Integrated Counseling And Testing Centre Research Articles

IJCM_427A : Profile of HIV Positive Attendees at I.C.T.C. Attavar - A Retrospective Study

Background: Acquired Immunodeficiency Syndrome (AIDS) continues to pose a significant public health threat worldwide, with India experiencing a substantial burden. Integrated Counseling and Testing Centers (ICTCs) play a pivotal role in addressing HIV/AIDS by providing crucial healthcare access and dispelling misconceptions surrounding the disease. Objectives: To study the profile of PLHIV patients attending ICTC centre. Methodology: This descriptive record-based study was conducted at the ICTC of Kasturba Medical College Hospital, Mangalore, aiming to profile HIV-positive attendees. Data on sociodemographic characteristics, mode of transmission, referrals, and counseling practices were collected from records of 137 seropositive attendees using convenient sampling. Statistical analysis was conducted using SPSS version 11.5. Results: The study revealed that most attendees were male (63.5%), married (78.8%), and aged 40 and above (40.1%). Heterosexual contact was identified as the primary mode of transmission (95.6%), with no cases attributed to blood transfusion. Private health facilities were the primary referrers (72.9%), and ICTC mainly referred patients to Antiretroviral Therapy (ART) centers (72.3%). Post-test counseling included spousal testing (33.6%) and condom counseling (90.5%), with limited condom uptake (18.9%) and follow-up of seropositive attendees (35.8%). Conclusion: The study underscores the critical role of ICTCs in HIV/AIDS management, highlighting trends in attendee profiles, transmission modes, referrals, and counseling practices. It emphasizes the necessity for targeted interventions to enhance follow-up and promote condom usage, alongside continued efforts to mitigate HIV transmission.

Impact of Covid-19 Pandemic on HIV/AIDS Testing and Treatment

Objective: This study aimed to assess the impact of the COVID-19 pandemic on HIV testing, diagnosis, treatment, and care in Nagpur, India by analyzing trends across patient data from 2017-2021. The goal was to outline challenges and future policy measures to mitigate disruptions and improve engagement of individuals living with HIV/AIDS. Materials and Methods: Data were analyzed for 971 diagnosed HIV/AIDS patients undergoing antiretroviral therapy at the Government Medical College's Integrated Counseling and Testing Centre and Antiretroviral Therapy Centre in Nagpur, spanning 2017-2021. Descriptive statistics were used to evaluate trends in key parameters - HIV screening, positivity rates, patient characteristics, ICTC-ART linkages, treatment outcomes. Appropriate ethical guidelines were adhered to. Results: Notable declines in HIV testing and positivity rates were observed during the COVID-19 period. Changes in patient demographic distribution and service gaps (drop in eligible spouse testing; ICTC-ART linkage gaps) indicated likely challenges in care access and engagement during the pandemic. Issues also emerged in critical areas including ART adherence, loss to follow-ups, and cessation of treatment over 2019-2021. Discussion: The results underscore pandemic-related disruptions faced by HIV care systems, potentially stemming from lockdowns, restrictions, and healthcare service limitations. Addressing detriments through multi-faceted approaches is imperative - improved ICTC-ART linkages, adoption of telemedicine/multi-month ART models and decentralized care can aid optimization of HIV care delivery during outbreaks. The learnings can inform the development of resilient health systems equipped to support vulnerable groups through co-occurring epidemics. Keywords: COVID-19, healthcare utilization, ICTCs (Integrated counseling and testing centers), linkage, pandemic, patient retention, service gaps, HIV/AIDS, vulnerable populations.

Caregivers’ experiences of accessing HIV Early Infant Diagnosis (EID) services and its barriers and facilitators, India

BackgroundIndia has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers’ perspectives on barriers and facilitators to access and utilize EID services.MethodsThe study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers’ of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers’ perspectives.ResultsThe stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade.DiscussionThe study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers’ perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors.ConclusionThe study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services.

Declining Trend of HIV Seroprevalence in Pregnant Women: A Retrospective Observational Analysis of 12 Years’ Experience at a Tertiary Care Hospital in Central India

Introduction: Human Immunodeficiency Virus (HIV) infection among antenatal women has been reported throughout the country, with a relatively high prevalence in the state of Maharashtra. Data on HIV seroprevalence in antenatal women serve as an indirect indicator of the HIV epidemic's burden in the general population and aid in predicting the same in young children. Diagnostic and treatment services for HIV are concentrated in selected states and districts with high seroprevalence, making it necessary to accurately calculate the prevalence of HIV. Aim: To assess the effectiveness of Prevention of Parentto-Child Transmission (PPTCT) services and to study the effectiveness of the National Acquired Immunodeficiency Syndrome (AIDS) Control Programme (NACP) in the functioning of PPTCT services. Materials and Methods: A retrospective observational analysis of 12-year data, from January 2007 to December 2018, was conducted in the Department of Microbiology at the Government Medical College and Hospital, Nagpur, Maharashtra, representing Central India. Data collection took place from June 2019 to December 2019, and analysis occurred over the subsequent two months (January 2020 to February 2020). The total sample size was 101,865 patients. All pregnant women registered in the Antenatal Clinic (ANC) under the PPTCT Program were included in the present study, and Strategy III of the National HIV testing algorithm was followed. The women's ages, their partners' serostatus, and records of babies born to HIV seropositive mothers were obtained and analysed. The statistical analysis of the data was performed using Stata (version 10.4.2009, STATA Corp., Texas, USA) and Epi Info 7 (version 7.1.06, 2012, CDC, Atlanta, USA), employing the Chi-square test for linear trend (Extended Mantel-Haenszel). A p-value <0.05 was considered significant. Results: The seroprevalence of HIV infection among pregnant women was 1.04% in 2007, decreasing to 0.23% by 2017. In 2009, 88.9% of women were counselled, and 100% were tested for HIV, with pretest counselling steadily increasing to 100% by 2012. The trend in HIV testing, however, remained at 100% over the span of 10 years. Post-test counselling varied from 89.6% to 99.9%, whereas the trend of HIV testing among partners fluctuated from 50% to 94.44%. The overall HIV positivity among babies, after 18 months of follow-up, was 4.77%. Conclusion: The HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing themselves of the facilities at Integrated Counselling and Testing Centre (ICTC). Intensive health education and the availability of diagnostic and therapeutic services across the country have reduced the burden of the HIV/AIDS problem in the country

Awareness and knowledge of integrated counselling and testing centres (ICTC) counsellors about depression among people with human immunodeficiency virus (HIV): A descriptive study from Karnataka

Background: Depression among people living with human immunodeficiency virus (PLHIV) is highly prevalent and it is associated with increased morbidity, poor adherence to antiretroviral therapy, and poor psychosocial outcomes. To address this, integrated counselling and testing centres (ICTC) counsellors provide psychosocial support to PLHIV. Materials and Methods: This descriptive study aims to assess the awareness and knowledge of ICTC counsellors about depression and its management. A total of 338 (n = 452) ICTC counsellors participated in the study. A demographic data sheet and a semi-structured questionnaire were used to collect data. Results: More than half of the participants reported that biochemical imbalances cause depression. 71.60% and 79.59% of participants reported that depression was common among PLHIV and required immediate attention. 92.60% of counsellors reported that a combination of counselling and medication would be effective to treat depression. 86.98% and 81.95% of counsellors were confident and actively screened for depression among PLHIV, and 78.11% of counsellors had access to a psychiatrist. In contrast. One-third of participants had difficulties working with PLHIV, and 55.56% of participants expressed that addressing issues of PLHIVs’ depression to be left to mental health professionals. Conclusion: ICTC counsellors had adequate knowledge about depression and its symptoms. However, lack of knowledge on intervention strategies, time constraints and work targets are significant barriers. These findings suggest that training on mental illness screening; brief intervention strategies may help counsellors to assist PLHIV in overcoming depression complications.

Access, timeliness and retention for HIV testing under early infant diagnosis (EID) program, India

Early Infant Diagnosis of HIV infection services are crucial for managing the perinatally acquired HIV infection. Assessing the performance of the EID services and its underlying determinants is important for the National AIDS Control Program, India. The objectives of this study were to find out access to HIV testing, the timeliness of the testing cascade, and the proportion of HIV exposed infants who are followed up to 18 months for a definitive diagnosis of HIV. The study design was a mixed method. A total of 11 states accounting for 80% of HIV-positive pregnant women were selected. Program records from a total of 62 Integrated counselling and testing centres (ICTCs) served as the source of information. The qualitative component included interviews of program managers at the state and district level, service providers at the ICTC level, and caregivers of HIV exposed infants. In the sampled 62 ICTCs, 78% of the HIV exposed infants had at least one HIV test. Of the infants who had HIV tests, 50% had at first sample collected by 8 weeks of age. The median turnaround time from sample collection to DNA PCR testing was 36 (IQR 19–70) days and that to next sample collection in case of detection of virus in the first sample was 66 (IQR 55–116) days. At 18 months of age, 544 (62%) HIV exposed infants were retained in the EID testing cascade. A total of 30 infants were diagnosed with HIV at a median age of 421 (IQR 149–650) days. More than three fourth of the HIV exposed infants had access to early infant diagnosis (EID) services. Both demand and supply-side factors contribute to access, timeliness and retention and there is a need to address these factors.

MICROSCOPIC AND DEMOGRAPHIC PROFILE OF SEXUALLY TRANSMITTED DISEASES AT A TERTIARY CARE CENTRE OF CENTRAL INDIA

Objective: To find out the prevalence of sexually transmitted diseases (STDS) among the patients attending the tertiary care center through microscopic screening. Methods: This Cross Sectional study was conducted from April 2018 to December 2019 wherein 500 samples were collected from patients attending the STD clinic of Skin and VD-OPD, and integrated counseling and testing center (ICTC), having cervical or urethral discharge along with signs and symptoms of sexually transmitted infections (STI) and were screened microscopically for the same. Results: This study reported only 2 cases suggestive of N. gonorrhoeae on microscopy, wherein the Gram-stained smear showed the presence of a particular arrangement of Gram-negative coffee bean shape cocci, both intracellular and extracellular, and plenty of pus cells. In Direct Microscopy findings, 49.2% of samples showed normal flora, 20.4% Gram-positive cocci, 15.8% Gram-negative cocci, 4% Clue cells, 13.8% with mixed flora, 3% Budding yeast-like cells and 0.4% showed Gram-negative cocci. Conclusion: Such studies involving the laboratory and demographic data should be conducted regularly, which can help in estimating the disease burden, strengthening the diagnostic capacity, and formulating the requisite strategy for tackling this problem through a syndromic approach.

Proportion of syphilis and hepatitis B and C virus infections among the Integrated Counselling and Testing Centre attendees of a tertiary care hospital.

Human Immunodeficiency Virus (HIV) affects the immune system of the body, causing a breakdown in its normal defenses and leaving it vulnerable to a host of life-threatening diseases. High-risk behaviors and routes of transmission for sexually transmitted infections such as syphilis, hepatitis B and hepatitis C are identical with HIV. This study was conducted to assess the proportion of syphilis and hepatitis B and C virus infections in HIV-positive and HIV-negative individuals, and their association with socioeconomic and other factors in Integrated Counselling and Testing Centre (ICTC) attendees, and to determine the association of absolute CD4+ T-lymphocyte count with these co-infections in HIV-positive individuals. The study was conducted in the Department of Microbiology of a tertiary care hospital. It included 100 HIV-positive individuals and 100 matched HIV-negative controls attending the ICTC. HIV-positive patients on antiretroviral therapy and patients with history of current/past treatment for chronic hepatitis infection were excluded from the study. Blood samples were tested for HIV, syphilis, and hepatitis B and C infections. The prevalence of syphilis, hepatitis B, and hepatitis C was observed in 3.5%, 2%, and 10% of patients, respectively. The frequency of hepatitis B virus (HBV) infection in HIV-positive and HIV-negative individuals was 1% and 3%, respectively. Hepatitis C virus (HCV) infection among HIV-positive and HIV-negative patients was 16% and 4%, respectively. Syphilis was seen in 7% of the HIV-infected patients. The mean CD4+ count for the HIV-positive patients with either syphilis, HBV, or HCV infections was 252 ± 137.5 cells/μl. Significant associations between HIV infection and education below high school, IV drug abuse, and multiple sexual partners were observed. The HIV-infected patients were observed to be at an increased risk of acquiring syphilis and HCV co-infections through the shared routes of transmission. Routine screening of these patients for concurrent syphilis and viral hepatitis may aid in prompt diagnosis and treatment with improved outcomes, which in turn may decrease the further spread of these infections.

Seroprevalence of Syphilis, Human Immunodeficiency Virus and its Co-infection in Patients Attending an ICTC at a Tertiary Care Hospital in Villupuram, Tamil Nadu, India

Introduction: Human Immunodeficiency Virus (HIV) and syphilis co-infection is common and affects similar age groups. The presence of syphilis infection increases the chances of transmission of HIV. Syphilis has a negative impact on HIV infection, resulting in increasing viral loads and decreasing Cluster of Differentiation 4 (CD4) cell counts during syphilis infection. Aim: To determine the seroprevalence of syphilis, quantify HIV-Syphilis co-infection in patients attending an Integrated Counseling and Testing Centre (ICTC) centre. Materials and Methods: This cross-sectional study was conducted at the Department of Microbiology, Government Villupuram Medical College, Tamil Nadu, India, for a period of four months from March 2021 to June 2021. All consecutive adult patients attending ICTC during the study period for voluntary testing or referred from antenatal clinic or Sexually Transmitted Disease (STD) clinic were included. Patients who were on treatment or follow-up of syphilis were excluded. Pretest counselling session was given and consent was taken for HIV testing. The HIV antibody tests were performed and interpreted according to the National AIDS Control Programme (NACO) guidelines. Rapid Plasma Reagin test (RPR) screening was done. Positive cases were subjected to Treponema pallidum Haemagglutination Assay (TPHA) and Syphilis Rapid Immunochromatographic Test (RICT). The results were analysed with the data systematically entered in Microsoft Excel format and p-value was calculated by Fisher’s- exact test using epi infoTM software. Results: Among the 400 patients attending the ICTC who were included in the study, six patients had a reactive HIV test. The overall HIV positivity was 1.5% (6/400). The RPR test was positive in 7/400 patients (1.75%). Among the seven patients with RPR positivity, five patients were positive by TPHA and Syphilis RICT. Biological False Positivity (BFP) rate in RPR against TPHA was 28%. Thus the frequency of syphilis among the study population by the confirmatory test TPHA was 1.25%. Among the five confirmed cases of syphilis, four patients were males (80%) and one patient was female gender (20%). Four of the five patients were in the 28-37 year old age group (80%) and one patient was in the 38-47 year age group (20%). The frequency of syphilis was 16.67% among HIV positives (17%) and 1.02% among HIV negatives biological false positivity by RPR was observed in 29% of the cases. Conclusion: HIV and Syphilis co-infection is common and Specific Treponemal tests could contribute to reducing errors due to false positivity by non specific tests like RPR which can be used as a screening test in microbiology laboratories.

A study on prevalence of HIV and its associated risk factors in patients visiting tertiary care center of North India

Background: India is home to the second largest population of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) with an estimated 5.134 million infections. HIV has infected >75 million people worldwide, with an estimated 37 million people now living with the virus making it the major cause of morbidity and mortality worldwide. HIV is a significant public health problem with tremendous social and economic implications. Aims and Objectives: Our primary aim is to estimate the prevalence of HIV infection and the associated risk factors of HIV infection. Materials and Methods: This is a retrospective study of the patients who visited in integrated counseling and testing center (ICTC) and State Reference Laboratory at a tertiary care center of Agra, Uttar Pradesh from January 2017 to December 2021. The data are in accordance with NACO portal. Results: The highest HIV seropositivity was observed in 35–49 years age group in both males and females in three consecutive years 2017, 2018, and 2019, respectively. HIV seropositivity in males decreased from 8.3% in 2017 to 4.9% in 2021 and in females from 6.0% to 4.6%. The most seropositives belong to married population (41.2%) and the least in divorced population (4.2%). Overall, housewives (20.7%) were maximally affected by HIV seropositivity, followed by skilled workers (15.8%) and unemployed/retired persons (15.7%). Uneducated population had maximum seropositivity rate (35.3%). Majority of HIV positives were heterosexual non-commercial partner (47.4%), while the homosexuals were the least (1.8%) affected. Conclusion: This study highlights the most affected group of HIV seropositive population and their risk behavior. Thus, by making ICTC, more accessible to ramp up the focused screening and prevention efforts for the suspected HIV population and evolving the appropriate policies/strategies for public awareness program will help to reduce the spread of HIV infection among the masses.

HIV-TB Cross-referral and Collaborative Strategy: 8 Years of Our Experience from An Urban Health Centre in North India

Human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics continue to fuel each other and with dual infections with these two deadly diseases on the rise, it becomes imperative to devise effective HIV-TB collaborative strategies. The present study was designed to evaluate the existing HIV-TB cross-referral mechanism at an urban health centre; to determine HIV sero-prevalence among pulmonary TB patients referred from chest clinic to the integrated counselling and testing centre (ICTC); and to evaluate the TB suspects referred from ICTC to the chest clinic for a possible TB aetiology. The present study was a retrospective analysis of HIV-TB cross-referrals whereby a line list of all the patients referred under this strategy from January 2006 to December 2013 was retrieved and analysed. A total of 3726 TB cases were referred to the ICTC and 641 TB suspects were identified by ICTC counsellors and referred to the chest clinic during this period. HIV sero-prevalence among TB patients was 2.8% (106 of 3726) and TB prevalence among HIV sero-positive and sero-negative TB suspects was 9.3% (10/108) and 4.3% (9/211), respectively (p=0.07). HIV prevalence was found to be significantly higher among male (n=2024) than among female (n=1702) TB patients (4.4% versus 0.9%; p<0.0001). Only 319 of 641 (49.8%) ICTC patients referred to the chest clinic reached there. Our study highlights the strong need to scale up the integration and partnership between HIV and TB programmes for better and integrated diagnosis and care of HIV-TB co-infected patients.

Prevalence of HLA-B*57:01 allele in HIV-positive and HIV-negative population of eastern India: An epidemiological study

IntroductionThe nucleoside analogue reverse-transcriptase inhibitor Abacavir has potent antiviral activity against HIV; however, 5–8% patients develop hypersensitivity reactions within six weeks of treatment. The presence of the HLA-B*57:01 allele is strongly associated with the risk of Abacavir-associated hypersensitivity reaction (ABC-HSR). Prevalence of HLA-B*57:01 allele varies in different populations. This observational study was performed to determine the prevalence of HLA-B*57:01 allele in the population of Eastern India which included both HIV-positive and HIV-negative subjects. MethodsWe screened 406 subjects attending the ART (antiretroviral treatment) centre and linked ICTC (Integrated counselling and testing centre), however 6 samples did not have adequate DNA. HLA-B*57:01 typing was done using direct sequence specific primer PCR (SSP-PCR). All PCR positive samples were sequenced using Sanger's method. ResultsThe prevalence of HLA-B*57:01 genotype in our cohort was 12.25% (49/400). Prevalence among men was 13.3% (33/248) and female was 10.5% (16/152). The prevalence was similar in HIV-positive subjects (13.5%) and in HIV-negative subjects (11%). ConclusionsPrevalence of HLA-B*57:01 in our eastern Indian population was high. Therefore, screening for HLA-B*57:01 before ABC administration would be useful to prevent ABC-HSR.

Client Satisfaction with Services Provided at Integrated Counselling and Testing Centre in a Rural Hospital, Panvel, Maharashtra, India

Introduction : HIV is a global pandemic and has been a serious concern for public health among individuals and communities. Measuring client satisfaction can help the country to carry out an evaluation of the health service system as well as, clients can develop a long-lasting relationship with the service provider. Objectives: 1) To assess the client satisfaction by the services provided at the Integrated Counselling and Testing Centre at the Rural Hospital, Panvel. 2) To provide recommendations to improve the services provided at the Integrated Counselling and Testing Centre. Method: A descriptive, crosssectional, facility-based study was conducted in an Integrated Counselling and Testing Centre (ICTC) at a Rural Hospital, Panvel using simple random sampling technique. Exit interviews were conducted for three hundred clients after the required consent was obtained. Clients were stratified into pregnant and nonpregnant females. All clients above 18 years were included in the study however, clients not giving consent or severely ill were excluded. The data was analyzed using Microsoft Excel, and Epi Info Version 7.2. Results: Among 300 clients, 66% (198) of the clients belonged to the age group of 18-28 years and 54.3% (163) were literate. The study found that nearly74% (222) of the clients were referred and about 71.7% (215) clients were unsatisfied with the ICTC services. Conclusion: Majority of the clients were unsatisfied with the services provided at ICTC. Literate clients were more unsatisfied as compared to illiterate clients.It is further recommended that the counsellors at ICTCs should spend more time with the clients and tere should be a mandatory requirement of female counsellors.

Psychiatric morbidity among human immunodeficiency virus test seekers attending the integrated counseling and testing center facility of a tertiary care hospital in South India.

Background:Testing for human immunodeficiency virus (HIV) infection has become a mandatory and routine regimen for various reasons. Literature suggests that the level of psychiatric morbidity is high among HIV-infected individuals. However, often psychiatric problems are undetected and untreated among these people and this is possible by the simple measure of screening when these people contact a health-care facility such as an integrated counseling and testing center (ICTC). The paucity of published data in this arena necessitates exploring the facts related to this issue. Hence, this study was aimed to identify the psychiatric morbidity among people undergoing HIV testing by a screening method.Methods:A cross-sectional, descriptive study was carried out among 384 individuals, those who were undergoing HIV testing at an ICTC facility of a tertiary care hospital in South India. They were assessed for psychiatric morbidity by a structured clinical diagnostic interview using mini international neuropsychiatric interview. Those people who were identified as having psychiatric problem were referred to psychiatric clinic for further management.Results:The mean age of the patients was 40 (±13.27) years and the males (n = 254, 66.1%) predominated than the females (n = 130, 33.9%). Psychiatric illness was identified in many patients (n = 91, 24%) including major depressive disorder (n = 64, 16.7%), suicidal ideas (n = 31, 8%), panic disorder (n = 26, 6.8%), and substance abuse (n = 15, 3.9%).Conclusion:The findings imply the need to integrate screening and referral services for the people undergoing HIV testing. Early screening of psychiatric morbidity among individuals utilizing the ICTC facility may help identify and treat the illness at an early stage.

Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study

Background: Integrated Counseling and Testing Centers (ICTC) provide counseling and testing for HIV to the clients. Satisfaction of the clients attending an ICTC determines its acceptance among people, and it is crucial for preventing this disease. Objectives: To estimate the level of satisfaction and to determine its association with sociodemographic parameters of the clients attending ICTC in a teaching hospital. Methodology: This hospital-based cross-sectional study was conducted in October 2019 among 213 clients attending ICTC of Agartala Government Medical College, chosen by census technique. An interview schedule containing information regarding age, sex, marital status, education, socioeconomic class, along with a component for evaluating HIV counseling and testing services initially used by UNAIDS, was used for data collection. Results: Among the clients, 54.5% (116) were male, 45.5% were aged between 35 and 80 years, 79.3% were from rural areas, 87.8% were Hindu by religion, 33.8% belonged to scheduled caste community, 63.4% were primary educated, 35.2% belonged to BG Prasad's Class II socioeconomic status, 83.6% were married, and 10.3% attended ICTC by self-initiated approach. Only 39% of the clients were found to be satisfied with the services of this ICTC. Waiting time in queue was found to be significantly associated with client's satisfaction. Conclusion: The client's satisfaction level was found to be low. Reduction in queuing time, caring attitude, and use of the client's own language might improve the scenario.

A Clinico-Demographic Profile and Sexual Behaviour Pattern in Attendees of Designated STI/RTI Clinic Having Sexually Transmitted Infections with Special Reference to HIV Seropositivity.

The dynamics of sexually transmitted infections (STIs) are influenced by sexual behaviour (age of first sexual exposure, number of sexual partner/s, sexual orientation, mode of intercourse, addiction, occupation, correct and consistent use of condom). The presence of the human immunodeficiency virus (HIV) influences the clinical pattern of STIs and the course of disease too. Our study was conducted to find the prevalence of STIs among attendees of a designated STI/RTI clinic (DSRC) with the description of clinico-demographic profile and sexual behaviour and association of HIV seropositivity with STIs. Ours was an institution-based cross-sectional study conducted at DSRC after obtaining ethics committee approval and consent from patients. Clinical diagnosis, demographic profile and sexual history were obtained after maintaining audio-visual privacy. Medcalc, version 10.2 was used. Among 167 patients attending DSRC during the study period, 76 having sexual dysfunctions were excluded. The major STIs diagnosed were primary syphilis (6.59%), secondary syphilis (2.2%), herpes genitalis (42.86%), condyloma acuminata (26.37%), molluscum contagiosum (5.49%), genital candidiasis (7.69%), bowenoid papulosis (3.3%), genital scabies (4.4%) and chancroid (1.1%). Sexual orientations were heterosexual (64.83%), lesbian (1.1%), gay (12.1%), bisexual (17.58%) and with an animal partner (4.4%). Among the total study population, 8.8% was rapid plasma reagin (RPR) reactive and 12.1% was Integrated Counselling and Testing Centre (ICTC) reactive. Among the total patients who used condoms (n = 49), only 15 (16.4% of total participants) used condoms correctly and consistently. Peno-vaginal mode of intercourse (n = 78) was found to be most common followed by oro-insertive (n = 42), oro-receptive (n = 34), ano-insertive (n = 24), ano-receptive (n = 17) and digital insertion (n = 20). Sexual behaviour influences the disease outcome in patients with reproductive tract infection (RTI)/STI.

Intestinal Parasite Infestation in HIV Infected Patients in Tertiary Care Center

Every year, the number of people living with HIV rises as a consequence of advanced infections and the positive effects of highly active antiretroviral therapy (HAART). Gastrointestinal involvement is common, with 90% of patients seeking treatment for gastrointestinal problems as their HIV infection progresses. Nonetheless, identifying and characterization of infectious agents is important for patient management by excluding a clinical diagnosis and determining appropriate treatment, as well as determining public healthcare policy for true pathogen prevalence and yielding epidemiological risk factors for specific infections. The aim of this study is to evaluate the prevalence of symptomatic or asymptomatic intestinal parasitic infection among HIV or AIDS patients. For this study with 80 HIV seropositive patients being recruited from various wards and the Integrated Counseling and Testing Center (ICTC) affiliated to the microbiology department. Patients with acute and chronic diarrhea with abdominal disorder were taken as symptomatic whereas patients without these clinical complaints and who came for routine investigations were taken as asymptomatic. Firstly stool samples were analyzed by macroscopically for the presence of mucus, blood, larvae, segments of tapeworm and adult worms. The consistencies of stool were also recorded such as formed, watery or soft or loose with odor and color. It was examined microscopically after macroscopically for protozoan cysts and trophozoites, helminthic ova and larvae, as wet mount preparation by saline and iodine preparation as well as formal ether concentrated. For the detection of intestinal coccidian parasites, smears were prepared from stool samples and a modified Ziel-Nelseen (MZN) stain was also performed. Stool samples with the detection of parasites were informed for treatment. The prevalence of intestinal parasite was 23.75% with asymptomatic and symptomatic groups having a prevalence of 16.98% and 37.04% respectively. Out of total patients, 56.25% were male and 43.75% were female. Among the male patients, 11 (13.75%) were positive for an intestinal parasitic infection and 8 (10%) were positive among females. The age distribution data revealed that the age group 21-40 years old had the highest number of intestinal parasites, followed by 41-60, 61-80, and 0-20 years old. The most intestinal parasites were found in the young and middle-aged patients, according to this study. Different parasites were identified as Entamoeba histolytica, Taenia species, Ascaris lumbricoides, Cryptosporidium parvum and Isospora with one protozoan, two coccidian parasites and two helminthes. The most common parasite was Taenia species 6 (7.5%) followed by Entamoeba histolytica 5 (6.3%) and Cryptosporidium parvum 5 (6.3%). Intestinal parasitic infection is not uncommon in HIV seropositive patients. This study underscores the need for early diagnosis and treatment of these intestinal parasites in both symptomatic and asymptomatic HIV patients.

Function of Serum Adenosine Deaminase as an Indicator of Immune Status in HIV Patients treated with Combination Antiretroviral Therapy

Acquired immunodeficiency syndrome (AIDS) is one of the greatest public health and social problems threatening the human race. The trend of annual AIDS deaths is showing a steady decline since the implementation of the free Anti-Retroviral Therapy (ART) program in India (2004). HIV infection is characterized by replication of virus by abnormal non specific immune activation and persistent inflammation. Adenosine deaminase (ADA) has a cytokine-like co-stimulatory role in T cell proliferation which is independent of catalytic activity. Therefore, we decided to study the role of ADA as an indicator of immune status in HIV patients treated with combination antiretroviral therapy (cART). Adenosine deaminase activity (ADA) in HIV patients was estimated before and after 3 months interval of antiretroviral therapy (ART) up to 9 months. The study included 150 HIV positive patients between age group of 20-50 years from ICTC (Integrated Counseling and Testing Centre) and ART centre. Venous blood samples were collected in plain bulb to estimate serum ADA activity before and after 3 months interval upto 9 months of ART. Serum ADA activity was estimated using colorimetric method of Giusti and Galanti. Activity of serum ADA was significantly raised before and after 3 months interval of ART with decrease in CD4 cell count. After 6 months, increased ADA activity started declining and comes to near normal after 9 months of ART (p&lt;0.001). Elevated serum adenosine deaminase activity in HIV patients is an indicator of T-cell activation. Serum ADA activity along with other markers can be used as a prognostic marker to monitor response to antiretroviral therapy and immunocompetence in HIV patients.

Trend of HIV Infection and Associated Risk Factors at Integrated Counselling and Testing Centre in a Tertiary Care Hospital in Bihar: A Retrospective Study

Introduction: Human Immunodeficiency Virus (HIV) infection became a major global health issue and a priority in many countries because it is the leading cause of morbidity and mortality throughout the world. In India, about 71% of total annual new HIV infections were reported from Telangana, Bihar, West Bengal, Uttar Pradesh, Andhra Pradesh, Maharashtra, Karnataka, Gujrat, Tamil Nadu and Delhi. The major cause of concern is that around 25% of the infected people are not aware that they are infected by HIV virus and is one of the major risk factor responsible for the spread of HIV infection. Aim: To evaluate the trends, pattern and associated risk factors responsible for the spread of Human Immunodeficiency Virus (HIV) infection in patients who attended Integrated Counselling and Testing Centre (ICTC) of a tertiary care centre of Bihar, India. Materials and Methods: A retrospective study was conducted on the available records of all the patients who attended ICTC of a tertiary care centre in Bihar, India, between January 2016 to December 2018. The data regarding the age, sex, marital status, educational status and behavioural pattern of the patients tested for HIV infection at the ICTC were assessed and analysed. Descriptive statistical analysis was done. Results: The total of 16333 and 15969 patients received counselling and testing services respectively during the study period. The prevalence of HIV infection was 3.70%, amongst whom 64.38% were males and 32.93% were females including 2.69% pregnant female patients. The ratio of seropositive male to seropositive female was 2.07:1. Maximum seroreactivity was found in 35-49 years age group (38.57%) followed by 25-34 years age group (28.42%). The major factor for the transmission and spread of HIV infection was unprotected sexual contact (88.33%) followed by mother to child transmission, infected blood and its products and infected needles and syringes. Illiteracy (45%) and unawareness was the major associated factor for spread of HIV infection. Conclusion: The high prevalence of HIV infection can be minimised by creating awareness, following safe sexual practices, promoting antenatal screening, procuring blood and its product from authorised blood banks where proper screening of Transfusion Transmitted Infections (TTI) is done.

Unsterile injection equipment associated with HIV outbreak and an extremely high prevalence of HCV-A case-control investigation from Unnao, India.

The integrated counseling and testing center (ICTC) located in the district hospital, Unnao in the northern state of Uttar Pradesh (UP), India witnessed an increased detection of HIV among its attendees in July 2017. Subsequently, health camps were organized by the UP State AIDS Control Society in the villages and townships contributing to such detection. We conducted a case-control study to identify factors associated with this increased detection; 33 cases and 125 controls were enrolled. Cases were individuals, detected HIV sero-reactive during November 2017-April 2018 from three locations namely Premganj, Karimuddinpur and Chakmeerapur in the Bangarmau block of the district of Unnao. Controls hailed from the same geographical setting and tested HIV sero-nonreactive either in health camps or at ICTC centers from where the cases were detected. Misclassification bias was avoided by confirming HIV sero-status of both cases as well as controls prior to final analysis. Study participants were interviewed on various risk practices and invasive treatment procedures. They were also tested for HIV and other bio-markers reflecting unsafe injecting and sexual exposures such as hepatitis B surface antigen (HBsAg), anti-HCV antibody (HCV Ab), anti-herpes simplex-2 Immunoglobulin G (HSV-2 IgG) and rapid plasma regain (RPR) test for syphilis. Secondary data analysis on three time points during 2015 through 2018 revealed a rising trend of HIV among attendees of the ICTCs (ICTC-Hasanganj, ICTC-Unnao district hospital and ICTC- Nawabganj) catering to the entire district of Unnao. While there was a seven fold rise of HIV among ICTC attendees of Hasanganj (χ2 value for trend 23.83; p < 0.001), the rise in Unnao district hospital was twofold (χ2 value for trend 4.37; p < 0.05) and was tenfold at ICTC-Nawabganj (χ2 value for trend 5.23; p < 0.05) indicating risk of infection prevailing throughout the district. Primary data was generated through interviews and laboratory investigations as mentioned above. The median age of cases and controls was 50 year (minimum 18 -maximum 68; IQR 31-57) and 38 year (minimum 18 -maximum 78; IQR 29-50) respectively. Thirty six percent of the cases and 47% of controls were male. A significantly higher proportion of cases (85%) had HCV Ab compared to controls (56%; OR 4.4, 95% CI 1.5-12.1); none reported injection drug use. However, cases and controls did not differ significantly regarding presence of HSV-2 IgG (6% versus 8% respectively). Neither any significant difference existed between cases and controls in terms of receiving blood transfusion, undergoing invasive surgical procedures, tattooing, tonsuring of head or skin piercing. In multivariate logistic regression model, 'unsafe injection exposure during treatment-seeking'(AOR 6.61, 95% CI 1.80-24.18) and 'receipt of intramuscular injection in last five years' (AOR 7.20, 95% CI 1.48-34.88) were independently associated with HIV sero-reactive status. The monophyletic clustering of HIV sequences from 14 cases (HIV-1 pol gene amplified) indicated a common ancestry. Availability of auto-disabled syringes and needles, empowerment of the local communities and effective regulatory practices across care settings would serve as important intervention measures in this context.