Descriptive Epidemiology of Factors Associated with Human Immunodeficiency Virus Infections among Men and Transgender Women Who Have Sex with Men in South India

PURPOSE:

Men and transgender women who have sex with men (MTWSM) continue to be an at-risk population for human immunodeficiency virus (HIV) infection in India. Identification of risk factors and determinants of HIV infection is urgently needed to inform prevention and intervention programming.

METHODS:

Data were collected from cross-sectional biological and behavioral surveys from four districts in Karnataka, India. Multivariable logistic regression models were constructed to examine factors related to HIV infection. Sociodemographic, sexual history, sex work history, condom practices, and substance use covariates were included in regression models.

RESULTS:

A total of 456 participants were included; HIV prevalence was 12.4%, with the highest prevalence (26%) among MTWSM from Bellary District. In bivariate analyses, district (P = 0.002), lack of a current regular female partner (P = 0.022), and reported consumption of an alcoholic drink in the last month (P = 0.004) were associated with HIV infection. In multivariable models, only alcohol use remained statistically significant (adjusted odds ratios: 2.6, 95% confidence intervals: 1.2-5.8; P = 0.02).

CONCLUSION:

The prevalence of HIV continues to be high among MTWSM, with the highest prevalence found in Bellary district.

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By:  Shaw SY1, Lorway R1, Bhattacharjee P2, Reza-Paul S1, duPlessis E1, McKinnon L3,4, Thompson LH1, Isac S2, Ramesh BM2, Washington R2,5, Moses S1,6,Blanchard JF1

• 1 Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba , Winnipeg, Manitoba, Canada .
• 2 Karnataka Health Promotion Trust , Bangalore, India .
• 3 Department of Medicine, University of Toronto , Toronto, Ontario, Canada .
• 4 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya .
• 5 St. John's Research Institute , Bangalore, India .
• 6 Department of Medical Microbiology, University of Manitoba , Winnipeg, Manitoba, Canada .
• LGBT Health. 2016 Apr 8. [ 

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Predictors of Mortality and Mortality Rate in a Cohort of Children Living with HIV from India

OBJECTIVES:

To study the predictors of mortality and mortality rate in a clinical cohort of Children Living with Human Immunodeficiency Virus infection (CLHIV) from India.

METHODS:

This retrospective cohort analysis of CLHIV aged between 2 mo and 18 y registered during January 2004 through December 2014 at Pediatric Centre of Excellence (PCOE), Indira Gandhi Institute of Child Health (IGICH), was conducted using standard data collection sheet. Demographic and clinical characteristics of all eligible children were analyzed. The primary outcome measured was mortality. The authors also analyzed the cause of death and baseline parameters associated with death to study the predictors of mortality.

RESULTS:

Out of 1289 CLHIV registered in the PCOE during the study period, 834 (64.7 %) CLHIV, with or without antiretroviral therapy (ART) care, were included. The total time contributed by the study participants was 2872.8 child-years. The mortality rate in these children was 4.9/100 child-years. A significantly higher mortality rate of 28.2 % was found in children < 5 y, 38.6 % in children with advanced WHO clinical staging, 35.2 % among severely immunosuppressed children and 22.3 % in severely malnourished children. Tuberculosis accounted for 28 % of deaths. Univariate Cox regression analysis showed treatment status, age <5 y, baseline WHO clinical stage 3 and 4, severe immune suppression and severe malnutrition were strongly associated with mortality.

CONCLUSIONS:

The mortality rate in the index study cohort was 4.9/100 child-years and tuberculosis was the major cause of death. Younger age, baseline advanced clinical and immunological staging were predictors of mortality. Even though mortality was significantly higher in Pre-ART children, treatment status was not found to be an independent predictor of mortality.

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By:  Sanjeeva GN1,2, Gujjal Chebbi P3, Pavithra HB4, Sahana M4, Sunil Kumar DR5, Hande L6.

• 1Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
• 2Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
• 3Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
• 4Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
• 5CST, Ministry of Health and Family Welfare, National AIDS Control Organization, Bangalore, Karnataka, India.
• 6DD (ICTC/PPTCT), KSAPS, Bangalore, Karnataka, India. 
• Indian J Pediatr. 2016 Feb 26.

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HIV-Infected Presumptive Tuberculosis Patients Without Tuberculosis: How Many Are Eligible for Antiretroviral Therapy in Karnataka, India?

For certain subgroups within people living with the human immunodeficiency virus (HIV) [active tuberculosis (TB), pregnant women, children <5 years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy (ART) irrespective of CD4 count. Another subgroup which has received increased attention is "HIV-infected presumptive TB patients without TB". 

In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State (population 60 million), India. This was a cross-sectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. 

Of 42,585 presumptive TB patients, 28,964 (68%) were tested for HIV and 2262 (8%) were HIV positive. Of the latter, 377 (17%) had active TB. Of 1885 "presumptive TB patients without active TB", 1100 (58%) were already receiving ART. Of the remaining 789 who were not receiving ART, 617 (79%) were assessed for ART eligibility and of those, 548 (89%) were eligible for ART. About 90% of "HIV-infected presumptive TB patients without TB" were eligible for ART. 

This evidence supports a public health approach of starting all "HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'.

Full article at:   http://goo.gl/TBg0pA

By:  Kumar AM1, Singarajipura A2, Naik B3, Guddemane DK3, Patel Y3, Shastri S2, Kumar S4, Deshmukh R5, Rewari BB5, Harries AD6.

• 1International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. Electronic address: akumar@theunion.org.
• 2State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India.
• 3World Health Organization Country Office, New Delhi, India.
• 4Karnataka State AIDS Prevention Society, Bangalore, Karnataka, India; National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
• 5National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
• 6International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, United Kingdom. 
• J Epidemiol Glob Health. 2016 Jan 25. pii: S2210-6006(15)30080-0. doi: 10.1016/j.jegh.2015.12.002.

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TB-HIV Co-Infection among Pregnant Women in Karnataka, South India: A Case Series

Tuberculosis (TB) is a significant contributor to mortality in HIV-infected patients. Concurrent TB infection is also a significant contributing factor to maternal mortality in human immunodeficiency virus (HIV)-infected pregnant women. Studies addressing the outcomes of TB and HIV co-infection among pregnant women are generally infrequent. 

Although limited, the records maintained by the Revised National Tuberculosis Control Programme (RNTCP) and the National AIDS Control Programme (NACP) in Karnataka State, Southern India provide information about the numbers of pregnant women who are co-infected with TB and HIV and their pregnancy outcomes. We reviewed the data and conducted this study to understand how TB-HIV co-infection influences the outcomes of pregnancy in this setting. We sought to determine the incidence and treatment and delivery outcomes of TB-HIV co-infected pregnant women in programmatic settings in Karnataka State in southern India. 

The study participants were all the HIV-infected pregnant women who were screened for tuberculosis under the NACP from 2008 to 2012. For the purposes of this study, the program staff in the field gathered the data regarding on treatment and delivery outcomes of pregnant women. A total of seventeen pregnant women with TB-HIV co-infection were identified among 3,165,729 pregnant women (for an incidence of 5.4 per million pregnancies). 

The median age of these pregnant women was 24 years, and majority were primiparous women with WHO HIV stage III disease and were on a stavudine-based ART regimen. The maternal mortality rates were 18% before delivery and 24% after delivery. The abortion rate was 24%, and the neonatal mortality rate was 10%. The anti-tuberculosis treatment and anti-retroviral treatment outcome mortality rates were 30% and 53%, respectively. 

Although the incidence of TB among the HIV-infected pregnant women was marginally less than that among the non-HIV-infected women, the delivery outcomes were relatively poorer. 

The current strategy for the management of TB among the HIV-positive pregnant women needs urgent review.

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By:   Suresh S1, Sharath BN2, Anita S3, Lalitha R4, Jaya Prasad T5, Rewari BB6.

• 1State Tuberculosis Office, Bangalore, India.
• 2ESIC Medical College and PGIMSR, Bangalore, India. Electronic address: sharathbn@yahoo.com.
• 3St. John's Medical College Hospital, Bangalore, India.
• 4Karnataka State AIDS Prevention Society, Bangalore, India.
• 5School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
• 6National AIDS Control Organization, New Delhi, India. 

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Frontline Health Service Providers’ Perspectives on HIV Vaccine Trials among Female Sex Workers and Men Who Have Sex with Men in Karnataka, South India

Little qualitative research is available on the role of frontline health service providers (FHSPs) in the implementation of clinical trials, particularly in developing countries. This paper presents findings from a qualitative study about the perspectives of FHSPs on future HIV vaccine trials involving female sex workers (FSWs) and men who have sex with men (MSM) in three districts of Karnataka, India. In particular, we explore FHSPs’ knowledge of and views on clinical trials in general, and examine their potential willingness to play a role if such trials were introduced or implemented in the region.

A field team of four researchers from Karnataka—two of whom self-identified with FSW or MSM communities (“community researchers”) and two with backgrounds in social work—conducted in-depth interviews with FHSPs. Including community researchers in the study helped to build rapport with FSW and MSM participants and facilitate in-depth discussions. A coding scheme for transcribed and translated data was developed using a framework analysis approach. Data was then analysed thematically using a combination of a priori and emergent codes.

Over half of FHSPs demonstrated limited knowledge or understanding of clinical trials. Despite reported skepticism around the testing of HIV vaccines in developing countries and concerns around potential side effects, most FHSPs strongly advocated for the implementation of HIV vaccine clinical trials in Karnataka. Further, most FHSPs expressed their willingness to be involved in future HIV vaccine clinical trials in varying capacities.

Given that FHSPs are often directly involved in the promotion of health and well-being of FSWs and MSM, they are well-positioned to play leadership, ethical, and communicative roles in future HIV vaccine trials. However, our findings reveal a lack of awareness of clinical trials among FHSP participants, suggesting an important area for capacity building and staff development before viable and ethical clinical trials can be set up in the region.

Full article at: http://goo.gl/oNqnaX

By:

Satyanarayana Ramanaik

Centre for Multi-Disciplinary Development Research, Dharwad, Karnataka, India

Satyanarayana Ramanaik, B. M. Ramesh

Karnataka Health Promotion Trust, Bangalore, Karnataka, India

Leigh M. McClarty, B. M. Ramesh, Monika Doshi, Marissa L. Becker, Robert R. Lorway

Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

Shamshad Khan

Department of Communication, University of Texas at San Antonio, San Antonio, Texas, United States of America

Marissa L. Becker

Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

  

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“From Me to HIV”: A Case Study of the Community Experience of Donor Transition of Health Programs

Below:  Avahan and the National AIDS Control Program (NACP)

Below:  Stakeholders involved in transition of Avahan program to Government of India

We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries’ view of transition.

While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.

Read more at:   http://ht.ly/R60vH HT @JohnsHopkinsSPH