The free testing, to be done by empaneled private labs in co-ordination with 530 anti-retroviral therapy centres, aims to benefit 12 lakh HIV-affected people in India.
New Delhi: After years of wait, the government has finally included free viral load testing for people living with HIV as part of the its national HIV programme.
The government has said it will provide free testing for 12 lakh people living with HIV, at least once a year.
Health minister J.P. Nadda said this was a historic decision and would help the government monitor the uptake of the first line anti-retroviral therapy (ART) much better. This will, in turn, prevent drug resistance, can track whether people follow up on their treatment and ultimately ensure the longevity of people with HIV.
The viral load test is a diagnostic tool which gives an idea of how much of the HIV virus is in one’s body. It measures the number of HIV copies in a mililitre of blood.
The test predicts how fast the disease can progress. A low viral load will mean greater life expectancy, provided treatment is adhered to.
One viral load test needs to be done just after a person is diagnosed. This gives doctors a baseline measurement. Subsequently, the test needs to be done so that doctors can monitor how the anti-retroviral therapy has been working on the patient. Effective drug combinations can drop the viral load substantially. In about six months of adhering well to the treatment regimen, a person’s viral load can drop substantially.
The government has also finalised the National Guidelines for for HIV-1 Viral Load Laboratory Testing, National Operational Guidelines for Viral Load Testing, Standard Operating Procedure for HIV-1 Quant Assay with CBNAAT and Guidelines on Quality Monitoring System for Outsourced Viral Load Tests. They have not yet published these on the ministry’s website.
Giving sight to a “blind” programme
“India’s HIV programme was so far working blind, without giving this viral load test. Access to viral load test is an essential diagnostic for a patient but is also a quality indicator for any ART programme. So this is a very welcome step,” said Leena Menghaney from Doctors Without Borders.
For a patient, access to this test tells doctors if their regimen needs to be changed or if they are adhering well to the existing regimen. “Regimen change should not come in the end when a person has full blown AIDS,” said Meghaney, adding that the government had been planning for this for three years.
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The government’s programme will work in a public-private partnership. The labs empaneled for this testing will be private ones, and they will coordinate with the 530 ART centres in the country.
“Labs will collect samples from the ART centres, prepare the viral load test and communicate this back to the ART centre. Doctors there will communicate the further course of treatment,” says Sanjeeva Kumar, Director General, National Aids Control Organisation (NACO).
So far, the government was providing the test only to about 15,000 to 18,000 people and only once a year.
The machines for testing which the government will be using for the tests are by the global giant, Abbott. Previously, Roche has had a monopoly over viral load testing. “The government has forced different private providers to bring prices down by creating competition and opening bids. Because of the monopoly of Roche so far, the programme was finding it very difficult to reduce prices. South Africa did this three years ago, India is doing this now,” said Menghaney.
Roche’s test cost about Rs 2,000 per test whereas the prices for Abbott’s test are likely to be about Rs 1,200.
“Public-private partnership in labs will increase the government’s reach, save costs and the results will come in faster,” said Kumar. “Apart from the machines working on public-private partnership mode, there will also be stand-alone machines by the government, placed in ART centres. But this will take time,” he said.
Last year, the government also revised ART protocols and began the ‘Treat All’ initiative. This was to ensure that treatment starts early and virus transmission can be curtailed early. This covers 12 lakh people living with HIV for free treatment at the 530 ART centres in the country.
The government also passed the HIV/AIDS Act last year, to deter the stigma and discrimination targeted at people living with HIV and to push for more informed consent, protection of property of affected children and safe working environment for people with HIV and so on.