Cost of lab tests before starting ART roll out in Govt set up

[Guest guest]

Dear FORUM,

Sub: Cost of tests before starting ART roll out in Govt set up

Greetings from Assam Network of Positive People (ANP+)

We all are working in the filled of HIV. In this field we meet many

HIV positive people who are not able to spend Rs 50 in a day. Being as a

Network of PLWHA,in our office many people come for seeking help before they

stat ART as they have to do many tests, where they need lot of money for such

tests.

But we do not have such kind of money to support all. Please advise what we

should do.

Should we let them die with out any treatment or what?

Because in the ART roll out program the Drs will not start

treatment if the person not capable of doing this investment for the required

tests.

In this regard we would like to receive some good comment form this

forum, why this test not free for those people who even do not have Rs 50 in a

day. Also in Assam still CD4 is not free who are all ready in ART roll out.

I look forward to hear your comments .

Jahnabi Goswami

President, ANP+

e-mail: <jahnabig@...>

[Guest guest]

Dear FORUM,

This is in response to the posting from Ms. Jahnabi Goswami Re: Cost of lab

tests before starting ART roll out in Govt set up

At least now this kind of practical issues in the roll out of ARV has become a

point for discussion. NACO now offer ARV medicines for a limited number of HIV

positives from selected centres. There are many issues yet need to be discussed

and decided.This include:

1. Costing of the program and involvement of state and health services in

that-There is a costing study underway now.

2. How to make the roll out sustainable

3. How to support the patients on ARV by providing other services like

CD4,Inverigations, nutrition, IO treatment,Treatment education etc

4. Prioritizing the support services – with limited amount of money and

infrastructure should we start more and more ARV centers which is unlikely to

be sustainable or maintain the quality of existing ones? Should we provide

support for blood tests /travel/ nutrition/food basic needs for those who are on

ARV or start new patients on ARV?

5. Should we offer few patients with second line drugs or try to improve

existing first line program?

This is an end less list and I feel it is time we should discuss in forums like

this at least if not a national debate.

Also we should not forget the large number of patients with other diseases who

die in the streets for want of any medical care when we priorities our needs.

As far as the investigations are concerned , in Kerala any patient below poverty

line gets all investigations free of cost , above poverty line patient has to

pay.( I agree that because of the stigma existing, most of our patients falls

below poverty line the moment they are detected HIV positive).

Dr Ajithkumar.K

TD Medical college Alapuzha

e-mail: <ajisudha@...>

[Guest guest]

[Moderators note: Jahnabi's question on the " Cost of lab tests before starting

ART roll out in Govt set up " raised another deeply troubling question of Indian

Council of Medical Researcher (ICMR)'s inability to develop an HIV clinical

research agenda to address urgent and locally relevant clinical challenges. ICMR

should have come out with an alternative clinical or lab indicators to expensive

CD4 count to initiate ART. They did not even manage to come out a locally

standardized pediatric ART protocol].

Dear forum,

I think the cheaper ways are available, although not very scientific or copybook

like.

What I do with my poor patients is that, I try to get CBC,ESR,B.Grouping,

mantoux, X-ray,U/S,Urine c/e from Govt/charitable hospitals.

If one can not spend on cd4 then I rely on absolute Lymphocyte count and

clinical conditions.

This strategy can be replicated by all clinicians with a nice clinical sense.

Dr.Rakesh Bharti,

BDC Research Center,

27-D,SantAvenue,The Mall,

Amritsar,Punjab143001

email-rakesh.bharti1@...

[Guest guest]

Dear forum

Yes, I'm agree with you Jahnabi, you are rigth, however is not only in Assam the

PLA have to face this investment, in JJ Hospital in Mumbai too.

And this is a subtle exclusion, so you are excluded not only if you don't have a

ration card!!

CD4 and all base line it cost for a PLA more than 400 Rps, therefore Access

problem there.

Facing that PLA have to mortage their lives to survival.

In Behalf of PLA we appeal for a FREE access to health.

Best regards

Dr

Guillermo CARAVOTTA

e-mail: jorge.caravotta@...