Accomplishments in external quality assurance scheme related to HIV testing of stand-alone state reference laboratory at a tertiary care institute of North India

Background: Quality assurance (QA) implemented through quality management systems (QMS) is essential for HIV testing to ensure validity, reliability and accuracy of test results.  The Department of Microbiology, PGIMS Rohtak, is working as stand-alone SRL for 117 underlying integrated counselling and testing centres (ICTCs) in whole Haryana state and regularly conducts external quality assurance scheme (EQAS) programs including retesting, proficiency panel testing (PT), etc. in collaboration with National AIDS Control Organization (NACO) and Haryana State AIDS Control Society (HSACS). Objective of study was to assess and analyse data related to EQAS activities viz. retesting and proficiency panel testing of all linked ICTCs in Haryana Methods: Retrospective study was conducted over a period of six years (2017-2022). PT was conducted twice a year whereas rechecking of samples was done at quarterly intervals. Testing was done as per NACO guidelines. Results: Total 19113 samples were received and tested at SRL from underlying ICTCs for EQAS retesting. Out of this, 998 samples were HIV positive with no indeterminate result. SRL also provided 4052 panel sera to ICTCs. All results were 100% concordant. Participation of ICTCs increased from 80% in 2017 to around 98% in 2022 with constant support, supervision and monitoring from SRL. Conclusions: Important cornerstone for containing HIV remains timely and accurate diagnosis. It becomes ethical responsibility of everyone connected with laboratory framework to diligently follow QMS protocols. This ensures patients are accurately diagnosed and treatment initiated timely, thereby fulfilling ultimate goal of ending HIV epidemic as major public health threat by 2030

Cancer Biomarkers and Targets in Digestive Organs

Identification and development of cancer biomarkers and targets have greatly accelerated progress towards precision medicine in oncology. Studies of tumor biology have not only provided insights into the mechanisms underlying carcinogenesis, but also led to discovery of molecules that have been developed into cancer biomarkers and targets. Multi-platforms for molecular characterization of tumors using next-generation genomic sequencing, immunohistochemistry, in situ hybridization, and blood-based biopsies have greatly expanded the portfolio of potential biomarkers and targets. These cancer biomarkers have been developed for diagnosis, early detection, prognosis, and prediction of treatment response. The molecular targets have been exploited for anti-cancer therapy and delivery of therapeutic agents. This Special Issue of Biomedicines focuses on recent advances in the discovery, characterization, translation, and clinical application of cancer biomarkers and targets in malignant diseases of the digestive system. The goal is to stimulate basic and translational research and clinical collaboration in this exciting field with the hope of developing strategies for prevention and early detection/diagnosis of cancer in digestive organs, and improving therapeutic and psychosocial outcomes in patients with these malignant diseases

Control of Sexually Transmitted Infections, Reproductive Tract Infections, and HIV/AIDS in India: Current Status and the Way Forward

Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) form an important public health problem with a huge burden of disease and an adverse impact on reproductive health of people worldwide. Caused by a variety of infectious agents and manifesting as different clinical syndromes, STIs/RTIs remain highly prevalent in India too, reportedly up to 6% in general population (and maybe higher in reality due to secrecy maintained by many people around such diseases) and much more in certain vulnerable population groups. The situation has worsened further with the epidemic of human immunodeficiency virus (HIV) infection and resultant acquired immunodeficiency syndrome (AIDS). Similarities of unique host risk behaviors and socio-demographic factors associated with STIs, RTIs and HIV/AIDS call for an integrated approach for their control with multipronged intervention strategies. The National AIDS Control Programme, the National RTI/STI Control Programme, the National Strategy for Elimination of Parent-to-Child Transmission of Syphilis, the National Blood Policy, and other related health programs and policies have set out clear objectives and guiding principles for phased programmatic interventions, with focus on checking the spread of these infections through health education, behavior change, targeted interventions, early diagnosis, and prompt treatment. Freely available and easily accessible services for comprehensive care, support, and treatment of patients with these infections will help reduce the disease burden and improve their reproductive health as well as overall well-being. Increased decentralization of public health services; strengthening institutional capacities; setting up of designated STI/RTI clinics, antiretroviral treatment (ART) clinics and integrated counseling and testing centers; availability of rapid test kits, color-coded drug kits for syndromic treatment and ART treatment; promotion of condoms; integrated counseling and testing; partner notification; involvement of non-governmental organizations; community mobilization; universal precautions and augmentation of voluntary blood donation; robust surveillance; evidence-based planning, and effective program implementation are major components for control of these infections. The present systematic review discusses the current situation, the key programmatic measures, and the way forward for control of STIs/RTIs and HIV/AIDS in India

HIV and cancer registry linkage identifies a substantial burden of cancers in persons with HIV in India.

We utilized computerized record-linkage methods to link HIV and cancer databases with limited unique identifiers in Pune, India, to determine feasibility of linkage and obtain preliminary estimates of cancer risk in persons living with HIV (PLHIV) as compared with the general population.Records of 32,575 PLHIV were linked to 31,754 Pune Cancer Registry records (1996-2008) using a probabilistic-matching algorithm. Cancer risk was estimated by calculating standardized incidence ratios (SIRs) in the early (4-27 months after HIV registration), late (28-60 months), and overall (4-60 months) incidence periods. Cancers diagnosed prior to or within 3 months of HIV registration were considered prevalent.Of 613 linked cancers to PLHIV, 188 were prevalent, 106 early incident, and 319 late incident. Incident cancers comprised 11.5% AIDS-defining cancers (ADCs), including cervical cancer and non-Hodgkin lymphoma (NHL), but not Kaposi sarcoma (KS), and 88.5% non-AIDS-defining cancers (NADCs). Risk for any incident cancer diagnosis in early, late, and combined periods was significantly elevated among PLHIV (SIRs: 5.6 [95% CI 4.6-6.8], 17.7 [95% CI 15.8-19.8], and 11.5 [95% CI 10-12.6], respectively). Cervical cancer risk was elevated in both incidence periods (SIRs: 9.6 [95% CI 4.8-17.2] and 22.6 [95% CI 14.3-33.9], respectively), while NHL risk was elevated only in the late incidence period (SIR: 18.0 [95% CI 9.8-30.20]). Risks for NADCs were dramatically elevated (SIR > 100) for eye-orbit, substantially (SIR > 20) for all-mouth, esophagus, breast, unspecified-leukemia, colon-rectum-anus, and other/unspecified cancers; moderately elevated (SIR > 10) for salivary gland, penis, nasopharynx, and brain-nervous system, and mildly elevated (SIR > 5) for stomach. Risks for 6 NADCs (small intestine, testis, lymphocytic leukemia, prostate, ovary, and melanoma) were not elevated and 5 cancers, including multiple myeloma not seen.Our study demonstrates the feasibility of using probabilistic record-linkage to study cancer/other comorbidities among PLHIV in India and provides preliminary population-based estimates of cancer risks in PLHIV in India. Our results, suggesting a potentially substantial burden and slightly different spectrum of cancers among PLHIV in India, support efforts to conduct multicenter linkage studies to obtain precise estimates and to monitor cancer risk in PLHIV in India

Ten years’ trend of HIV seroprevalence among Indian pregnant women attending antenatal clinic at tertiary hospital in Dhule, Maharashtra, India

Background: In India, HIV epidemic is in fourth decade and has the heterogeneity. The trend indicated HIV infection spreads from high risk behavior groups to general population. Maternal to foetal HIV transmission rate is found to vary from 20 to 25% in absence of any interventions. Newly infected persons contribute to the total number of persons living with HIV, they will progress to disease and death over the time and are a potential source of further infection. Maternal HIV status directly affects the perinatal transmission and hence the paediatric HIV cases. This transmission of HIV from mother to child can be prevented by appropriate measures. So this study is intended to identify ten years’ trends in HIV seroprevalence among antenatal population at a tertiary hospital in Dhule, Maharashtra, India.Methods: Retrospective study of ICTC evaluation of pregnant women attending antenatal clinic at obstetrics and gynaecology department of Shri Bhausaheb Hire Government Medical College in Dhule, Maharashtra, India. Blood samples were collected after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per WHO and NACO guidelines. The data of ten years period from January 2004 to December 2013 was evaluated to identify the trends of HIV seroprevalence among pregnant women attending antenatal clinic.Results: 309 pregnant women were HIV positive out of 70453 tested from 84608 ANC women during the study period. The overall prevalence for the 10 years was 0.44%. HIV prevalence had reduced from 0.89% in 2004 to 0.17% in 2013. Maximum HIV positive women i.e. 63.2% were 18 to 23 years old, primigravida (53.8%) and from rural area (58.5%). Mother to foetal transmission was noted 10 babies were detected to be HIV positive while 223 were HIV negative. 10 HIV positive mothers decided for MTP, while in 36 neonatal death was noted.Conclusions: Declining HIV seroprevalence rate is noted among pregnant women attending the antenatal clinics from 2004 to 2013. The effective implementation of prevention of parent to child transmission of HIV/AIDS (PPTCT) programmed is helping in control of the spread of HIV

HIV infection among pregnant women attending an integrated counseling & testing centre at Agra: comparison with studies in other regions of India

Background: HIV in pregnant women has become an important focus of HIV research because of its role in the spread of HIV infection, particularly, among children. The aim of this seven year (2005-2011) observational study was to determine the prevalence, trend and risk factors associated with HIV infections among pregnant women presenting to ICTC at Agra.Methods: The socio-demographic data like age, marital status, literacy status, profession, locality of residence and index of gravity were analysed in the context of symptoms at the time testing.Results: 433 pregnant women were screened for HIV and VDRL infections. 5.7% were HIV-positive and 14.3% were VDRL-reactive. HIV-positivity ranged between 2-5% whereas that of VDRL ranged from 8-12%. During 2011, there was a surge in HIV-positivity (11%) and VDRL reactivity (24%).Conclusions: There is an urgent need to perform surveys of HIV and other co-infections like HBV, HCV and STD prevalence among pregnant women to assess the true extent of the problem. Cost-effective treatment regimens and HIV prevention programmes for low-risk group clients are urgently needed in most parts of the country. This is the first review of HIV and other co-infections among pregnant women in different regions of the country

Disorder-driven doping activation in organic semiconductors

Conductivity doping of organic semiconductors is an essential prerequisite for many organic devices, but the specifics of dopant activation are still not well understood. Using many-body simulations that include Coulomb interactions and dopant ionization/de-ionization events explicitly we here show significant doping efficiency even before the electron affinity of the dopant exceeds the ionization potential of the organic matrix (p-doping), similar to organic salts. We explicitly demonstrate that the ionization of weak molecular dopants in organic semiconductors is a disorder-, rather than thermally induced process. Practical implications of this finding are a weak dependence of the ionized dopant fraction on the electron affinity of the dopant, and an enhanced ionization of the weak dopants upon increasing dopant molar fraction. As a result, strategies towards dopant optimization should aim for presently neglected goals, such as the binding energy in host-dopant charge-transfer states being responsible for the number of mobile charge carriers. Insights into reported effects are provided from the analysis of the density of states, where two novel features appear upon partial dopant ionization. The findings in this work can be used in the rational design of dopant molecules and devices

HIV Testing among Patients with Presumptive Tuberculosis: How Do We Implement in a Routine Programmatic Setting? Results of a Large Operational Research from India.

BACKGROUND: In March 2012, World Health Organization recommended that HIV testing should be offered to all patients with presumptive TB (previously called TB suspects). How this is best implemented and monitored in routine health care settings in India was not known. An operational research was conducted in Karnataka State (South India, population 64 million, accounts for 10% of India's HIV burden), to test processes and learn results and challenges of screening presumptive TB patients for HIV within routine health care settings. METHODS: In this cross-sectional study conducted between January-March 2012, all presumptive TB patients attending public sector sputum microscopy centres state-wide were offered HIV testing by the laboratory technician, and referred to the nearest public sector HIV counselling and testing services, usually within the same facility. The HIV status of the patients was recorded in the routine TB laboratory form and TB laboratory register. The laboratory register was compiled to obtain the number of presumptive TB patients whose HIV status was ascertained, and the number found HIV positive. Aggregate data on reasons for non-testing were compiled at district level. RESULTS: Overall, 115,308 patients with presumptive TB were examined for sputum smear microscopy at 645 microscopy centres state-wide. Of these, HIV status was ascertained for 62,847(55%) among whom 7,559(12%) were HIV-positive, and of these, 3,034(40%) were newly diagnosed. Reasons for non-testing were reported for 37,700(72%) of the 52,461 patients without HIV testing; non-availability of testing services at site of sputum collection was cited by health staff in 54% of respondents. Only 4% of patients opted out of HIV testing. CONCLUSION: Offering HIV testing routinely to presumptive TB patients detected large numbers of previously-undetected instances of HIV infection. Several operational challenges were noted which provide useful lessons for improving uptake of HIV testing in this important group

The Impact of the Internet on International Criminal Law

This chapter discusses how international criminal tribunals and courts (ICTCs) collect, receive and share information through the internet and, thus, how the internet has changed International Criminal Law (ICL). More specifically, it focuses on the flow of information from society to ICTCs and, vice versa, on the data released via the internet by the ICTCs to local communities. Thus, this chapter covers two different aspects of the work of ICTCs. First, this chapter demonstrates that the internet enhances the quality of international criminal prosecutions because of the new low-cost and increasingly accessible technologies available via the internet, social networks such as Facebook and Twitter, crowdsourcing, as well as satellite imagery and other forms of surveillance technologies that might bring about better, cheaper, and safer prosecutions. Indeed, these technologies used to pursue individuals’ retribution and deterrence might, for instance, help to preserve destroyed or threatened cultural heritage for future generations. Also, it gives individuals the power to gain control over the information and evidence that are then forwarded to the ICTCs. Howe­ver, these positive trends are also characterized by some setbacks. For instance, considering the scarce international practice, some doubts on the admissibility and verifiability of this type of evidence exist. Also, the relationship with third parties that store the video footages still remains unchartered territory. Second, the internet has also strengthened the outreach programs of the ICTCs enhancing quality and the quantity of data released via the internet by the ICTCs to local communities. This chapter demonstrates that the failure to engage with the local population had a negative impact on the legitimacy and legacy of the ICTCs. Thus, outreach could benefit from developments in new forms of technology to design innovative and meaningful outreach strategies