[Ip-health] Supreme Court directs Universal Access to Second Line ART in a phased manner
mihir.samson at lawyerscollective.org
Thu Dec 16 00:23:26 PST 2010
Update: Sahara House v. UOI W.P. (C) 535/1998 &
Sankalp Rehabilitation Trust v. UOI W.P (C) 512/1999
Sankalp Rehabilitation Trust had filed an application in the above petition
in the Supreme Court challenging the constitutionality of NACO's criteria
for second line ART and seeking a direction that second line be made
available to all those who need it, irrespective of any other criteria.
Under Indian law, commenting on the merits of a case which is pending before
a court amounts to contempt. The update below is a fair reporting of the
proceedings before the Supreme Court in this matter.
The Petitioner argued that limiting access to 2nd line was violative of
fundamental right to life of PLHIV. Taking a serious view of the situation,
the Hon'ble Supreme Court made it clear to the government that access to
second line must be universalized. On 16th December, the following
statement, appended below, was endorsed as an order of the Hon'ble Supreme
As per the order, second line ART will be provided to all PLHIV who need it,
whether they were in the private or public sector or on rational or
irrational treatment. In the first phase (3 months), universal access to
second line treatment would be started at four Centres of Excellence (JJ
Hospital in Mumbai, GHTM Tambaram, Maulana Azad Medical College (MAMC), New
Delhi and Calcutta School of Tropical Medicines, Kolkata) with immediate
effect. This pilot initiative would be studied over a period of three
months, after which it will be scaled up to more ART Centres.
Lawyers Collective HIV/AIDS Unit will organize a meeting in January 2011
with PLHIV and NACO to further explain the order and discuss the remaining
issues in the ART Rollout Programme.
Statement/Minutes of Meeting for bringing about Universal Access to Second
SAHARA HOUSE vs. UNION OF INDIA,
WRIT PETITION (C) No. 535 of 1998
SANKALP REHABILITATION TRUST & ANR. V. UNION OF INDIA
WRIT PETITION (C) No.512/1999
VOLUNTARY HEALTH ASSOCIATION OF PUNJAB vs UNION OF INDIA
WRIT PETITION No. (C ) No. 311/2003
COMMON CAUSE Vs. UNION OF INDIA WRIT PETITION (C) No. 61/2003
One of the issues that has arisen in the above-referenced Writ Petitions
concerns the criteria currently being employed by the National AIDS Control
Organization (NACO) for administering second line treatment to persons
suffering from HIV / AIDS. Specifically, the Petitioners have sought
extension of second line treatment to all persons in need of it - whether
they underwent first line treatment in government or private sector, and
irrespective of whether they were put on a rational regimen for first line
treatment. The NACO has consistently maintained that the ultimate goal is to
have universal access to second line treatment, but there were various
capacity-related and other constraints on doing so, and this was therefore
sought to be achieved in a phased manner. In proceedings before this Hon'ble
Court, the parties undertook to hold a review meeting to discuss the
modalities for bringing about universal access to second line treatment to
all those in need of it. A meeting was held on 13.12.10, where the following
decisions were taken:
1. The private practitioners are required to follow the ART
guidelines out lined in the OM no. T-11020/29/1998 (Admn.-ART) dated 9th
September 2010 and earlier OM no. T-11020/29/1998 (Admn.-ART) dated 26th
August 2008 approved by Hon'ble Supreme Court of India in its order dated
1st October 2008.
2 NACO commits to making second line treatment available to all
those in need of it - whether they underwent first line treatment in the
government sector or private sector, and irrespective of whether they were
put on rational / irrational treatment regimen.
3. However, there are some immediate constraints that need to be
addressed, before second line treatment can be universally available. The
process for drug procurement (through international competitive bidding) is
likely to take at least six to eight months, and some lead-up time is also
required for strengthening viral load capacity and trained personnel.
4. Further, complete data on the number of persons who would seek
second line treatment in the government sector is presently unavailable.
Without such data, it is difficult for NACO to gauge the nature and extent
of capacity addition that is required to handle the additional inflow of
persons in need of treatment without compromising on quality of care.
5. Therefore, it is proposed that in the first phase, universal
access to second line treatment would be started at four Centres of
Excellence (JJ Hospital in Mumbai, GHTM Tambaram, Maulana Azad Medical
College(MAMC), New Delhi and Calcutta School of Tropical Medicines, Kolkata)
with immediate effect. This pilot initiative would be studied over a period
of three months, which would give an indication of the numbers of additional
persons seeking second line treatment, thus enabling capacity addition to
proceed in a planned and phased manner. A Status Report would be presented
to this Hon'ble Court after three months, along with a plan for Phase II
(where such treatment is likely to be made universally available at some
more Centres of Excellence).
6. By way of clarification, it is submitted that persons from
anywhere in the country (in need of second line treatment) may be referred
to these four Centres of Excellence presently.
7. As a matter of procedure, person in need of second line treatment
will register at the local ART centre. This could be a person who suspects
treatment failure, or a person already on second line treatment. The local
ART centre will then refer the person to the State AIDS Clinical Expert
Panel (SACEP) in the Centre of Excellence, as per existing operational
guidelines and prior appointment shall be given. The person shall then
report to SACEP where further viral load tests etc. will be conducted as
required, and a decision would be taken on whether there is genuine
treatment failure necessitating second line treatment.
8. The precise progression of phases depends, in large part, on the
number of persons requiring treatment once access to such treatment is
universalized and patients are referred by the practitioners / information
provided by networks. NACO shall make its best efforts to ensure that such
treatment is universally available at the earliest.
Shivangi Rai and Mihir Samson
Lawyers Collective HIV/AIDS Unit
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