Countdown is on: 32 months left to achieve 90:90:90 HIV targets

UP Health Minister Siddharth Nath Singh met a high level delegation of AIDS Society of India (national network of HIV medical experts) led by ASI President Dr Ishwar Gilada and Head of Microbiology Department of Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) Professor (Dr) Tapan N Dhole. "Master plan is needed to control HIV, hepatitis B and hepatitis C infections in UP" said Dr Ishwar Gilada, who is among the few doctors to begin HIV care when the first case got diagnosed in India in 1986.

"The recent incident of over 50 people becoming infected with HIV in Unnao district of UP has triggered shock-waves in medical circles and sent officials in the knee-jerk mode. Though initially it was publicized that infections were through a quack using contaminated syringes to administer injections, reality is far removed from this rumour. As elsewhere in the country, sexual mode of transmission is more likely here as well. HIV is known to garner larger public attention but there are more than 20 other Sexually Transmitted Infections (STIs) and an equal number of infections that get transmitted through unhygienic syringes/needles, some are even more transmissible than HIV. Hepatitis C Virus (HCV) is 10 times and Hepatitis B Virus (HBV) is 100 times more transmissible than HIV)" shared Dr Gilada.

"Though currently HIV infections are low in Uttar Pradesh but the recent data released by the National AIDS Control Organisation (NACO) reveals that new infection rates of HIV are highest in UP, Bihar, Rajasthan and Gujarat, whereas the erstwhile high HIV-prone states of Maharashtra, Karnataka and Tamil Nadu have taken a backseat" added Dr Ishwar Gilada.

Dr Gilada offered the UP Government that AIDS Society of India, with nation's collective HIV medical expertise, will provide its professional service without any charges.

32 months left to achieve 90:90:90 HIV targets: Where are we?

Dr Ishwar Gilada delivered a guest lecture as part of Continuing Medical Education (CME) session in SGPGIMS. Dr Ehtesham Uddin Siddiqui, senior surgeon; officials of UP State AIDS Control Society including Dr Preeti Pathak; communications expert Darvesh Singh Yadavendra; were among the key people who attended this session. The lecture was chaired by Professor (Dr) Tapan N Dhole, Head of Microbiology Department of SGPGIMS.

Dr Gilada said that the government of India has committed in its National Health Policy (NHP) to achieve the global target of 90:90:90, for HIV/AIDS by 2020— that is, 90% of all people living with HIV (PLHIV) will know their HIV status, 90% of all people diagnosed with HIV infection will receive sustained anti retroviral therapy (ART), and 90% of all people receiving ART will have viral load suppression (Source: 2.4.1.3. of National Health Policy 2017 of Government of India). These NHP-2017 goals are in line with UNAIDS commitments too. "Despite progress there is a very long way ahead of us, if we are to meet these goals in UP and across the country" said Dr Gilada.

Scientific evidence has shown that if every PLHIV is on ART with viral load suppression, the risk of HIV transmission is negligible, and the person can lead a normal healthy life. "India needs to be commended for scaling up to 600 ART centres across the country, where over one million people are receiving free ART. But we have very few Viral Load Testing (VLT) laboratories. If every PLHIV needs a viral load test twice a year, then we need to scale up VLT capacity to conduct over 4 million (40 lakh) tests every year. Currently we do a few thousand viral load tests only. With such a small capacity to do viral load testing, it is not known how many of the documented 10,05,000 people on ART are virally suppressed. How would India meet the goal of achieving viral load suppression for 90% of those PLHIV who are receiving ART by 2020 if business as usual continues?" asks Dr Ishwar Gilada.

“In India today, almost 80-90% of PLHIV on ART are being managed, not treated, at 600 ART centres of NACO, and the remaining PLHIV access private healthcare. Retaining PLHIV on ART at public sector ART centres is extremely crucial for managing HIV in India. Clinical studies tell us about efficacy of drugs in a controlled environment, but long-term effectiveness studies are important to corroborate clinical studies' findings” added Dr Ishwar Gilada. “We have really come a long way and contained HIV in a good manner. But we still need to find those who either do not know their HIV status, or despite knowing their status have not reached ART centres. They should be enrolled for ART. Drug management has to be streamlined."

As of 2016, 67% of PLHIV (21 lakhs) know their status; 1.4 million (14 lakh) are diagnosed with HIV and 10,05,000 PLHIV are on life-saving ART. So we have not yet reached out to 33% of PLHIV, and barely 50% of all PLHIV are on ART, despite WHO and NACO guidelines to 'test and treat all'. As of now, only 65% of PLHIV who know their status, are receiving ART. We cannot be complacent in our efforts, because failing to reach out to each PLHIV and not putting them on ART threatens to reverse the progress made in fighting AIDS" said Dr Gilada.

Current data, trends and experiences of HIV experts pose serious concerns on if we are on track to end AIDS by 2030. “Since India diagnosed its first case in 1986, we have enough scientific evidence to know what are the proven approaches for preventing HIV transmission and caring for PLHIV, so that they can live normal lives. But is this a reality on the ground?” questions Dr Ishwar Gilada who has been at the forefront of HIV response when the first case got diagnosed in the country. "We need unprecedented action to meet NHP-2017 goals" said Dr Gilada.

Shobha Shukla and Bobby Ramakant, CNS (Citizen News Service)
12 April 2018
The Pioneer, 13th April 2018

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