Lok Sabha Question No. 2221 (UNSTARRED), answered on 2022-07-29
Subject: Antiretroviral Therapy Drugs
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Pradyut Bordoloi

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2221 TO BE ANSWERED ON 29 TH  JULY, 2022

## 'ANTIRETROVIRAL THERAPY DRUGS'

## 2221. SHRI PRADYUT BORDOLOI

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether  shortage  of  Antiretroviral  Therapy  (ART)  Drugs  used  by  HIV/AIDS  patients  has been  reported  from  various  States  during  the  current  year  2022,  if  so,  the  details  thereof including duration of shortage; State/UT-wise particularly in the North east region;
- (b) the number of ART Centres and number of patients seeking antiretroviral therapy during the last five years, State/UT-wise and year-wise;
- (c) whether the Government is aware that stopping of free ART supply in some States/UTs and policies  to  reimburse  the  expenditure  incurred  to  patients  based  on  receipts  may  compel patients to drop out of treatment, if so, the details thereof;
- (d) the  reasons  for  which  responsibility  of  ART  drug  procurement  has  been  passed  on  from National AIDS Control organization (NACO) to State/UT Governments;
- (e) whether the Government  has  assessed the difficulties being faced by the State/UT Governments with procurement and funding of ART drugs; and
- (f) if so, the details thereof along with steps taken/proposed to be taken by the Government to resolve such difficulties?

## ANSWER THE MINISTER OF STATE IN MINISTRY OF HEALTH AND FAMILY WELFARE (Dr. BHARATI PRAVIN PAWAR)

(a) to (f): India provides free antiretroviral (ARV) medicines of HIV/AIDS for lifelong treatment of  around 14.8 lakh People Living with HIV (PLHIV) through 681 Anti-Retroviral Treatment (ART) centres under its National AIDS and STD Control Programme (NACP), which is fully funded by the Government of India. The National AIDS Control Organisation centrally procures ARV medicines for PLHIV as per national guidelines.  The details of number of ART centres under NACP and number of patients on ART during last five years is given at Annex-1.

There is adequate stock of ARV medicines nationally for around 95% PLHIV in India who are on various 1 st and  2 nd line  ARV  regimens.  For  treatment  of  PLHIV,  Dolutegravir-based  ARV regimens are globally acclaimed as the best and safest ARV with minimal side effects and most of  the  PLHIV  in  India  are  on  the  single  pill  Dolutegravir-based  regimen  (Tablet  TLD: Tenofovir+Lamivudine+Dolutegravir), for which there is around 3 months' stock nationally.

The ARV stock status is monitored stringently  by  NACO. There is  no  reported  stock  out  for ARV drugs at the state level.

If  there  is  occasional  anticipated shortage issue at  some ART centres, then proactive steps are taken to ensure uninterrupted supply of ARV drugs to all PLHIV through immediate relocation from  nearby  ART  centres  or  other  States.  Further,  State/District  AIDS  Control  Societies (SACS/DACS) under State Governments are authorized to do emergency local procurement of ARV drugs  (as  per  requirement,  &  as  an  interim  measure)  from  their  budgeted  Grant-in-aid under NACP. Sufficient budget is allocated under the head 'ARV for exceptional cases' for all 36  SACS  under  Annual  Action  Plan  by  NACO  for  emergency  local  procurement  of  ARV medicines and there is no need for purchase of ARV medicine by PLHIV or its reimbursement thereof.

Annex 1: Details of ART Centres and PLHIV Alive on ART

| S. No.   | States/ UTs                           | As on March 2018   | As on March 2018   | As on March 2019   | As on March 2019   | As on March 2020   | As on March 2020   | As on March 2021   | As on March 2021   | As on June 2022   | As on June 2022   |
|----------|---------------------------------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|-------------------|-------------------|
| S. No.   | States/ UTs                           | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre        | PLHIV On ART      |
| 1        | Andaman & Nicobar Islands             | 1                  | 106                | 1                  | 113                | 1                  | 125                | 1                  | 127                | 1                 | 151               |
| 2        | Andhra Pradesh                        | 40                 | 1,77,27 3          | 40                 | 1,84,33 6          | 40                 | 1,92,69 3          | 40                 | 1,90,24 3          | 53                | 2,01,739          |
| 3        | Arunachal Pradesh                     | 1                  | 96                 | 1                  | 135                | 1                  | 169                | 1                  | 183                | 1                 | 252               |
| 4        | Assam                                 | 6                  | 5,846              | 6                  | 6,752              | 7                  | 7,819              | 7                  | 7,880              | 9                 | 9,736             |
| 5        | Bihar                                 | 17                 | 46,047             | 19                 | 53,259             | 20                 | 60,544             | 20                 | 63,448             | 28                | 70,601            |
| 6        | Chandigarh                            | 2                  | 5,804              | 2                  | 6,476              | 2                  | 6,480              | 2                  | 6,478              | 2                 | 5,047             |
| 7        | Chhattisgarh                          | 5                  | 12,235             | 5                  | 13,092             | 5                  | 14,798             | 8                  | 15,216             | 8                 | 17,261            |
| 8        | Delhi                                 | 11                 | 27,250             | 11                 | 30,565             | 12                 | 33,376             | 12                 | 32,663             | 12                | 35,349            |
| 9        | Dadar &Nagar Haveli and Daman and Diu | -                  | -                  | -                  | -                  | -                  | -                  | -                  | -                  | 1                 | 284               |
| 10       | Goa                                   | 2                  | 2,884              | 2                  | 2,980              | 2                  | 3,058              | 2                  | 3,027              | 2                 | 3,159             |
| 11       | Gujarat                               | 30                 | 62,752             | 30                 | 67,517             | 34                 | 71,499             | 36                 | 71,711             | 44                | 75,650            |
| 12       | Haryana                               | 1                  | 11,059             | 7                  | 10,614             | 7                  | 15,371             | 7                  | 16,085             | 15                | 23,883            |
| 13       | Himachal Pradesh                      | 6                  | 3,959              | 6                  | 4,219              | 6                  | 4,544              | 6                  | 4,606              | 6                 | 4,978             |
| 14       | Jammu& Kashmir                        | 2                  | 2,350              | 2                  | 2,610              | 2                  | 2,841              | 3                  | 2,925              | 3                 | 3,214             |
| 15       | Ladakh                                |                    |                    |                    |                    |                    |                    |                    |                    |                   |                   |
| 16       | Jharkhand                             | 8                  | 9,471              | 8                  | 10,766             | 8                  | 11,897             | 12                 | 12,130             | 13                | 13,597            |
| 17       | Karnataka                             | 64                 | 1,55,41            | 64                 | 1,65,44            | 65                 | 1,71,28            | 68                 | 1,69,83            | 71                | 1,73,718          |

| S. No.   | States/ UTs    | As on March 2018   | As on March 2018   | As on March 2019   | As on March 2019   | As on March 2020   | As on March 2020   | As on March 2021   | As on March 2021   | As on June 2022   | As on June 2022   |
|----------|----------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|--------------------|-------------------|-------------------|
| S. No.   | States/ UTs    | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre         | PLHIV On ART       | ART centre        | PLHIV On ART      |
|          |                |                    | 1                  |                    | 5                  |                    | 8                  |                    | 0                  |                   |                   |
| 18       | Kerala         | 10                 | 12,919             | 10                 | 13,839             | 10                 | 14,445             | 10                 | 14,713             | 15                | 15,379            |
| 19       | Madhya Pradesh | 18                 | 22,133             | 18                 | 25,193             | 18                 | 29,183             | 19                 | 29,733             | 25                | 33,670            |
| 20       | Maharashtra    | 90                 | 2,37,79 6          | 89                 | 2,47,09 5          | 91                 | 2,57,39 1          | 92                 | 2,53,63 6          | 95                | 2,61,061          |
| 21       | Manipur        | 13                 | 12,483             | 13                 | 12,879             | 13                 | 13,216             | 13                 | 13,366             | 13                | 13,795            |
| 22       | Meghalaya      | 1                  | 1,777              | 2                  | 2,324              | 4                  | 2,745              | 4                  | 3,047              | 4                 | 3,943             |
| 23       | Mizoram        | 6                  | 7,412              | 6                  | 8,568              | 6                  | 9,870              | 12                 | 11,365             | 14                | 13,122            |
| 24       | Nagaland       | 8                  | 7,290              | 8                  | 8,093              | 9                  | 9,772              | 12                 | 10,082             | 12                | 10,940            |
| 25       | Odisha         | 15                 | 17,142             | 15                 | 19,127             | 15                 | 20,944             | 15                 | 21,692             | 16                | 23,158            |
| 26       | Puducherry     | 1                  | 1,193              | 1                  | 1,237              | 1                  | 1,262              | 1                  | 1,252              | 1                 | 1,263             |
| 27       | Punjab         | 12                 | 27,697             | 13                 | 32,544             | 13                 | 38,424             | 19                 | 40,344             | 22                | 49,609            |
| 28       | Rajasthan      | 24                 | 37,092             | 24                 | 41,408             | 24                 | 45,209             | 35                 | 46,514             | 35                | 51,721            |
| 29       | Sikkim         | 1                  | 170                | 1                  | 184                | 1                  | 207                | 1                  | 218                | 1                 | 277               |
| 30       | Tamil Nadu     | 55                 | 1,12,77 8          | 55                 | 1,17,71 2          | 55                 | 1,21,65 0          | 55                 | 1,20,91 1          | 55                | 1,23,173          |
| 31       | Telangana      | 22                 | 73,198             | 22                 | 80,579             | 23                 | 83,517             | 23                 | 83,490             | 23                | 88,955            |
| 32       | Tripura        | 3                  | 1,186              | 3                  | 1,389              | 3                  | 1,759              | 3                  | 2,061              | 3                 | 3,108             |
| 33       | Uttar Pradesh  | 38                 | 67,855             | 38                 | 77,608             | 38                 | 86,303             | 44                 | 90,857             | 52                | 98,933            |
| 34       | Uttarakhand    | 3                  | 3,575              | 3                  | 4,062              | 3                  | 4,468              | 5                  | 4,459              | 6                 | 4,751             |
| 35       | West Bengal    | 19                 | 35,680             | 19                 | 40,233             | 19                 | 43,261             | 20                 | 44,084             | 20                | 47,694            |