Q&A: Dr Suniti Solomon, Director of YRG Care, India
HDN Key Correspondent
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(April, 2005)

Dr Suniti Solomon, Director, YRG Care (Y.R. Gaitonde Centre for AIDS Research and Education) diagnosed the first case of HIV in the Indian population, in 1986. She is a leading expert on the HIV/AIDS epidemic. Speaking with Health and Development Networks in New Delhi she gave an update about the Round II GFATM (Global Fund for AIDS, TB and Malaria) funding, fund disbursement and utilization at YRG Care, Chennai, India.

The organizations – YRG Care in Chennai, ARCON in Mumbai and Freedom Foundation in Bangalore and Hyderabad are the sub-recipients for a Round II GFATM proposal, falling under Objective 3 – ‘Upscaling of Antiretroviral Therapy through Public-Private Linkages’. The grant amount of $ 12 million will go towards funding to provide antiretroviral therapy (ART) to people with HIV/AIDS (PLWHAs). The project intends to examine public-private partnerships in providing ART drugs to those living with HIV/AIDS.

HDN: Dr Solomon, YRG Care s the sub-recipient for a Round II Global Fund grant. What is the current status of fund disbursement and fund utilization at YRG Care?

Dr Solomon: This fund is for 5 years and has several heads of expenditure which include developing of infrastructure, training of physicians, setting public-private linkages and designing the socio-economic criteria of PLWHAs.

We have got the first funding instalment in October, 2004 for Rs. 87 lakhs [8.7 million rupees, or about 200,000US$]; from then we have built up our infrastructure. But at our centre YRG care in Chennai, the infrastructure was already in place. We currently have enough patients – more than 1000 to roll out the program to. We need to understand that the program is not for free treatment – but based on a graduated cost recovery of anti-retroviral drugs. So initially we ran workshops with experts from different parts of the country and we developed a scoring system which is in place. This system has been piloted at YRG Care and it is working well. The system is being administered to every patient who walks into our centre. We then score how the patient will be paying for the drug costs – 100%, 75%, 50% or no costs. This means that the poor get drugs for free, while the middle class pays 50%, upper middle class pays 75% and those who can afford pay 100% of the cost of drugs.

HDN: How many people living with HIV/AIDS are currently on treatment at YRG Care through the Round II funding of the GFTAM?

Dr Solomon: From March 1, 2005, we have interviewed 97 patients of whom 60 have so far been enrolled in to the service at YRG Care; of these 44 are male and 16 are female. For patients in Tier 4 – paying 100% of the costs, there are a total of 17 patients; Tier 3 – paying 75% of the costs, there are 3 patients; Tier 2 – paying 50% of the costs, there are 20 patients; and in Tier 1 – paying no costs, there are 20 patients. The group requiring free treatment – for those living below the poverty line is overflowing.

HDN: How is the fund money being utilized for other heads of expenditure?

Dr Solomon: At YRG Care, we are running workshops for training of physicians. The Global Fund has provided the funding for the training of doctors – these include not only our doctors, but doctors in the state of Tamil Nadu – this is for the Tamil Nadu State AIDS Society (TNSACS). We have completed two batches of training for doctors – one for doctors from government hospitals and the second for doctors in private practice. The training module is not finalized but has been piloted through these training sessions.

HDN: Is there any delay in fund disbursement from the government or the GFTAM?

Dr Solomon: There was an initial delay in signing of the grant. But once it was signed it was okay. The funding comes in to NACO (National AIDS Control Organization) and is disbursed through ARCON. There could be some delay as all the three NGOs have to keep pace together. There is going to be some delay with this because the other organizations are building up capacity but we are running – we are taking care of 8000 patients out of which 2000 are waiting for ARVs.

HDN: How are the three NGOs – YRG Care, ARCON and Freedom Foundation working together for collaborating and capacity building on this project?

Dr Solomon: There is collaboration for capacity building and we are coordinating to develop common modules for training physicians. Both these organizations, ARCON and Freedom Foundation were at our centre for a two day workshop. We have also agreed to train doctors for Freedom Foundation – so doctors from the state of Karnataka will be coming to us for their training.

HDN: What are your concerns about the limited duration of the funding and its impact on drug supply and support for your patients beyond the five years of the GFTAM funding?

Dr Solomon: The sustainability of funding and support for patients beyond five years is a big concern. It may not be a concern for the patients in Tier 4 and in Tier 3 – paying 100% and 75%. These patients will be managed, but for the patients below the poverty line – it will be a concern. I am hoping that the cost will come down further so they can afford to buy the drugs inexpensively. The second hope is that the quality of life of these patients may become better so they can earn some money and support themselves. The third option is that there will be other projects at YRG care – so we can roll on these patients on the ongoing additional programmes; that way we will take care of all our patients.

Anything that happens at YRG Care in Chennai we make sure it is sustainable; otherwise we don’t take it up.

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