High Prevalence States Research Articles

Human immunodeficiency virus prevalence and high-risk behavior of home-based and nonhome-based female sex workers in three high-prevalent North-Eastern States of India.

Female sex workers (FSWs) have been identified as an important target group for human immunodeficiency virus (HIV)/sexually transmitted infections prevention. This study aimed to describe sociodemographic and sex work characteristics and to identify the risk factors for HIV infection with special focus on the variations between home-based (HB) and non-HB (NHB) FSWs in three high-prevalent North-Eastern states of India: Manipur, Mizoram, and Nagaland. Data from the National Integrated Bio-Behavioural Surveillance (IBBS) conducted in India during 2014-2015 were utilized in the study. IBBS is a quantitative survey conducted among identified high risk sub within India. Logistic regression analyses were performed using SAS 9.3.2 to determine the distribution and associations of sociodemographics and risk behaviors with HIV seropositivity of HB and NHB FSWs. HIV prevalence was found higher among NHB FSWs compared to HB FSW (7.3% vs. 4.6%). The proportions of FSW among HB (66.7%) were in sex work for longer duration are significantly higher than for NHB (60.2%) while risk of HIV infection due to injecting drug use was higher in NHB FSW (11.7% vs. 8.7%). Reference to FSW who were currently married, those who were widowed/divorced/separated had 2.73-fold risk of HIV. FSW who did not have any other income source were associated with 1.73 times more risk of HIV infection. Injecting drugs user among FSW respondents had four times higher likelihood to be HIV positive. A substantial proportion of NHB FSWs is mobile in nature. Targeted interventions are required urgently to minimize HIV risk among those FSWs especially the widowed/divorced/separated, sex work is only income source and who used injecting drugs for nonmedical purpose.

Interest in Tobacco and Smoking Cessation Interventions Among Pharmacists and Student Pharmacists in a High Prevalence State

Interest in Tobacco and Smoking Cessation Interventions Among Pharmacists and Student Pharmacists in a High Prevalence State

HIV prevalence correlated with circumcision prevalence and high-risk sexual behavior in India's states: an ecological study.

Background: HIV prevalence varies between 0% and 1.6% in India's states. The factors underpinning this variation are poorly defined. Methods: We evaluated the relationship between HIV prevalence by state and a range of risk factors in the Indian 2015 National Family Health Survey. Pearson's correlation was used to assess the relationship between HIV prevalence and each variable. The prevalence of each risk factor was compared between five high-HIV-prevalence states (>1% prevalence) and a large low-HIV-prevalence state (Uttar Pradesh; HIV prevalence, 0.06%). Results: There was an association between HIV prevalence and men's mean lifetime number of partners (r = 0.55; P = 0.001) and men reporting sex with a non-married, non-cohabiting partner (r = 0.40; P = 0.014). In general, men in high-prevalence states were less likely to be circumcised and (with the exception of Chandigarh) use condoms at last sex. In two high prevalence states (Mizoram and Nagaland), men reported a higher number of lifetime partners and a higher prevalence of multiple partners and high-risk sex in the past year. Conclusions: Variation in circumcision prevalence and sexual behavior may contribute to the large variations in HIV prevalence by state in India.

HIV prevalence correlated with circumcision prevalence and high-risk sexual behavior in India's states: an ecological study

Background: HIV prevalence varies between 0% and 1.6% in India's states. The factors underpinning this variation are poorly defined. Methods: We evaluated the relationship between HIV prevalence by state and a range of risk factors in the Indian 2015 National Family Health Survey. Pearson’s correlation was used to assess the relationship between HIV prevalence and each variable. The prevalence of each risk factor was compared between five high-HIV-prevalence states (>1% prevalence) and a large low-HIV-prevalence state (Uttar Pradesh; HIV prevalence, 0.06%). Results: There was an association between HIV prevalence and men's mean lifetime number of partners (r = 0.55; P = 0.001) and men reporting sex with a non-married, non-cohabiting partner (r = 0.40; P = 0.014). In general, men in high-prevalence states were less likely to be circumcised and (with the exception of Chandigarh) use condoms at last sex. In two high prevalence states (Mizoram and Nagaland), men reported a higher number of lifetime partners and a higher prevalence of multiple partners and high-risk sex in the past year. Conclusions: Variation in circumcision prevalence and sexual behavior may contribute to the large variations in HIV prevalence by state in India.

HIV prevalence correlated with circumcision prevalence and high-risk sexual behavior in India's states: an ecological study

Background: HIV prevalence varies between 0% and 1.6% in India's states. The factors underpinning this variation are poorly defined. Methods: We evaluated the relationship between HIV prevalence by state and a range of risk factors in the Indian 2015 National Family Health Survey. Pearson’s correlation was used to assess the relationship between HIV prevalence and each variable. The prevalence of each risk factor was compared between five high-HIV-prevalence states (>1% prevalence) and a large low-HIV-prevalence state (Uttar Pradesh; HIV prevalence, 0.06%). Results: There was an association between HIV prevalence and men's mean lifetime number of partners (r = 0.55; P = 0.001) and men reporting sex with a non-married, non-cohabiting partner (r = 0.40; P = 0.014). In general, men in high-prevalence states were less likely to be circumcised and (with the exception of Chandigarh) use condoms at last sex. In two high prevalence states (Mizoram and Nagaland), men reported a higher number of lifetime partners and a higher prevalence of multiple partners and high-risk sex in the past year. Conclusions: Variation in circumcision prevalence and sexual behavior may contribute to the large variations in HIV prevalence by state in India.

Rural Urban Differentials in Awareness, Knowledge and Perception about HIV/AIDS among Men in High and Low Prevalence States in India

Rural Urban Differentials in Awareness, Knowledge and Perception about HIV/AIDS among Men in High and Low Prevalence States in India

Diversity of hysteresis in a fully cooperative coinfection model.

We propose a fully cooperative coinfection model in which singly infected individuals are more likely to acquire a second disease than susceptible ones and doubly infected individuals are also assumed to be more contagious than singly infected ones. The dynamics of such a fully cooperative coinfection model is investigated through the well-mixed approach. In particular, discontinuous outbreak transitions from the disease free state or the low prevalence state to the high prevalence state can be separately observed as a disease transmission rate crosses a threshold αo from the below when the epidemic is still in the early stages. Moreover, discontinuous eradications from the high prevalence state to the low prevalence or disease free state are also separately seen as the transmission rate reaches a threshold αe(<αo) from the above when the outbreak occurs. Such phenomena constitute three types of hysteresis, where only one type has been identified before. Complete characterization of these three types of hysteresis in terms of parameters measuring the uniformity of the model is both analytically and numerically provided.

Management tool to guide rabies elimination programmes

ObjectiveTo provide surveillance tools to support policymakers andpractitioners to identify epidemiological situations and inform theprogressive implementation of rabies elimination programmes.IntroductionGlobal targets for elimination of human rabies mediated by dogshave been set for 2030. In the Americas countries are progressingtowards interruption of transmission and declaration of rabiesfreedom1. Guidance for managing elimination programmes toensure continued progress during the endgame is critical, yet oftenlimited and lacking in specific recommendations. Characteristicspatiotemporal incidence patterns are indicative of progress, andthrough their identification, tailored guidance can be provided.MethodsUsing SIRVERA, a surveillance database for rabies in theAmericas2, we developed a classification framework for identificationof epidemiological situations at subnational level. Each situationexhibits a characteristic pattern identified via a set of objective criteriaincluding trends in case detection, assessment of virus variants, caselocations and measures of incursion risk.We refined our framework through application to Mexico inconsultation with stakeholders. To understand factors predictingincursions we analysed state-level data on vaccination campaigns,populations and socioeconomic indicators employing multivariateregression models.ResultsWe were able to classify all states in Mexico and providecorrespondingly tailored guidance. Control efforts have resultedin progress towards elimination; however rabies still circulatesendemically in one state Chiapas, putting its neighbours at risk ofre-emergence.Epidemiological and socioeconomic factors associated withincursions were primarily geographic proximity to endemic and high-prevalence states, and inconsistent vaccination campaigns associatedwith a low human development index.ConclusionsOur management tool can support rabies programme managersat subnational levels to identify their epidemiological situation,develop tailored plans to meet targets, and sustainably maintainrabies freedom, as demonstrated for Mexico. Effective surveillanceis critical for disease elimination. Control options differ dependingon whether disease circulates intermittently through reintroductionsor persists focally, but with poor detection these situations mightbe indistinguishable. Our analysis enables identification of at-riskareas and methods to reduce risk. Investment in remaining endemicareas, through improved implementation and monitoring of mass dogvaccinations, is expected to provide the most cost-effective approachto elimination whilst preventing re-emergence elsewhere.Decision-tree framework.Rabies incursions in Mexico, 2005-2015. Blue circles indicate incursionlocations, and resulting outbreak sizes, with darker shading for more recentincursions. Red shading indicates the duration of endemic circulation over theten-year period.

Claims-Based Diagnostic Patterns of Patients Evaluated for Lyme Disease and Given Extended Antibiotic Therapy.

A Lyme disease (LD) diagnosis can be far from straightforward, particularly if erythema migrans does not develop or is not noticed. Extended courses of antibiotics for LD are not recommended, but their use is increasing. We sought to elucidate the patient patterns toward a diagnosis of LD, hypothesizing that a subset of patients ultimately receiving extended courses antibiotics may be symptomatic for an extended period before the first LD diagnosis. Claims submitted to a nationwide U.S. health insurance plan in 14 high-prevalence states were grouped into standardized diagnostic categories. The patterns of diagnostic categories over time were compared between patients evaluated for LD and given standard antibiotic therapy (PLDSA) and patients evaluated for LD and given extended antibiotic therapy (PLDEA) in 2011-2012. The incidence of PLDSA was 40.45 (N = 3207) and that of PLDEA was 7.57 (N = 600) per 100,000 insured over 2011-2012. 50.3% of PLDEA were diagnosed in the nonsummer months. Seven diagnostic categories were associated with PLDEA. From 180 days before the first LD diagnosis, the risks of having claims associated with back problems (odds ratio [OR], 2.1; confidence interval [95% CI], 1.4-2.9; p < 0.001) and connective tissue disease (OR, 1.6; 95% CI, 1.1-2.3; p < 0.01) complaints were higher among PLDEA. From 90 days before the diagnosis, malaise and fatigue (OR, 1.7; 95% CI, 1.1-2.6; p < 0.05), other nervous system disorders (OR, 2.0; 95% CI, 1.3-3.1; p < 0.01), and nontraumatic joint disorder (OR, 1.4; 95% CI, 1.0-2.0; p < 0.05) were more likely found among PLDEA than PLDSA. From 30 days before the diagnosis, the risk for mental health (OR 1.6; 95% CI, 1.1-2.0; p < 0.01) and headache (OR 1.5; 95% CI, 1.1-2.0; p < 0.05) among PLDEA was elevated. Among patients evaluated for LD and ultimately receiving an extended course of antibiotics for LD, 15.8% of them were symptomatic and seeking care for several months before their first LD diagnosis.

Risk factors associated with contagious caprine pleuro-pneumonia in goats in pastoral areas in the Rift Valley region of Kenya

A cross-sectional study to determine risk factors associated with sero-prevalence of contagious caprine pleuro-pneumonia (CCPP) in goats was carried out between the months of March, 2014 and March, 2015 in Pokot East, Turkana West and Kajiado Central Sub-counties. A semi-structured questionnaire focusing on risk factors for CCPP was completed for each flock whose serum samples were collected. A logistic regression model was developed to assess the association between the risk factors and CCPP sero-positivity. Of the 54 flocks, 49 (90.7%) presented at least one sero-positive animal. Two hundred and four of the 432 goats tested sero-positive at monoclonal antibody based competitive Enzyme-linked immuno-sorbent assay (c-ELISA), hence a sero-prevalence of 47.2% (95% CI=42.5– 51.9). Previous exposure of flocks to CCPP (p<0.001, OR=52.8; CI=6.45, 432), distant sources of veterinary drugs (p<0.001, OR=6.17; CI=3.41, 11.1), movement of goats to dry season feeding areas (p<0.001, OR=4.31; CI=2.39, 7.75) and markets as a source of new introductions to the flock (p=0.033, OR=1.86; CI=1.05, 3.27) were identified as risk factors significantly associated with CCPP sero-prevalence. The findings provide further evidence supporting the high prevalence and endemic state of the disease in pastoral flocks and hence there is need for adequate measures to be put in place to control the disease effectively.

Declining trends in risk behaviors and HIV/ STIs among Clients of FSWs in India: findings from large scale bio-behavioral surveys from three high prevalent Southern states

Declining trends in risk behaviors and HIV/ STIs among Clients of FSWs in India: findings from large scale bio-behavioral surveys from three high prevalent Southern states

Analysis of malaria epidemic situation and control in Hubei Province from 1974 to 2015

To analyze the malaria control measures and epidemic trend in Hubei Province from 1974 to 2015, so as to provide the evidence for malaria elimination path analysis. The malaria control data in Hubei Province from 1974 to 2015 were collected and analyzed retrospectively by descriptive epidemiological methods. The epidemic process of malaria in Hubei Province was divided into four stages. From 1974 to 1979, it was high prevalence state of malaria, and the average annual incidence was 174.47/10 000. From 1980 to 1999, the main control strategies were to control the infection source and mosquitoes, and the average annual incidence was 17.30/10 000, significantly downward. From 2000 to 2009, through the surveillance of infection sources and controlling malaria outbreaks and strengthening the floating population management, the average annual incidence was 0.42/10 000. After 2010, followed by the elimination phase of malaria, the incidence continued to decline. In 2013, there was no local infection for the first time. The difference of average annual incidence among above-mentioned stages was statistically significant (χ2 = 1 254.36, P < 0.05). The malaria epidemic process in Hubei Provincial experienced the high epidemic stage, sharply drop stage, low incidence phase and the elimination phase. However, the natural factors affecting malaria still exist. Therefore, strengthening the control of imported malaria and surveillance should be the main task in the process of eliminating malaria in the future.

Gender differentials in prevalence of self-reported non-communicable diseases (NCDs) in India: evidence from recent NSSO survey

This study examines the current scenario of the self-reported prevalence of non-communicable diseases (NCDs) in India and states, with a gender perspective. It also explores different factors affecting the prevalence of NCDs among men and women. The study has used data from recent NSSO (71st Round, 2014) survey. Simple bivariate analyses are used to calculate the prevalence rate of NCDs per thousand persons. Binary logistics regression is applied to examine the effects of demographic and socioeconomic variables on the prevalence of NCDs. The overall prevalence of NCDs is 55 per thousand persons. The prevalence is higher among women (63) as compared to men (47). Among Indian states, difference in the prevalence of NCDs between men and women is the highest in Punjab (45), followed by Himachal Pradesh (44) and Uttaranchal (37), whereas among the union territories (UTs), Daman and Diu (230) shows the widest gap in the prevalence of NCDs between men and women. Rural women (86) are found at the higher risk of NCDs as compared to rural men (64) and their counterpart in urban areas (53). The NCD prevalence is significantly higher among the population aged above 60 years (OR = 8.30, p < 0.001) and in richer section (OR = 1.21, p < 0.001). In India, women are disproportionately affected by NCDs as compared to men. Across the region, a large gap exists in NCD prevalence between men and women. Hence, there is an urgent need to address this issue in high NCD prevalent states, particularly focusing women from socio-economically disadvantaged background.

Assessing the Effectiveness of On-Farm and Abattoir Interventions in Reducing Pig Meat-Borne Salmonellosis within E.U. Member States.

As part of the evidence base for the development of national control plans for Salmonella spp. in pigs for E.U. Member States, a quantitative microbiological risk assessment was funded to support the scientific opinion required by the EC from the European Food Safety Authority. The main aim of the risk assessment was to assess the effectiveness of interventions implemented on-farm and at the abattoir in reducing human cases of pig meat-borne salmonellosis, and how the effects of these interventions may vary across E.U. Member States. Two case study Member States have been chosen to assess the effect of the interventions investigated. Reducing both breeding herd and slaughter pig prevalence were effective in achieving reductions in the number of expected human illnesses in both case study Member States. However, there is scarce evidence to suggest which specific on-farm interventions could achieve consistent reductions in either breeding herd or slaughter pig prevalence. Hypothetical reductions in feed contamination rates were important in reducing slaughter pig prevalence for the case study Member State where prevalence of infection was already low, but not for the high-prevalence case study. The most significant reductions were achieved by a 1- or 2-log decrease of Salmonella contamination of the carcass post-evisceration; a 1-log decrease in average contamination produced a 90% reduction in human illness. The intervention analyses suggest that abattoir intervention may be the most effective way to reduce human exposure to Salmonella spp. However, a combined farm/abattoir approach would likely have cumulative benefits. On-farm intervention is probably most effective at the breeding-herd level for high-prevalence Member States; once infection in the breeding herd has been reduced to a low enough level, then feed and biosecurity measures would become increasingly more effective.

Clinico-Epidemiological Profile of Extra Pulmonary Tuberculosis: A Report from a High Prevalence State of Northern India.

Background: Ext ra pulmonary tuberculosis is substantially higher in Himachal Pradesh state of India than the national average according to the available data. Aim: The aim of the study was to understand the clinco-epidemiological profile of patients diagnosed as EPTB cases. Material and Methods: The study was a questionnaire based cross sectional survey in low and high prevalence Tuberculosis Units of Himachal Pradesh. Results: Of the 86 pat ients enrolled, 70.9% were fro m high prevalence TU and 29.1% were fro m lo w prevalence TU. Mean age of the patients was 26.67 ± 11.72 years. Of 86 patients 57 (66.3%) were in the age group of 15 - 34 years. Overall, p leural TB was the most common type of EPTB followed by ly mph node TB (53 cases, 61.6% and 20 cases, 23.2% respectively).

Using Nation-Wide Health Insurance Claims Data to Augment Lyme Disease Surveillance.

Lyme disease (LD) is the most commonly reported tick-borne illness in North America. To improve LD surveillance, we explored claims data as an adjunct data source for monitoring trends in Lyme disease incidence. We retrospectively analyzed claims from a nationwide US health insurance plan, identifying patients with newly diagnosed LD in 13 high-prevalence states over two time periods, 2004-2006 and 2010-2012. The average LD case incidence as estimated by using claims data in 2010-2012 (75.67 per 100,000 person-years, n = 3474) was 1.50 times higher than 2004-2006 (50.25 per 100,000 person-years, n = 1965) (p < 0.001) and higher than incidence reported by the states to the Centers for Disease Control and Prevention. Among the 13 highest-prevalence states, there were 11 states with increased LD incidence over time. Surveillance systems should explore a fusion of data sources, including payer claims that appear to be highly sensitive with limitations, with electronic laboratory data that afford high specificity, but appear to miss cases.

Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease.

Most patients with Lyme disease (LD) can be treated effectively with 2-4 weeks of antibiotics. The Infectious Disease Society of America guidelines do not currently recommend extended treatment even in patients with persistent symptoms. To estimate the incidence of extended use of antibiotics in patients evaluated for LD, we retrospectively analyzed claims from a nationwide US health insurance plan in 14 high-prevalence states over 2 periods: 2004-2006 and 2010-2012. As measured by payer claims, the incidence of extended antibiotic therapy among patients evaluated for LD was higher in 2010-2012 (14.72 per 100 000 person-years; n = 684) than in 2004-2006 (9.94 per 100 000 person-years; n = 394) (P < .001). Among these patients, 48.8% were treated with ≥2 antibiotics in 2010-2012 and 29.9% in 2004-2006 (P < .001). In each study period, a distinct small group of providers (roughly 3%-4%) made the diagnosis in >20% of the patients who were evaluated for LD and prescribed extended antibiotic treatment. Insurance claims data suggest that the use of extended courses of antibiotics and multiple antibiotics in the treatment of LD has increased in recent years.

Addressing unmet need and religious barrier towards the use of family planning method among Muslim women in India

Purpose – The purpose of this paper is to find out the prevalence and determinants of unmet need with a special focus on religious barrier towards the use of contraception among Muslim women in India. The study also addresses their future intention to use family planning method. Design/methodology/approach – Data from the latest round of District Level Household and Facility Survey (DLHS-3) in India is used. A multi-stage stratified probability proportion to size sampling design was adopted. The present analysis is based on 70,016 currently married Muslim women across the country. Findings – The prevalence of total unmet need is the highest in Bihar (48.5 per cent), which is two times higher than the national level (27.6 per cent). About 9 per cent Muslim women in India do not use contraception due to religious opposition. There is considerable gap in the future intention to use family planning method between Muslim (9.2 per cent) and non-Muslim (19.6 per cent) women particularly for limiting birth. The logistic regression analysis shows non-Muslim women are significantly more likely (OR=1.540, p&lt;0.001) to have the intention to use family planning method in the future than Muslim women. Research limitations/implications – Men are not included to explore the differences in the perception of men and women towards family planning. Interventions targeting men and aiming at overcoming cultural barriers to using family planning method are equally imperative. Couple's knowledge, attitude and perception towards acceptance of family planning methods need to be addressed simultaneously by interviewing the couples separately. Practical implications – Public-private collaboration to promote family planning programme and providing services in the high prevalence (unmet need) states is required. Support from the religious leaders to overcome the cultural barriers towards the use of family planning is also needed. Originality/value – This is the first ever effort to address the existing unmet need for family planning among Muslim women in India, which is an important determinant of high fertility among Muslim women.

The Effect of Early Marriages and Early Childbearing on Women's Nutritional Status in India.

The consequences of early childbearing on the growth and nutritional status of women in India has not been quantified in previous studies. Our study aimed to fill this gap by analysing the association between early marriage and early childbearing on nutritional status of Indian women, with a focus on Bihar and Andhra Pradesh, the two states accounting for the highest proportion of women marrying and giving first birth before 18 years of age. Our findings revealed that a substantial number of women were married before 18 years and thereby exposed to early pregnancy. Furthermore, a significantly higher proportion of women in the 'thin' category were married before 18 years, both in the Indian sample (33 %, p < 0.001) and in the selected states, Andhra Pradesh (31 %, p < 0.001) and Bihar (43 %, p < 0.001), compared to those women married at higher ages. Similarly, across all our samples women whose first birth was before age 18 years also had a significantly higher probability of being in the 'thin' category across all our samples. This pattern was also observed for associations between early childbirth and anemia levels. We conclude that the net effect of the early age at marriage and age at first birth on nutritional status is significant. Our results underline the need for preventing early marriages and the consequent high adolescent pregnancies in India, particularly in high prevalence states. This will help to improve nutritional status and health care utilisation among women, thereby, prevent maternal and child mortality and thus, achieve the MDGs 4-5.

Nontuberculous mycobacteria among patients with cystic fibrosis in the United States: screening practices and environmental risk.

Persons with cystic fibrosis (CF) are at greater risk of nontuberculous mycobacterial (NTM) infections than the general population. However, among patients with CF, geographic variation in prevalence is poorly understood. To describe the prevalence and screening practices of NTM among U.S. patients with CF. CF Patient Registry data from 2010-2011 were obtained to estimate the prevalence of NTM among patients with CF 12 years of age or older by state. Climatic data were also obtained and predictors of NTM infection analyzed using regression analysis. Geographic clustering and mycobacterial culture rates by state were also assessed. Among patients with CF 12 years of age or older, 58% had mycobacterial cultures; 14% were positive for NTM. Most states (n = 31) had a prevalence of 10-20%; seven states predominantly in the West and Southeast had a prevalence of 20% or greater, including Alaska, which cultured patients more frequently than any other state. Nearly 60% of positive cultures were for Mycobacterium avium complex, although this ranged by state, from 29% in Louisiana to 100% for Nebraska/Delaware. Significant (P < 0.002) spatial clustering of NTM was detected, centering in Wisconsin, Arizona, Florida, and Maryland. Higher saturated vapor pressure increased risk for NTM (odds ratio = 1.06; 95% confidence interval = 1.02-1.10). The proportion of patients cultured for mycobacteria varied greatly by state of residence (median = 46%; range = 9-73%). NTM prevalence varies significantly among patients with CF by geographic area, and is largely influenced by environmental factors. However, NTM culture practices vary greatly, with some high-prevalence states screening less than 25% annually. Routine screening for all patients with CF is needed for timely detection.