National AIDS Control Organization Research Articles

A cross sectional study to assess the client's satisfaction with services provided at integrated counselling and testing centers for HIV/AIDS in selected districts of Madhya Pradesh

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is one of the global pandemic that continues to spread at an alarming rate with over 6,000 new infections per day. The purpose of this work was to ascertain the satisfaction of the clients by the services provided at the ICTCs centers. Methods: A cross sectional study was conducted among clients attending Integrated Counselling and Testing Centers (ICTC) centers located at district hospitals of Indore division. The study was conducted keeping in consideration the original guidelines issued by the National AIDS Control Organization (NACO) and Madhya Pradesh State AIDS prevention and Control Society (MPSACS) during the inception of the integrated counselling and testing centers. The clients were clients served by selected ICTCs. Sample size was calculated by using OpenEpi software, version 2. Results: The present study highlights the fact that among the clients interviewed, male contribute (66.56%) while female clients comprised 34.45%. According to the study 90.8% of clients were aged between 18-50 years (the most sexually active age group). The study found that nearly one quarter (21.85%) of the clients were of direct walk in type, which is lower than a study conducted integrated counseling and testing centre (ICTC) of a tertiary care hospital (27%). There was low intention to share the test results with partners only 55.8% (N=86) this may be due to poor communication between partners due to traditional beliefs in our society, difficulty in discussing sensitive subjects such as sex, among the clients who received their test result. Conclusions: Majority of the clients were satisfied with the services provided at the ICTC. Illiterate clients were more satisfied as compared to the literate clients. More female clients were share the test result with their partner compared to male clients.

Prevalence of human papillomavirus infection & cervical abnormalities in HIV-positive women in eastern India.

Background & objectives:India has the third highest burden of HIV and highest number of cervical cancer in the world. A cross-sectional study was performed to determine the prevalence and types of human papillomavirus (HPV) infection, and the factors associated with HPV infection and abnormal cervical cytology in HIV-positive women attending the Antiretroviral Therapy (ART) Centre in a tertiary care hospital in eastern India.Methods:We screened 216 HIV- positive women with Papanicolau smear cytology and HPV testing. HPV DNA was detected by using consensus primers followed by sequencing.Results:Of the 216 HIV-positive women screened, 58 (26.85%) were HPV-positive; 56 (25.9%) were of high-risk (HR) HPV type. The most prevalent HPV type was HPV-16 (7.9%); non 16 and 18 HPV types were present in 17.6 per cent patients. Age ≤ 35 yr [(OR), 2.56 (1.26-5.19)], illiteracy [OR, 2.30 (1.19-4.46)], rural residence [OR, 3.99 (1.27-12.56)] and CD4 ≤350/μl [OR, 2.46 (1.26-4.83)] were associated with increased risk of acquisition of HPV. One hundred thirty nine (74.33%) patients had normal/ negative for intraepithelial lesions (NILM) cytology, three (1.60%) had atypical squamous cells of undetermined significance (ASCUS), 32 (17.11%) had low-grade squamous intraepithelial lesions (LSIL), 10 (5.35%) had high-grade squamous intraepithelial lesions (HSIL) and three (1.60%) had carcinoma cervix. WHO clinical Stage III and IV [OR, 2.83 (1.07-7.49)] and CD4 ≤350/μl [OR, 2.84 (1.30-6.20)] were risk factors for abnormal cytology.Interpretation &conclusions:Our study showed 26.85 per cent HPV positivity in HIV infected women in this region, with HPV-16 as the commonest genotype. Abnormal cervical cytology was seen in about 25 per cent women. Regular Pap smear screening as recommended by the National AIDS Control Organization will help in early detection of cervical abnormalities in HIV- positive women.

Trends in the Seroprevalence of Human Immunodeficiency Virus Infection in Pregnant Women Attending a Tertiary Care Center in Navi Mumbai, Western India

Expanding HIV testing and counselling among pregnant women is critical for identifying those in need of followup care and subsequent interventions. Data from PPTCT centers provide invaluable inputs for estimating the seroprevalence of HIV among pregnant women within a region of the state. A retrospective analysis was carried out to look at the trends in the seroprevalence over a ten years period and overall effectiveness of the PPTCT program. At the M.G.M. Hospital in Kalamboli, Navi Mumbai, Maharashtra in India, women registered at the antenatal clinic of the hospital and consenting to undergo testing after counselling were tested for HIV seropositivity. Three different HIV antibody detection tests were used as per the National AIDS Control Organization (NACO) guidelines. Out of a total of 27256 women who had registered, 26516 (97.3%) underwent counselling and all of these agreed to undergo testing. Most women that underwent counselling and testing for HIV were in the second trimester of their pregnancy. Maximum women (66%) who agreed for counselling and HIV testing belonged to the age group of 21-30 years. Majority of the women counseled (82%) were aware of HIV and AIDS. 89% of the women who were positive for HIV belonged to the age group of 21-30 years. Overall seropositivity for the ten years was 0.6%. The HIV seropositivity decay rate of -0.351 (p<0.0006, 95% CI: -0.499 to -0.203) shows significant downward trend among pregnant women in Navi Mumbai over the last decade. The trend analysis of the data in our study suggests that if the PPTCT program is implemented effectively, the prevalence of new seropositive women could be halved in as little as two years.

A Retrospective Study on the Prevalence of HIV among Patients Attending a Tertiary Care Hospital of Northeast India

Objective: The main objective of this study is to evaluate the prevalence of HIV infection among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, for a period of seven years, i.e., from April 2008 to March 2015. Material & Method: A total of 40,983 clients attended ICTC, Gauhati Medical College & Hospital from the year 2008 to 2015. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Of the total 40,983 clients tested for HIV infection, 1919 (4.68%) were found to be HIV seropositive. Seropositivity was higher in male clients i.e. 1314 (68.47%) than female i.e. 604 (31.47%) followed by transgender (TG), i.e., 1 (0.0005%). Heterosexual route of transmission was the major route seen in 1666 clients (86.81%). Maximum HIV seropositivity was in the age group of 45 - 49 years (43.62%). Conclusion: HIV prevalence of 4.68 % among the clients attending ICTC, Gauhati Medical College & Hospital, Guwahati, puts the spotlight on the HIV burden in this part of the country and suggests the need for the scaling up of focused prevention efforts in high-risk groups.

Antiretroviral pre-exposure prophylaxis: A new opportunity to slow HIV spread in India.

Since the first case of HIV was diagnosed in Chennai in 1986, there have been close to three million Indians who have become infected with HIV and approximately 2.4 million currently living with the virus1. Although this represents the third largest HIV epidemic in the world (after South Africa and Nigeria), the current number of infected Indians actually reflects the success of the National AIDS Control Organization's prevention programmes with HIV incidence decreasing in many districts2. The prevalence of HIV in antenatal clinics was 0.35 per cent, and over the past decade, the number of districts where HIV prevalence exceeded 1 per cent decreased from 140 to 803. Part of the containment of the epidemic may be due to increased awareness and community education, but increased uptake of antiretroviral medications may also play a role, given that more than one million Indians have been prescribed highly active antiretroviral therapy (HAART), which could attenuate HIV spread3. However, the epidemic continues to be highly concentrated in key populations, ranging from injecting drug users (IDUs) in the northeast with overall rates of HIV ranging from 7 to 9 per cent in large sentinel surveillance studies, to men who have sex with men (MSM) in many cities with rates between 4 and 6 per cent (and even higher rates in transgender women), and female sex workers (FSWs) with rates generally exceeding 5 per cent1,2.

Study of prevalence of seropositivity in multi-transfused thalassemia patients - A hospital based study

Background: Thalassemia is an inherited hemoglobinopathy for which blood transfusion is an obligatory treatment. However, blood transfusion has its own adverse effects among which transfusion transmitted infections (TTIs) are major threat to the patients. Objective: To evaluate the seroprevalence of various TTIs in thalassemia patients. It also aims to correlate age group and prevalence of TTIs. Materials and Methods: In this study, a total of 55 beta thalassemia major patients attending C U Shah Medical College, Surendranagar, Gujarat, India, were screened for human immunodeficiency virus (HIV)-1 and HIV-2 IgG and IgM antibodies, hepatitis C virus (HCV) IgG antibody, HBsAg antigen, and IgG antibodies against Treponema pallidum using National AIDS Control Organization approved third generation enzyme-linked immunosorbent assay (ELISA) kits. Selected clinical, sociodemographic, and other characteristics were also recorded to understand the determinants of risks of these infections. Result: It was observed that of the total 55 patients, 2 (3.63%) were HIV reactive, 20 (36.36%) were HCV reactive, and none was found to be hepatitis B virus or venereal disease research laboratory reactive. Conclusion: To reduce the incidence of TTIs, especially HCV and HIV, stringent screening of donor should be done with fourth generation ELISA methods, polymerase chain reaction, or nucleic acid amplification techniques.

Long Term Outcome of Adult Patients on Antiretroviral Therapy (ART) in India

We report the data analysis of 10 years (2005-2015) of follow up of an antiretroviral therapy (ART) centre in Mumbai (India) treating adult patients (age >18 years) working under corporation sector funded by national AIDS control organization (NACO). In the duration of study, total registered Human Immunodeficiency Virus (HIV) positive patients were 18554. Five thousand three hundred patients were lost to follow up and 1393 patients were transferred out to other ART centre. Thus only 11861 patients were evaluable. Male: female: transgender ratio was 1.92: 1: 0.015. HIV- 1 patients were 18474 and HIV- 2 patients were 80. ART was offered to the 6138 eligible patients. Out of these 4581 patients are alive and on ART. Total deaths were 942. One hundred and sixty patients required alternative ART while another 175 patients were put on second line ART. At a median follow up of 5 years overall survival was 92% and adherence was 86%. The percentage of patients having documented opportunistic infections was as follows: candidiasis 35%, tuberculosis 23%, bacterial respiratory infections 15%, bacterial skin infections 14%, cryptosporidiosis 9%, Herpes simplex 7%, Herpes zoster 6%, pneumocystis jirovaci 5%, cryptococcal meningitis 2%, toxoplasmosis 2%, and micosporidiasis 1%, cytomegalovirus retinitis 0.5%. Most common dose limiting side effects of the ART were Zidovudin induced anemia (15%), Stavudine induced neuropathy and lip dystrophy (18% each) and efavirenz induced disorientation (8%) and they required substitution of drugs. Two percent patients were referred for second line ART (Switch regimen). The incidence of multidrug resistant kochs was 1.3%.

Constructing Gender and Sexuality in HIV/AIDS IEC Materials in Tamil Nadu: a Social Semiotic Approach

The epidemic HIV/AIDS has been alarmingly threatening the developing countries like India. To address the issues of control and management of this vexatious infection, nations of the world have developed, created and circulated Information, Education, and Communication (IEC) materials. Following in the footsteps of the National AIDS Control Organisation (NACO), Tamil Nadu has produced many IEC materials. It is in the portrayals of such materials that construction of gender and sexuality takes place in the form of gendered social actors. Many impact studies have been conducted on these materials. But this study concentrates on the less researched area of how the construction of Gender and Sexuality in these IEC materials takes place using Social Semiotic Approach through the Gupta’s Continuum of Social Construction of Gender and Sexuality in HIV/AIDS programmes. Five IEC materials in the form of posters were taken for the analysis. While analysing these materials under Gupta’s continuum consisting of stereotypical, neutral, sensitive, transformative and empowering constructions, the fact as to what type of gendered social actors were made of were also revealed.

P14.11 Developing sustainable, international partnerships model to build capacity in hiv and stis

Introduction Effective public health responses in prevention and management of HIV/STIs require strong human resources, focused on the development and implementation of evidence-based policies. We wished to explore how best to leverage Australian pedagogic and research skills in HIV/STIs into an Indian setting, in order to build human resource capacity. Methods An appropriate institutional partner in India was chosen on the basis of their academic track record. Financial support was obtained from the Australian Government’s aid agency. Three phases were developed: Phase 1: Stakeholder consultation and survey to establish local needs, together with pedagogic skill development at the partner institution; Phase 2: Curriculum mapping and development to reflect local educational priorities; Phase 3: Pilot delivery, followed by regional expansion. Results The University of Sydney partnered with the Public Health Foundation of India (PHFI), due to their focus on public health education, coupled with their technical and pedagogic expertise. 27 local faculty members of PHFI and affiliated organisations were trained in Australia and an enabling environment created by reciprocal visits and close collaboration. Forty three stakeholders from 14 Indian institutions participated in the national consultation. These included academic institutions, the National AIDS Control Organisation, NGOs and prospective participants. The preference was for a 6-month course focussing on public health aspects of HIV/STIs. To minimise costs, an e-learning site was developed using open source software and containing jointly developed content. The pilot course was delivered in 2013–2014, subsequently extended to include a regional component. A total of 53 students have successfully completed the course to date. Conclusion Clarity of purpose, careful matching of institutions and effective communication were keys to building informed partnerships. The leveraging of existing expertise, local adaptation, together with the use of open-source software has led to the development and running of a cost effective, scalable capacity-building resource. Disclosure of interest statement Australian aid agency of the Department of Foreign Affairs and Trade, Australia funded the project.

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.

The imperative to integrate suicide prevention within community-based harm reduction programs for people who inject drugs: Informed by the situation in Delhi, India

Elevated rates of suicidal behaviour have been documented in connection with injecting drug use (Cottler, Campbell, Krishna, Cunningham-Williams, & Abdallah, 2005; Darke & Ross, 2002; Harris & Barraclough, 1997; Havens et al., 2004). The proportion of deaths among heroin users attributed to suicide is estimated to range from 3% to 35% and a meta-analysis found heroin users were 14 times more likely than matched peers to die from suicide (Darke & Ross, 2002; Harris & Barraclough, 1997). Consequently, suicide prevention is a major challenge for those working with people who inject drugs (PWID). Despite the severity of the suicide risk, there is a vacuum in the literature regarding practical suicide prevention interventions that can be implemented by those who are working closely in the community with this sub-population. In Delhi, one of the worlds most heavily populated megacities, the HIV prevalence among PWID is estimated to have risen from 10.0% in 2006 to 18.3% in 2010–11 (National AIDS Control Organisation, 2006, 2012). Consequently, harm reduction interventions have been implemented to mitigate HIV transmission risk in this sub-population, including needle syringe exchange, opioid substitution therapy, peer education, and HIV testing and counselling. These interventions are vital and necessary but nevertheless in some ways bypass the arguably more urgent psychosocial needs of this extremely vulnerable and marginalised sub-population. Our recent study of PWID in Delhi documented an extremely high prevalence of past-year suicidal thoughts (53%) and attempts (36%) (Armstrong, Jorm, et al., 2013; Armstrong, Nuken, et al., 2013). These results are in line with findings from surveys of PWID elsewhere in the world, which have found lifetime prevalence of attempted suicide ranging between 17.0 and 47.0% (Backmund, Meyer, Schutz, & Reimer, 2011; Darke & Ross, 2001; Darke et al., 2007; Havens, Sherman, Sapun, & Strathdee, 2006; Johnsson & Fridell, 1997; Murphy, Rounsaville, Eyre, & Kleber, 1983; Ravndal & Vaglum, 1999; Rossow & Lauritzen, 1999), as compared to

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.

Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India.

BackgroundHeterogeneity of the HIV epidemic across districts of south India is reflected in HIV positivity among antenatal clinic (ANC) attendees. Along with individual factors, contextual factors also need consideration for effective HIV interventions. Thus, identifying district and individual level factors that influence ANC HIV positivity assumes importance to intervene effectively.MethodsData on HIV sentinel surveillance among the ANC population were obtained from the National AIDS Control Organization (NACO) between years 2004 and 2007. Data from serial cross-sectional studies among female sex workers (FSWs) conducted during this time period in 24 districts were used to generate district level variables corresponding to parameters concerning this high risk population. Other district level data were obtained from various official/governmental agencies. Multilevel logistic regression was used to identify individual and district level factors associated with ANC-HIV positivity.ResultsThe average ANC-HIV prevalence from 2004 to 2007 in the 24 integrated biological and behavioural assessments (IBBA) districts ranged from 0.25 to 3.25%. HIV positivity was significantly higher among ANC women with age≥25 years [adjusted odds ratio (AOR):1.49; 95% confidence interval (95%CI):1.27 to 1.76] compared to those with age<25 years; illiterate (AOR:1.62; 95%CI:1.03 to 2.54) compared to literate; employed in agriculture (AOR:1.34; 95%CI:1.11 to 1.62) or with occupations like driver/helper/industry/factory workers/hotel staff (AOR:1.59; 95%CI:1.26 to 2.01) compared to unemployed. District level HIV prevalence among FSWs (AOR:1.03; 95%CI:1.0 to 1.05) and percentage women marrying under 18 years were significantly associated with ANC-HIV positivity (AOR:1.02; 95%CI:1.00 to 1.04).ConclusionIlliteracy of the woman, higher HIV prevalence among FSWs and early marriage were associated with HIV positivity among pregnant women in southern India. In addition to targeted HIV preventive interventions among FSWs, studying and changing the behavior of FSW clients and addressing structural drivers of the epidemic might indirectly help reduce HIV infection among women in southern India.

Monitoring stock-outs in national AIDS programme facilities in India: a case study by DNP+

National AIDS Control Organisation (NACO) has been facing stock-outs of antiretrovirals (ARVs), drugs used for opportunistic infections (OI) and diagnostics resulting in treatment interruptions, which compromise patient outcomes and may contribute to HIV drug resistance. DNP+, a nongovernmental organization(NGO),undertook monitoring for stock-outs of drugs and diagnostics at government antiretroviral therapy (ART)centres.

Prevalence of HIV in pregnant women in a rural area of Maharashtra, India

Abstract not availableBangladesh Journal of Medical Science Vol.14(2) 2015 p.216

Youth and Challenges: Case of Injecting Drug Users in Chhattisgarh

HIV/AIDS is one of the major issues emerging as a serious social problems and a challenge to public health system in India. Prevalence rate of HIV/AIDS in India is increasing rampantly and for controlling the spreading rate of HIV/AIDS National AIDS Control Organization- NACO launched the TI- Targeted Intervention projects in different phases throughout country in the states of high prevalence rate of HIV/AIDS. TI projects intervene with different high risk groups for spreading awareness throughout country with FSWs, MSMs, IDUs, Truckers and Migrants etc. IDUs i.e. Injecting Drug Users are the drug users who intake drugs by injecting themselves, one of the important characteristic of IDUs is that they take drugs in group, sharing of the same syringe in group makes them prone and increases the risk factor of getting infection of HIV/AIDS and other blood related diseases. In Bilaspur numbers of IDUs are increasing day by day, maximum IDUs belongs to age group of 20 to 40 years which is a matter of concern as this group of people constitute youth and adult are considered to be the most productive age/group. Peer pressure and friend circle influence are also contributory factors in increasing the number of youth taking drugs and becoming addict of it. Injecting drugs for IDUs are expensive, because prohibition on supply and public selling of these drugs results in black marketing of it which directly increases the rate of these drugs. IDUs get addict of it and they buy it at any cost due to which their maximum share of income gets spend on it and generates lots of socio-economic problems. This paper is a study based on content analysis, interview, observation and case studies from fields in which highlighting features are to understand the IDUs socio-economic status, their drug seeking behavior, pattern, and risk factor associated with IDUs, impact of it on their life as well as intervention of TI projects.

Prevalence of HIV in a Tertiary Care Centre in Delhi: A Five-Year ICTC Based Study

Objective: The purpose of this study is to estimate the prevalence of HIV infection among the clients attending ICTC, LHMC of New Delhi, for a period of five years, i.e., from 2008 to 2012. Material & Method: A total of 25,413 clients attended ICTC, LHMC from the year 2008 to 2012. Serum samples were collected after taking informed consent and pre-test counseling. In India for all ICTCs, NACO (National AIDS Control Organization), a national guidelines has been followed for HIV testing, reporting and release of results with post test counseling. Results: Out of the total 25,413 clients tested for HIV infection, 963 (3.78%) were found to be HIV-1 seropositive. Seropositivity was higher in male clients i.e. 625 (64.4%) than female i.e. 336 (34.8%) followed by transgender (TG), i.e., 2 (0.2%). Heterosexual route of transmission was the major route seen in 676 clients (70.1%). Maximum HIV seropositivity was in the age group of 25 - 34 years (35.4%). No HIV-2 case was found among the studied population. Conclusion: HIV prevalence of 3.78% among the clients attending ICTC, LHMC, New Delhi, 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.

Towards elimination of parent-to-child transmission of syphilis in India: a rapid situation review to inform national strategy.

In February 2015, India's National AIDS Control Organisation, Ministry of Health and Family Welfare, launched a national strategy towards elimination of parent-to-child transmission (E-PTCT) of syphilis, with a goal to reduce the incidence of congenital syphilis to 0.3 cases per 1000 live births by 2017. As part of the development of the national strategy, a rapid situation analysis was undertaken to ascertain the current practices, challenges and barriers for E-PTCT of syphilis in India. The analysis was conducted during February and March 2014 in five states selected from five different regions of India. Key informant interviews were conducted with key stakeholders at facility, state and district level. Content analysis was used to identify the themes. Key barriers identified for E-PTCT of syphilis were: low priority for antenatal syphilis testing among providers, limited access to testing, untrained human resources, shortage of test kits and benzathine penicillin, nonadherence to the national protocol for syphilis testing, and poor recording and reporting of antenatal syphilis data. The analysis also identified opportunities for functional integration of E-PTCT within existing maternal and child health programmes. Health-care providers and programme managers expressed a need for training in the programme for E-PTCT of syphilis. The situation analysis identified that, for successful implementation of E-PTCT of syphilis, it is essential that state and district programme managers adopt this initiative; coordinate the programme; plan for an adequate budget in their programme implementation plan; ensure an uninterrupted supply of standardized diagnostics kits and drugs at all levels of health care; and adhere to E-PTCT guidelines when implementing the programme.

Levels, Trends and Inter-Regional Variations in Transfusion Transmissible Infection Positivity among Blood Donors in India: Evidence from India’s National HIV Program

In India, transfusion transmissible infections (TTIs) are monitored for trends at the blood bank level, but limited efforts have been made to analyze data from a large number of blood banks and present it at the national, regional and state levels. The Computerized Management Information System (CMIS), National AIDS Control Organization’s (NACO) online data capturing system, systematically collects information on TTIs in a monthly aggregated format from blood banks across the country. This information is being captured in NACO’s annual reports, but a systematic scientific analysis and publication of the same have not been attempted so far. Hence, the objective of this study is to analyze and report TTIs among blood donors in India at three different levels—national, regional and state—from 497 consistent blood banks reporting through CMIS during 2008-2012. National level analysis shows an increasing trend in voluntary blood donation from 9.28 lakh to 19.02 lakh, and a decreasing trend in TTIs, with female donors constituting only 6% of the entire pool of donors. Of the five TTIs studied, in 2012 Hepatitis-B-surface Antigen (HBsAg) positivity was highest (0.9%), followed by Hepatitis C Virus (HCV) (0.45%), syphilis (0.23%), HIV (0.17%) and malaria (0.03%). Regional analysis indicated that voluntary donation was high in the Eastern and Western regions, with 11% of female donors in Eastern India in 2012. All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions. The level of positivity for all the five TTIs was higher than the national average in the Eastern region. Among the TTIs, HIV positivity among voluntary donors was below the national average, while in Mizoram both HBsAg and HCV of more than 1% seropositivity and VDRL of 1.7% in Arunachal Pradesh had been reported. Malaria has the lowest national positivity, with Nagaland reporting a high positivity of 0.4%. Although the national and regional trends in TTI positivity are declining, regional level variations in TTIs, especially in hepatitis, suggest the importance of advocating for pre-donation counseling and educating donors on self-exclusion.

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India

Background:Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis.Aims and Objectives:To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach.Materials and Methods:A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence.Results:The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive.Conclusion:Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.