As the COVID-19 pandemic exposes the failure of the government across the country to take serious note of the concerning situation of the healthcare system, Manipur State AIDS Control Society (MACS) has allegedly failed to comply with the national operational viral load testing guidelines laid by National AIDS Control Organization (NACO) for people living with HIV (PLHIV).
The government of India has adopted the WHO guidelines of Test and Treat Policy for PLHIV in March 2017. Since then, routine viral load (VL) testing has been taken up in the state.
The main objective of VL testing is to provide early and accurate indication of HIV treatment failures and assess the need of switching the treatment regimen. But, due to the limited availability of testing facilities owing to the pandemic, many PLHIVs in the state are reportedly unable to do the tests at their respective Anti-Retro Viral Therapy (ART) Centres despite crossing the date of testing schedules.
According to the norms of NACO, which is an implementing agency of the guidelines, new patients in first line ART should conduct viral load (VL) testing at the sixth month and 12th month from the date of ART initiation in the first year itself. From the following year, the patient should conduct tests once in a year.
For the existing patients of first line ART, the testing should be done once in a year from the initiation of ART. For new patients of second line ART or third line ART, VL test should be conducted at the sixth month after the initiation of ART. But patients whose viral count is more than 1000 copies per ml should conduct their VL tests after every three months.
In the case of a patient holding ART card number 4437Ukl, the ART treatment began in 2002 and he took the viral load tests four times.
The patient conducted the viral load test for the first time on November 11, 2018 from the ART Centre of JNIMS and the result came with 1,605 copies per ml. The second test was conducted on March 3, 2019 and the results increased excessively to 6,491 copies per ml.
The patient took two more tests on August 8, 2019 and January 9, 2020 with results being 2,481 copies per ml and 4,021 copies per ml respectively, exceeding the baseline of 1000 copies per ml.
Based on the report, ART Centre referred the patient to the State AIDS Clinical Expert Panel (SACEP) and was advised to attend a meeting on February 2, 2020. Following the instruction, the patient attended the meeting where panel experts suggested continuing the treatment with the same regimen for three months and then to test the viral load. But the patient has been unable to take the test till date even if the viral load stands more than 1,000 copies per ml.
Speaking to the Imphal Free Press, the patient he said, “I am getting ART treatment from JNIMS ART Centre. I went to test my viral load at JNIMS in the month of May as my counsellor told me to undergo the VL test after three months. But I am not able to take the test. The authority of the ART Centre told me that the testing facility is not functional due to COVID-19 pandemic.”
The patient further said, “My health condition is deteriorating. Few days ago, I was feeling extremely unwell. So, I went to meet a physician to check my health on June 10. The doctor advised me to take tests for Cytomegalovirus, Toxoplasmosis and Cryptosporidium infections.” As the symptoms of health deterioration have appeared to the patient, he now faces a grave danger by not getting the required viral load tests.
Another patient holding ART card number 5668 IW conducted viral load test at JNIMS twice and the last viral load was tested on February 3, 2020. The result came out with 8,943 copies per ml. The third viral load test was to be taken on May 3, 2020 so as to decide whether to switch the treatment regimen but due to the unavailability of the testing facility, the patient like the rest of the several ART card holders, is facing an uncertain future in the prevailing circumstances.
Other patients holding ART card 7,964 IW had conducted VL testing on February 3, 2020 and patients got the result with 2425 copies per ml. The patient was supposed to take the second VL testing on May 3 but it remains pending till date.
When IFP consulted with Community Response on COVID-19 (CROC) Manipur, an organisation formed recently to support the already stigmatised community of drug users and PLHIVs, its convener RK Nalinikanta said the COVID-19 outbreak has engulfed many existing problems among the community.
Concerning VL testing, Nalinikanta said the main objective of ART treatment is to suppress the viral load at an undetectable limit to prevent HIV transmission from an infected person to another person.
The patient would notice their viral count and decide their treatment regimen from time to time from the result of viral load testing. As such, it is very essential to carry out such testing in a timely manner, he added.
He further said it is very unfortunate that due to COVID-19, HIV related services are hampered despite Manipur being among the high-prevalence rate of HIV in the country. Ignoring this service may lead to serious consequences as it is one of chronic diseases that needs proper care and attention all the time, he added.
Enraged with the way 4437Ukl patient has been treated by ART Centre, Nalinikanta said despite learning that the patient’s VL count is more than 1000 copies per ml four times, allowing the patient to wait till manifestation of clinical failure symptom is not only violation of right to health of the patient but also non-compliance of NACO viral load testing guidelines.
“I feel sorry with the kind of treatment given to this patient. As far as I am concerned, this is not a medical treatment but rather a crime,” he said.
Authority concerned should not take the matter lightly, he said.
“We do not mind delaying the VL testing for patients whose results came out with targets not detected. But the authority concerned should not take lightly those whose viral count is more than 1,000 copies per ml,” he lamented.
On behalf of CROC Manipur, he appealed to MACS that it is necessary to fight COVID-19 outbreak to save lives. But ignoring all other medical treatment for PLHIVs is extremely wrong. This kind of irresponsible act of the authority concerned may lead to development of various opportunistic infections and serious health complications that may even lead to death, he said.
As the state is abiding by the VL testing guidelines prescribed by NACO, MACS should not stop following it in this critical situation to save the lives of many PLHIV, he asserted.