SHORTAGE OF HIV TEST KIT PUTS BABIES AT RISK

Forpast 4 months, city's ART centre has not given dried blood spot kits to HIV+mothers so they can check if their infant has contracted disease; earlydetection increases chances of a baby's survival, say doctors

S umita, an HIVp o s i t i v e patient from Ahmedabad, delivered a baby boy four months ago. As if handling a newborn in her weakened condition is not taxing enough, the 20-year-old ­ who lives on the outskirts of the city -has to frequently travel 35 km to the anti retroviral therapy centre at Civil Hospital to ensure her baby undergoes blood tests that detect HIV infection.

Her repeated trips could have been easily avoided if the centre had given her free dried blood spot (DBS) kits so she could easily perform the tests at home and mail it to the lab for testing.

“My baby needs to undergo blood tests at least four times till he is 18 months old. I do not keep well, yet I am forced to travel to the centre so that I can be assured that he is free of this dreaded disease. There is a shortage of these home-testing kits and no one seems interested in sorting out the issue. Meanwhile, needy people like me are forced to make the rounds of hospitals, expending time, energy and money, so that we can put our fears to rest,“ says Sumita.

There are hundreds of mothers like her who are in the same situation for past four months due to shortage of DBS kits that allow for diagnosis of HIV as early as six weeks of age. Babies have the best chance of thriving when diagnosed early in life, and receive proper healthcare and nutrition. Most ART centres distribute these kits to HIV-infected mothers with newborns for free.

Daksha Patel of Gujarat State Network for People living with HIV AIDS said, “The shortage has reached crisis status as the kits are out of stock not just in Gujarat but also in Punjab, Rajasthan, and Haryana.“

Who is to blame for the shortage?

Fingers point at National Aids Control Organisation, a national body that formulates policy and implements programmes for prevention and control of HIVAIDS through 35 state AIDS prevention and control societies (SACS).

Gujarat State Aids Control Society officials confirmed, “The problem is at the central level. NACO is responsible for supplying all kits, drugs and other medical facilities. We only distribute it at the grassroots level.“

Several attempts to contact NACO Deputy Director General (Gujarat) A S Rathore were in vain.

HIV expert Keyur Shah said, “Most HIV infection in kids results from mother-to-child transmission, which can occur during pregnancy, labour and delivery, or breast-feeding period. Despite advances that have been made to prevent HIV transmission from infected mothers to infants, hundreds of babies in poor countries are infected with HIV every day through MTCT. According to medical guidelines, an infant has to undergo 4-6 blood tests till she is 18 months old. At the end of the 18th month, the last antibody test will make it clear whether she has been infected.“

EASY TO USE DBS

kits are of great help in resourcepoor settings due to the samples' long lifespan with reduced need for refrig eration. As nature of the test is less invasive compared to other methods, handlers are at reduced risk of contract HIV while conducting the test.“The convenience and cost-effectiveness of DBS make this methodology feasible in identifying HIV-infected infants,“ states the International Journal of STD and AIDS.

Dr Shah said, “A small quantity of blood, i.e., 50 l, is enough to make a dried blood spot (DBS) whereas for the whole blood 500 l is required to perform the test. So, the process is less painful for the child.“

“It is easy to teach a family member to use a DBS kit properly. People who stay far away from a hospital and do not have easy access to medical facilities can easily use the kit at home to carry out a blood test then send it through testing centres. This ensures that the tests are conducted regularly and in time which helps with detection and treatment,“ says Matin Ahmad Khan of Medical Association of India.

(Names have been changed to protect identities)

DBS TESTING

Diagnosis of HIV infection in infants is difficult due to the presence of maternal anti bodies; only nucleic acid assays are very helpful in early detection. However, whole blood has to be processed withing 4 days of collection. Here, DBS testing works.

Whole blood from a baby's heel is smeared on filter paper; thus avoiding use of sy ringes or vaccum tubes. The paper dissolves the cells and binds the DNA. Dried blood is stable and can be stored at room temperature. It can be transported easily and is convenient to use in areas with limited resources.

In the lab, a small disc of the saturated paper is separated from the sheet using a hole punch and dropped into a plate. It from the sheet using an automated or manual hole punch, dropping the disc into a plate. A solution is added to leach out the blood which is then tested for genetic material of actual human immunodeficiency virus.