Re: On NACO's promotion of HIV testing

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Dear Forum Members,

Re: /message/7917

Further to my posting on the same subject a few days ago I wanted to add few

more facts/etails as follows: -

Extract from WHO/ UNAIDS- WHO/CDS/CSR/EDC/2001.16UNAIDS/01.22E

3.1.1 Advantages and Disadvantages of Whole Blood, Serum, and Plasma Whole

blood, serum, and plasma, which can be collected by enipuncture or finger stick

(see 3.2), have the following advantages and disadvantages in HIV testing:

Advantages

Have higher concentrations of HIV antibodies than urine or oral fluids (Rose et

al.1997).

Have potential for additional routine testing (e.g., syphilis, hepatitis B,

hepatitis C) from a single specimen.

Have potential for special studies (e.g., HIV typing [HIV-1 vs. HIV-2], HIV

subtyping,antiretroviral resistance).

Are easy to collect and test in clinical settings with a laboratory and a

trained phlebotomist.

Are easy to collect in nonclinical settings (whole blood from finger stick).

Disadvantages

Require invasive collection technique.

Require skilled technician (for collecting and processing serum or plasma).

Compared with urine and oral fluids, require more equipment ( e.g., needles,

tubes, or lancets) and biohazard waste facilities.

Is difficult to collect serum or plasma in nonclinical settings if venipuncture

is required.

Compared with oral fluids, pose a greater risk to health-care workers and

technicians through inadvertent exposure, both because of higher antibody

concentrations and the use of sharp collecting devices " .

2. Use of invasive technique is full of risk- risk to the individual (volunteer)

and healthcare worker.

3. It is well known that in India, about 30 - 50 % one time use injection

equipment (plastic Syringes) come back into circulation, and reuse of these

syringes is one of the causes of spread of blood and body fluid transmissible

diseases, including HIV. It is also well known that needle- stick injuries are

common. Under the circumstances will it be right to put such large population at

risk? Has health impact been assessed of such a programme?

4. If everyone in India volunteers for the test it would throw up huge amount of

plastic syringe waste to be taken care of- disinfection and disposal. Even if

A/D syringes are used (which I doubt since availablity does not meet the

perceived requirement even for HBV vaccination), it would require to be disposed

(even if disinfection procedure at the point of generation is considered 'not

required', as in case of A/D syringe waste), and it would be a very large

quantity. Disposal strategy should be worked out before such a massive

surveillance is attempted. Indiscriminate disposal and its impact on already

problematic healthcare waste disposal should be assessed beforehand.

5. Has the ICMR been consulted?

6. Has ethical clearance been obtained?

7. Are volunteers explained associated risks (including risk of infection by

contaminated syringe equipment), and the fact that one test may not be

sufficient?

8. Has untoward psychological effects on volunteers when told that they may be

'positive' been considered?

9. If NACO decides to go ahead they must satisfy that patients' rights have been

addressed.

10. At worst there may be about 6 million people living with HIV (estimates vary

between 2.3 - 5.6 million). Is it logical to test more than a billion just to

ascertain how many more could be 'positive'? Is the exercise worth it with so

many associated risks?

Knowing that proper bio-medical waste management is still a far cry such a

program will be a potential hazard. I feel this programme should be withheld,

and withdrawn immediately.

I invite all to share their views.

Thanks,

Air Mshl Lalji K Verma AVSM (Retd)

President ISHWM

253, AFNO Enclave, Plot-11, Sector- 7, Dwarka, New Delhi - 110075

Tele +91-11-25094702, +9312626462

e-mail: <lalji.lkv2007@...>