Date: 26 Sep 2007
From: Sanjeev Jain sanj1966@...

Subject: Query: Rational Use of ARV and ARV Regulation.

Dear Sir/ Madam

Over the period of time ARV access has increased and the costs reduced.
While Government is the major player to provide ARV, pharmaceutical
companies have also placed the same on the shelves of the private pharmacies
and people who do not want to access ARV from the government system are
procuring ARV from the private pharmacies and drug dispensing shops. Now in
the market ARV is available like any other drug.

One of the major challenges visible is the rational use of ARV. While ARV
shall be prescribed only by qualified medical doctors, the ARV is also now
freely prescribed by non qualified doctors. People have started sharing
stories where the ARV was prescribed even when it was not required by the
positive person or in one family only one person was HIV positive but all
the other family members will still prescribed ARV with their HIV negative
status, ARV is also prescribed without doing the needed investigations,
viral load or CD4.

This raises few queries:-

a. What Medical Council has to say on this? How the Drug controller can be
made more responsible.

b. Has anyone heard of a prescription audit on ARV been conducted by some
one or by the national authorities?

c. What is the opinion of Pharmaceutical companies? Can there be a
mechanism/system that the drugs will be dispersed and regulated only through
selected pharmacies and it will be closely monitored. Many examples are
present world wide including India of Desferal / Kelfer disbursement for
Thallasemics, or factor VIII and IX for Hemophiliacs, or close monitoring in
case of vaccines.

d. And if both the above things are not possible, what could be the
other strategies besides building the capacities of the medical for
appropriate and rational prescription and referrals and adherence counseling
by non medical doctors

Please help me in educating myself and find the possible solutions/
strategies before ARV reaches the masses marketed/ promoted as vitamins and
health tonics, or misused like Oxytocin or Depo-provera and other drugs.

Regards,

Sanjeev Jain
+91- 9415160430
sanj1966@...

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