Monitoring equipment in critical short supply

Despite the government’s plans to triple the number of HIV/AIDS patients under treatment, many of India’s clinics don’t have the equipment to monitor them, heightening the risk they could develop and pass on drug-resistant strains of the virus.

If that happens, patients could require more expensive drugs, which can drive up the price of treatment tenfold, say experts.

Some centres lack equipment that can read blood samples for CD4 cells, which boost the immune system and fight infections. The machines, which cost $30,000-100,000 (Rs12-40 lakh), also indicate whether a patient needs drugs and if they are working.

CD4 testing is “an absolute must” for those on drug treatment, says Dr N. Kumaraswamy, chief medical officer for the YRG Centre for AIDS Research and Education, a non-profit that runs a major treatment centre in Chennai. “Without it, we can’t tell what is happening. As the drugs work, the patient’s CD4 count goes up and their immune system improves.”

India’s need for sophisticated equipment inspired a partnership among the National AIDS Control Organization (Naco), the Clinton Foundation and medical equipment company Becton Dickinson India Pvt. Ltd to install subsidized or free machines in about 50 hospitals and clinics. This helped bring down the cost of the test significantly on a national basis—but a large gap remains on the ground.

The Chennai-headquartered INP+, a network for people living with HIV/AIDS, says one of its goals is to see CD4 testing available in every district with a known presence of the disease, said programme manager Christhurha P.

Often, patients must travel long distances for the test, which doctors recommend undergoing twice a year and if treatment changes.

“Suppose you take just Chennai. People come all the time from parts of Andhra Pradesh, Maharashtra, Karnataka where they can’t always get access,” said Christhurha. “You can’t imagine the state of affairs in some places.”

In Goa, considered at-risk because it borders high-prevalence areas, one machine at the state medical college serves the entire state and is inoperable for long periods at least several times a year, according to Zindagi, the network for people living with HIV/AIDS there.

Those who haven’t been travelling for tests have been going without, said Mahesh Govkar, a management information systems officer.

A hospital official said the machine is in working order but recently experienced some problems. Dr S. Rodrigues, head of microbiology at the medial college, said the nine-year-old machine was repaired quickly, but declined to specify how long it was out of service.

The machine is only partially covered under the partnership with Clinton and Naco, said a Becton Dickinson representative. Free repairs were performed when rats chewed through the wires in May, she said.

With about 3% of the country’s 2.5 million to three million AIDS patients on treatment, India probably performs about 250,000 to 300,000 CD4 blood tests per year, according to experts. About one-fifth of the Rs11,585 crore national plan to fight the disease is dedicated to patient treatment and care. The plan envisages the expansion of the number of government treatment sites to 250 from about 100 over the next five years. But experts wonder how that can happen with such limited equipment.

In 2000, Delhi’s Dr Ram Manohar Lohia Hospital received a machine for free from Naco, the arm of the health ministry tasked with fighting the epidemic. The machine’s capacity is strained and the patients keep coming, says Dr Charoo Hans, head of microbiology. The hospital has asked Naco for a second machine.

“Not only because the government is giving the drugs free, but because of more knowledge about AIDS and where you can go to get tests and treatment, people are now coming forward,” said Hans.

With its in-house clinic treating 300-400 patients a month, several other clinics feed their samples into Ram Manohar Lohia’s lab.

Becton Dickinson, a Rs275 crore company, donated $1 million to the Clinton Foundation for Naco programmes. It also provides free training and support as part of a 2005 agreement with Naco and the global non-profit run by former US president Bill Clinton.

That heavily subsidizes both the cost of owning the machines and the cost of individual tests, down 75% to Rs250 from Rs1,000 about a decade ago, said Sunit Trivedi, general manager of biosciences for the company.

The government wants to expand the network of CD4 machines into district hospitals, according to experts. “People shouldn’t have to travel long distances to get a simple, essential test done,” said Vishal Brijlal, director of the foundation’s Indian HIV and AIDS programme.