National AIDS Control Organization Research Articles

Study of behavioral and psychosocial factors relating to needle stick injuries in nursing staff of a tertiary care cancer hospital of Punjab, India

Background and Objectives: Needle stick injury (NSI) is the most dreaded occupational health hazard affecting a health- care worker (HCW) psychologically and physically. The risk of infection post needle stick injury ranges between 1.9% to greater than 40% for HBV infections, 2.7-10% for HCV and 0.2-0.44% for HIV infections. As per National AIDS Control Organisation (NACO) records, nursing staff is at highest risk (43%) followed by physicians (28%). The main objective of this study was to evaluate knowledge of nursing staff about needle stick injuries and to study factors leading to such incidents in their working areas, impart them knowledge regarding the same and fill gaps in knowledge.
 Materials and Methods: This is a cross-sectional retrospective analysis involving nursing staff and students. p values were calculated using SPSS software.
 Results: Overall NSI prevalence among nursing staff and students was 51.6% whereas in more exposed and less exposed group was 47.45% and 10.16% respectively (p=0.2056). The most common cause of NSI incident was recapping of needle (38.5%) followed by transferring needle to sharp container (35%).
 Conclusion: Consequences of NSI are serious and this study has tried to emphasize on the need to study the factors leading to NSI.

Trend of HIV Prevalence in Antenatal Women in a Tertiary Care Hospital in the Western Region of India.

Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding thetrends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and theART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data fornine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positivewere collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouseand children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was adeclining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42remained bookedat our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serveas index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.

Adverse Drug Reactions and Prescription Patterns of Antiretroviral Drugs: A Longitudinal Observational Study From a Tertiary Care Hospital in Western India.

Background In 2018, the World Health Organisation (WHO) released interim guidelines, advising a change of regimens to dolutegravir-based first- and second-line antiretroviral therapy (ART), based on which, in 2021, the National Aids Control Organisation (NACO) updated its guidelines to include the tenofovir+ lamivudine + dolutegravir (TLD) regimen as a first line of therapy for all people living with HIV (PLHIV) and second- and third-line regimens to dolutegravir-based regimens. Considering this change of regimen, the adverse drug reaction (ADR) profiling and longitudinal prescription pattern of antiretroviral and concomitant medications in adult patients at the ART centre of a tertiary care hospital were assessed in this study. Methods Ninety-seven PLHIV out of all the patients who attended the ART centre from September 2021 to July 2022 were enrolled and followed up for six months. The ADRs that occurred during this period were collected along with details of prescription patterns and analyzed by descriptive statistics. Causality assessment for ADR was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Results Seventy-eight percent (n=76 out of 97) of patients experienced at least one ADR, and 128 ADRs were seen in 97 patients. The most common ADRs were increased alkaline phosphatase (39.0%, n=128), dyslipidaemia (12.5%, n=128), and nephrotoxicity (10.1%, n=128). The drug most suspected of causing ADRs was dolutegravir (27.5%, n=342). The most common therapeutic regimen was TLD (71.2%, n=97). The most prescribed drug was lamivudine (30.6%, n=1183). The most prescribed concomitant medication was cotrimoxazole (15%, n=312). Conclusions Dolutegravir-based regimens have been implemented for PLHIV in a phased-out manner from previous non-dolutegravir-based ART regimens, which is in line with the recent NACO guidelines. However, it has also led to an increase in dolutegravir-associated ADRs like increased alkaline phosphatase, dyslipidaemia, and nephrotoxicity. Continuous monitoring of prescriptions and ADRs can add to our knowledge regarding their use and ADRs.

Improvement of laboratory testing services by implementation of quality assurance scheme

Introduction: The National AIDS Control Organization (NACO), Government of India and the Uttar Pradesh State AIDS Control Society (UPSACS) established the State Referral Laboratory (SRL) in the Department of Microbiology, Motilal Nehru Medical College, Prayagraj for HIV testing and monitoring of linked HIV Counselling and Testing Services (HCTS) in Uttar Pradesh.Methods: This is a retrospective study conducted from 2008 to 2021. In this evaluation period 10144 serum samples (9580 HIV negative, 555 HIV positive and 9 discordant) were received for retesting at SRL. The Quality Control serum samples received from testing sites consisted of 5% negative and 20% positive from all tested samples collected in the first seven days in the External Quality Assurance Scheme (EQAS) quarter month i.e. January, April, July and October. All samples were tested using rapid diagnostic kits procured by NACO/UPSACS with NACO testing strategy. All linked centres with SRL received 4 coded serum samples for proficiency testing (PT) which were tested similarly.Results: Of 10144 serum samples, 99.92% reported correct results and 0.08% reported discrepancy due to various issues. Similarly in the proficiency testing programme, of 4072 samples tested between 2010 to 2021 by testing sites, 4061 (99.07%) reported concordant results and the remaining14 (0.34%) samples reported indeterminate results. Of the 4072 samples, 14 shows discordant results by three different rapid tests based on different principles. Hands on training were provided for technicians who reported indeterminate results in PT or retesting.Conclusion: The tremendous increase in quality testing at peripheral centrally linked centres increase the reliability of HIV diagnosis at ground level. The study also concluded that continuous monitoring and mentoring of technicians of the diagnostic laboratories under EQAS improves their quality for HIV diagnosis.

Estimation of HIV Prevalence among the Female Population in South India: A Bayesian Approach

Introduction: The HIV Sentinel Surveillance (HSS) conducted by National AIDS Control Organization (NACO) is the predominant data source for HIV estimations in India. While the HSS targets the key populations at risk of HIV infection, the National Family Health Survey (NFHS) measures the community- based HIV prevalence. Improvised HIV estimates in India were attributed to the HIV prevalence data obtained from the NACO-HSS and NFHS.
 Methods: Bayesian analysis was performed to determine the state-level prevalence of HIV among females in seven South Indian States. The analysis involved plotting the prior, likelihood, and posterior distributions, facilitating a visual assessment of the data. The HIV prevalence among females calculated from the NFHS (2015-16) survey data was used for prior distributions. HIV prevalence among pregnant women obtained from the HIV Sentinel Surveillance 2019 was used for likelihood. Bayesian analysis was performed using the R programming (RStudio 2022.02.0). A posterior probability distribution was obtained using the prior distribution and the likelihood by applying the Bayes theorem. Graphical representation was achieved through R's plotting functions. Kerala and Pondicherry were not included in the analysis due to zero or very low prevalence reported in both NFHS and HSS.
 Results: The Bayesian estimates of HIV prevalence among females were 0.38 % [95% CI:0.29 - 0.47] in Andhra Pradesh, 0.28 [95% CI:0.23 - 0.35] in Karnataka, 0.27 [95% CI:0.20 - 0.34] Odisha, 0.27 % [95% CI:0.19 - 0.36] in Telangana and 0.19 [95% CI:0.15 - 0.24] in Tamil Nadu.
 Conclusion: Bayesian techniques present a versatile and robust strategy for modelling and analysing HIV- related data, offering a flexible and powerful approach to data analysis.

Carotid Intima-Media Thickness and Metabolic Complications in Children with HIV on Antiretroviral Therapy: A Cross-Sectional Study.

To evaluate carotid intima media thickness (CIMT) in children with Human immunodeficiency virus (HIV) on anti-retroviral therapy (ART) and in controls. Also, to compare body mass index (BMI), body fat percentage, skin-fold thickness (SFT), waist-to-height ratio (WHtR), lipid profile, blood pressure, lipodystrophy syndrome (LDS), non-alcoholic fatty liver disease (NAFLD) in children with HIV and in controls and to determine association between lipid profile, LDS, liver amino-transferases, NAFLD, BMI, body fat percentage, SFT, WHtR and CIMT. This cross-sectional study was done in 7 to 12 y old children attending the ART clinic and receiving ART for ≥6 mo according to 2018 National Aids Control Organization (NACO) guidelines. Thirty age and gender matched controls were enrolled from the pediatrics OPD. Weight, height, BMI, waist circumference, skin fold thickness and blood pressure were recorded. Lipid profile,liver amino-transferases, USG abdomen and CIMT were done with prior appointment. The present study had 43% females and 57% males (mean age of 9.33 ± 1.65 y). All cases were on combination ART (mean treatment duration: 59.1 mo). CIMT was significantly increased in cases as compared to controls 0.481 ± 0.087mm vs. 0.418 ± 0.072mm (p = 0.003). However, CIMT did not correlate with any other parameter. Cases had significantly higher body fat percentage (17% vs. 13.15%), systolic blood pressure (SBP), SFT, total cholesterol (TC) and low density lipoprotein- cholesterol (LDL-C) as compared to controls. NAFLD was seen in 3 cases (1%), lipohypertrophy in 7 (23%) cases and 5 (16%) controls. Children with HIV on ART have significantly higher CIMT and increased metabolic abnormalities.

Efficacy and Tolerability of Tenofovir/Lamivudine/Dolutegravir among Antiretroviral Therapy Naive Human Immunodeficiency Virus Infected Patients of a Tertiary Care Center in Eastern India.

Although many drug regimens have been used in the treatment of human immunodeficiency virus (HIV) infection, the National AIDS Control Organization (NACO) of India recommends the use of a fixed-dose combination of tenofovir/lamivudine/dolutegravir (TLD) as a first-line regimen since 2020. In spite of much global data on the use of this combination, experience in the Indian population is still limited. We aim to find out the efficacy and tolerability of this novel regimen, in a tertiary care center of Eastern India. A descriptive observational study, longitudinal in design performed in the antiretroviral therapy (ART) center of a tertiary care hospital in Kolkata, West Bengal, India. All patients who attended the ART center from April 2021 to October 2022 were enrolled in the study following inclusion and exclusion criteria. A detailed history, clinical examination, necessary biochemical tests, and CD4 count of all patients were done at baseline. Subsequently, they were followed up for 6 months with monthly visits when they were enquired about any adverse effects requiring therapy interruptions. At the end of 6 months, CD4 count and viral load were measured. Out of a total sample of 249 patients, the TLD regimen was efficacious in 99.2% (n = 247) in whom viral load was suppressed to <1,000 copies/mL after 6 months of treatment. The regimen had to be temporarily discontinued in 6% of patients (n = 15). The most common cause of treatment interruption was hepatic dysfunction (3.2%) followed by cutaneous manifestation (2.4%). In 14 out of 15 patients, the regimen could be reintroduced and was safely tolerated afterward. Only one patient had to be shifted to an alternative regimen due to tenofovir-induced nephrotoxicity. Thus TLD was tolerated in 99.6% (n = 248) patients. The fixed-dose combination of TLD is a highly efficacious and well-tolerated first-line regimen for ART naïve patients with HIV infection having >95% adherence. How to cite this article: Sengupta D, Ghosh S, Pain S, et al. Efficacy and Tolerability of Tenofovir/Lamivudine/Dolutegravir among Antiretroviral Therapy Naive Human Immunodeficiency Virus Infected Patients of a Tertiary Care Center in Eastern India. J Assoc Physicians India 2023;71(9):72-74.

Hepatitis C virus seroprevalence among patients enrolled at the opioid substitution therapy center in Bihar: A cross-sectional study.

Hepatitis C virus (HCV) infection poses a major public health challenge in Indian settings due to its huge population and easy transmissibility of HCV among individuals who inject drugs (PWID, which is increasing in India). The National AIDS Control Organization (NACO), India has started the Opioid Substitution Therapy (OST) centers to improve the health status of opioid dependent PWID and prevent the spread of HIV/AIDS among them. We conducted a cross-sectional study to find out the HCV sero-positive status and associated determinants in patients attending the OST centre in the ICMR-RMRIMS, Patna. We utilized the routinely collected (as a part of the National AIDS Control Program) and de-identified data from the OST center from 2014 to 2022 (N = 268). We abstracted the information for exposure variables (such as socio-demographic features and drug history) and outcome variable (HCV serostatus). The association of exposure variables with HCV serostatus was examined using robust Poisson regression. All the enrolled participants were male and the prevalence of HCV seropositivity was 28% [95% confidence interval (CI): 22.7% - 33.8%)]. There was a rising prevalence of HCV seropositivity with number of years of injection use (p-trend <0.001) and age (p-trend 0.025). Approximately, 6.3% participants were injecting drugs for >10 years and reported the maximum prevalence of HCV seropositivity (47.1%, 95% CI: 23.3%-70.8%). In adjusted analyses, being employed compared to unemployed patients [adjusted prevalence ratio (aPR) = 0.59; 95% CI: 0.38-0.89]; graduated patients compared to illiterate patients [aPR = 0.11; 95% CI: 0.02-0.78]; and patients with education up to higher secondary compared to illiterate patients [aPR = 0.64; 95% CI: 0.43-0.94] had significantly lesser HCV seropositivity. A-one year increase in injection use [aPR = 1.07; 95% CI: 1.04-1.10] was associated with 7% higher prevalence of HCV seropositivity. In this OST center-based study of 268 PWIDs residing in Patna, ~28% of patients were HCV seropositive, which was positively associated with years of injection use, unemployment, and illiteracy. Our findings suggest that OST centers offer an opportunity to reach a high-risk difficult to reach group for HCV infection and thus support the notion of integrating HCV care into the OST or de-addiction centres.

Utilizing Telemedicine as a Tool for Management of PLHIV at a Tertiary Care Institute

ABSTRACT Telemedicine has been increasingly utilized in health sector. In our study we bring to light various applications of telemedicine consultation for patients receiving anti-retroviral therapy. We have observed that in a resource-limited setting, CD4-based assessment via telemedicine can still be useful, provided a serial record is maintained. We evaluated 430 cases in terms of demographics, CD4-trend and adverse effect profile. Tracking and monitoring of lost to follow-up cases could be done using this platform. Aim: The study focuses on the benefits of using telemedicine as a tool for consultation and referral of people living with HIV at centers located away from tertiary care institutes. Settings and Design: The study was conducted at telemedicine center, which is a tertiary referral center for all the districts in Maharashtra. We retrospectively analyzed the data obtained from telemedicine consultations carried out for patients from district-level antiretroviral therapy (ART) center. Methods and Material: The subjects who satisfied the following criteria were included for data analysis. Inclusion Criteria: All the HIV-infected persons on antiretroviral therapy enrolled at distant ART centers for which opinion was sought through telemedicine. This is an observational retrospective study. We reviewed the records of all patients enrolled in HIV healthcare through National Aids Control Organization from distant treating antiretroviral therapy centers (henceforth referred to as ART centers) for whom expert consultation was sought through telemedicine. These patients were given opinion for several consultations including response to therapy, management of opportunistic infections, drug-related adverse events, and treatment failure. We analyzed the demographics, the duration of treatment, and response to therapy. Statistical Analysis Used: Descriptive data analysis is used in this study. Results: We analyzed 430 case referrals through telemedicine from ART center. In 21% (N = 94) patients, CD4 was less than 50 and 11 cases had CD4 more than 500. An increasing CD4 trend was noted in 190 cases and a decreasing trend in 204 cases. In 36 cases, there was no change in CD4 progression. We had 20 cases lost to follow-up. The baseline regimen was Zidovudine Lamivudine Nevirapine (ZLN) in most cases (N = 237). Adverse drug reactions were the reasons for referral in 79 cases, maximum being AZT-induced anemia (N = 57). Of the total 430 cases referred, 253 cases had been wait-listed for SACEP meeting as per existing protocol. In 177 cases, physical attendance for the SACEP meeting could be deferred. Conclusion: Telemedicine has emerged as an immensely useful tool in management of People Living with HIV (PLHIV).

Equity in HIV/AIDS management and prophylaxis: How free is the free ART program in India?

The concern for most public health policies and decision-makers is the equitable distribution of the nation’s healthcare resources. Also, in the public health care system, the primary aim is assuaging the burden of the disease. This study captures and evaluates some important health equity aspects with its relevance with the ART (Antiretroviral Therapy) program in India. The study is an exploratory and descriptive study based on secondary data. The sources of secondary data are published official reports from NACO (National AIDS Control Organization), United Nations AIDS Program (UNAIDS), World Health Organization (WHO) etc. The roll-out of the ART program in 2004 by the Govt. of India made a paradigm shift in the HIV/AIDS scenario in the country. “The adult HIV prevalence at the national level has continued its steady decline from an estimated level of 0.41% in 2001 through 0.35% in 2006 to 0.27% in 2011”. Equity in plain words means fairness. In the sense of health policy and HIV/AIDS studies, the reduction in prevalence rate equates to positive health equity. The enervation of HIV infection by taking ART drugs had helped in curbing the prevalence and the fact that it is provided free of cost has proven this program to be the epitome of distributive justice in public health.

Epidemiology and changing trends of sexually transmitted diseases over the past 17 years in a tertiary care center: A retrospective study.

Sexually transmitted diseases (STDs) continue to be a major public health problem with significant burden on the society. Some of this can be attributed to our lack of knowledge about the change of disease spectrum from time to time. The aim of the study was to understand the changing pattern of STDs over the past 17 years (2003-2019). It was a retrospective study where data of patients who attended our Suraksha Clinic from 2003 to 2019 were collected. All the cases were subjected to detailed history, examination, and investigations done to rule out STDs. A total of 2436 patients were included in the study. The majority of the patients were in the age group of 18-30 years. The most frequent diagnosis was vulvovaginal candidiasis, followed by herpes genitalis. 3.3% of patients had human immunodeficiency virus. 4.8% of patients were men sex men (MSM). Overall, viral STDs were most common, followed by fungal and bacterial. To understand the changing trends, data were divided into different phases according to the time period. During Phase 1 (2003-2007), viral STDs were most common, followed by bacterial and fungal. However, this trend changed in Phase 4 (2016-2019) and fungal STDs became most common. Despite numerous health initiatives, the number of STD cases is rising day by day. The increasing number of MSM over the study period necessitates dedicated efforts to address the health needs of this population. The National AIDS Control Organization should take necessary measures and steps to address the overall increase in STDs considering recent trends showing a drop in bacterial STDs and an increase in fungal and viral STDs.

Assessment of levels and trends of HIV infections among different subgroup populations of Gujarat State - Prioritization of the districts.

In India, HIV prevalence varies by region and high-risk groups. General population rates have decreased in high prevalence states through HIV Sentinel Surveillance among pregnant women, while low-moderate prevalence states show variable trends. Gujarat, in western India, has mixed HIV prevalence according to 2017 Sentinel Surveillance data. To study the level and trend of HIV positivity among pregnant women and high-risk groups (HRGs) across different districts of the state of Gujarat from year 2012-13 to 2016-17. To review the possible determinants of the HIV epidemic across the selected districts in the state of Gujarat. Data from the National AIDS Control Organization (NACO) spanning 2012-17 was analyzed for HIV trends in Gujarat. This included combined HIV testing data from pregnant women at Integrated and Counseling Testing Centers, blood unit testing data from selected districts, and HIV testing among high-risk populations through Targeted Intervention sites. HIV cases in Kheda district declined post-2013-14 among pregnant women (0.38% to 0.21% in 2016-17), and in general ICTC clients (5.53% to 0.264% in 2017-18). MSM seropositivity dropped from 1.15% (2014-15) to 0.74% (2016-17), FSWs from 0.7% (2014-15) to 0.29% (2015-16). Contrastingly, blood donors exhibited an increasing trend, rising from 0.15% (2012-13) to 0.24% (2016-17). In Mehsana, ANC mother seropositivity rose to 0.6% (2013-14), fell to 0.32% (2015-16), and rose again to 0.48% (2016-17). General ICTC clients declined from 1.2% (2012-13) to 0.53% (2016-17). FSWs had 0.25% seropositivity (2015-16), while MSM saw a drop from 0.44% (2014-15) to 0.23% (2016-17). Blood donors' trend was inconsistent. Sabarkantha's pregnant women seropositivity dipped from 0.59% (2012-13) to 0.20% (2014-15), rising to 0.25% (2017-18). General ICTC client seropositivity decreased from 5.34% (2012-13) to 1.17% (2017-18). While declines in HIV prevalence are evident among certain groups such as pregnant women and general ICTC clients, there are fluctuations in seropositivity among high-risk populations like MSM, FSWs, and blood donors. These insights emphasize the need for targeted interventions and ongoing monitoring to effectively address the evolving HIV landscape in these districts.

POS-130 RENAL MANIFESTATIONS OF HIV IN THE HAART ERA: CLINICOPATHOLOGICAL PROFILE AND OUTCOME AT 3 MONTHS AND 6 MONTHS

Human immunodeficiency virus (HIV) infection is a global pandemic with 37.6 million people infected worldwide. As per National AIDS Control Organization (NACO), in India, 2.1 million people were estimated to be infected in 2017 with an adult prevalence of 0.2%, leading to 69,000 deaths per year. Renal disease is a relatively common complication in patients with HIV infection globally, and prevalence of renal disease in HIV patients is about 5–30%. Since the introduction of highly active antiretroviral therapy (HAART), the number of deaths due to opportunistic infections has significantly declined, while a greater proportion of patients are developing chronic conditions not traditionally related to HIV, such as cardiovascular, liver, and kidney disease.

POS-131 RENAL MANIFESTATIONS OF HIV IN THE HAART ERA: CLINICOPATHOLOGICAL PROFILE AND OUTCOME AT 3 MONTHS AND 6 MONTHS

Human immunodeficiency virus (HIV) infection is a global pandemic with 37.6 million people infected worldwide. As per National AIDS Control Organization (NACO), in India, 2.1 million people were estimated to be infected in 2017 with an adult prevalence of 0.2%, leading to 69,000 deaths per year. Renal disease is a relatively common complication in patients with HIV infection globally, and prevalence of renal disease in HIV patients is about 5–30%. Since the introduction of highly active antiretroviral therapy (HAART), the number of deaths due to opportunistic infections has significantly declined, while a greater proportion of patients are developing chronic conditions not traditionally related to HIV, such as cardiovascular, liver, and kidney disease.

On Emancipatory Potentials of a Virus: Some Thoughts

On Emancipatory Potentials of a Virus: Some Thoughts

A study of T/NK cell distribution in HIV positive adults by flow cytometry

Background: HIV attacks a specific type of immune system cell such as CD4 helper cell or T cell in the body. Also, natural killer (NK) cells play a key role in immune response against HIV infection. The present study was undertaken to evaluate the variation of T/NK cells in HIV positive adults by flow cytometry and its correlation to disease status. Method: A total of 100 HIV positive cases >18 years of age diagnosed as per National AIDS Control Organization (NACO) guidelines were included. The data was collected from patients regarding demographic profile, clinical spectrum and T/NK cells parameters. Results: WHO staging of patients showed that maximum patients belong to Stage III (33%) followed by Stage II (29%), Stage I (27%) and Stage IV (11%). Majority of patients had lower CD4 count

A STUDY ON THE WORKING OF BLOOD BANK

Blood is an important drug in times of critical medical ailments during this pandemic. Plasma-related therapy (PR) is an efficient way to treat critical patients that decrease the rate of hospitalizations by intensive care. In the meantime, Plasma Bank reviewed the Blood Transfusion Systems in India, which lies at the root of Plasma Bank network development. An analysis report on the blood banks in India has been presented to improve the blood transfusion systems in India. For this study we take into account the blood bank data available on the Indian government's data portal data.gov.in. The study concludes that India's blood banks are not proportionate to the population of the States and Union territories and are non-uniform in distribution. In India, blood storage units are not a proposal for blood banks that can lead to blood wastage. In order to facilitate recovery plasma therapy during the current crisis, blood bank distributed necessary machines to NON- NACO Blood Bank too.&#x0D; The convalescent plasma therapy was considered to be one of the treatments for SARS-CoV-2 during this pandemic due to serious acute respiratory syndrome coronavirus, but current evidence shows that convalescent plasma does not improve survival or reduce the need for mechanical ventilation (WHO guidelines 7th December 2021). Though over the past two decades, convalescent Plasma Therapy (CP) has also proved to be one of the efficient means for quick recovery in the treatment of SARS-CoV-1, MERS-CoV. This involves collecting plasma containing the COVID antibodies from the recovered people to treating infected people. The retrieved Sars-Cov-2 infected between 18-60 years can donate 500-600 cc of plasma collected in a therapeutic apheresis device after 14 days. This therapy is considered to be an effective method for dealing with critical patients, among several studies relating to Convalescent Plasma (CP) therapy, which can reduce the high demand rate of intensive care hospitalizations during this pandemic. In India, Delhi's government has taken steps to establish a plasma bank to help patients in Delhi/NCR, as COVID-19 cases are exponentially growing. This plasma theory was approved by the Indian Government to save people's lives from serious health problems. But as off now owing to the current studies and WHO latest guidelines (7th December 2021) convalescent plasma does not hold any relevance in covid cases as convalescent plasma does not improve survival or reduce the need for mechanical ventilation.&#x0D; The Blood transfusion service (BTS) is an important unit. During blood transfers and donations that save lives and improve health, the National AIDS Control Organization has increased awareness and implementation of current infectious markers (T.T.I). India ranks third in HIV/AIDS, which is closely related to blood and healthcare practices, as the WHO country cooperative strategy reports. The report of WHO statistical survey suggests that over 95 percent of countries with high income have blood self-sustainability, while middle and lower national blood requirements do not meet their own needs. Blood donation camps throughout the countries should be organized regularly to meet the daily needs of the patients for their blood.&#x0D; The blood banks in India have been supported by NACO, the Health Ministry, the Indian government as well as well as some of the Non-NACO blood banks. In order to deliver the equipment, consumables, labor, and capacity building, NACO's efforts had strengthened all the blood banks across the country. There are three sources to get blood such as walk-in licensed blood banks, blood donation camps and mobile blood camps. Maintaining the self-sustainability of blood supplies and blood needs is one of the main issues for the government in most countries. In 2013, only high-income WHO nations reported a 95% self-sustainability of their use in the WHO safety and availability fact sheets. Non-sustainability problems in low- and middle-income countries are due to lack of motive and poor perception of voluntary blood donations and waste of blood and manual errors could another be the reason behind it, and due to which the blood requirement is not met. There are currently so many challenges that has prevented the donation of plasma among patients which could be result of fear of COVID-19. During this pandemic crisis the study was carried out with the objective of improving the blood transfusion systems in India. This study presents the analysis report on India's blood banks in accordance with the geographical distribution, population and facilities such as apheresis and CBSU.

Blood supply management amid COVID 19 pandemic: Challenges and strategies.

ABSTRACTBackground:Blood supply management amid the coronavirus disease 2019 (COVID-19) pandemic became a cause of concern. Blood donations in the pandemic reduced significantly because of travel restrictions and fear of contracting the virus by visiting blood banks. The WHO (World Health Organization), NACO (National AIDS Control Organization) and the SBTC (State Blood Transfusion Council) published guidelines to ensure the safety of blood donors and staff during the pandemic and to ensure correct procedures are followed. The blood centre physicians took measures for appropriate clinical use of blood and blood products, which reduced the number of transfusions and thereby safeguarded the blood supply for those who needed it the most.Materials and Methods:The study was conducted at the All India Institute of Medical Sciences, Bhopal, and 33 blood banks from 33 districts of Madhya Pradesh in collaboration with the National Health Mission and NACO. This was a retrospective study from pre-lockdown to lockdown and unlock phases 1 to 5 for nine months (February 2020 to October 2020) from 33 district-level blood centres of Central India, and the study compared the impact on blood supply from pre-pandemic time to the COVID-19 pandemic time. During the stipulated time period of 9 months, which included the pre-pandemic blood supply, the phases of lockdown when Section 144 was imposed in the country and the unlock phases, the management of transfusion services by the district blood banks of Central India during the COVID-19 pandemic was evaluated. The strategies adopted to maintain the blood supply and adequate inventory were studied.Results:The blood donation percentage in the district hospitals of Madhya Pradesh dropped drastically by 61.5% in February 2020 (pre-pandemic time) to 3.35% in April 2020 (COVID-19 pandemic). The nadir of fall in blood donations was seen in April 2020 (phase 1 of COVID-19 pandemic lockdown) with a zenith in February 2020 (pre-pandemic time). The minimum number of donations 8,037 (3.32%) in all 33 districts of Central India was seen in April, when the lockdown restrictions in the country were the strictest. In response to the reduced blood supply, the blood centres adopted strategies to maintain the inventory. Routine requests and inventory were monitored strictly for judicious and rational use of blood and its components.Conclusion:The motivation, dedication and the judicious use of blood products in addition to blood conservation strategies, first-in-first-out policy, maintaining an emergency stock of blood and strict monitoring by blood centre physicians led to the gradual upward trend of blood stocks, and hence blood supply management amid the COVID-19 pandemic could be sustained.

HIV epidemic amidst COVID-19 pandemic in India: a conundrum for the country's healthcare system.

India has the third-largest burden of human immunodeficiency virus (HIV) infection in the world. The coronavirus disease 2019 (COVID-19) pandemic has only exposed the cracks in the Indian healthcare infrastructure concerning HIV. The prevalence of HIV in India is more among the destitute or sections of society shrouded by years of social stigma such as prostitutes, truck drivers, transsexuals and intravenous drug users. National AIDS Control Organisation and The Joint United Nations Programme on HIV/AIDS (UNAIDS) organisation have many several efforts over the years to set up counselling and testing centres all over the country and spread awareness about HIV among the masses. COVID-19 pandemic has reversed years of progress made by the same. HIV patients are biologically more susceptible to COVID-19, and the lockdown has led to the loss of jobs, economic crises, shortage of drugs and necessities such as food and housing among this vulnerable population, which can result in lowered CD4-T cell counts in the coming months and make way for dangerous opportunistic infection outbreaks in this population increasing the overall HIV burden of India. This article explores how COVID-19 has impacted India's already existing HIV epidemic and tries to put forth recommendations based on the evidence found to be better prepared in treating the HIV-positive population in India in the face of another catastrophe like the COVID-19.

Symposium

Opioids are one of the most common illicit substances used globally as well as in India. Opioid Agonist Maintenance Treatment (OAMT) is the most evidence-based long-term treatment for patients with opioid dependence syndrome. Buprenorphine is the most commonly used opioid medication for OAMT in India, while methadone and slow-release oral morphine are used less commonly. Buprenorphine was introduced in India around three decades back, and since then, many Indian studies have confirmed its effectiveness as OAMT in the Indian opioid-using population. The significant expansion of OAMT in India occurred when it became a part of the National AIDS Control Programme as an HIV prevention strategy. Since then, there has been a gradual expansion of OAMT under the National AIDS Control Programme. However, the provision of OAMT under this programme is limited to only people who inject drugs (PWID), thus leaving out the majority of opioid users in India. The Drug De-addiction Programme (currently renamed as National Program for Tobacco Control and Drug Addiction Treatment) under the Ministry of Health and Family Welfare (MoHFW) provides OAMT through its Drug Treatment Clinics (DTCs) in government hospitals across the country. The number of such DTCs is limited. More recently, the Ministry of Social Justice and Empowerment (MSJE) has approved a scheme of Addiction Treatment Facility (ATF) under which OAMT shall be available in Government hospitals at district level. The symposium will cover many of these issues and challenges. Presenter 1 will give a background of OAMT and will focus on its effectiveness in the Indian population. Presenter 2 will talk about the history and current status of OAMT under the National AIDS Control Organization. Presenter 3 will cover the history and current status of OAMT under MoHFW and MSJE. Presenter 4 will discuss the significant changes in the OAMT programs during the COVID-19 pandemic and the impact. Presenter 5 will discuss the major issues faced during the expansion of OAMT in India during the last three decades and the future directions in the various Indian settings.