Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India

We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count <200 and <350 cells/mm3 were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm3, the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries

The costs of HIV prevention for different target populations in Mumbai, Thane and Bangalore.

BACKGROUND: Avahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Although the broad costs of such HIV interventions are known, to-date there has been little data available on the comparative costs of reaching different target groups, including female sex workers (FSWs), replace with 'high risk men who have sex with men (HR-MSM) and trans-genders. METHODS: Costs are estimated for the first three years of Avahan scale up differentiated by typology of female sex workers (brothel, street, home, lodge based, bar based), HR-MSM and transgenders in urban districts in India: Mumbai and Thane in Maharashtra and Bangalore in Karnataka. Financial and economic costs were collected prospectively from a provider perspective. Outputs were measured using data collected by the Avahan programme. Costs are presented in US$2008. RESULTS: Costs were found to vary substantially by target group. Non-governmental organisations (NGOs) working with transgender populations had a higher mean cost (US$116) per person reached compared to those dealing primarily with FSWs (US $75-96) and MSWs (US$90) by the end of year three of the programme in Mumbai. The mean cost of delivering the intervention to HR-MSMs (US $42) was higher than delivering it to FSWs (US$37) in Bangalore. The package of services delivered to each target group was similar, and our results suggest that cost variation is related to the target population size, the intensity of the programme (in terms of number of contacts made per year) and a number of specific issues related to each target group. CONCLUSIONS: Based on our data policy makers and program managers need to consider the ease of accessing high risk population when planning and budgeting for HIV prevention services for these populations and avoid funding programmes on the basis of target population size alone

Cost-effectiveness of HIV prevention interventions in Andhra Pradesh state of India

<p>Abstract</p> <p>Background</p> <p>Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India.</p> <p>Methods</p> <p>Based on data from a representative sample of 128 public-funded HIV prevention programs of 14 types in Andhra Pradesh, we have recently reported the number of HIV infections averted by each type of HIV prevention intervention and their cost. Using estimates of the age of onset of HIV infection, we used standard methods to calculate the cost per Disability Adjusted Life Year (DALY) saved as a measure of cost-effectiveness of each type of HIV prevention intervention.</p> <p>Results</p> <p>The point estimates of the cost per DALY saved were less than US $50 for blood banks, men who have sex with men programmes, voluntary counselling and testing centres, prevention of parent to child transmission clinics, sexually transmitted infection clinics, and women sex worker programmes; between US$50 and 100 for truckers and migrant labourer programmes; more than US $100 and up to US$410 for composite, street children, condom promotion, prisoners and workplace programmes and mass media campaign for the general public. The uncertainty range around these estimates was very wide for several interventions, with the ratio of the high to the low estimates infinite for five interventions.</p> <p>Conclusions</p> <p>The point estimates for the cost per DALY saved from the averted HIV infections for all interventions was much lower than the per capita gross domestic product in this Indian state. While these indicative cost-effectiveness estimates can inform HIV control planning currently, the wide uncertainty range around estimates for several interventions suggest the need for more firm data for estimating cost-effectiveness of HIV prevention interventions in India.</p

HIV status among presumptive tuberculosis cases attending tertiary care centre in South India

Introduction: In India, to increase human immunodeficiency virus (HIV) case detection, the National Technical Working Group onTB /HIV had made it mandatory to screen for HIV infection among presumptive tuberculosis (TB) cases. Material and methods: Our study was a cross-sectional study, conducted between June 2015 and December 2016 in a tertiarycare institute (JIPMER), in South India, to estimate the prevalence of HIV among presumptive TB cases. Results: Among the 964 presumptive TB cases who attended pulmonary medicine OPD, 189 patients were sputum acid-fastbacilli (AFB) positive. Among the 189 sputum positive cases, 9 were HIV positive. Of the 964 presumptive TB cases, 879 gaveconsent for HIV testing and 33 (3.7%) turned out to be HIV positive. If only sputum positive cases had been screened for HIV,we would have missed 24 new HIV positive cases. The number needed to screen was 27 among presumptive TB cases and 18among TB patients. Conclusions: The uptake of HIV testing (91%) and the diagnostic yield of 3.7% of HIV positive cases among the presumptiveTB patients is quite high compared to that of the Revised National Tuberculosis Control Programme (RNTCP) mechanism of Puducherry.This reinforces the need to screen all the presumptive cases for HIV infection, to increase HIV case detection so thatanti-retroviral therapy (ART) can be initiated early

Management of Blood Transfusion Services in India: An Illustrative Study of Maharashtra and Gujarat States

Blood is a vital healthcare resource routinely used in a broad range of hospital procedures. It is also a potential vector for harmful, and sometimes fatal, infectious diseases such as HIV, HBV, and HCV. Morbidity and mortality resulting from the transfusion of infected blood have far-reaching consequences. The economic cost of a failure to control the transmission of infection is visible in countries with a high prevalence of HIV. Shortfalls in blood supply have a particular impact on women with pregnancy complications, trauma victims and children with severe life-threatening anaemia. Ensuring a safe, source and ethical supply of blood and blood products and rational clinical use of blood are important public health responsibilities of every national government. Blood transfusion services in India rely on very fragmented mix of competing independent and hospital based blood banks of different levels of sophistication, serving different types of hospitals and patients. Voluntary and non-remunerated blood is in short supply. The SACS ensure only the availability of safe blood in blood banks. Clinical use of blood is not monitored, and the use of blood components is very low. Managing blood transfusion services involves donor management, blood collection, testing, processing, storing, issue of safe blood and blood products when clinically needed, and staff training. Maharashtra Government, by setting up its State Blood Transfusion Council as an independent unit under the Department of Health, has set up an excellent example to address the above managerial issues in meeting the transfusion requirements than any fragmented system. We strongly recommend the Maharashtra model to all other states and union territories in India.

Socioepidemiologic Profile and Treatment-seeking Behaviour of HIV/AIDS Patients in a Tertiary-care Hospital in South India

India has the third largest number of people living with HIV/AIDS. Provision of free antiretroviral therapy (ART) for eligible persons living with HIV (PLHA) has been scaled up significantly both in terms of facilities for treatment and number of beneficiaries. This study aimed at describing the profile of HIV/AIDS patients on ART from a tertiary-care hospital and to explore the factors associated with treatment-seeking behaviour, family support, and perceptions regarding HIV and ART. This is a descriptive study conducted at the ART centre in a tertiary-care hospital in Puducherry. Study population consisted of 130 HIV-positive patients aged more than 18 years on free firstline ART for at least 6 months. Data on sociodemographic details, clinical details, treatment-seeking behaviour, family support, and perceptions regarding HIV and ART were collected using a pretested questionnaire. Data are presented as percentages. In total, 130 patients on ART for at least 6 months were included in the study\u201461% were males (n=79), 39% were females (n=51); half of them belonged to the age-group of 36-50 years. Half of the participants were diagnosed to have HIV/AIDS between 1 and 3 year(s); two-thirds had one or more co-infection(s). The majority were aware of the side-effects of ART. After advice to start ART, there was a delay in starting treatment in one-fifth of the subjects due to depression, fear of stigma, disclosure to family, and side-effects. More than two-thirds of the patients travelled more than 30 km distance. Families of HIV-positive subjects were supportive in accompanying to the ART centre, collecting drugs, reminders to take medication, and motivation to complete the treatment. Alcohol (50%) and tobacco consumption (39%) was common among the subjects. Half of the respondents stated stigma, death, and pain as the main fears, and all of them stated high levels of trust and rapport with their doctors. This study reveals several positive aspects among ART beneficiaries. However, issues, like tobacco and alcohol consumption, travelling long distance for drug collection, fear of stigma and death, and concerns regarding the future, need to be addressed

Clinical Study Factors Associated with Late Presentation of HIV and Estimation of Antiretroviral Treatment Need according to CD4 Lymphocyte Count in a Resource-Limited Setting: Data from an HIV Cohort Study in India

We describe the CD4 lymphocyte count at HIV presentation in an HIV cohort from a rural district of India. The majority of patients were diagnosed for their HIV-related symptoms, although a sizeable proportion of women were diagnosed because of antenatal screening or for having an HIV-positive partner. Patients diagnosed of HIV for antenatal screening or having an HIV-positive sexual partner had higher CD4 lymphocyte count than patients having tuberculosis or HIV-related symptoms. The proportion of patients diagnosed with CD4 count &lt;200 and &lt;350 cells/mm 3 were 46% and 68.7%, respectively, and these figures did not change during the five years of the study. Factors associated with late presentations were male sex, older age, not having a permanent house, and, in women, lower education and being a widow or separated. With the implementation of 2010 WHO guidelines, the number of newly diagnosed patients who will require HIV treatment will increase 13.8%. If the CD4 count threshold for initiating HIV treatment is increased from 350 to 500 cells/mm 3 , the number of patients in need of treatment would increase 15.7%. Therefore, new strategies for avoiding HIV late presentation are urgently needed in developing countries

Etiology of opportunistic respiratory tract infections in patients suffering with HIV/AIDS from a tertiary care hospital, Chinakakani, Andhra Pradesh

Background: HIV infection / AIDS is a global pandemic with cases reported from every part of the globe. India currently harbours 20.89 Lakh of HIV infected patients. Opportunistic infections (OI’s) and cancers have been recognized as common complications of HIV infection. The present study has been taken up with an aim to know the incidence of various opportunistic infections in HIV positive patients attending our hospital for either medical / surgical treatment.Methods: One hundred patients who were known to be infected with HIV having pulmonary symptoms, who were clinically diagnosed to have lower respiratory tract infections are included in the study. Early morning sputum samples were obtained from the patients and are sent to the Department of Microbiology for isolation and identification of infectious agents. All the samples were processed as per standard guidelines for Bacterial, Mycobacterial and Fungal cultures.Results: All the sputum samples were subjected to bacteriological, Mycobacterial and fungal cultures. Most of the samples grew either monomicorbial or polymicrobial bacterial cultures associated with either Mycobacterial or fungal pathogens. Out of 100 samples, 32 were positive for single pathogenic organisms and 68 were positive for polymicrobial organisms. The bacterial flora isolated in the present study includes Staphylococcus aureus (32.38%) followed by Streptococcus pneumoniae (17.14%), Coagulase Negative Staphylococci (CONS) (15.23%), Streptococcus spp (12.38%), Klebsiella pneumoniae (8.57%), Pseudomonas aeruginosa (5.7%), Acinetobater spp (3.8%) and Escherichia coli (3.8%). Antibiotic sensitivity for all the bacterial isolates were performed where Linezolid was the most sensitive drug in case of Gram Positive Organisms and Imipenem in case of Gram Negative Organisms. Conclusion: Education, counseling and behavior modification are important issues which are the need of the hour and concerted effort from every organization and individual is requested to save us from the brink of this inevitable disastrous pandemic called AIDS, which will be undoubtedly the scourge of this century.