Global Viral Hepatitis Strategy: Issues with Hepatitis B Immunization in India

Hepatitis B vaccination, a key component of the recently adopted Global Viral Hepatitis Strategy, has been plagued by various issues since its introduction under the National immunization program in India. While the concerns relating to the inclusion of the vaccine under the Universal Immunization Program, the vaccination strategies adopted and prevention of mother to child transmission of hepatitis B have been largely resolved, data from recent research has underscored the need for regular monitoring of immunological and epidemiological outcomes of the vaccine. Controversies surrounding the safety and efficacy of the recently introduced combination pentavalent vaccine have highlighted that besides reinforcing surveillance of adverse events following immunization in the public sector, the private health sector in the country needs to be supported in this activity by increasing awareness and strengthening public-private collaboratio

Global Viral Hepatitis Strategy: Issues with Hepatitis B Immunization in India

Hepatitis B vaccination, a key component of the recently adopted Global Viral Hepatitis Strategy, has been plagued by various issues since its introduction under the National immunization program in India. While the concerns relating to the inclusion of the vaccine under the Universal Immunization Program, the vaccination strategies adopted and prevention of mother to child transmission of hepatitis B have been largely resolved, data from recent research has underscored the need for regular monitoring of immunological and epidemiological outcomes of the vaccine. Controversies surrounding the safety and efficacy of the recently introduced combination pentavalent vaccine have highlighted that besides reinforcing surveillance of adverse events following immunization in the public sector, the private health sector in the country needs to be supported in this activity by increasing awareness and strengthening public-private collaboratio

Prevalence of Multi-Drug Resistant Tuberculosis among Patients with HIV and Tuberculosis: The Indian Scenario

Introduction: Globally, India has the highest burden of tuberculosis (TB). In 2014, 2.2% of notified new cases and 15% of notified previously treated cases of pulmonary TB had multidrug resistant TB (MDR-TB). In addition, India has the second highest burden of people living with HIV and TB. However, there is paucity of data regarding the prevalence of multidrug resistant TB (MDR-TB) among HIV-positive TB patients in India. This study was undertaken to review the existing literature and assess the prevalence of MDR-TB among HIV-positive TB patients in the country.Methodology: A thorough PubMed and Google Scholar subject search was undertaken for studies conducted after the year 2000 that described the burden of MDR-TB in people living with HIV in India. The search-strategy used keywords, and was comprehensive with cross-checking of reference lists from the articles retrieved.Results: A total of 11 studies were collated that showed that the prevalence of MDR-TB among patients with HIV and TB varied widely between individual studies and ranged from 4.4% to 50%. Five studies showed that prevalence of MDR-TB among HIV-positive patients with primary TB ranged between 4.2%-11.4%. Among HIV-positive patients with pulmonary TB only, the MDR-TB prevalence ranged between 5.9% and 27.3%. In addition, prevalence of extensively drug-resistant TB (XDR-TB), ranged from 0% to 16.7% among HIV-positive TB patients.Conclusion: While the review showed no clear association between MDR-TB and HIV infection in India, there is a need for further research in this area. Scaling up of TB drug resistance testing facilities in the country will improve surveillance among people living with HIV and potentially provide programmatic trends on the burden of MDR-TB in HIV positive individuals in the future

Prices of combination medicines and single‐molecule antihypertensive medicines in India's private health care sector

Abstract More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti‐hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti‐hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti‐hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti‐hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti‐hypertensive SPCs represent approximately 39.1% of India's private sector anti‐hypertensive drug market. Multiple manufacturers produce the same top‐selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual‐drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti‐hypertensive SPCs

Phone calls for improving blood pressure control among hypertensive patients attending private medical practitioners in India: Findings from Mumbai hypertension project

Abstract Despite the availability of effective medication, blood pressure control rates are low, particularly in low‐ and middle‐income countries. Adherence to medication and follow‐up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow‐up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives from January 2019 to February 2020. The study included hypertensive patients attending 164 private practices in Mumbai, India; practitioners screened all adults visiting their clinic during the project period. Among 13 184 hypertensive patients registered, the mean age was 53 years (SD = 12.38) and 52% were female. Among the 11 544 patients that provided phone numbers and gave consent for follow‐up calls, 9528 responded to phone calls at least once and 5250 patients followed up at least once. Of the 5250 patients, 82% visited the clinic for follow‐up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 23.6% to 48.8% (P <.001) and 21.0% to 44.3% (P <.001), respectively. The blood pressure control rate at follow‐up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 ‐ 1.71). The study demonstrates that telephone call intervention and follow‐up visits can improve patient retention in care and, subsequently, blood pressure control among hypertensive patients attending urban private sector clinics in India