World Bank To Hire Consultants To Investigate Concerns About HIV Testing Kits in India, Washington Post Reports

The World Bank plans to hire two independent consultants to investigate concerns about the reliability of some HIV testing kits in India, Graeme Wheeler, the bank's managing director, and Kees Kostermans, a medical expert who oversees the bank's South Asia public health operations, said last week, the Washington Post reports (Johnson, Washington Post, 10/13).

The move follows allegations from HIV/AIDS specialist Kunal Saha -- who was commissioned by the bank earlier this year to investigate an HIV-prevention program in India -- that some hospitals and blood banks in the country were using faulty diagnostic test kits to screen for HIV. Saha, a professor at Ohio State University, traveled to India as a bank consultant on a team investigating potential problems with the $230 million AIDS control project funded by the World Bank between 1999 and 2006. Saha and two India-based medical specialists in March and April visited hospitals and blood banks in major cities, gathering laboratory documents that Saha said indicate the facilities were using defective diagnostic testing kits. He cited 2004 and 2005 test results from two Indian hospitals in which blood samples that were known to be HIV-positive tested negative during a second, confirmatory test performed with defective kits. Saha said he found a document suggesting that questionable kits were available for use as late as April despite public statements from Indian health workers and World Bank officials in the country that defective test kits were no longer available.

The bank has not released a draft report from the visit by Saha and the other two doctors. According to a copy of an April 26 e-mail, the draft notes that there were significant quality issues with HIV tests at blood banks and testing centers between 2003 and 2006. Saha said he discussed the matter with former World Bank President Paul Wolfowitz before he left the bank and in August briefed staff members at the bank about his concerns. This year, bank officials approved an additional $250 million to a new HIV program in association with India's National AIDS Control Organization after regarding the previous program as "satisfactory" (Kaiser Daily HIV/AIDS Report, 9/28).

Reaction
Saha has criticized World Bank officials for not acting more quickly to regulate NACO, the Post reports. He also has called on the bank and NACO to issue a nationwide public health alert about potential problems with the HIV tests. "What is the point in assigning new consultants to revisit the same issues?" Saha wrote in an e-mail to Wheeler on Friday, adding, "It is regrettable that in spite of the grave nature of these complaints that obviously pose serious risk of transmitting HIV to innocent citizens in India, NACO has shown little inclination to act expeditiously to solve this issue."

Kostermans said the agency is working with Indian officials to ensure the safety of the HIV testing program. He said the bank needs to examine a larger sample of data to identify and avoid future problems, the Post reports. Saha is a "medical doctor, I am a medical doctor," Kostermans said, adding, "We have the same concerns." Kostermans said the bank has not determined if the consultants will interview Saha. He also said that finding people in India who might have been exposed to HIV can be a logistical challenge because of inconsistencies in record-keeping and the time that has passed since Saha's investigation.

Beatrice Edwards, who monitors World Bank operations for the Government Accountability Project and is working with Saha, said the bank's response has been inadequate. She added that the "major issue is to protect public health, not protect the reputation of NACO, which seems to be the priority." Wheeler and Kostermans did not say when the consultants will be hired, the Post reports (Washington Post, 10/13).