Seroprevalence of HIV among blood donors in a teaching hospital at Kolar, South India.

Sir,

Mandatory screening of all donors for such infections has significantly reduced the problem, but not completely eliminated such risk because the donor may be at the window period or may lack sufficient response for our tool to detect it. The risk of such infection is clearly higher in recipients of blood obtained from a commercial source, compared to blood from volunteer donors.[1]

A 10-year study of the blood bank donor records from January 2001 to December 2009 was undertaken in our institute, located in Kolar, which serves as a tertiary center. Donors were screened according to the standard operating procedures (SOP).

All the units were screened for HIV-1 and 2 by enzyme-linked immunosorbent assay (ELISA) using Vironostika HIV Uni-Form 11 Ag/AB Elisa kit, which is a IV generation HIV screening test based on one-step “sandwich” method. For confirmation, Western Blot (J - Mitra Co., India) was done. Test methodology was followed as per the kit insert. The results were interpreted as per the World Health Organization (WHO) guidelines. The seropositive cases were referred to the Integrated Counselling and Testing Centre (ICTC).

Total number of donors was 36,700 (100%), with male donors 35,000 (86%) and female donors 1700 (14%). First-time donors were 16,700 (85%) and repeat donors were 20,000 (15%). The seroprevalence of HIV was 0.027 (95% CI = 0.15-0.25). There were no significant differences among the different categories of age, sex, and time of donation (P > 0.05). The seroprevalence of HIV was marginally higher in volunteer donors than in replacement donors (P > 0.05).

HIV testing is offered by both government and private institutions with no uniform, national information grid for HIV testing. Hence, prevalence is estimated based solely on sentinel surveillance mechanism.[2] The majority of the laboratories in India do not participate in quality-assurance and quality-control programs.[3] Results are often inaccurate because of the following reasons: Expired test kits are used, kits are not stored at the correct temperature, air-conditioning is erratic, and tubes, tips, and other equipments are often recycled. In addition, laboratories do not provide pre-and post-test counseling facilities.[3]

Diagnosis of HIV infection remains a challenge because of unresolved ethical, technical, and personnel issues. Health counseling is a new concept in India.[1] Rural population is much less proactive in seeking health care benefits. HIV counseling involves discussing the sexual lifestyle of the clients which again remains a taboo and is considered as a social stigma.[4] HIV testing is neither anonymous nor confidential, with scant regard for the privacy with the laboratories readily providing the test results without proper verifications.[2]

The exploding epidemic in India calls for radical and courageous steps and a departure from previous public health planning.[5] We need to remind ourselves of the enormous task at hand: The establishment of quality-assured HIV testing centers, expansion of clinical facilities that provide HIV care, increased access to drugs with attendant laboratory facilities, and enhanced psychosocial support for those living with or affected by HIV.[5]