The ART of India’s HIV/AIDS response

Context:

India commemorates the 20th anniversary of the launch of Free Antiretroviral Therapy (ART) for Persons living with HIV (PLHIV) on April 1, 2004.

Evolution of Free ART Initiative

• Origins of the Initiative:Launched amidst global efforts to combat HIV/AIDS, the Free ART initiative aimed to address the challenges of limited access and affordability of antiretroviral drugs for PLHIV in India.
• Impact and Expansion: Over the past two decades, the initiative has significantly expanded, with the establishment of around 700 ART centres and provision of free ART drugs to approximately 1.8 million PLHIV.
• Achievements: The initiative has contributed to reducing the prevalence of HIV, with notable declines in new infections and AIDS-related mortalities, aligning with global targets set by UNAIDS.

Complementary Initiatives and Adaptations:

• Comprehensive Approach: Success of the Free ART initiative attributed to complementary measures such as free diagnostic facilities, prevention of parent-to-child transmission services, and management of opportunistic infections.
• Adaptive Strategies: Programme evolved over time, incorporating early initiation of ART, 'Treat All' policy, and rapid ART initiation to enhance effectiveness and reduce virus transmission.
• Patient-Centric Services: Introduction of patient-centric services, including provision of longer medication supplies, facilitated adherence to treatment and minimized clinic visits, enhancing overall healthcare delivery.

Challenges and Future Directions:

• Persistent Challenges: Despite successes, challenges such as delayed enrolment, patient adherence, and sustained supply of ART drugs persist, necessitating focused attention and intervention.
• Integration and Capacity Building: Emphasis on integration with other health programmes, private sector engagement, and continuous capacity building crucial for addressing evolving healthcare needs.
• Policy Lessons and Way Forward: The Free ART initiative underscores the importance of political will, sustained funding, and community engagement in delivering quality healthcare services. Its success provides valuable insights for strengthening other public health programmes and advancing towards disease elimination goals.