A 23-year-old pregnant woman in Tamil Nadu tested positive for HIV after receiving a unit of blood at a government hospital blood bank, indicating glaring lapses in screening procedures. The blood was donated on November 30 and transfused to the pregnant woman on December 3.
Testing all donated blood units for a number of transfusion-transmissible infections, including HIV, is mandatory in India. The ELISA test used in all blood banks to screen for HIV has very high levels of sensitivity to diagnose samples positive for the virus. It can be said with certainty that the blood bank had failed to screen the blood for HIV. The question of testing the donated blood for HIV during the window period (the time between potential exposure to HIV and when the test reveals for sure if the person has HIV) does not arise as the donor’s HIV-positive status became known in 2016 when he donated blood at the same blood bank.
Since 2004, prior to donation, all blood banks are required to obtain from donors written consent as to whether they wish to be informed about a positive test result. In case a donor tests positive for HIV, blood banks are required to refer the donors to designated voluntary counselling and testing centres (VCTCs) for disclosure and counselling. That the blood bank tried but failed to contact the donor in 2016 indicates that the donor had consented to be informed of a positive result.
In a further tragic twist, he found out elsewhere that he was HIV-positive, and dutifully contacted the hospital on December 10, but his blood had already been transfused by then. On Sunday he passed away after consuming poison.
Studies show that blood banks in India have a success rate of less than 50% in contacting donors who have tested positive for transfusion-transmissible infections. Under the 2004 National AIDS Control Organisation (NACO) Action Plan, VCTCs are required to inform the blood bank of a donor’s HIV-positive status to stop the person from donating blood in the future only when the confirmatory test done at the VCTC too is positive. Since only half of the consented donors are contactable and even fewer visit a VCTC, it is imperative that NACO finds a viable alternative without compromising the donor’s identity.
The focus should also be on creating awareness among donors to visit a VCTC to confirm their HIV status when alerted by blood banks. After all, timely confirmation helps donors start on early treatment to keep the virus under check and take precautionary measures to reduce the risk of infecting their partners and others through sexual and other kinds of contact and through blood donation.
After winning a protracted battle to keep away professional donors from donating blood by encouraging voluntary donation, it is time blood banks and NACO worked to make safe blood availability a reality at all times.