‘27% pregnant women not screened for HIV in 2021-22’
PATNA: At least 27% of women in Bihar who reported pregnancy during financial year 2021-22 have not been screened for human immunodeficiency virus (HIV), as per health department’s records that shows there were 30.43 lakh antenatal care (ANC) registrations during the same period, officials monitoring the AIDS control programme in the state said.
This goes against the Centre and the state’s mandate to screen all pregnant women for HIV as part of efforts to eliminate the transmission of the disease from mother to child during pregnancy.
HIV causes acquired immunodeficiency syndrome (AIDS), a chronic and potentially lifethreatening condition.
Against this backdrop, Bihar, with 67,601 people living with HIV (PLHIV) on anti-retroviral treatment (ART) till March this year, ranks eighth in India after Maharashtra (220,436),
Andhra Pradesh (198,698), Karnataka (171,647), Tamil Nadu (121,955), Uttar Pradesh (96,205), Telangana (87,217) and Gujarat (74,457), as per data sourced from the National AIDS Control Organisation (NACO).
Bihar, which records around 8,000 new cases of PLHIV annually, ranks third, after Maharashtra and Uttar Pradesh, in new HIV infections every year, despite a 27% reduction in new infection rate from 2010, said Dr S Siddhartha Shankar Reddy, health specialist of Bihar chapter of UNICEF (United Nations International Children’s Emergency Fund).
Officials attribute over 25% testing gap to underreporting by private maternity clinics. The remaining 2% is due to lack of testing in case of non-institutional, normal vaginal deliveries either at home or at remote areas.
“Private nursing home owners are either not screening pregnant women for HIV or are testing them but not sharing data with the government. In absence of any legislation, we cannot force them to share with us data of HIV tests conducted. The gap between the number of ANC registrations and documented HIV tests shows up as ‘untested cases’ in government records,” said an official. “We achieved 73% HIV testing of the total 30.43 lakh ANC registrations in 2021-22. This was more as compared to the previous financial year (2020-21) when we tested 67% of the 31.36 lakh pregnant women registered for ANC.”
The HIV testing percentage of pregnant women increased from 60.34% of the 32.48 lakh ANC registrations in 2018-19 to 65.54% of the 33.92 lakh ANC registrations in 2019-20.
Bihar’s HIV positivity among pregnant women has hovered between 0.02% and 0.03% since 2018-19. Among the general population, the figure has come down from 1.50% in 2018-19 to 0.92% in 2021-22.
The Patna chapter of the Federation of Obstetrics and Gynaecological Societies of India (FOGSI), a forum of 870 gynaecologists, said the government guidelines on reporting of HIV testing were not clear.
“All pregnancies are screened for HIV. However, there are no clear-cut guidelines regarding reporting of HIV testing to the government. It may also be due to lack of awareness among doctors, as the authorities have not done enough to sensitise them,” said Dr Kumari Manju, treasurer of the Patna Obstetrics and Gynaecological Society and also professor of obstetrics and gynaecology department, Patna Medical College Hospital, the state’s largest health-care facility having around 2,800 beds.
“It is clear in case of radiologists that they have to report to the district’s civil surgeon about every ultrasonography test of a pregnant woman. There is no such defined reporting channel for HIV testing. Even if there is one, the government has not done enough to disseminate information,” she said.
Dr Vinita Singh, president of the Patna Obstetrics and Gynaecological Society, said a sensitisation programme for gynaecologists has been planned with the Bihar State AIDS Control Society (BSACS), the UNICEF and the FOGSI in Patna later this month.
“Documentation is poor not only in private clinics but also in government health facilities of Bihar. Most gynaecologists do not know they have to report about HIV testing to the government,” she said.
Private sector accounts for nearly 20% ANC registrations in Bihar, as per government records. Anshul Agarwal, project director of the Bihar State AIDS Control Society, defended the government.
“We have held at least five meetings with different district representatives of the FOGSI to sensitise doctors about HIV testing since 2018-19. Besides, 32 meetings on elimination of mother to children transmission have been conducted during this period with district officials, members of the civil society and representatives of FOGSI. We have planned more such sensitisation programmes engaging doctors in future,” said Agarwal.
“We have also signed memorandum of understanding to share HIV testing data with 501 of the 1,200 reputed private maternity clinics, hospitals and diagnostic centres that the BSACS had identified two years back in Bihar. We hope to bridge the HIV testing gap among pregnant women soon,” he said.