Dip in HIV tests, diagnosis during pandemic: Experts fear surge in advanced infections
The pandemic and the ensuing lockdown restrictions severely impacted human immunodeficiency virus (HIV) testing in Mumbai. Data from the Mumbai District AIDS Control Society (MDACS) shows that the testing for the infection has dropped by 50% from 475,540 tests in 2019-2020 to 236,392 tests in 2020-2021
The pandemic and the ensuing lockdown restrictions severely impacted human immunodeficiency virus (HIV) testing in Mumbai. Data from the Mumbai District AIDS Control Society (MDACS) shows that the testing for the infection has dropped by 50% from 475,540 tests in 2019-2020 to 236,392 tests in 2020-2021. The reduced testing had a direct impact on the detection of new cases — the city recorded 4,473 new cases in 2019-2020 and the number fell to 2,063 in 2020-2021.
With the decline in Covid-19 cases and the lifting of lockdown restrictions, Mumbai’s HIV programme has shown some signs of recovery. From April to October this year, the city has conducted 190,691 tests and made 1,659 new cases detections.
However, the experts are now worried about a surge in the cases of advanced disease among the population that remained undiagnosed. “We started seeing some recovery in the programme from July onwards when restrictions were largely lifted and transportation norms were relaxed,” said Dr Shrikala Acharya, additional project director, MDACS. “But we are worried about people coming with advanced stages of the infection, as they may have delayed their testing and treatment,” she said.
HIV attacks the immune system. Its chronic and advanced stage is known as the Acquired Immunodeficiency Syndrome (AIDS), which is now termed Advanced HIV Disease (AHD) by the World Health Organization.
Mumbai has 36,674 people living with HIV AIDS (PLHA) who are on lifelong anti-retroviral therapy (ART). Many faced disruptions in their treatment regimen as they migrated back to their hometowns or could not access the ART centres due to the lockdown restrictions and fear of the SARS-CoV-2.
“Treatment retention was our main focus in the past 20 months,” said Dr Acharya, adding that a notification allowing the patients to travel on trains by showing the treatment card helped tremendously. She said that her staff was in touch with the patients on phone, to coordinate and help them access the treatment. In addition to this, the MDACS, for the very first time, used postal services to deliver drugs to 96 patients on ART and nearly 300 patients were delivered the medication by MDACS staff, by meeting them at a public place nearest to their homes.
“During the surging Covid-19 waves, testing and new case detections almost came to standstill not just in Mumbai but across the country,” said health activist Ganesh Acharya adding that the pandemic has led to a severe setback to the HIV programme and the government will now require to undertake intensive interventions. “Some of the basic, cheap drugs given for opportunistic infections found in HIV patients are not available in centres. Such lacunae will only lead to worse outcomes,” he said.
Tuberculosis is the number one cause of mortality among HIV/AIDS patients. But the current preventive therapy — known as the Isoniazid Preventive Therapy (IPT) — has a very high pill burden with 180 doses for six months. “There is another promising preventive therapy known as 3HP, which includes a course of 12 doses spread over 12 weeks, but that is not available in India,” said Eldred Tellis, director of the Sankalp Rehabilitation Trust, a non-profit that works in the field of prevention of drug abuse and blood-borne diseases. “The added burden of the undiagnosed population during the pandemic also calls for better strategies to tackle the existing loopholes like lack of drugs, rolling out effective drug regimens etc,” he said.