Rational Use of ARV Medicines Dr BB Rewari, India Objectives Estimate number of patients on ART in private sector on the basis of ARV drugs sales Collect information on ARV drug prescription by the private sector doctors and their availability Methodology Structured questionnaires and interviews with broad range of stakeholders : government, pharmaceutical companies, private doctors and retail chemists (March till May 2007) Qualitative and quantitative estimates made based on expert opinion. 3 slides, 5 mins

Result From 2006 drug sales, an estimated minimum of 30,055 patients are receiving ARVs through the private sector Assumptions: all patients are treated correctly, with the correct prescription and have 100% adherence However, mal-prescriptions are common in the private sector: Assuming 25% do not prescribe correctly, then more than 37,000 patients are being given ARVs in the private sector Assuming 50% do not prescribe correctly, then more than 45,000 patients are being given ARVs in the private sector

Conclusion and Recommendations Figures on private sector treatment is likely to be higher for the following reasons: mal-prescriptions by private sector is relatively common Due to financial reasons, patients may not purchase the complete standard regimen or have 100% adherence since they have to bear the all costs of drugs The reported ARV drug sales database may be incomplete ARVs can be bought over the counter in private chemist shops Tracking prescriptions by private sector is difficult as there are no systems to do this Recommendations: Engage and advocate with the private sector for rational use of ARVs Promoting public-private partnership Promote patient education and treatment literacy