Cost-Effectiveness of HIV Testing Referral Strategies among Tuberculosis Patients in India

Background: Indian guidelines recommend routine referral for HIV testing of all tuberculosis (TB) patients in the nine states with the highest HIV prevalence, and selective referral for testing elsewhere. We assessed the clinical impact and cost-effectiveness of alternative HIV testing referral strategies among TB patients in India. Methods and Findings: We utilized a computer model of HIV and TB disease to project outcomes for patients with active TB in India. We compared life expectancy, cost, and cost-effectiveness for three HIV testing referral strategies: 1) selective referral for HIV testing of those with increased HIV risk, 2) routine referral of patients in the nine highest HIV prevalence states with selective referral elsewhere (current standard), and 3) routine referral of all patients for HIV testing. TB-related data were from the World Health Organization. HIV prevalence among TB patients was 9.0% in the highest prevalence states, 2.9% in the other states, and 4.9% overall. The selective referral strategy, beginning from age 33.50 years, had a projected discounted life expectancy of 16.88 years and a mean lifetime HIV/TB treatment cost of US$100. The current standard increased mean life expectancy to 16.90 years with additional per-person cost of US$10; the incremental cost-effectiveness ratio was US$650/year of life saved (YLS) compared to selective referral. Routine referral of all patients for HIV testing increased life expectancy to 16.91 years, with an incremental cost-effectiveness ratio of US$730/YLS compared to the current standard. For HIV-infected patients cured of TB, receiving antiretroviral therapy increased survival from 4.71 to 13.87 years. Results were most sensitive to the HIV prevalence and the cost of second-line antiretroviral therapy. Conclusions: Referral of all patients with active TB in India for HIV testing will be both effective and cost-effective. While effective implementation of this strategy would require investment, routine, voluntary HIV testing of TB patients in India should be recommended

Impact of targeted interventions on heterosexual transmission of HIV in India

<p>Abstract</p> <p>Background</p> <p>Targeted interventions (TIs) have been a major strategy for HIV prevention in India. We evaluated the impact of TIs on HIV prevalence in high HIV prevalence southern states (Tamil Nadu, Karnataka, Andhra Pradesh and Maharashtra).</p> <p>Methods</p> <p>A quasi-experimental approach was used to retrospectively compare changes in HIV prevalence according to the intensity of targeted intervention implementation. Condom gap (number of condoms required minus condoms supplied by TIs) was used as an indicator of TI intensity. Annual average number of commercial sex acts per female sex worker (FSW) reported in Behavioral Surveillance Survey was multiplied by the estimated number of FSWs in each district to calculate annual requirement of condoms in the district. Data of condoms supplied by TIs from 1995 to 2008 was obtained from program records. Districts in each state were ranked into quartiles based on the TI intensity. Primary data of HIV Sentinel Surveillance was analyzed to calculate HIV prevalence reductions in each successive year taking 2001 as reference year according to the quartiles of TI intensity districts using generalized linear model with logit link and binomial distribution after adjusting for age, education, and place of residence (urban or rural).</p> <p>Results</p> <p>In the high HIV prevalence southern states, the number of TI projects for FSWs increased from 5 to 310 between 1995 and 2008. In high TI intensity quartile districts (n = 30), 186 condoms per FSW/year were distributed through TIs as compared to 45 condoms/FSW/year in the low TI intensity districts (n = 29). Behavioral surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7% (p < 0.001), and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6% (p < 0.001). A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. Among young (15-24 years) antenatal clinic attendees significant decline was observed in HIV prevalence from 2001 to 2008 (OR = 0.42, 95% CI 0.28-0.62) in high TI intensity districts whereas in low TI intensity districts the change was not significant (OR = 1.01, 95% CI 0.67-1.5).</p> <p>Conclusion</p> <p>Targeted interventions are associated with HIV prevalence decline.</p

Director General National AIDS Control Organization, Ministry of Health and Family Welfare

The primary aim of the present study was to determine the prevalence of HIV infection in Nagaland and to study knowledge and attitude of study participants towards HIV/AIDS and related Government programs. A population based survey was carried out during April-October, 2007. Stratifi ed sampling technique was adopted with an anonymous, linked design for HIV testing using Dried Blood Spot Testing Method (Tri-Dot). A total of 1965 households were interviewed in which 5661 eligible respondents (male:15-54 years and female:15-49 years) completed the interview. The total individual response rate was 95.2%. Blood samples were collected from 5637 respondents. Results revealed that the prevalence of HIV was estimated to be 0.74 % in Nagaland. Dimapur was identifi ed as the only district where HIV prevalence was higher than 1%. Wokha (0.98%) and Tuensang (0.92%) also had higher prevalence compared to other districts. Knowledge of HIV/AIDS prevention methods and the services available under National HIV/AIDS program was low. Further steps therefore need to be taken to ensure higher utilization of services

DIETARY PRACTICES AND PHYSICAL ACTIVITY PERFORMED BY ADOLESCENT IN SELECTED DISTRICTS OF INDIA

Objectives: The present study assesses the dietary practices and physical activity performed by adolescent in selected districts of India. Also, an attempt was made to correlate key indicators of dietary practices and physical activity with Body Mass Index (BMI). Methodology: The study was carried out between July and December 2011 covering adolescent studying in 8 to 10 standard using WHO recommended STEPS method in 5 districts of Uttrakhand, Maharashtra, Kerala, Madhya Pradesh and Andhra Pradesh of India. In each district, 6 schools (4 rural, 2 urban; 5 Government, 1 Private) were selected through stratified random sampling method. Results: Study revealed that only 8.8% boys and 9.2% girls had good scores both for healthy diet and physical activity. On the other hand 25.2% boys and 24.7% girls had poor scores in both the parameters. Overall nearly 84% adolescents were within normal range of BMI. It was observed that 8.8% boys and 9.2% girls had good index for diet and physical activity. On the other hand 25.2% boys and 24.7% girls had poor index for diet as well as physical activity. Conclusions: Unhealthy diet are consumed quite often, hence steps need to be taken to modify lifestyle that include educating children by teachers, making available healthy and traditional food and high taxation on unhealthy foods, subsidy on fruits and vegetables. Physical activity periods should be re-emphasized and taken seriously by students and teachers

Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities

Abstract Background Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian districts, Shimla and Udaipur. Methods We conducted household and health facility surveys, as well as qualitative focus group discussions and interviews. The household survey randomly sampled individuals aged 15 and above in rural and urban areas in both districts. The survey included questions on NCD knowledge, history, and risk factors. Blood pressure, weight, height, and blood glucose measurements were obtained. The health facility survey was administered in 48 health care facilities, focusing on NCD diagnosis and treatment capacity, including staffing, equipment, and pharmaceuticals. Qualitative data was collected through semi-structured key informant interviews with health professionals and public health officials, as well as focus groups with patients and community members. Results Among 7181 individuals, 32% either reported a history of hypertension or were found to have a systolic blood pressure ≥ 140 mmHg and/or diastolic ≥90 mmHg. Only 26% of those found to have elevated blood pressure reported a prior diagnosis, and just 42% of individuals with a prior diagnosis of hypertension were found to be normotensive. A history of diabetes or an elevated blood sugar (Random blood glucose (RBG) ≥200 mg/dl or fasting blood glucose (FBG) ≥126 mg/dl) was noted in 7% of the population. Among those with an elevated RBG/FBG, 59% had previously received a diagnosis of diabetes. Only 60% of diabetics on treatment were measured with a RBG <200 mg/dl. Lower-level health facilities were noted to have limited capacity to measure blood glucose as well as significant gaps in the availability of first-line pharmaceuticals for both hypertension and diabetes. Conclusions We found high rates of uncontrolled diabetes and undiagnosed and uncontrolled hypertension. Lower level health facilities were constrained by capacity to test, monitor and treat diabetes and hypertension. Interventions aimed at improving patient outcomes will need to focus on the expanding access to quality care in order to accommodate the growing demand for NCD services

Additional file 2: of Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities

Health facility survey. (PDF 2323 kb