Global Fund response to calls for 2nd Line ARV medicines in India

[Guest guest]

18 December 2006

Mr Stem

Director, Agua Buena Human Rights Association

San , Costa Rica

Dear ,

I am responding to your letter of 5 December 2006 to Dr Feachem

regarding India ARV second line drugs. I have been part of this discussion

during my last two visits to India and I have raised this issue with senior

officials and partners. I would like to summarize what I know and what we have

done so far.

The Government of India has not decided yet to introduce second line ARV drugs

because of high costs. The first year alone would cost over $3m and second year

approximately $7m, and in later years it would cost approximately $70m or more.

These are estimates only, however, large amounts are needed to provide the much

needed drugs. The Government of India is committed to introducing the second

line drugs but they want to make sure they have the resources or commitment to

receiving the drugs over a longer period of time so that once the drugs are

introduced there are no interruptions of supply.

In 2006, NACO focused on rapid scaling up of ARV treatment which was very low in

2005. Such scaling up required major national efforts and now over 45,000 people

are on ARV treatment. It is expected that more than 60,000 HIV patients will be

on treatment by March/April 2007.

Second priority was to bring in drugs for HIV+ children. This drug is expensive

and NACO wanted the Global Fund to fund for this. Based on our discussions with

the Clinton Foundation, the pediatric drugs were made available through the

Clinton Foundation, thus facilitating a major collaboration between Clinton

Foundation, NACO, and The Global Fund. Therefore, Clinton Foundation will

provide pediatric drugs to cover as many as 10,000 children and the drugs are of

course funded by UNITAID.

The next priority will be second line drugs. Multiple discussions with NACO,

Clinton Foundation, UNAIDS, and WHO took place over the last four to eight

weeks. My recent discussion with Clinton Foundation indicates that they are

ready to provide second line drugs to NACO with support from UNITAID. On 30

November, the French Foreign Minister also visited India when President Clinton

was there for the pediatric program. UNITAID has offered to cover the second

line drug supply for two years but the Government of India wants some assurances

from UNITAID, that the support will be continued beyond two years. This is under

discussion. The Government of India will also have to train staff and prepare

for the introduction of the second line drugs. The Global Fund funds could be

used for building the necessary capacity to introduce the drugs. While we have

assured India that we are flexible in our funding but it is important for NACO

to also pursue what is being offered from the

Clinton Foundation and UNITAID. NACO can always seek long term Global Fund

resources through upcoming rounds.

As to disbursements under Round 4 grant, we have processed a $17m disbursement

which will reach NACO within two weeks. Under this program, the Government of

India has used over $8m of their fiords to continue the grant activities which

will be reimbursed by us.

Procurement was delayed by several months but has now been completed. NACO

management is under strong leadership of Sujatha Rao and we see major scaling up

of treatment.

Please let me know if you need additional information on this.. As to drugs, the

Government of India is implementing their policy on ARV which was developed in

close consultation with WHO. They also adhere to the Global Fund QA policy.

Please feel free to contact me if I can be of any assistance. Yours sincerely,

Taufiqur Rahman

Team Leader

South and West Asia Cluster