIV treatment at ART centres and reporting problems like stock outs to NACO. PLHIV networks should be further encouraged to continue reporting such incidents. Stock outs are related to inefficiencies such as poor planning, incorrect projections of local requirements, poor distribution and supply at treatment facilities, expiry of medicines as the stock that was received earlier is not distributed first, according to the panel.

The Department said as in January, 2012, there were 14.86 lakhs people living with HIV/AIDS (PLHIV) who are registered in the anti-retroviral treatment (ART) centres across the country. Out of them 4,86,173 could be  found and given free ART. 4208 AIDS cases are provided second line ART on account of complicated and drug resistant cases.  The provision of second line ART for such patients with treatment failure was started in the year 2008 and is  presently provided at 10 Centres of Excellence and 20 ART Plus centres across the country.

“The Committee feels that the slow rate of scale up of ART treatment over the last decade has forced patients into the private sector where inappropriate HIV drug regimens are often prescribed, leading to a long term public health problem of drug resistance. Many economic and bureaucratic barriers have been noted in the eligibility criteria for enrolling in the programme for those needing alternative first line or second line HIV drugs. As a result, patient groups have had to approach the Supreme Court,” it said.

“These barriers must be addressed and must not be created for patients who will need third line HIV medicines. Currently the proportion of HIV patients who have failed to the second-line treatment is probably very small. The programme must start planning for ART Centres of Excellence to take in these few patients. This will control drug resistance. Cost alone should not the only criteria. Failure to procure the third line drugs will have future public health complications as PLHIVs could develop a very resistance HIV which could prove costly. Planning and treating third line in a few patients will build capacity and experience of public health facilities classified as centres of excellence by Department of AIDS Control,” the report said.