ABSTRACT
The book Healers or Predators? Healthcare Corruption in India edited by Samiran Nundy, Keshav Desiraju and Sanjay Nagral is a compilation of 41 essays covering a broad array of topics of central concern to India’s health system. As the title of the book suggests, at the core is corruption in medical practice, defined by most authors as “abuse of entrusted power for private gain,” a concern that has been engaging attention in the media and public discourse, albeit in a limited manner.
ABSTRACT
This is in reference to the book review “India’s health system: No lessons learned” by Sunil K Pandya, published online in IJME on August 30, 2017. Before responding to the review, a clarification may be in order. The book Do We Care? India’s Health System is not an autobiography. It neither lists out my achievements nor explains my failures. It only records my understanding of the evolution of India’s health system over the years and provides an insider’s perceptions on how policies are made in the corridors of power.
ABSTRACT
Background. We aimed to analyse treatment outcomes of patients receiving first-line antiretroviral therapy (ART) through the national AIDS control programme of India. Methods. Using routinely collected programme data, we analysed mortality, CD4 evolution and adherence outcomes over a 2-year period in 972 patients who received first-line ART between 1 October 2004 and 31 January 2005 at 3 government ART centres. Cox regression analysis was used to identify independent predictors of mortality. Results. Of the 972 patients (median age 35 years, 66% men), 71% received the stavudine/lamivudine/nevirapine regimen. The median CD4 count of enrolled patients was 119 cells/cmm (interquartile range [IQR] 50–200 cells/ cmm) at treatment initiation; 44% had baseline CD4 count <100 cells/cmm. Of the 927 patients for whom treatment outcomes were available, 71% were alive after 2 years of treatment. The median increase in CD4 count was 142 cells/ cmm (IQR 57–750 cells/cmm; n=616) at 6 months and 184 cells/cmm (IQR 102–299 cells/cmm; n=582) at 12 months after treatment. Over 2 years, 124 patients (13%) died; the majority of deaths (68%) occurred within the first 6 months of treatment. Those with baseline CD4 count <50 cells/cmm were significantly more likely to die (adjusted hazard ratio 2.5, 95% confidence interval 1.3–3.2) compared with patients who had baseline CD4 count >50 cells/cmm. Over the 2-year period, 323 patients (35%) missed picking up their monthly drugs at least once and 147 patients (16%) were lost to follow up. Conclusion. Survival rates of HIV-infected patients on first-line ART in India were comparable with those from other resource-limited countries. Most deaths occurred early and among patients who had advanced disease. Earlier initiation of HIV treatment and improving long term treatment adherence are key priorities for India’s ART programme.