MSF OCBA in Bihar

MSF has been working in Bihar treating kala azar since 2007 with a gradual transition of the project to focus on HIV-kala azar co-infected patients. After treating more than 13,000 patients in Vaishali, MSF began focusing on the treatment of kala azar-HIV co-infection in partnership with the Rajendra Memorial Research Institute of Medical Sciences (RMRIMS) in Patna in 2016. 

Further, MSF has collaboration with All India Institute of Medical Sciences (AIIMS), Patna and Bihar State AIDS Control Society (BSACS) with whom MSF is conducting two qualitative studies focusing on perception of quality of life by VL-HIV co-infected patients and the stigma which PLHIV group faces at health facilities and in community. Anecdotal evidence from different sources suggests that there is a very high level of stigma attached with HIV in Bihar. Data collected from health structures show that PLHIV often seek for health services with advanced HIV bearing multiple opportunistic infections and complications. To make the matter worse, these patients do not get adequate and prompt healthcare, this leaves them with no option but succumb to their illness at home. Hence, MSF strives to implement a project for treating life threatening diseases in people living with HIV in Bihar in collaboration with BSACS and Government of Bihar (GoB). 

This seamless partnership for over more than a decade with the Government of India, the State Government and other stakeholders has enabled MSF to provide best quality of care, free of cost treatment to the people of Bihar without any discrimination on the basis of caste, colour, religion or economic status. The major beneficiaries of MSF services have been the most vulnerable and the most in need.

Working in HIV-VL confection, has led us to realise the systematised discrimination against HIV patients by the community and even by health care providers with them often being excluded from healthcare outside of government ART centres. Bihar, with a population of 110 million people is one of the largest states and least economically developed. It has an estimated adult HIV prevalence in the range of 0.21– 0.25% accounting for 150,000 PLHIV and 7,514 deaths (5,794-10,575) annually. By March 2018, 46047 PLHIV were on ART in Bihar, number representing under 50% of all diagnosed PLHIV in the state, this is far from the global goal of having on ART the 90% of all diagnosed as HIV infected. 

As per July 2017 WHO guidelines for those above 5 years of age, Advanced HIV disease is defined as presenting for care with a CD4 count below 200 cells/mm3 or presenting with an AIDS-defining event, regardless of the CD4 cell count. All children less than 5 years are considered to have Advanced HIV Disease. 

The mortality rate of advanced HIV disease is estimated to be between 30 to 40%. In Bihar, within MSF´s existing HIV related project we have a number of observed cases bearing severe disease where specialized medical care is required including palliative and end of life care for some among them including psychosocial support for patients and family members. In such situations, where we have tried to refer the patients into the public or private sector, they have been refused admission, ignored, and ultimately sent home to die. 

COVID-19 MSF response 

Due to the ongoing COVID-19 pandemic Doctors Without Borders India (DWBI) is planning to set up a treatment facility in Patna (Bihar state), witht the purpose of treating mild and moderate cases of COVID-19 with some capacity for palliative care, thereby decongesting the current referral hospital (Nalanda Medical College & Hospital) to be able to focus on the severe cases.