CHENNAI: The incident in which a 23-year-old pregnant woman in Virudhunagar district contracted HIV after being transfused blood from an HIV+ blood donor, who had tested positive in 2016 but was not informed at the time, raised questions about how well Tamil Nadu has been adhering to safety protocols.
Express found that as many as 23 voluntary blood donors whose blood tested positive for HIV during routine screening at blood banks slipped under the Tamil Nadu State AIDS Control Society (TANSACS) radar from 2015 to 2018.
According to the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Act, 2017, a person who has tested positive for HIV should be informed of his or her condition in person by counsellors or physician at the HIV Counselling and Testing Centres. State health department officials claim the persons who slip under the radar may not have come to the Integrated Counselling and Testing Centres (ICTC) after being summoned by the counsellor.
However, the Act also says that the cases of those who have failed to show up must be followed up. This reveals a gap in the system that results not only in HIV+ persons losing out on treatment but also in unknowingly spreading the infection to others. TANSACS and the health department admit there is a problem but have few answers on how to fix these gaps.
How the system should work
According to the National HIV Counselling and Testing Services Guidelines of National AIDS Control Organisation (NACO), it is the duty of the counsellor at the stand-alone ICTC to share the laboratory report of their blood tests with the individual, provide post-test counselling and stress the need for follow-up testing.
Home visit to people living with HIV/AIDS with prior consent, is one of the outreach activities of the counsellor. The visit should be planned based on need, such as loss of contact, or non-compliance to the prescribed services. The counsellor reports to the medical officer in charge of the SA-ICTC.
The medical officer in charge, lab technician and the counsellor at various levels of the ICTC are responsible for supportive supervision of a case. A counsellor at an SA-ICTC centre explained how various people were involved in the follow up of a case. “The report of the person testing positive for HIV has to be submitted only after it has been reviewed by the medical officer in charge.
The district project manager and district supervisor oversee the case to ensure that the case is followed up. We submit our reports on a daily basis to TANSACS and discuss the positive cases tested and follow-up status in the review meetings with the officials,” the counsellor said. “Unless we look into the history of every missed case, we can’t comment on where this system has failed.”
However, the counsellor explained some of the stumbling blocks ICTC staff face in reaching persons who have tested positive. For instance, some people give fake addresses. Even after the commencement of treatment, some people ‘disappear’ by changing their contact number. “I have seen cases where the mobile number was changed. The ART (Antiretroviral Therapy) centre staff will contact me asking for the patient’s whereabouts. Of late, I have started casually asking for Aadhaar card or driving license so as to avoid being duped. Then, some people are willing to show up when called and others refuse,” the counsellor said.
Another counsellor said that counsellors would make a visit to the home of the HIV+ person, identifying as a health worker, if the person didn’t turn up at the ICTC. They would also engage NGOs to track them down if the person has given a fake address or is a migrant worker. “Despite this, we still miss some cases,” the counsellor said.
TANSACS project director Dr K Senthil Raj admitted that this was indeed the case. “Over 95 per cent of people who test HIV positive are put on ART drugs. Only the remaining five per cent is lost in follow-up. In some cases, even when an NGO tried to find them, they couldn’t be traced,” he said.
What’s the fix?
Stressing that there was already a system in place and that NACO protocols were strictly followed, Senthil Raj said, in the wake of the Virudhunagar district incident, the government was thinking of strengthening the system further. “After expert committee constituted to probe the Virudhunagar incident submits its report to the government, we will analyse and make rules and laws more stringent,” he said, without going into specifics. However, he did not explain what was being done to close the gap between blood found testing positive for HIV and the donor being informed of their HIV status.
Not the only problem
In the Virudhunagar incident, the donor whose blood had tested positive for HIV in 2016 did not learn that he had the virus till 2018. Before he learnt of his HIV status, he had donated blood at a Sivakasi Government Hospital on November 30. His blood was somehow labelled HIV negative and transfused to a 23-year old pregnant woman on December 3 at the Sattur Government Hospital.
On December 13, after learning of his HIV status, the 19-year-old donor informed the Sivakasi hospital but by then it was too late. The youth died on December 29 of complications related to his attempt to commit suicide. How had his blood been labelled HIV- has been the question on everyone’s minds. Increase in workload and shortage of lab technicians, medical experts said, have led to NACO guidelines remaining only on paper, even if officials insist they are strictly followed. According to the health department, over 8 lakh people donate blood annually in Tamil Nadu, 4 lakh in government hospitals alone. Over 12 lakh benefit from blood donations.
According to the Guidelines for Blood Donor Selection and Blood Donor Referral framed by the National Blood Transfusion Council in 2017, a blood donor counsellor should provide pre-donation information, pre-donation counselling, administer a donor questionnaire, ensure a health check-up, provide counselling during blood donation, and post-donation counselling to donors at blood banks or camps. A medical officer should review the donor’s health and perform a physical examination. It is the medical officer who takes the final decision on whether the person can donate blood.
A regular blood donor told Express that he had never received any such counselling, nor had he ever been subjected to a physical examination prior to blood donation. “In our college, many NGOs come and regularly conduct blood camps. They will check my haemoglobin count, blood pressure, ask what my weight is, make me fill up a questionnaire, take the blood, give one biscuit packet and juice after blood donation and send us off. I have never been counselled post-donation,” said B Ramesh Lal, a 31-year-old faculty at a private college.
“During medical camps because of the crowd, it is difficult to give individual care to the donors. We give the questionnaire to fill and then take blood and later test it for HIV, Hepatitis B and C, syphilis and malaria,” said a medical officer attached to a government hospital blood bank. These are the routine things done to those who donate blood at blood banks in government hospitals, said a blood bank laboratory technician at a government medical college hospital in Chennai.
However, P Kousalya, president, Positive Women Network alleged, “NACO guidelines are only on paper, in reality, there is no manpower to handle the increasing volume of donors. Also, reduction in fund allocation by the NACO is ruining the system slowly.”
“In every district, there is a designated district blood transfusion officer who oversees day-to-day activities related to blood donation and transfusions in government as well as private hospitals. Every quarter, quality assessment of kits is being done by the technical team. Protocols are being followed,” Senthil Raj, who is also member secretary of the State Blood Transfusion Council, said. He dismissed the allegations that there was a manpower shortage.