Challenges faced by marginalized communities such as transgenders in Pakistan

Challenges faced by marginalized communities such as transgenders in Pakistan. Read more at: http://ow.ly/M0yD30mlMyV   

Expanding Access to HIV Testing & Counseling & Exploring Vulnerabilities among Spouses of HIV-Positive Men Who Inject Drugs in Pakistan

Objectives

To explore the utility of home and community-based HIV testing and counseling (HTC) to increase detection of undiagnosed HIV among female spouses and children of HIV-positive PWID in Punjab province, Pakistan.

Design

Between March 2014 and March 2015, home-based HTC was provided by a local NGO to spouses of HIV-positive PWID in Lahore, Faisalabad, and Sargodha. Convenience sampling was used to identify 2400 married, HIV-positive men who inject drugs and who were currently registered and receiving harm reduction services from the NGO ‘Roshan Rasta’ and seek consent to approach their wives.

Method

Trained outreach teams conducted HTC and administered a short sociodemographic and behavioral questionnaire to consenting spouses in their homes. HIV-exposed children were also tested with parental consent.

Results

of the 2400 married HIV positive male-injecting drug users, only 1959 spouses were approached and 1896 agreed to HTC (96.8%). HIV prevalence was 5.3% (n = 101) among spouses and they had very low level of HIV-related knowledge and protective behaviors

Conclusion

Home and community-based HTC was effective in identifying undiagnosed HIV among spouses of PWID, the majority of whom reported low rates of prior HIV testing and low HIV-related knowledge. Expansion of HIV prevention services and linkages to treatment and care including PMTCT are urgently needed for this group.

Below:  Ability of spouses to either identify correct responses or reject misconceptions regarding routes of HIV transmission. ^∗There was some confusion about how to administer this question in the survey by field teams, resulting in a substantial amount of incomplete data, which was subsequently excluded. Consequently, the number of respondents for each mode of transmission varies. We calculate ‘all correct’ based only on spouses that provided a response to all seven modes.

Full article at:   http://goo.gl/ZBUQl8

By:  Salman Shahid,a Mohammad Faisal Majeed,a Ahmad Bakhsh Awaan,b Humayun Mirza,b Nasir Sarfraz,c and Vanessa Veronesed

^aPunjab AIDS Control Program, Department of Health, Government of Punjab, Lahore

^bRoshan Rasta, Lahore

^cHealth Section, UNICEF Pakistan, Islamabad, Pakistan

^dHIV and AIDS Section, UNICEF Regional Office for South Asia, Kathmandu, Nepal

Correspondence to Salman Shahid, 7-B, LDA Flats, Huma Block, Allama Iqbal Town, Lahore 2060, Pakistan. Tel: +092 42 3780 2425

Curr Opin HIV AIDS. 2016 Mar; 11(Suppl 1): S6–S12.

Published online 2016 Mar 10. doi:  10.1097/COH.0000000000000263

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How a Trans Woman Found Refuge in Pakistan's Progressive Fashion World

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Pre-Donation Screening of Volunteer Prisoner Blood Donors for Hepatitis B & C in Prisons of Punjab, Pakistan

BACKGROUND:

Prisoners as a high risk group are never recommended for blood donations. In Pakistan, prisoners are legally allowed to donate blood and get thirty days extra remission. Inspectorate of prisons allowed Alizaib Foundation for blood donation camps subject to predonation screening of volunteer prisoner blood donor against infectious diseases. This study was conducted to identify the potential benefits of pre-donation screening.

METHODS:

This cross sectional study was conducted in October, 2009 in Punjab. Intending volunteer prisoner blood donors from January, 2007 to September, 2009 from prisons of Punjab were included. Physically fit were tested for Hepatitis C Virus (HCV) and B Virus (HBV) by Rapid test kit before bleeding. Data was analysed by Epi-Info.

RESULTS:

A total of 5894 male volunteer prisoner donors were screened and 1038 (17.6%) were rejected. The mean age was 28 years (range: 17-70 years). Of 5894, 857 (14.5%) were HCV positive and 222 (3.8%) were HBV positive. HCV & HBV co-infection was present among 41 (0.7%). Being convicted prisoner blood donor is significantly associated with higher seroprevalence for HCV (OR 1.35, 95% C.I. 1.17-1.57) and being under trial prisoner is significantly associated with higher seroprevalence for HBV (OR 1.40, 95% C.I. 1.06-1.85).

CONCLUSION:

Hepatitis B & C viruses were responsible for almost 18% prisoner blood donor rejection. Pre-donation screening of blood donors is an effective intervention to improve the safety and limit the cost of blood. Treatment of identified cases may contribute to public health. In the international scenario this study findings necessitate the amendments in the relevant prison rules.

Article at:   http://goo.gl/mU8HbM  Abstract:  http://goo.gl/8U8ovZ

By:  Pervaiz A, Sipra FS, Rana TH, Qadeer I.

J Ayub Med Coll Abbottabad. 2015 Oct-Dec;27(4):794-7.

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Heterogeneity among Sex Workers in Overlapping HIV Risk Interactions with People Who Inject Drugs: A Cross-Sectional Study from 8 Major Cities in Pakistan

Concerns remain regarding the heterogeneity in overlapping human immunodeficiency virus (HIV) risk behaviors among sex workers (SWs) in Pakistan; specifically, the degree to which SWs interact with people who inject drugs (PWID) through sex and/or needle sharing.

Following an in-depth mapping performed in 2011 to determine the size and distribution of key populations at highest risk of HIV acquisition in Pakistan, a cross-sectional biological and behavioral survey was conducted among PWID, female (FSWs), male (MSWs), and hijra/transgender (HSWs) sex workers, and data from 8 major cities were used for analyses. Logistic regression was used to identify factors, including city of residence and mode of SW-client solicitation, contributing to the overlapping risks of drug injection and sexual interaction with PWID.

The study comprised 8483 SWs (34.5% FSWs, 32.4% HSWs, and 33.1% MSWs). Among SWs who had sex with PWID, HSWs were 2.61 (95% confidence interval [CI], 1.19-5.74) and 1.99 (95% CI, 0.94-4.22) times more likely to inject drugs than MSWs and FSWs, respectively. There was up to a 3-fold difference in drug injecting probability, dependent on where and/or how the SW solicited clients. Compared with SWs in Larkana, the highest likelihood of drug injection use was among SWs in Multan (OR = 4.52; 95% CI: 3.27-6.26), followed by those in Lahore, Quetta, and Faisalabad.Heterogeneity exists in the overlapping patterns of HIV risk behaviors of SWs. The risk of drug injection among SWs also varies by city. Some means of sexual client solicitation may be along the pathway to overlapping HIV risk vulnerability due to increased likelihood of drug injection among SWs. 

There is a need to closely to monitor the mixing patterns between SWs and PWID and underlying structural factors, such as means of sexual client solicitation, that mediate HIV risk, and implement prevention programs customized to local subepidemics.

Below:  Unadjusted odds of injecting drugs in the past 6 months, by type of sex worker and sexual activity with people who inject drugs

Full article at:   http://goo.gl/PxD5ch

By:  Melesse DY1, Shafer LA, Shaw SY, Thompson LH, Achakzai BK, Furqan S, Reza T, Emmanuel F, Blanchard JF.

• 1From the Centre for Global Public Health, Department of Community Health Sciences (DYM, SYS, LHT, FE, JFB); Department of Internal Medicine (LAS), Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and National AIDS Control Program (BKA, SF, TR), National Institute of Health, Islamabad, Pakistan. 
• Medicine (Baltimore). 2016 Mar;95(12):e3085. doi: 10.1097/MD.0000000000003085.

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Risk Factors for Loss to Follow-Up among People Who Inject Drugs in a Risk Reduction Program at Karachi, Pakistan

INTRODUCTION:

Retention of male people who inject drugs (PWIDs) is a major challenge for harm reduction programs that include sterile needle/syringe exchange in resource-limited settings like Pakistan. We assessed the risk factors for loss to follow-up among male PWIDs enrolled in a risk reduction program in Karachi, Pakistan.

METHODS:

We conducted a prospective cohort study among 636 HIV-uninfected male PWIDs enrolled during March-June 2009 in a harm reduction program for the estimation of incidence rate. At 24 months post-enrollment, clients who had dropped out of the program were defined as lost to follow-up and included as cases for case-cohort study.

RESULTS:

The median age of the participants was 29 years (interquartile range: 23-36). Active outreach accounted for 76% (483/636) of cohort recruits. Loss to follow-up at 24 months was 25.5% (162/636). In multivariable logistic regression, younger age (AOR: 0.97, 95% CI: 0.92-0.99, p = 0.028), clients from other provinces than Sindh (AOR: 1.49, 95% CI: 1.01-2.22, p = 0.046), having no formal education (AOR: 3.44, 95% CI: 2.35-4.90, p<0.001), a history of incarceration (AOR: 1.68, 95% CI: 1.14-2.46, p<0.008), and being homeless (AOR: 1.47, 95% CI: 1.00-2.19, p<0.049) were associated with loss to follow-up.

CONCLUSIONS:

Our cohort retained 74.5% of male PWIDs in Karachi for 24 months. Its loss to follow up rate suggested substantial ongoing programmatic challenges. Programmatic enhancements are needed for the highest risk male PWIDs, i.e., younger men, men not from Sindh Province, men who are poorly educated, formerly incarcerated, and/or homeless.

Full article at:  http://goo.gl/nhE42m

By:  Samo RN1, Agha A2, Shah SA3, Altaf A3, Memon A4, Blevins M5, Qian HZ6, Vermund SH7.

• 1Polio Eradication Initiative, World Health Organization, Larkana, Pakistan.
• 2Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
• 3Bridge Consultants Foundation, Karachi, Pakistan.
• 4Sindh AIDS Control Program, Karachi, Pakistan.
• 5Vanderbilt Institute for Global Health & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
• 6Vanderbilt Institute for Global Health & Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
• 7Vanderbilt Institute for Global Health & Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America. 
• PLoS One. 2016 Feb 3;11(2):e0147912. doi: 10.1371/journal.pone.0147912. eCollection 2016.

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Hepatitis C Virus and HIV Infections among People Who Inject Drugs in the Middle East and North Africa: A Neglected Public Health Burden?

People who inject drugs (PWID) are a key population at risk of hepatitis C virus (HCV) and HIV infections. Globally, 63% of PWID are HCV infected [1, 2] and 19% are HIV infected [2], leading to an estimated 10 million and 3 million HCV- and HIV-infected PWID, respectively [1–3]. The Middle East and North Africa (MENA), a region comprising 23 countries from Morocco in the West to Pakistan in the East, is at the centre of major drug production and trade, creating a context of vulnerability to injecting drug use [4]. PWID in MENA are a large, mostly young and stigmatized population experiencing a substantial HCV and HIV burden, with potential for even further HIV epidemic growth. Yet, they lack access to comprehensive and confidential HCV and HIV testing, prevention and treatment services.

Below:  Median HCV prevalence among people who inject drugs in the Middle East and North Africa as per available studies [6]. Error bars represent the lower and upper bounds of the interquartile range if more than one data point was available per country.

Full article at:   http://goo.gl/qK72Up

By:   Ghina R Mumtaz,§,1,2 Helen A Weiss,3 and Laith J Abu-Raddad1,4

¹Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar

²Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

³MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

⁴Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA

^§Corresponding author: Ghina R Mumtaz, Infectious Disease Epidemiology Group, Weill Cornell Medical College – Qatar, Cornell University, Qatar Foundation – Education City, P.O. Box 24144, Doha, Qatar. Tel: +(974) 4492 8406. Fax: +(974) 4492 8422. (Email:ude.llenroc.dem-rataq@6002mig) 

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Injection Drug User, Female Sex Workers & Combined Male Sex Workers/Hijra (Transgender) Sex Workers per 1000 Adult Men in Six Cities in Pakistan

Background

Considerable HIV transmission occurs among injection drug users (IDUs) in Pakistan and recently the HIV prevalence has been increasing among male (MSW), hijra (transgender; HSW) and female (FSW) sex workers. We describe past and estimate future patterns of HIV emergence among these populations in several cities in Pakistan.

Methods

The density of these key populations per 1000 adult men was calculated using 2011 mapping data from Karachi, Lahore, Faisalabad, Larkana, Peshawar and Quetta, and surveillance data were used to assess bridging between these key populations. We used the UNAIDS Estimation and Projection Package model to estimate and project HIV epidemics among these key populations in Karachi, Lahore, Faisalabad and Larkana.

Results

The density and bridging of key populations varied across cities. Lahore had the largest FSW population (11.5/1000 adult men) and the smallest IDU population (1.7/1000 adult men). Quetta had the most sexual and drug injection bridging between sex workers and IDUs (6.7%, 7.0% and 3.8% of FSW, MSW and HSW, respectively, reported injecting drugs). Model evidence suggests that by 2015 HIV prevalence is likely to reach 17–22% among MSWs/HSWs in Karachi, 44–49% among IDUs in Lahore and 46–66% among IDUs in Karachi. Projection suggests the prevalence may reach as high as 65–75% among IDUs in Faisalabad by 2025. HIV prevalence is also estimated to increase among FSWs, particularly in Karachi and Larkana.

Conclusions

There is a need to closely monitor regional and subpopulation epidemic patterns and implement prevention programmes customised to local epidemics.

Full article at:   http://goo.gl/gGnKI6

By:   Tahira Reza,1 Dessalegn Y Melesse,2 Leigh Anne Shafer,3 Momina Salim,1 Arshad Altaf,1 Altaf Sonia,1 Gayatri C Jayaraman,4 Faran Emmanuel,1,2 Laura H Thompson,2 and James F Blanchard2

¹Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan

²Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada

³Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada

⁴Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada

Correspondence to Dr James F Blanchard, Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, R070-771 McDermot Ave, Winnipeg, Canada R3E 0T6; Email: ac.abotinamu@drahcnalb_semaj

 

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Determinants of Default from Tuberculosis Treatment among Patients with Drug-Susceptible Tuberculosis in Karachi, Pakistan

Non-adherence to tuberculosis therapy can lead to drug resistance, prolonged infectiousness, and death; therefore, understanding what causes treatment default is important. Pakistan has one of the highest burdens of tuberculosis in the world, yet there have been no qualitative studies in Pakistan that have specifically examined why default occurs. We conducted a mixed methods study at a tuberculosis clinic in Karachi to understand why patients with drug-susceptible tuberculosis default from treatment, and to identify factors associated with default. Patients attending this clinic pick up medications weekly and undergo family-supported directly observed therapy.

In-depth interviews were administered to 21 patients who had defaulted. We also compared patients who defaulted with those who were cured, had completed, or had failed treatment in 2013.

Qualitative analyses showed the most common reasons for default were the financial burden of treatment, and medication side effects and beliefs. The influence of finances on other causes of default was also prominent, as was concern about the effect of treatment on family members. In quantitative analysis, of 2120 patients, 301 (14.2%) defaulted. Univariate analysis found that male gender, being 35–59 years of age, or being 60 years of age or older were associated with default. After adjusting for gender, disease site, and patient category, being 35–59 years of age or 60 years of age or older) were associated with default.

In multivariate analysis age was the only variable associated with default. This lack of identifiable risk factors and our qualitative findings imply that default is complex and often due to extrinsic and medication-related factors. More tolerable medications, improved side effect management, and innovative cost-reduction measures are needed to reduce default from tuberculosis treatment.

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

By:  Natasha Chida, Stephen Symes

Jay Weiss Institute for Health Equity at Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America

Natasha Chida

Department of Internal Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

Zara Ansari, Aamir J. Khan, Shama Mohammed

Interactive Research and Development, Karachi, Sindh, Pakistan

Hamidah Hussain, Maria Jaswal, Aamir J. Khan

Indus Hospital Research Center, Indus Hospital, Karachi, Sindh, Pakistan

 

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Estimation of Cancer Burden Attributable to Infection in Asia

Some infectious agents have been shown to be human carcinogens. The current study focused on estimation of cancer burden attributable to infection in different regions of Asia.

By systematically reviewing previous studies of the infection prevalence data of 13 countries in Asia and relative risks of specific cancers, we calculated the population attributable fraction of carcinogenic infections. Using data from GLOBOCAN 2012, the overall country-specific and gender-specific number of new cancer cases and deaths resulting from infection were estimated.

Across 13 principal Asian countries, the average prevalence and range was 6.6% (0.5% in Japanese women to 15.0% in Vietnamese men) for hepatitis B virus (HBV), 2.6% (0.3% in Iran to 5.1% in Saudi Arabia) for hepatitis C virus (HCV), 7.9% (2.8% in Pakistan to 17.7% in China) for human papillomavirus (HPV), and 61.8% (12.8% in Indonesia to 91.7% in Bangladesh) for Helicobacter pylori (HP). 

The estimated total number of cancer cases and deaths caused by infection in these 13 countries were 1 212 026 (19.6% of all new cancer cases) and 908 549 (22.0% of all deaths from cancer). The fractions of cancer incidence attributable to infection were 19.7% and 19.5% in men and women, respectively. 

The percentages of cancer deaths attributable to infection were 21.9% and 22.1% in men and women, respectively. Among the main infectious agents, HP was responsible for 31.5% of infection-related cancer cases and 32.8% of infection-related cancer deaths, followed by HBV (28.6% of new cases and 23.8% of deaths), HPV (22.0% of new cases and 27.3% of deaths), and HCV (12.2% of new cases and 10.6% of deaths).

Approximately one quarter of all cancer cases and deaths were infection-associated in Asia, which could be effectively prevented if appropriate long-term controls of infectious agents were applied.

Below: Proportion of estimated new cancer cases and deaths attributable to different infectious agents in men and women

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

By: He Huang,1,2 Xiao-Feng Hu,3 Fang-Hui Zhao,1 Suzanne M. Garland,4 Neerja Bhatla,5 and You-Lin Qiao1

¹Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

²Department of Prevention and Control of Communicable Disease, Guizhou Center for Disease Control and Prevention, Guiyang, Guizhou, China

³Shijingshan District Center for Disease Control and Prevention, Beijing, China

⁴The Microbiology and Infectious Diseases Department, Royal Women’s Hospital, and the Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia

⁵Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Address for correspondence. Fang-Hui Zhao, Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, P.O. Box 2258, Beijing 100021, China (e-mail: nc.ca.smacic@hgnafoahz).

 

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Drug-Related HIV Epidemic in Pakistan: A Review of Current Situation & Response & The Way Forward Beyond 2015

Pakistan is among four countries in Asia where the estimated number of new HIV infections has been increasing year by year ever since 1990. The Asian Epidemic Modelling (AEM), conducted in 2015, reconfirmed that the use of contaminated injection equipment among people who inject drugs (PWID) remains the main mode of HIV transmission in the country. The estimated number of PWID ranges from 104,804 to 420,000 PWID. HIV prevalence in this population is above 40 % in several cities, including Faisalabad (52.5 %), D.G. Khan (49.6 %), Gujrat (46.2 %), Karachi (42.2 %) and Sargodha (40.6 %), respectively. Harm reduction service delivery is being implemented through a public-private partnership led by the National and Provincial AIDS Control Programmes and Nai Zindagi with funding support from the Global Fund. Current programmatic coverage of the needle and syringe programme, HIV testing and counselling and antiretroviral treatment among PWID remain insufficient to control ongoing transmission of HIV in the country. While opioid substitution therapy (OST) is yet to be introduced, significant progress and coordination among various ministries have taken place recently to register buprenorphine in the dosage required for treatment of opioid dependence, and possible introduction of OST will greatly facilitate adherence to antiretroviral treatment among PWID living with HIV...

The findings from the household survey indicated that an estimated 860,000 people, or 0.8 % of the population aged 15–64, used heroin regularly. Based on the findings from the problem drug use survey, an estimated 430,000 (range 190,000 to 657,000), or 0.4 % (range 0.3 to 0.5 %) people aged 15–64, inject drugs. Among these, 78 % injected heroin and the remaining injected pharmaceutical opioids, including morphine, pentazocine or pethidine, and tranquilisers for non-therapeutic purposes. Poly drug use was a common phenomenon with over 75 % of opioid users injecting a combination of substances. In this survey, the majority reported injecting two to four times a day…

Ensuring access to and adherence to ARVs among people living with HIV, especially those who inject drugs, has the potential to prevent much of the ongoing transmission of HIV in Pakistan. Given low rates of HIV testing and counselling overall, and among PWID in particular, there is a need to explore new approaches that will attract much larger numbers of PWID to test for HIV so that those who test positive can benefit from treatment. Eventual introduction of OST will greatly improve adherence to ART, leading to the suppression of viral load among HIV-positive PWID and consequently averting new cases of transmission of HIV from this population.

The voice of people who inject drugs is mostly silent in national policy making, planning, implementation, monitoring and evaluation processes. With support from the International Network of People who use Drugs (INPUD) and Mainline, The Association of People Living with HIV/AIDS (APLHIV) has in 2015 launched a Drug Users Network (“DUNE”). The mission of DUNE is to mobilise community leadership in order to influence laws, policies, programmes and funds through meaningful involvement of people who use drugs. It is anticipated that the formation of such a national network will enhance the representation and voice of people who use drugs in relevant fora...

  

Full article at: http://goo.gl/AZOC6j

By: Anne Bergenstrom^1*, Baseer Achakzai², Sofia Furqan², Manzoor ul Haq³, Rajwal Khan⁴and Marc Saba⁴

¹United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

²National AIDS Control Programme, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan

³United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

⁴UNAIDS Country Office for Pakistan & Afghanistan, Level-5, Serena Business Complex, Khyaban-e-Suhrwardy, Islamabad, Pakistan

  

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Drug-Related HIV Epidemic in Pakistan: A Review of Current Situation & Response & the Way Forward Beyond 2015

Pakistan is among four countries in Asia where the estimated number of new HIV infections has been increasing year by year ever since 1990. The Asian Epidemic Modelling (AEM), conducted in 2015, reconfirmed that the use of contaminated injection equipment among people who inject drugs (PWID) remains the main mode of HIV transmission in the country. 

The estimated number of PWID ranges from 104,804 to 420,000 PWID. HIV prevalence in this population is above 40 % in several cities, including Faisalabad (52.5 %), D.G. Khan (49.6 %), Gujrat (46.2 %), Karachi (42.2 %) and Sargodha (40.6 %), respectively. Harm reduction service delivery is being implemented through a public-private partnership led by the National and Provincial AIDS Control Programmes and Nai Zindagi with funding support from the Global Fund. Current programmatic coverage of the needle and syringe programme, HIV testing and counselling and antiretroviral treatment among PWID remain insufficient to control ongoing transmission of HIV in the country. 

While opioid substitution therapy (OST) is yet to be introduced, significant progress and coordination among various ministries have taken place recently to register buprenorphine in the dosage required for treatment of opioid dependence, and possible introduction of OST will greatly facilitate adherence to antiretroviral treatment among PWID living with HIV.

Full article at:  http://goo.gl/Qu22bC

By: Anne Bergenstrom^1*, Baseer Achakzai², Sofia Furqan², Manzoor ul Haq³, Rajwal Khan⁴and Marc Saba⁴

¹United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

²National AIDS Control Programme, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan

³United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

⁴UNAIDS Country Office for Pakistan & Afghanistan, Level-5, Serena Business Complex, Khyaban-e-Suhrwardy, Islamabad, Pakistan

  

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Understanding Market Size and Reporting Gaps for Paediatric TB in Indonesia, Nigeria and Pakistan: Supporting Improved Treatment of Childhood TB in the Advent of New Medicines

Objective of the Study

We sought to understand gaps in reporting childhood TB cases among public and private sector health facilities (dubbed “non-NTP” facilities) outside the network of national TB control programmes, and the resulting impact of under-reporting on estimates of paediatric disease burden and market demand for new medicines.

Methodology

Exploratory assessments were carried out in Indonesia, Nigeria and Pakistan, reaching a range of facility types in two selected areas of each country. Record reviews and interviews of healthcare providers were carried out to assess numbers of unreported paediatric TB cases, diagnostic pathways followed and treatment regimens prescribed.

Main Findings

A total of 985 unreported diagnosed paediatric TB cases were identified over a three month period in 2013 in Indonesia from 64 facilities, 463 in Pakistan from 35 facilities and 24 in Nigeria from 20 facilities. These represent an absolute additional annualised yield to 2013 notifications reported to WHO of 15% for Indonesia, 2% for Nigeria and 7% for Pakistan. Only 12% of all facilities provided age and sex-disaggregated data. Findings highlight the challenges of confirming childhood TB. Diagnosis patterns in Nigeria highlight a very low suspicion for childhood TB. Providers note the need for paediatric medicines aligned to WHO recommendations.

Conclusion: 

This study emphasises the impact of incomplete reporting on the estimation of disease burden and potential market size of paediatric TB medicines. Further studies on “hubs” (facilities treating large numbers of childhood TB cases) will improve our understanding of the epidemic, support introduction efforts for new treatments and better measure markets for new paediatric medicines.

Full article at: http://goo.gl/axCy6V

By:

Renia Coghlan

TESS Development Advisors, Geneva, Switzerland

Elizabeth Gardiner

Consultant, New York, New York, United States of America

Farhana Amanullah

Paediatric TB Programme, The Indus Hospital, Karachi, Pakistan

Chikwe Ihekweazu

EpiAfric, Abuja, Nigeria

Rina Triasih

Department of Paediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia

Malgorzata Grzemska, Charalambos Sismanidis

Global TB Programme, World Health Organization, Geneva, Switzerland

   

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