AIDS control programme running blind without enough testing kits

‘Test and Treat’ policy launched, but capacity for testing far short of demand

April 28, 2017 10:18 pm | Updated 10:19 pm IST - New Delhi

Without regular testing, it is not possible to determine what level of treatment (first line, second line or third line) a patient needs. File

Without regular testing, it is not possible to determine what level of treatment (first line, second line or third line) a patient needs. File

In a policy shift, the Health Ministry started a ‘test and treat’ policy for HIV patients on Friday. This would entitle every person who tests positive for HIV to free treatment.

While launching the test & treat policy, Health Minister J.P. Nadda, announced that India will soon develop a National Strategic Plan for HIV for next seven years and these seven years will be crucial for ending AIDS. The draft strategy document, accessed by The Hindu, reveals that the government’s testing capacity, as of 2016-17, was only for 14,341 patients, but it currently has more than a million patients on anti-retroviral therapy (ART).

Without regular testing, it is not possible to determine what level of treatment (first line, second line or third line) a patient needs. “The government does not know if patients are responding to treatment or have turned drug-resistant,” said Paul Lhungdim, President, the Delhi Network of Positive People (DNP+). “There is rationing of the viral load testing kits due to a shortage. The government is working blind.”

Late failure detection

There are two HIV tests: the ELISA detects infection, and viral load test, the HIV’s RNA in an infected person. Viral suppression (reducing viral load to an undetectable level) is the treatment goal.

Without the viral load test, by the Ministry’s own admission, “immunological failure is detected very late, leading to continuation on failing regimen, accumulation of mutations, and compromised future treatment options.” This was submitted by Dr. Naresh Goel, Deputy Director General, National AIDS Control Organisation (NACO), at a Joint WHO/UNAIDS meeting with diagnostics manufacturers.

The government is unable to do viral load testing at the required scale due to a shortage of kits. The cause of this shortage: apparently, there are no takers for the government’s tender for manufacture and distribution of kits.

“The government has taken a decision to test and treat every person who is HIV positive. Patients will have to be tested once a year,” Mr. Goel said. “But this policy change cannot be implemented just yet because we have not been able to engage an agency. We are not getting bidders, and giving a contract could take anywhere from two weeks to two months.” With the policy change, about two lakh new HIV-positive people could be detected every year, who would then need annual tests.

India is party to a UNAIDS programme under which it must implement the ‘90-90-90’ strategy: diagnose 90% of HIV-infected people in India; put 90% of cases on ART; and achieve viral suppression among 90% of the ART recipients. For early detection of treatment failure, and to achieve the 90-90-90 target by 2020, NACO wants a million viral load tests a year.

In the Strategic Plan for HIV/AIDS (2017-2024), NACO says “India has over a million people on ART, and only 2% are on second line treatment. Viral load failure over 10 months is 10%. Clients whose viral load is not being suppressed need to be moved to an improved regimen... Lack of equipment affects the last 90”.

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