Blood spots and politics

A couple of years back, a health department official calculated that every day around ten babies are probably born with HIV in Indonesia. We still don't find many - only a total 228 have been reported as at the latest report, although there has been a 12% increase in reported cases over the last quarter! But in my travels I'm hearing of more and more cases, although clearly most cases remain undetected and contribute to the overall 35/1000 infant mortality rate here.

Babies born to HIV-positive mums inherit the mother's antibodies, and so a standard HIV test (which looks for antibodies) will show a positive result until the mother's antibodies are lost, which can take up to 18 months. So we can't be sure if a baby is infected until the age of 18 months. As a result, antiretroviral therapy (ART) is often delayed 'until we can be sure'. The problem is that, if babies are infected, the chances are high that they will die before celebrating their first birthday. (Forgive me if you already know this!)

A recent trial in Africa found that HIV-infected babies should start ART as soon as possible after birth, even if they don't show any symptoms. So a better test is urgently needed.

At a meeting late last week, the same official said the government is developing a policy that all babies born by HIV-positive mums should be tested by PCR (which looks for the virus) soon after birth. If they are found to be infected, they should be started on ART immediately. Ah, but a PCR test here costs Rp 850 thousand (almost US$100) and there are few labs with the equipment needed. Who pays?

Currently Spiritia has limited funding for this purpose - probably only enough for another 20 or so kids. But a couple of years back, we discussed this with the kindly folks in Australia. They were developing a system which could provide a diagnosis based on dried blood spots (DBS). Basically (if I understand it right), you prick the babies heel, and sop up a drop of blood onto filter paper. This paper can then be sent through the normal mail to a lab able to carry out the test, at a cost much lower than the normal PCR. The Australians even offered to do the test for free if we could send the DBS. Easy, you'd think. No transport of hazardous blood, no need for a courier, low cost.

Ah, but we forgot the politics! As you may have heard, there's been a problem with samples of bird flu virus being sent overseas. As a result, there is strict control over sending any sort of samples to other countries. So although we could start yesterday, doing so would offend against the regulations. So the testing will have to be done in country. It'll start Real Soon Now!

Babé