Health Care Workers In India Research Articles

Psychological impact of the COVID-19 pandemic on healthcare workers in India: An observational study.

Background:The World Health Organization (WHO) in January 2020 declared outbreak of novel coronavirus disease, COVID-19, an international public health emergency. It was stated that there was high COVID-19 spread risk to various other countries across world. According to WHO in March 2020, COVID-19 was characterized as pandemic. However, this sudden crisis is generating great deal of stress, anxiety, and depression throughout the world.Aim:The aim of this study was to assess the psychological impact and various associated factors during the developing COVID-19 situation among both the healthcare and non-healthcare working professionals in India.Materials and Methods:This was an observation-based cross-sectional study conducted during the lockdown period and following the lifting of the lockdown for a total of 3 months duration. A structured questionnaire was send via the (email) electronic mail system to a target population of 350 people. Out of which 300 responded. The questionnaire was comprised of study variables: (a) Gender; (b) age-group range which was categorized into- (i) Between 30 snf 50 years and (ii) More than 50 years; (c) Presence of any comorbid medical condition; psychological symptoms of- (d) insomnia; (e) anxiety; and (f) depression. Statistical analysis was performed using the Chi-square test for determining significance.Results:Mean ± SD values for age were found to be 35.54 ± 6.09; 33.84 ± 7.87; 32.16 ± 5.89 and 55.76 ± 8.98 for physicians, nurses, technical staff, and non-healthcare professionals while the percentages of male study participants was found to be 37.2%, 15%, 57%, and 65% and female study participants was 62.8%, 85%, 43%, and 35% for the physicians, nursing staff, technicians, and non-healthcare professionals. Depression, insomnia, and anxiety between healthcare and non-healthcare professional workers, demonstrated significant P values of 0.05, 0.03, and 0.02, respectively.Conclusion:The present study has shown a significant psychological impact arising from this crisis.

Assessing Competency of Community Healthcare Workers

Background: Community healthcare workers (CHW) play an important role in preventive healthcare system in India. CHW link the community to the health system of the country. As the population in India covers majorly in village, community healthcare workers are the face of the healthcare. These CHW competencies are yet to be ascertained. Objectives: To determine standardized framework for competency of the Community healthcare workers in India. Methods: By using structured questionnaire with 5 point Likert scale is implemented to evaluate the competency of CHW. Respondents are 35 participants including Accredited Social Health Activist (ASHA), Medical social worker and diabetes educator in and around Chennai. Findings: Suggested that community health workers are highly competent. More clarity in role of community healthcare workers is required. Government should initiate program to nurture the service quality of primary centers, equipment, manpower facility in health centers, etc Training regarding the maternity care and communication skills are core competency required for a CHW to perform his/her role properly. Conclusions: The results of the study show that CHW of India is also competent. Community healthcare workers are contributing more in maternal care and preventive care. They put more effort in health education and sanitation in rural areas.

Tuberculosis Occupational Risks in Field-based Health Care Workers in India

International Journal of Medicine and Public Health,2019,9,2,34-35.DOI:10.5530/ijmedph.2019.2.9Published:June 2019Type:EditorialTuberculosis Occupational Risks in Field-based Health Care Workers in IndiaSenbagavalli Prakash Babu, and Sonali Sarkar Senbagavalli Prakash Babu, Sonali Sarkar* Department of Preventive and Social Medicine, JIPMER, Pondicherry, INDIA. Abstract:Health care workers are the most valuable resource in biomedical research and the World Health Organization (WHO) had declared the years 2006 to 2015 as the “The decade of the human resources for health”. The target of tuberculosis (TB) elimination globally is 2030, but India has proposed to eliminate it by 2025. TB research and development is essential to achieve the global TB targets set in the Sustainable Development Goals and the End TB Strategy. One of the pillars proposed by WHO for END TB strategy is intensified research and innovation.1 Priorities for TB research and development include vaccines to lower the risk of infection, a vaccine or new drug treatment to reduce the risk of TB disease in already latently infected, rapid diagnostics for use at the point of care and simpler and shorter drug regimens for treating TB disease. India is working hard towards intensifying research in TB with a recent surge in field-based research for the discovery and development of newer tools and their implementation; interventions and to develop strategies. Treatment for TB is domiciliary and community-based interventions are mandatory for the prevention and care. Field-based health workers (FHW) including Medical Social Workers, Nurses, RNTCP workers and DOTS providers play key role in the treatment for tuberculosis, enhancing active case finding and intensifying research and innovation. The risk that Mycobacterium tuberculosis can be transmitted from patients with active tuberculosis (TB) to other patients and healthcare workers has been recognized for many years.2 It is high-time that proper safety measures are framed to prevent and support FHW working in tuberculosis. The level of risk varies by setting, occupation, patient population and effectiveness of TB infection control measures. If average community based annual risk of infection in India is about 1.5%, healthcare workers have additional 3.5% risk, which may be attributable to nosocomial exposure.3 Read more.... Keywords:EditorialView:PDF (74.28 KB)

Low reporting of violence against health-care workers in India in spite of high prevalence

BackgroundViolence against health-care workers has become a great issue in health-care organizations. This study was conceptualized with the aim to know the prevalence of violence and to identify gap between rate of reporting of an incident of violence at a tertiary care hospital in India. MethodsThe study was descriptive and cross-sectional; a validated questionnaire was used as a tool. Reported incidents of violence against workers were collected. P value <0.05 was considered statistically significant in the analysis. A Z test for proportion at 95% confidence interval was applied to analyze the level of difference between prevalence, rate of reporting, and their level of awareness. ResultsOf 394 respondents, 136(34.5%) workers had experienced workplace violence in the last 12 months. It was found that total 32 incidents of workplace violence were reported to the concerned authority. The reporting rate of violence is significantly low (23.5%), in spite of high prevalence (34.5%). Level of awareness regarding the reporting mechanism and regulations for the safeguard of health-care workers against workplace violence is only 24.6 %. ConclusionThis study concluded that the prevalence of violence among health-care workers is quite high, but the reporting rate is significantly low. The low rate of reporting is because of lack of awareness about the reporting mechanism of workplace violence. It is recommended that sensitizing workshops should be conducted to increase the level of awareness, which will result in reduction in the prevalence of violence and building a safe and secured workplace for health-care providers.

COVID-19 global health security and costs: Up close and painfully personal!

Sir, We read with existential concern, the editorial by Agarwal and Agarwal: “Quo Vadis COVID Responder – Beat the Chinese Virus,” Carpe Diem in the January–April 2019 issue of the journal.[1] The authors have very rightly highlighted the disruptive threat that the severe acute respiratory syndrome-coronavirus-2 represents through the coronavirus disease 2019 (COVID-19) pandemic. Virtually nothing has been left untouched within a few months of its onset, from significant mortality in the general population and frontline health workers, the calamitous effect on global economy, to the negative influence on individual mental health. Worse, the predicted nadir is still awaited in the Indian subcontinent and the Americas.[2] Of special interest is the focus the authors have placed on the distinct subcontinental biological ecosystem and diet, providing a putative immunomodulatory native benefit. This realistically cannot be overlooked as the present incidence of infection and mortality per million population in India is significantly low, albeit the relative undertesting.[2] The coming months will surely test this hypothesis. As clinical evidence is still emerging and fragmented, it is too soon to even analyse some of the data, and far too early to project sweeping advocacy. In this respect, the authors urge the cautious application of fundamentals and common-sense. In this respect, it is of grave concern that an epidemic could slip out of a modern city and an advanced country, resulting in half a million deaths globally within 6 months, with no end in sight. Unfortunately, the COVID-19 related-mortality in India, is now 8th overall and 4th in the last 24 h, globally.[2] This is alarming as the pandemic in India is just “beginning to surge.” There is a significant incidence of COVID-19 associated morbidity and mortality amongst healthcare workers in India. In contrast (while this maybe not completely comparable), India contained within a state, the Nipah virus outbreak in 2018 and 2019, with a cumulative mortality statistic of 16 deaths.[3] Certain truths are now inescapable: It is increasingly harder to ignore the subjective response to this disaster. When medical colleagues begin to die and others battle for their lives, the issue becomes intensely personal. Furthermore, personal, professional, and family safety is uncomfortably tested through the 'new-normal' with its pain and grim reality [Figure 1]. It is now imperative to build professional resilience and coping mechanisms into healthcare systems before the next global disaster, whose occurrence is but a matter of time. We now live in a globalized world, where even local public health actions or inactions have planetary impact. Global analysis of the pandemic reveals source issues and systemic unpreparedness as real causes for concern. While we break our backs to build system-responsiveness, a persistent, recurrent, and common source for viral pandemics requires immediate redressal. Underlining this is the negative influence of totalitarianism on global health, based on emerging evidence.[45] This represents a significant opportunity for systems improvement globally! Figure 1: Providing healthcare during the COVID-19 pandemic can be challenging - Reduced patient volumes and opportunities for trainees, reduced economic inflow to hospitals along with increased operational costs, lack of a fallback reserve / strategy for many hospitals, reduced medical-staff salaries, higher hospital bills, uncomfortable personal protective equipment, demand of strict safety protocols, lack of clear clinical guidance, frequently changing public health directives, healthcare worker sickness, hospital admissions for medical-staff, death of colleagues, mental stress, political opportunism, and a predatory media are among the many challengesInvesting in our common future by building maturity, autonomy, and transparency into public health goes a long way in creating a safer planet. Is anyone listening? Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prevalence and associated factors of latex-related symptoms and sensitization at a multispecialty hospital: A cross-sectional study

Background and Aim: Upsurge in usage of latex gloves over the last few decades, coupled with the proliferation of medical latex products at the workplace, has led to a higher incidence of latex-related symptoms among health-care workers (HCWs). This study aimed to assess the prevalence and associated factors of latex glove-related symptoms and sensitization among HCW at a multispecialty hospital. Materials and Methods: The study included all the paramedical personnel and nurses employed at a multispecialty hospital where powdered latex gloves were in use. Consenting participants were evaluated by a questionnaire for symptoms of latex allergy, followed by a skin prick test (SPT) for evaluating sensitization to latex allergen. Statistical Analysis Used: Mean, standard deviation, and Student's t-test were used for continuous data. Categorical data were analyzed using the Chi-square test. Odds ratios and 95% confidence intervals were calculated. Results: Latex glove-related symptoms were present in 25 (10.91%) HCWs. Symptoms suggestive of Type I latex allergy were reported in 11 (4.8%), while those of contact dermatitis were reported in 17 (7.42%) HCWs. Of the 229 HCWs, 37 (16.16%) had a personal history of atopy; 14 (6.11%) were SPT positive to latex allergen. Conclusions: In this study among Indian HCW, there was a significant correlation of latex glove-related symptoms with the duration of glove use, personal atopy, and SPT positivity to latex allergen. Questionnaire-based evaluation of allergic symptoms along with SPT positivity was found to be a useful identifier of true latex allergy.

Knowledge about hepatitis B and hepatitis C virus infection and consequences: a cross-sectional assessment of baseline knowledge among infected patients in West Bengal, India

BackgroundIndia has a high burden of disease from hepatitis B virus (HBV), with 3.7 % point-prevalence, as well as from hepatitis C virus (HCV), with 1–1.5 % prevalence. Societal ignorance about HBV and HCV in India limits the potential for prevention and treatment efforts to bring these diseases under control. Since patients’ own knowledge about their health condition may have important health consequences, this study sought to assess knowledge levels among HBV and HCV patients referred to the virology laboratory of the Liver Foundation, West Bengal.MethodsPatients who had tested positive for HBsAg or anti-HCV at government specialty clinics were invited to enroll in the study when they presented for follow-up laboratory testing. Study participants completed a survey that contained three multiple-choice questions about viral hepatitis etiology and five multiple-choice questions about the consequences of HBV and HCV infection. Mean knowledge scores for male and female respondents were compared, and comparisons were also made across different places of residence, age groups, education levels and income levels. One-way ANOVA was used to test for significant differences.ResultsAmong 520 study participants, the mean knowledge score was 4.76 on an eight-point scale. Approximately 40 % of the study sample scored less than 4.0. Almost three-quarters of respondents correctly responded to the question, “Which organ of the human body is affected by hepatitis?” while almost two-thirds knew how hepatitis B is transmitted. Regarding consequences of HBV and HCV infection, less than one-third of study participants answered correctly when asked, “What happens when one is infected with hepatitis B or C?” Slightly more than two-thirds of people correctly answered the question about how hepatitis B is prevented. The mean knowledge score varied across age groups (P = 0.0009), education levels (P = 0.0001) and monthly household income levels (P = 0.0001). With higher levels of schooling and higher household income, there were corresponding increases in knowledge scores.ConclusionThere is room for improving knowledge of HBV and HCV etiology and consequences among patients as well as healthcare workers in India. More awareness activities should be organized, accompanied by further research to track whether knowledge scores improve over time.

Prevalence of non-responsiveness to an indigenous recombinant hepatitis B vaccine: A study among South Indian health care workers in a tertiary hospital

Background and Aim: Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. Study Design and Method: Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay AxSYM AUSAB, (Abbott, Germany). HLA typing was done using SSP-PCR assay AllSet+™ Gold SSP (Invitrogen, USA). Results: The overall seroconversion rate (anti-HBs > 10 mIU/mL) was 98.89% wherein 90.8% had titers >1000mIU/mL, 7.6% had titers 100–1000mIU/mL, 0.43% had titers < 100 mIU/mL and 1.1% were non-responsive (<10 mIU/mL) to the initial 3-dose regimen. Antibody titers <1000 mIU/mL were significantly associated with the highest quartile of body mass index (BMI) (P < 0.001). We found no significant difference in seroprotection rate between gender (P = 0.088). There was no difference in seroprotection rates among various ethnic groups (P = 0.62). Subjects who were non-responsive in our study had at least one HLA allele earlier known to be associated with non-responsiveness to the vaccine. Conclusion: Our findings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might influence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as postvaccination anti-HBs testing to prevent HAHI among HCWs.

Safety of the two-step tuberculin skin test in Indian health care workers

BackgroundHealth care workers (HCW) in low and middle income countries are at high risk of nosocomial tuberculosis infection. Periodic screening of health workers for both TB disease and infection can play a critical role in TB infection control. Occupational health programs that implement serial tuberculin skin testing (TST) are advised to use a two-step baseline TST. This helps to ensure that boosting of waned immune response is not mistaken as new TB infection (i.e. conversion). However, there are no data on safety of the two-step TST in the Indian context where HCWs are repeatedly exposed. Materials and methodsNursing students were recruited from 2007 to 2009 at the Christian Medical College and Hospital, Vellore, India. Consenting nursing students were screened with a baseline two-step TST at the time of recruitment. From 2007 to 2008 adverse events were recorded when reported during the TST reading (Cohort A). Nurses recruited in the final study year (2009) answered an investigator administered questionnaire assessing all likely side-effects Cohort B). This information was extracted from the case report forms and analysed. ResultsBetween 2007 and 09, 800 trainees consented to participate in the annual TB screening study and 779 did not have a past history of TB or recall a positive TST and were selected to administer TST. Of these, 755 returned for reading the result and had complete data and were included for the final analysis – 623 subjects in (cohort A) and 132 in (cohort B). These were included for the final analysis. In cohort A only 1.3% reported adverse events. In cohort B, as per the investigator administered questionnaire; 25% reported minor side effects. Itching and local pain were the most common side effects encountered. There were no major adverse events reported. In particular, the adverse events were similar in the second step of the test and not more severe. ConclusionScreening of HCWs with two-step TST for LTBI is simple and safe, and hence suitable for wide scale implementation in high-burden settings such as India.

Knowledge of and Attitudes Toward Clinical Depression Among Health Providers in Gujarat, India

BackgroundClinical depression is a major leading cause of morbidity and mortality but it is oftentimes overlooked and undertreated. The negative perception and lack of understanding of this condition prevents millions of people from seeking appropriate and on-time medical help, leading to distress and increased burden for affected people and their families. The implementation of public education campaigns and training of non-psychiatric health professionals on mental health and clinical depression has been neglected in several countries, including India, which is the second most populous country in the world with a population of more than 1.2 billion people, almost one-fifth of the world's population. ObjectiveThis study sought to explore the knowledge and attitudes toward the diagnosis and treatment of clinical depression in nonpsychiatric health care providers in Vadodara, Gujarat, India. MethodsA cross-sectional survey was conducted over a 4-week period In Gujarat, India among resident physicians and community health workers about their knowledge and views on clinical depression. FindingsWe found considerable stigma and misinformation about depression especially among health care workers in India. Most of the community health workers had a great deal of difficulty when defining clinical depression, and a large majority said that they never heard about depression or its definition and although the overwhelming majority of respondents did not believe that clinical depression results from a punishment from God (82% disagreed or strongly disagreed with this belief) or evil spirits (77.5%), a much smaller proportion disagreed with the assertions that depression was either solely due to difficult circumstances (38.2%) or that sufferers only had themselves to blame (47.2%). Meanwhile, only 32.6% disagreed with the position that clinical depression is a sign of weakness and 39.4% disagreed with the statement that suicide was a sign of weakness. ConclusionsOur findings underscore the considerable public health priority facing India’s policymakers and planners to better educate more non-psychiatric physicians and community health workers to identify, understand, and respond to early signs of mental illnesses, especially clinical depression.

Serial testing using interferon-γ release assays in nursing students in India

To the Editor: We have previously shown that Indian healthcare workers have higher prevalence of latent tuberculosis infection (LTBI) and are at increased risk for new infection [1]–[4]. Interferon-γ release assays (IGRAs) have been introduced as an alternative to the tuberculin skin test (TST) for diagnosing LTBI in healthcare workers and other high-risk groups. They have logistical advantages over the TST and will not cross-react with the bacille Calmette Guerin vaccine. IGRAs are now being widely used for screening healthcare workers [5], yet recent reports indicate that switching from TST to IGRAs for the serial testing of healthcare workers may result in increased rates of test conversions and reversions [3], [6]–[8]. Most of these studies are from low tuberculosis (TB) incidence settings, with limited opportunity for nosocomial TB exposure; as a result, the increased conversion rates are considered false-positive test conversions, making it difficult for clinicians to interpret IGRA test conversions in these settings [9]. It remains unclear whether IGRA conversions are associated with TB exposure in high TB incidence settings where unprotected exposure to infectious TB patients is more common among healthcare workers. To evaluate whether IGRA conversions may represent new cases of LTBI, in a high TB incidence setting, in the absence of a gold standard for LTBI, we employed TB exposure as a proxy measure. We established a cohort of nursing students who underwent IGRA testing annually for 3 years at a tertiary level hospital in southern India [1]. Annual rates of conversions and reversions were estimated in this cohort. A relationship between occupational TB exposure and change in continuous interferon-γ (IFN-γ) levels were …

Knowledge and risk perception regarding HIV among healthcare workers in a medical college hospital

Background: Ever since HIV was first identified in India among sex workers in Chennai during 1986, HIV infections have been reported in all states and territories. The knowledge and attitudes of healthcare workers (HCWs) in relation to HIV infection is an important factor influencing the willingness and ability of people with HIV to access care, and the quality of the care they receive. Aims & Objective: To assess HIV-related knowledge and risk perception among a group of north Indian health care workers (HCW), and to identify predictors of willingness to provide care for patients with HIV infection. Material and Methods: A cross-sectional survey of 450 HCWs from tertiary health care centre was undertaken in March 2011. The information was collected on a semi structured, self-administered questionnaire. Information was gathered regarding demographic details, HIV-related knowledge, risk perception and previous experience caring for HIV-positive patients. Results: Most (95.7%) were aware of the routes of transmission. 4.1% HCWs wished that they should be allowed to refuse to care for people with HIV/AIDS. HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care (p

Implementing a Sharps Injury Reduction Program at a Charity Hospital in India

Health care workers in India are at high risk of developing bloodborne infections from needlestick injuries. Indian hospitals often do not have the resources to invest in safety devices and protective equipment to decrease this risk. In collaboration with hospital staff, the primary author implemented a sharps injury prevention and biomedical waste program at an urban 60-bed charity hospital in northern India. The program aligned with hospital organizational objectives and was designed to be low-cost and sustainable. Occupational health nurses working in international settings or with international workers should be aware of employee and employer knowledge and commitment to occupational health and safety.

Risk factors for tuberculosis among health care workers in South India: a nested case–control study

ObjectiveThe epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case–control design assessing the risk factors for acquiring TB among HCWs in India. Study Design and SettingsIt is a nested case–control study conducted at a tertiary teaching hospital in India. Cases (n=101) were HCWs with active TB. Controls (n=101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables. ResultsThe cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19kg/m2 (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49–5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47–5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38–110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74–18.36) were independently associated with increased risk of acquiring TB. ConclusionHCWs with frequent patient contact and those with BMI <19kg/m2 were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities.

Predictive value of latent tuberculosis tests in Indian healthcare workers: a cohort study

To the Editors: Healthcare workers (HCWs) in high tuberculosis (TB)-burden countries are known to have a substantially higher risk of latent TB infection (LTBI) and TB disease [1], and this has been demonstrated repeatedly in India [2, 3]. Several studies have evaluated interferon-γ release assays (IGRAs) in HCWs [4], but no study has reported the predictive value of IGRAs in this population of HCWs at risk for TB exposure. Between January and June 2004, we had performed a cross-sectional comparison of the tuberculin skin test (TST) (1 tuberculin unit of purified protein derivation RT23) and QuantiFERON®-TB Gold In-Tube (QFT; Cellestis Ltd, Melbourne, Australia) in a cohort of 726 HCWs (719 had valid test results for both tests) at the Mahatma Gandhi Institute of Medical Sciences (Sevagram, India), with young trainees making up half the cohort [5]. A total of 360 (50%) HCWs were found to be positive using either the TST or QFT assay at baseline, and 226 (31%) were found to be positive using both tests. The prevalence estimates of TST and QFT positivity were comparable, with high concordance between test results [5]. Although isoniazid preventive therapy (IPT) was offered to HCWs with positive baseline TST or QFT results, only a small proportion had completed INH therapy. In 2010, ∼6 yrs after …

Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India

The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects. Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg-positive, and 24.7% of 700 HCWs screened had past exposure (IgG-anti-HBc-positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti-HBs titers > 10 IU/mL. Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.

Changing roles and responses of health care workers in HIV treatment and care

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

Can computers improve patient care by primary health care workers in India?

The objective was to test whether a decision support technology for non-physicians can increase health care utilization and quality. Before and after measurements were taken from a systematic random sample of patients and staff at randomly assigned intervention and control facilities. The study took place at primary health facilities in rural Tamil Nadu, India. One thousand two hundred and eighty-six patients and 82 staff were interviewed. A computer-assisted decision support technology was introduced to assist with patient screening. Outcome measures included new patient visits per month, a Global Patient Assessment of Care Index, and health worker attitude variables. There was a difference of difference of 430 new patient visits per month at the intervention sites (P = 0.005), an increase from baseline of 18% at intervention sites compared with a decline of 5% at control sites. The intervention was associated with significant improvements in a Global Patient Assessment of Care Index (mean difference of difference 7.9, P < 0.001). The largest gains were made in patient communication, technical quality, and general satisfaction with care. The attitudes of public health workers toward the new technology and their jobs did not change. Decision support technologies have considerable potential to improve coverage and quality of health care for the poor and where there is no doctor, but the unreceptive attitude of public health workers would need to be overcome. Application of these technologies should take advantage of their popularity with patients and the opportunity to work through the private sector.

Trends of HBV, HCV Prevalence and Vaccination Status in Healthcare Workers in India

Trends of HBV, HCV Prevalence and Vaccination Status in Healthcare Workers in India

Persistently elevated T cell interferon-γ responses after treatment for latent tuberculosis infection among health care workers in India: a preliminary report

BackgroundT cell-based interferon-γ (IFN-γ) release assays (IGRAs) are novel tests for latent tuberculosis infection (LTBI). It has been suggested that T cell responses may be correlated with bacterial burden and, therefore, IGRAs may have a role in monitoring treatment response. We investigated IFN-γ responses to specific TB antigens among Indian health care workers (HCWs) before, and after LTBI preventive therapy.MethodsIn 2004, we established a cohort of HCWs who underwent tuberculin skin testing (TST) and a whole-blood IGRA (QuantiFERON-TB-Gold In-Tube [QFT-G], Cellestis Ltd, Victoria, Australia) at a rural hospital in India. HCWs positive by either test were offered 6 months of isoniazid (INH) preventive therapy. Among the HCWs who underwent therapy, we prospectively followed-up 10 nursing students who were positive by both tests at baseline. The QFT-G assay was repeated 4 and 10 months after INH treatment completion (i.e. approximately 12 months and 18 months after the initial testing). IFN-γ responses to ESAT-6, CFP-10 and TB7.7 peptides were measured using ELISA, and IFN-γ ≥0.35 IU/mL was used to define a positive QFT-G test result.ResultsAll participants (N = 10) reported direct contact with smear-positive TB patients at baseline, during and after LTBI treatment. All participants except one started treatment with high baseline IFN-γ responses (median 10.0 IU/mL). The second QFT-G was positive in 9 of 10 participants, but IFN-γ responses had declined (median 5.0 IU/mL); however, this difference was not significant (P = 0.10). The third QFT-G assay continued to be positive in 9 of 10 participants, with persistently elevated IFN-γ responses (median 7.9 IU/mL; P = 0.32 for difference against baseline average).ConclusionIn an environment with ongoing, intensive nosocomial exposure, HCWs had strong IFN-γ responses at baseline, and continued to have persistently elevated responses, despite LTBI treatment. It is plausible that persistence of infection and/or re-infection might account for this phenomenon. Our preliminary findings need confirmation in larger studies in high transmission settings. Specifically, research is needed to study T cell kinetics during LTBI treatment, and determine the effect of recurrent exposures on host cellular immune responses.