Integrated Counseling And Testing Centre Research Articles

Late detection of human immunodeficiency status: An urgent need to promote early diagnosis

Background: People living with human immunodeficiency (HIV) was estimated to be 21.17 lakhs in India. Early diagnosis and early treatment with antiretroviral therapy (ART) have significant effect in reducing the morbidity and mortality in these patients and also have a crucial role in reducing the occurrence of new infections in the community. Objectives: (1) To find the prevalence of late presentation among newly diagnosed HIV reactive, (2) to identify factors associated with late presentation, and (3) to provide recommendations to improve early diagnosis. Materials and Methods: A retrospective record-based study was conducted in the Integrated Counseling and Testing Centre (ICTC) center in a tertiary care teaching hospital. Details of the individuals who have undergone HIV testing in the ICTC center between January and December 2016 were noted. All the identity details of the clients were kept confidential by creating coding for each of them. The data were analyzed using descriptive statistics, and the results were presented in the form of percentages. Results: A total of 777 individuals were tested for their HIV status in the year 2016, and 8.36% were found to be reactive for HIV. Majority (36.9%) of the HIV reactive individuals were in the age group of 36–45 years. 35 positive clients (53.8%) were females and the rest (46.2%) were males. 58 (7.46%) individuals were newly detected as having HIV, and the rest 7 have already undergone HIV testing in other centers and knew their HIV status. Among the newly detected HIV reactive, 82.3% had their CD4 count

A Retrospective Cohort Study on Protective Efficacy of Intrapartum Nevirapine Prophylaxis to Prevent Parent to Child Transmission of Human Immunodeficiency Virus in West Bengal

Background: : In Prevention of Parent to Child Transmission (PPTCT) program in India, single dose Nevirapine was used for prevention of intrapartum transmission of HIV, but the protective efficacy of this regimen in Indian population is not beyond question. Objective: To analyze the protective efficacy of single dose Nevirapine prophylaxis in preventing mother to child transmission of HIV and comparing the effect of Nevirapine prophylaxis in different types of infant feeding practices and modes of delivery. Methods: A retrospective cohort study was carried out through analysis of secondary data during October 2010 to September 2011 from 16 Integrated Counseling and Testing Centers (ICTCs) having DNAPCR (Polymerase Chain Reaction) collection facility in West Bengal among 224 babies born of HIV infected mothers, 168 unexposed (covered with intrapartum Nevirapine) and 56 exposed (not covered with intrapartum Nevirapine) to risk of transmission. HIV reactivity in babies was confirmed by DNA PCR of Dry Blood spot from 6 weeks age onwards. Data was entered and analyzed using Epi Info version 3.5.1 and Statistical Package for Social Sciences software version (SPSS 16.0). Results: About 10.12% of those received Nevirapine were found HIV reactive compared to 26.79% of those who did not. Overall Relative Risk of non coverage of Nevirapine for vertical transmission of HIV was 2.65 (95% CI : 1.42 ‐ 4.95). Overall Attributable Risk was 62.22%. Conclusion: Since in 62.2% cases vertical transmission of HIV was prevented, additional regimen may be thought of for rest 37.8% cases.

Prevalence of Enteric Parasites in HIV-Positive Patients with Diarrhoea and Their Correlation with CD4+ T-Lymphocyte Counts

Background and Objectives: Opportunistic parasitic infections are one of the most serious infections in human immunodeficiency virus (HIV) positive patients. The present study was conducted to determine the prevalence of these coccidian enteric parasites in HIV-positive patients and evaluate their association with their CD4 (CD4+ T lymphocyte) counts. Materials and Methods: The study was done on 100 HIV-positive patients presenting with diarrhoea and 100 HIV-positive patients without diarrhoea (control) attending the integrated counselling and testing centre (ICTC) of Burdwan Medical College & Hospital, Burdwan, West Bengal. The CD4+ T-cell count of these patients was also estimated. The stool slides were stained and the parasites were identified by direct microscopy. Results: Of the 100 diarrhoeic patients, parasites were isolated from 94 samples compared to 11 stool samples from patients without diarrhoea. Cryptosporidium parvum (51%) was the predominant parasite isolated in HIVpositive patients with diarrhoea followed by Cyclospora (26%). The maximum parasites were isolated in patients with CD4+ T cell counts below 200 cells/μl. Conclusions: HIV-positive patients with diarrhoea and CD4+ T-cell counts <200/μl has high prevalence of association with intestinal parasitic infections and identification of these parasites may play an important role in treatment to reduce morbidity and mortality in these patients.

Perception of HIV Testing and Counseling among Integrated Counseling and Testing Center Clients of Tertiary Level Hospitals.

The purpose of establishing integrated counseling and testing center (ICTC) is to detect HIV at the earliest time, providing information on modes of transmission and prevention of HIV by promoting behavioral change and reducing vulnerability, and informing individuals on HIV prevention, care, and treatment services. To know the awareness of the clients about ICTC before pretest counseling. This facility-based cross-sectional study was conducted among 105 pretest counseling clients who visited ICTC for the first time in 3 ICTCs of tertiary care hospitals attached to a medical college in Mangalore. Majority of the clients were pregnant women (n = 57, 54.30%), and most of the clients were referred by the treating doctor (n = 91, 86.7%). Most of the clients, being unaware of ICTC, are not aware of its functions and activities. Although ICTCs have been functional for nearly a decade, the awareness of ICTC and its functions among the people is poor.

Socio-demographic variables and psychosocial stressors among Integrated Counseling and Testing Centre (ICTC) attendees: A preliminary report from North India

Socio-demographic variables and psychosocial stressors among Integrated Counseling and Testing Centre (ICTC) attendees: A preliminary report from North India

Descriptive study of the utility of individual tracking tool in program monitoring for prevention of mother-to-child transmission of HIV, Maharashtra, India.

ObjectiveThe objective is to describe the utility of prevention of parent-to-child transmission tracking tool in terms of the in-depth information that it provides for better decision making to improve the services.MethodsThe excel-based tracking tool is initiated by 578 Integrated Counselling and Testing Centre (ICTC) Counsellor and shared with 70 antiretroviral treatment (ART) centres. Between April and September 2014, total of 1118 HIV-infected pregnant women were registered in the tool. The secondary data for this period that is captured in the prevention of parent-to-child transmission tracking tool has been analyzed and presented in this descriptive study.ResultsOf the total 1118 HIV-positive pregnant women, registered in the tool, 760 (68%) were newly detected with HIV infection and 358 (32%) had already been detected before their current pregnancy. In total, 1095 (98%) pregnant women were registered at ART centre out of which 1007 (91%) were initiated on lifelong ART. The average time delay between HIV detection and registration at ART centre was 12 days (n = 844). In this cohort of 1118 pregnant women, 45% delivered live babies, 7% underwent medical termination of pregnancy, 2% were stillbirths and abortions, and 46% were yet to deliver. Only 29 infants were tested for HIV at 6 weeks of age and six were found reactive.ConclusionThe tracking tool provides in-depth information regarding the pregnant women registered in the program and in the tracking tool. The information throws more light on the characteristics of the registered women and the various services provided to them and highlight key areas where the program has to be improved. The tool is effective for assessing the treatment status of HIV-positive pregnant woman, retention in care and early infant diagnosis of the baby. The tool has identified programmatic bottlenecks component wise such as the need to focus on earlier detection of HIV-positive women during pregnancy, decreasing the time delay between detection and ART registration, and improving the early infant diagnosis.

A five year prevalence of HIV among attendees of Integrated Counselling and Testing Centre (ICTC) of a Government Medical College of Central India

Background: Acquired immune deficiency syndrome (AIDS) has been one of the most devastating diseases to have affected mankind. In the past 30 years, AIDS has emerged as a devastatingly fatal disease, assuming pandemic proportions sparing no region of the world, so its early diagnosis and prompt treatment can provide the healthy life for the human immunodeficiency virus (HIV) infected persons. Objective: The purpose of this study was to estimate the prevalence of HIV infection and their gender variance among the clients attending ICTC, situated in microbiology department of S.S.M.C. Rewa, India, for a period of 5 years from 2010 to 2015. Materials and Methods: A total of 44,460 clients attended ICTC, situated in Microbiology Department of Shyam Shah Medical College Rewa, India, from 2011 to 2015. Serum samples were collected after taking informed consent and pretest counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guideline has been followed for HIV testing, reporting and release of results with posttest counseling. Result: Of the total 44,460 clients tested for HIV infection, 572 (1.28%) were found to be HIV-1 seropositive. Seropositivity was higher in male clients (i.e., 331 (57.86%)) than female (i.e., 241 (42.13%)). In all these cases pediatric age group (0–14 years) prevalence was 4.19%. Conclusion: HIV prevalence of 3.78% among the clients attending ICTC, situated in S.S.M.C. Rewa, M.P., Central India. Puts light on the burden on HIV in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups by various modes of IEC activities.

Performance of the prevention of parent to child transmission program: A decadal trend from rural Maharashtra, India.

Human immunodeficiency virus (HIV) infection is widely spread across the state of Maharashtra with high prevalence among antenatal women. To assess the effectiveness of prevention of parent to child transmission (PPTCT) services in rural Tertiary Health Care Centre of Western Maharashtra, India and to address the weaknesses in functioning of PPTCT services. A cross-sectional study was conducted at Integrated Counselling and Testing Centre (ICTC) of a rural tertiary health center located in rural area of Western Maharashtra over a period of 10 years from 2003 to 2012. A total of 32,575 pregnant women were included as study subjects and data were collected as per the indicators of PPTCT by viewing the retrospective PPTCT records. The data were analyzed over the period of 10 years for the outcome of PPTCT services. The trend of PPTCT indicators over a decade were analyzed by using Chi-square test. The seroprevalence of HIV infection among pregnant women was 2% in 2003 which decreased to 0.2% by 2012. The proportions of women counseled and HIV tested were 88.9% and 100%, respectively in 2003 and pretest counseling trend was steadily increased to 100% by 2012; however; HIV testing trend remained 100% throughout 10 years. Posttest counseling trend ranges from 89.6% to 99.9% whereas trend of HIV testing among partners has been fluctuating from 25% to 100%. The proportional trend of HIV-positive mothers delivered in a tertiary care hospital ranges from 60% to 100%. The proportions of pair receiving prophylaxis Nevirapine has been increased from 83.8% to 100% by 2009, but thereafter decreased to 83.3% by 2012. The overall HIV positivity among babies after 18 months of follow-up was 21%. HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing the facilities of ICTC centers. Intensive health education and availability of diagnostic and therapeutic services in rural health center have reduced the burden of HIV/AIDS problem in the rural community.

Trend of HIV seropositivity among children attending ICTC SMS Medical College Jaipur, Rajasthan

Background: In India about 0.1 million children are living with HIV and most of these infections are acquired by perinatal transmission. The prevention of parent-to-child transmission (PPTCT) program aims to prevent the perinatal transmission by interruption of transmission at different levels. This study was conducted to see the trend of HIV seropositivity among children after the implementation of the PPTCT program. Aims: The aim of this study was to investigate the magnitude of pediatric HIV seropositivity and its time trend in last 11 years at a tertiary care hospital in Rajasthan. Materials and Methods: Children of aged less than 14 years attending the Integrated Counseling and Testing Centre (ICTC) were screened for HIV antibodies. A detailed history about age, sex, HIV serostatus of the parents, and history of blood transfusion was recorded. Statistical Analysis: The level of significance was recorded using P value. Results: Out of the 17,612 subjects, a total of 887 (5.03%) children were positive for HIV infection. Out of these 887 subjects, 567 were male children (m:f = 1.77:1) and most of them (59.9%) were of age less than 5 years. Perinatal transmission was the commonest mode of transmission. A decreasing trend of HIV seropositivity is observed among children of age less than 14 years after year 2005 (x 2 for trend = 503.445, P< 0.001). Conclusion: Despite all this, combined efforts are still needed to prevent new HIV infection, to keep their mothers healthy and alive, and to improve the diagnosis and treatment of HIV for children.

Performance of the prevention of parent to child transmission program: A decadal trend from rural Maharashtra, India

Background:Human immunodeficiency virus (HIV) infection is widely spread across the state of Maharashtra with high prevalence among antenatal women.Aims:To assess the effectiveness of prevention of parent to child transmission (PPTCT) services in rural Tertiary Health Care Centre of Western Maharashtra, India and to address the weaknesses in functioning of PPTCT services.Materials and Methods:A cross-sectional study was conducted at Integrated Counselling and Testing Centre (ICTC) of a rural tertiary health center located in rural area of Western Maharashtra over a period of 10 years from 2003 to 2012. A total of 32,575 pregnant women were included as study subjects and data were collected as per the indicators of PPTCT by viewing the retrospective PPTCT records. The data were analyzed over the period of 10 years for the outcome of PPTCT services. The trend of PPTCT indicators over a decade were analyzed by using Chi-square test.Results:The seroprevalence of HIV infection among pregnant women was 2% in 2003 which decreased to 0.2% by 2012. The proportions of women counseled and HIV tested were 88.9% and 100%, respectively in 2003 and pretest counseling trend was steadily increased to 100% by 2012; however; HIV testing trend remained 100% throughout 10 years. Posttest counseling trend ranges from 89.6% to 99.9% whereas trend of HIV testing among partners has been fluctuating from 25% to 100%. The proportional trend of HIV-positive mothers delivered in a tertiary care hospital ranges from 60% to 100%. The proportions of pair receiving prophylaxis Nevirapine has been increased from 83.8% to 100% by 2009, but thereafter decreased to 83.3% by 2012. The overall HIV positivity among babies after 18 months of follow-up was 21%.Conclusion:HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing the facilities of ICTC centers. Intensive health education and availability of diagnostic and therapeutic services in rural health center have reduced the burden of HIV/AIDS problem in the rural community.

Outcome of Prevention of Parent-to-Child Transmission of HIV in an Urban Population in Southern India.

To analyze the outcomes of Prevention of Parent to Child Transmission (PPTCT) of HIV program in an urban Southern Indian setting. Observational study. Anti-retroviral Therapy (ART) Centers/ Integrated Counseling and Testing Centers (ICTC) at four government Obstetrics Institutes in an urban area. 100 HIV-positive pregnant women and their infants delivered in the study centers. Triple drug ART to HIV-positive pregnant women was started for maternal indications only. Rest of the pregnant women were given single dose Nevirapine (200 mg) at the onset of labor. All infants were given single dose Nevirapine (2 mg/kg) prophylaxis, according to National AIDS Control Organization guidelines. Mothers were counseled regarding breastfeeding and artificial feeding, and the choice was left to them. Whole blood HIV 1 DNA PCR was done for all infants at 6 weeks of life. A second PCR was done at 6 months or 6 weeks after stopping breastfeeds. PCR-positive infants were started on ART, and were followed-up till18 months of life. Four infants were PCR-positive for HIV. All of them were breastfed. They were born to mothers of HIV stage 1 or 2 who were not on ART as CD4 counts were >350 cells/mm3. Among the mothers in Stage 3 or 4 or CD4 count <200 cells/mm3 and on ART, none of the infants was HIV-positive. The cumulative HIV-free survival at 18 months was 94%. Parent-to-child transmission rate in HIV was low with the currently used strategies. Triple drug ART to mother reduces mother-to-child transmission despite advanced maternal stage or low CD4 counts.

Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi – policy implications

In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to <100 beds; n = 42) and small nursing homes (10 to <25 beds; n = 29). A pre-tested questionnaire was designed to obtain basic information about hospital in context to PMTCT programme. Interviews of heads of obstetrics and gynaecology and paediatric departments were conducted by trained interviewers. It was observed that in private hospitals in year 2012, out of 38,186 antenatal women tested, 52 (0.14%) were detected HIV-positive. However, against National Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering PMTCT services in private health sector.

FACTORS FOR DELAY IN REGISTRATION AT ART CENTRE UNDER NACO PROGRAMME AT GANDHI HOSPITAL, SECUNDERABAD

BACKGROUND: People Living with HIV (PLHIV) after detection of HIV positivity at Integrated Counseling and Testing Centre (ICTC) are referred to the Anti-Retroviral Treatment (ART) center for registration and Treatment services. However, significant numbers of patients are not registering at ART in time. OBJECTIVE: To analyze the reasons for delay in registering at ART after confirming HIV +ve at ICTC. METHODS: Five hundred consecutive new PLHIV registrations at ART center of this institution from 1 st May to 30 th Nov 2011 were included. Date of confirmation as HIV +ve at ICTC & date of registration at ART are recorded. Reasons for delay of more than 5 days for registration are collected through structured questionnaire by a single medical officer and analyzed. RESULTS: Of 500 new registrations at ART at this institution, 220 are from ICTC of this institution & 280 are from other ICTC centers. Out of 500 patients, 184 patients reported on the same day, 40 patients within 5 days and 276 patients beyond 5 days after confirmation at ICTC. The reasons for delay in reporting beyond 5 days are: Lack of motivation 123 (44.57%), Specific obstacles 92(33.33%) and Lack of awareness 61 (22.10%). CONCLUSIONS: On analysis of the factors for delaying registration, in Indian scenario, no single intervention will be able to address all the factors. A combination of interventions by all the stake holders including Out Reach Workers, Nurses, NGO's, General Physicians, play a key role in retention & effective treatment for PLHIV.

Contraceptive Use and Unintended Pregnancies Among HIV-Infected Women in Mumbai.

Background:Access to reproductive health services in Human Immunodeficiency Virus (HIV) programs can greatly enhance program's potential to limit the spread of disease, reduce unintended pregnancies and safeguard the health of infected people.Objectives:To assess (i) knowledge, attitude, and use regarding contraceptives; safe sex and dual protection; (ii) fertility desires and unintended pregnancies post HIV and (iii) symptoms of reproductive tract infection/sexually transmitted infection (RTI/STI) among women infected with HIV.Materials and Methods:A cross-sectional study among 300 currently married HIV-positive women who had not undergone permanent sterilization with no immediate desire for pregnancy. Study site was Integrated Counseling and Testing Centers (ICTC) in tertiary hospitals of Mumbai and women were interviewed using a semistructured questionnaire.Results:In spite of good awareness about modern methods, 42.7 felt that contraceptives other than condoms were harmful to use due to their HIV status. Knowledge on dual protection was limited to condom (75%). Condom use increased from 5.7% pre-HIV to 71.7% post-HIV, with 89.6% reporting regular use. Future fertility desire was expressed by 8.7% women. Induced abortions post-HIV was reported by16.6% women, as pregnancies were unintended. About 69% wished to use dual contraceptive methods for effective protection if it was not harmful to be used by people living with HIV (PLHIV).Conclusion:Data reveals a need to promote modern contraceptive methods along with regular condom use to prevent unintended pregnancies and improve health-seeking behavior for contraception. Health system models that converge or link HIV services with other reproductive health services need to be tested to provide comprehensive reproductive healthcare to infected women in India.

Seroprevalence of hepatitis ‘B’ co-infection among HIV infected patients in Government Medical College, Kota and associated hospitals

Introduction Human immunodeficiency virus (HIV) shares routes of transmission with Hepatitis B virus (HBV), so HIV patients have more chance to get co-infected with HBV and this type of concurrent infection with both viruses may alter the disease progression, natural history and treatment response. Material & Method The study was carried out at the Integrated Counselling and Testing Centre (ICTC) of Department of Microbiology, MBS Hospital, Government Medical College, Kota. The present study included 100 patients, diagnosed as HIV positive. Results Among the 100 HIV positive patients we found 35 patients co-infected with HBV. Among the 100 cases of HIV, 65 (65%) were male, 34 (34%) were female and 1 (1%) was intersexual. In HIV +HBV co-infected cases 22 (62.8%) were male and 13 (37.1%) were female. Of the 100 HIV patients most were married 73 (73%) followed by unmarried 16 (16%), widow 7 (7%), separate 4 (4%). Among HIV+HBV co-infection most was married 28 (80%) as compared to separate 3 (8.5%), unmarried, 2 (5.7%) and widow 2 (5.7%). Among the HIV patients route of transmission was mainly sexual 69 (69%).

Health profile of DOTS-registered tuberculosis cases in a tertiary care hospital

Background: Every year, more than 9 million new cases of tuberculosis (TB) occur worldwide and nearly 2 million people die of the disease. Problem of TB is enormous, and makes it a major public health problem in India. There is a need to study various sociodemographic factors associated with Directly Observed Treatment Short course (DOTS)-registered patients and health components affected by TB. Objective: To study health profile, sociodemographic profile of these patients, and to give recommendation based on study findings. Materials and Methods: It was a hospital-based cross sectional study conducted in DOTS OPD of our tertiary care hospital. All patients registered and taking treatment during January–June 2014 were included in study. Data were collected by a pre-structured questionnaire and were entered in a Microsoft Office Excel 2007 sheet and analyzed by Epi Info 7. Results: Of total 64 patients, 38 (60%) were male and 26 (40%) were females. Pulmonary TB was present in 43 (67%) and extrapulmonary TB was present in 21 (33%) DOTS-registered patients. Of 64 patients, 12 (19%) had a history of repeated admissions to the hospital for treatment of TB. HIV testing by an Integrated Counseling and Testing Centre (ICTC) were conducted in 63 (98%) patients and 7 (11%) were found to be reactive. All of them were on antiretroviral therapy (ART), and 51% of the patients had body mass index less than 18.5 kg/m2. Multidrug-resistant TB was 5% among total DOTS-registered patients in the present study. Irregular treatment was found in 17% patients. Conclusion: The study found that more than half of the patients were undernourished, and TB patients had low education and lower socioeconomic status along with problems of addictions, HIV co-infection, and irregular treatment. Adequate counseling and education of patients and their close relatives might help to improve treatment compliance and nutritional status of the TB patients.

Comment on “HIV/AIDS Awareness among VCT Clients: A Cross-Sectional Study from Delhi, India”

We read the article titled “HIV/AIDS awareness among VCT clients: a cross-sectional study from Delhi, India” by Mehra et al. [1], with curiosity. This study emphasizes the poor knowledge and prevailing misconceptions about HIV/AIDS among the clients of a VCT facility in Delhi, India. However, the following issues and concerns need to be addressed. The authors have conducted a cross-sectional analysis at the VCT facility of a tertiary care health centre situated in Delhi, India. Two hundred consecutive clients who were ≥18 years of age and consenting for participation were included. However, the following should have been mentioned: How was the sample size calculated? When VCT monthly attendance is 1100, do 200 consecutive clients represent the VCT clients attending the study setting? Study sample adequacy and representativeness are the prerequisites to ensure the internal validity of the study findings. Hence, authors should have calculated the sample size based on the published literature or hypothesis and, instead of consecutive clients, systematic random sampling (e.g., every fifth VCT client) should have been adopted. VCT centre [now renamed as Integrated Counseling and Testing Centre (ICTC)] is a place where a person is counseled and tested for HIV, of his own free will or as advised by a medical provider [2]. However, it is not the mandate of a VCT centre to counsel and test everyone in the general population [2]. But the authors mention that 31.5% of the VCT clients had never heard of HIV/AIDS. If they had never heard of HIV/AIDS, then how come they were in VCT for HIV/AIDS Counseling and Testing? Whom did the authors consider as a “VCT client”? In Table 5 of the study by Mehra et al. [1], chi-square (χ2) calculation for age and education is questionable as the sample size in “unaware” categories was very small. How many cells had an expected count less than 5? Did the authors consider Yates's correction or any other apt correction for chi-square (χ2)? Authors should have clearly addressed this in Materials and Methods. Authors could have reduced the degree of freedom by logically clubbing the age and education subgroups. The authors conclude that a significant proportion of Indian population is unaware of HIV/AIDS to the extent that they have not even heard of it and the prevalence of misconceptions regarding HIV transmission is also high in the Indian population. However, VCT clients do not represent the general population and extrapolating the findings of single VCT centre based study to Indian population is highly questionable [3]. In fact, authors should have stated it as a limitation. Nonetheless, we must applaud the authors for investigating an important public health problem.

Utilization of the prevention of parent-to-child transmission of HIV (PPTCT) services in a tertiary care hospital, Odisha, India

Aims: To assess seroprevalence of HIV among antenatal women and the extent of utilization of interventions to minimize the risk of mother-to-child transmission. Study Design: Descriptive cross-sectional study was carried out among antenatal women who attended integrated counseling and testing center (ICTC) of HIV. Sample sizes were determined from the number of pregnant women that attended ICTC. Place and Duration of Study: Data and samples were collected from a tertiary care hospital, Odisha, India during January 2009 to December 2012. Methodology: All pregnant women were counseled and tested for HIV by rapid test. All HIV-seropositive antenatal women (ANW) were linked to services and followed up for institutional delivery, single-dose nevirapine (sdNVP) prophylaxis, infant feeding options and testing of children at 18 months. Results: Out of 11,508 ANW registered and pretest counseled, 11,390 (98.97%) accepted HIV testing. Sixty women were found to be seropositive, thus showed seroprevalence rate of 0.53% (60/11,390). CD4 testing was carried out in all ANW and five (8.33%) were eligible for antiretroviral therapy (ART). Seven (11.67%) had opted for medical termination of pregnancy (MTP). All 48 ANW delivered institutionally, only 7 (14.58%) received cesarean delivery. Out of 46 live births, 5 (10.87%) ANW were on ART, 35/41 (85.37%) received sdNVP mother baby-pair prophylaxis and only 8/46 (17.39%) mother opted for replacement feeding. Twenty one children have reached 18 months till date and among them three (14.29%) were HIV-seropositive. All three were delivered vaginally, received sdNVP prophylaxis and were exclusively breast fed for 6 months. Conclusion: The HIV-seroprevalence rate among antenatal women was 0.53% and mother-to-child transmission (MTCT) rate was 14.29%. Reduction in MTCT rate needs pre or early antenatal HIV testing, prenatal antiretroviral medication, preference for cesarean delivery, 100% antiretroviral prophylaxis coverage and education on avoidance of breast-feeding. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18300 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.163-169

Eleven year performance of an Integrated Counseling and Testing Center in a tertiary care hospital in Himachal Pradesh, India

Introduction: The integrated counseling and testing centre (ICTC) has proved to be an essential human immunodeficiency virus (HIV) infection prevention intervention, especially in nations where poverty, social inequality, and weak health infrastructure exist. Objectives : The study was conducted to (i) assess the performance of ICTC in a referral hospital over a period of 11 years (ii) understand the regional risk determinants of HIV-positive clients. Materials and Methods : In this record based hospital study, data from January 2000 to December 2010 of all ICTC attendees and HIV-positive clients (excluding pregnant women; surveillance in this group is being conducted routinely) was collected by reviewing the records, compiled, and analyzed. Results : A total of 19,234 clients were counseled, of which 17,411 were tested and 970 were detected positive for HIV. The HIV seropositivity amongst the total tested clients was 5.57%. The intake of clients attending ICTC consistently increased from 781 clients in 2000 to 5574 clients in 2010. Amongst the total 970 HIV positives the ratio between male and female positives was 3:2 (m = 584; f = 386). Of these, 42.1% were in the age group of 25-44 years and children (<15 years) accounted for 7.8%. The heterosexual route of transmission was documented in 77.4%. In 13.6% (n = 132) HIV-positive clients, the route of transmission was not identified. The provider initiated client visits increased significantly from 4.85% in 2006 to 82.05% in 2010 than the direct walk-in clients (P < 0.0000001). However, the HIV-positive clients were three times more in the direct walk-in clients than in the provider initiated clients (P < 0. 0000001). Conclusion : Increased utilization of ICTC reflects the overall attitudinal changes in behavior and heterosexual high risk behavior continues to be the major route of HIV transmission.

Profile and client satisfaction among clients of Integrated Counselling and Testing Centre for human immunodeficiency virus in Delhi

Background: Integrated Counseling and Testing Centre (ICTC) is a place where a person is counseled and tested for human immunodeficiency virus (HIV) and also a key entry point to the prevention of HIV infection and treatment of HIV infected people. The ICTC services are cost-effective and noncoercive intervention in the prevention of HIV/AIDS. The satisfaction of the clients availing these services indicates the quality of the services provided. Objective: The objective was to study the profile and satisfaction of clients attending counseling services of integrated counseling and testing centers in Delhi. Materials and Methods: The study was a descriptive, cross-sectional, health facility based study. The study was done in 20 ICTCs of Delhi. The ICTCs were chosen on the basis of population proportion to size. Consecutive sampling method was followed for recruiting the clients. After obtaining written consent, exit interview of 300 clients was undertaken. Results: Among 300 clients, 204 (68%) were males, and 96 (32%) were females. Majority, 267 (89%) of the clients were staying with family and 33 (11%) were staying with friends/roommates. The total number of referred clients was 270 (90%) and self-referred or direct walk-in client was 30 (10%). Among the direct walk-in/self-referred clients, 12 (40%) clients were recommended by their friends to come, 4 (13.3%) clients seek to avail ICTC services because of high risk behavior and 14 (46.7%) clients wanted to get tested for HIV as their spouse was HIV positive. About 96.3% of the clients who attended the counseling services were found to be satisfied. Conclusion: The proportion of self-referred/direct walk-in clients was very low, and low level of awareness about the HIV test and counseling services was found among the clients. This reflects the need to enhance the efforts directed at increasing the awareness of HIV test and counseling services. The satisfaction of clients could be further improved by better counseling sessions.