Lab fails Karnataka's HIV-positive patients

Over 300 patients in a quandary as lone testing lab in state stops functioning

Three-hundred HIV patients in Karnataka are deprived of treatment, for the State’s only National Aids Control Organisation (NACO) recognised viral load test site at St John’s Hospital here has stopped functioning for the last three months.

Although drugs are available, they cannot be administered to the patients without the critical viral load test report. Among those in this dangerous period of waiting is Rajashekar (name changed), who had tested positive for HIV. His wife had died earlier after she contracted the virus through a blood transfusion. To add to his suffering, he developed resistance to the first-line Anti-Retroviral Therapy (ART).

He can now proceed to the second line of therapy only after undergoing a viral load (amount of virus in the blood) test. That test will have to wait due to the lab problem.
While there are over 300 HIV positive patients in Karnataka confronted with the problem, the number could go up further as there are an estimated 4,000 patients undergoing the second-line ART in the State. Sources told Deccan Herald that the testing site, jointly monitored by NACO and the Karnataka State Aids Prevention Society (KASAPS), at St John’s Hospital stopped functioning for reasons which are not strictly technical.

The equipment at the lab was set up by St John’s Research Institute and is run using reagents and kits supplied by NACO. The lab stopped functioning after its agreement with NACO for the viral load test failed.  The lab, headed by Dr John Kenneth at St John’s Research Institute, a part of St John’s National Academy of Health Sciences, is the only government-funded testing site in the State for the second-line ART. Bowring Hospital is the only distributor for drugs.

All HIV positive patients referred for the second line of ART from various centres have no access to drugs. As per NACO guidelines, patients are required to undergo a viral load test to ascertain the virus count before the second-line ART drugs are administered.
Sources said there is no shortage of second-line ART drugs at Bowring Hospital. But without the viral load testing, patients are forced to return without any treatment.

“I was told that the lab is under repair and that the test could not be carried out. Hence, I will have to wait until the test is performed, as the drugs available are not suitable to me. I have been surviving without proper drugs for the past seven months,” said a patient.

When Deccan Herald contacted the Bowring Hospital authorities, a top official with the hospital’s ART centre feigned ignorance about the situation. A doctor attached to an ART centre in Bangalore expressed concern over the inability of KASAPS and NACO to gear up to address the problem. “We cannot risk people’s lives. It is an irony that we who advise patients not to miss even a single dose of drugs are today faced with patients who have not been provided with medicine,” he said.

KSAPS Project Director Salma K Fahim said, “ We have sent a letter to St John’s Hospital seeking the reason for the breakdown of lab facilities and promised all assistance required.” She said It would take the KSAPS at least two months to set up a new test site with its own equipment. Moreover, a new site would come up in North Karnataka soon.

However, the authorities at St John’s Hospital declined to comment on the issue.
Setting up a new testing facility, sources said, will take at least another four months. Incidentally, there exists an alternative system in Bangalore for doing the viral load test, which uses a different platform.

Though the KSAPS is aware of the alternative site, it is still awaiting the NACO's approval.