Increased self-testing could make a profound difference to managing AIDS in India: Dr. Jalpa Thakker

Although India has the third highest number of people living with HIV (PLHIV) globally, the epidemic is largely concentrated among key populations i.e., men who have sex with men, female sex workers, hijras /transgender individuals, and people who inject drugs.

The Indian Government, through the National AIDS Control Organization (NACO), focuses much of its efforts on reaching these groups, providing access to HIV testing, expanding HIV treatment for PLHIV, and curbing the spread of HIV within and outside of these communities.

The NACO program has been reaching vulnerable populations since 1992 and has been able to achieve significant control over the epidemic. India has inched closer to achieve UNAIDS 95-95-95 goals. As per the 2019-2020 Sankalak report published by NACO, 76% of PLHIV know their status, 84% of PLHIV who know their HIV status are on treatment and 84% PLHIV on ART are virally suppressed.

Programs like ACCELERATE assist NACO in addressing gaps in programming and outreach among at-risk populations, including key populations and PLHIV.

People living with HIV should start antiretroviral treatment (ART) at the earliest to remain healthy, live longer, and prevent HIV transmission. ART stops the HIV virus from replicating in the blood, and if taken regularly, reduces the count of HIV virus to almost an undetectable level (Undetectable=Untransmittable). To keep the viral load to undetectable levels and avoid health complications, it is crucial to continue taking ART every day for the rest of one’s life. Further, it is important to maintain a healthy lifestyle through a nutritious diet and exercise.

ART is available free of cost through India’s public ART centers spread across 670 sites in India. With the advancements in treatment technology, PLHIV can live a full and healthy life by maintaining lifelong adherence to ART.

On December 1, World AIDS Day this year, Project ACCELERATE launched Safe Zindagi (www.safezindagi.in), an online platform that offers information and services for HIV testing, prevention, treatment, and retention in care through public sector and private organizations of India, in collaboration with various community-based organizations.

Safe Zindagi is a comprehensive demand generation and service delivery online platform for risk assessment, innovative prevention, and testing services (like PrEP and HIV Self-Testing) with linkage to treatment including tele-consultation with medical and counseling professionals to ensure adherence and retention on care. Safe Zindagi has a team of trained counselors, ready to support users with testing services virtually, answer their questions, offer counseling, and arrange linkage to doctors and health centers. The platform is currently active in 49 cities across 20 states of India.

Users can order HIV self-testing kits on Safezindagi.in and get these couriered to a convenient location or even pick up the kits from nearby listed pick up points. They can choose to test themselves on their own or under expert supervision. Through Safe Zindagi, we have created a virtual one stop shop that will meet people “where they are” to drive access to services and facilities they need, all while giving them the freedom of choice and comfort.

In Telangana and Maharashtra where Project ACCLERATE is operating in seven districts (Pune, Thane, Hyderabad, Ranga Reddy, Mahbubnagar, Karimnagar and Nalgonda) there was an interruption in services for people living with HIV as some of the facilities were converted into Covid-19 hospitals.

However, the National AIDS Control Organization (NACO) immediately passed some very progressive policies for home delivery of anti-retroviral viral medicines and multi-month dispensations – providing medicines for more than two months to avoid frequent visits to the ART centres during the COVID pandemic.

New HIV patients had to wait and found it difficult to travel due to restrictions to start treatment. Thus, there was almost a 40 per cent decline in the OPD influx at the HIV testing and treatment centres due to restrictions in travel. Those patients who were already on treatment were provided highly efficient home delivery by government facilities.

Test, track and treat is a strategy applicable in acute communicable diseases to contain the source of infection and interrupt transmission to potential individuals.

AIDS, being a long-term manageable disease, requires more focus on the Test and Treat Strategy. During Covid-19, online platforms offering HIV testing, and tele-consultation services continued to provide services to those in need.

Project ACCELERATE’s Safe Zindagi online platform provides counselling and HIV testing/ screening services through government and private facilities. The national policy outlining DSD guidance for HIV treatment in India recommends Multi-Month Dispensation (MMD) for “stable” clients as per NACO Guidelines. These services are provided through the network of ART centres. MMD and community distribution of ART during Covid-19 supported people living with HIV to continue treatment irrespective of the lockdown.

There was fear of COVID transmission so frontline health workers took all precautions and patients had access to virtual counselling. These adaptations were especially helpful for people in Covid-19 containment zones where movement was severely restricted. Special permissions from government authorities facilitated home delivery of ART.

Many people living with HIV felt that it would be beneficial to maintain MMD and community distribution as these options reduce transportation costs, time taken off work and the resulting loss of wages, and exposure to Covid-19 at hospitals. For children living with HIV, community distribution of ART and MMD helped ensure ART adherence through the pandemic and supported favourable treatment outcomes.

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