Missed opportunities for brief intervention in tobacco control in primary care: patients’ perspectives from primary health care settings in India

Photograph showing General view of centre front of building from SE above

HIV Surveillance in India: An Overview & Implications for Future

OBJECTIVE: To study and analyze the surveillance activities in HIV prevention and control in India. INTRODUCTION: Surveillance of risky behaviors of HIV infection and its manifest diseases has provided a better understanding of the complex nature of the HIV epidemic in India. However, little attempt is made to analyze progress of these surveillance activities. METHODS: A review & analysis of surveillance activities undertaken in India were done. Pub-med, cohrane library and peer-reviewed journals were referred for relevant literature. RESULTS: Initially, medical officers from multiple types of government hospitals in India were expected to report AIDS cases, including deaths. However, this reporting mechanism was inadequate, complicated by many disparate types of reporting units with incomplete and delayed reports. Therefore AIDS case reporting has been replaced by HIV case reporting from the 4532 Integrated Counseling and Testing Centers. Newer surveillance strategies like Behavior sentinel surveillance measure behaviors that affect risk for acquiring HIV. However, behavioral and biological data are resource-intensive and time-consuming. Facility-based sero-surveillance (also called HIV Sentinel Surveillance or HSS) has emerged as the key surveillance strategy for HIV/AIDS in India. Starting with 55 urban sentinel sites HIV Sentinel Surveillance expanded to 1215 in 1994. Most of these pre-selected sites were antenatal clinics but also included sexually transmitted infection clinics and special facilities. Subsequent expansion of high-risk group sites has improved the representation of all sub-populations in HSS. While stigma against most high-risk populations and HIV-positive people continues, it has lessened as shown by the behavioral surveys. Also, accessibility to testing sites has increased with increased availability of care and treatment options for infected individuals. CONCLUSIONS: While acknowledging the vastness and diversity of India, the key limitations remain suboptimal coverage and lack of representativeness surveillance data. Moreover, due to selection bias, the populations selected for HSS at targeted intervention sites may not represent everyone in that community. There is lack of national information system to collect HIV testing information from the private sector. Further efforts are needed to improve HIV surveillance data and usage of this data to predict the epidemic

Burden of Infectious Disease in a State of India: A Comparative Analysis

The presentation will throw light on the status of disease survelliance in infectious disease in a state of India in comparision to the entire country. This study is first to document case rates at a state-level in India and recognise the contribution of the IDSP system for epidemiological considerations

Burden of Infectious Disease in a State of India: A Comparative Analysis

The present study aims to analyze data from the Integrated Disease Surveillance Project (ISDP) to estimate the rates of selected infectious diseases in the state of Maharashtra in comparison to the rest of India

HIV Surveillance in India: An Overview & Implications for Future

HIV infection is one of the leading cause of death in India. Surveillance of risky behaviors as well as of HIV infection and its manifest diseases has provided a better understanding of the complex nature of the HIV epidemic in India, identifying multiple sub-epidemics unfolding at different rates in different populations. However, there is a scarcity of studies in Indian context which evaluates various surveillance activities in context of India. Present study aimed to analyze the HIV surveillance activities carried out in India till today

Cessation attempts in dual users (smoking plus smokeless): findings from two states in India

Background Concurrent use of smoking and smokeless tobacco products is common, but little is known regarding the association of smokeless tobacco use with smoking cessation. The present study aims to compare intention to quit and quit attempts among current smokers who also use smokeless tobacco (dual users) and exclusive smokers Methods A cross-sectional study was conducted among 1360 respondents (542 smokers and dual users; 818 smokeless tobacco users) visiting 22 primary care facilities in two high tobacco burden states of India in 2016. The health facilities and patients were chosen using systematic random sampling. We compared intention to quit between dual users and exclusive smokers, using multivariate regression model Results Out of 542 tobacco users, about 70% (378) were smokers and 30% (164) were dual tobacco users. Exclusive Smokers (62%) were more likely than dual users (38%) to have an intention to quit tobacco even after adjusting for demographic differences and tobacco dependence levels (OR:1.75; 95% CI 1.19-2.57). About 27% of smokers made an attempt to quit as compared to 23% of dual users. The quitting attempt last for less than 6 months for about 20% of smokers (19%) and smokeless tobacco users (17%). Less than 10% of smokers and smokeless tobacco users used counseling technique for tobacco cessation. Conclusions Smokers are more likely to intend to quit smoking and have recently made quit attempts as compared to dual users. Findings document a high level of interest in quitting among smokers than dual users suggesting the need to develop targeted interventions for dual users and smokeless tobacco users to enhance cessation attempts. Further population prospective studies are needed to understand the issues faced by dual users as they make an attempt in quitting tobacco

A factor analysis of the Fagerstrom Test for Nicotine Dependence for bidi smokers and smokeless tobacco users (FTND): findings from India

Background Fagerstrom Test for Nicotine Dependence (FTND) is widely used screening instrument for physical nicotine dependence. Psychometric properties of FTND have been validated among cigarette smokers, but the reliability and validity of its variant for smokeless tobacco users and bidi smokers is not well documented. The present study aims to evaluate reliability, construct validity, and structure model of FTND among bidi smokers and smokeless tobacco users. Methods A cross sectional survey was conducted among 1350 patients visiting primary care facilities in two states of India in 2016. FTND contains six items that evaluate the quantity of tobacco consumption and dependence. Cronbach´s coefficient alpha was estimated to evaluate reliability of the FTND scale. We applied exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser Normalization rotation to ascertain the factor structure of the FTND scale. Eigen values greater than 1 were used as a criterion for factor extraction. Results Out of 1350 tobacco users 406 (30%) were smokers, 818(60%) were smokeless tobacco users with mean FTND scores of 4.29 ± 1.67 and 4.42 ± 1. 72 respectively. Cronbach´s alpha coefficients were low for FTND among bidi smokers (FTND-0.47) and smokeless tobacco users (FTND-0.32). FTND score did not predict the intention to quit tobacco use. The results of exploratory factor analysis suggest eigenvalues greater than1 for item 1(How soon after you wake up do you smoke your first cigarette) and Item 4 (How many cigarettes per day do you smoke?). The other items in the scale add no relevant information. Conclusions Items of the FTND are best modeled as two correlated factors on tobacco use. A short version of FTND i.e. Heaviness of smoking index may represent an alternative to FTND. Future research should focus on refining questionnaires that more precisely measure nicotine dependence in bidi and smokeless tobacco users in primary care