Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of...Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of death among HIV-infected individuals registered at selected Anti-Retroviral Therapy (ART) centers in the era of treatment in north-eastern India. Data and Methods: A retrospective chart review of causes of death was undertaken among HIV-infected patients who were treated between January 2006 and November 2012 at three selected ART centers in Assam, a north-eastern state of India. Reported causes of death were coded as per the guidelines of the International Classification of Diseases (ICD-10) to determine the deaths to standard definitions. Results: Among 5612 HIV-infected patients registered over a period of 71 months, 370 deaths have occurred. Tuberculosis (28%) was the leading cause of death followed by death due to AIDS related complex (11%), wasting syndrome and multiple infections (9% each). Deaths due to selected causes were significantly associated with patient’s use of alcohol, WHO clinical stage, CD4 count at the time of diagnosis, presence of opportunistic infections during treatment and ART adherence. Median survival duration was shortest among patients who had CD4 count <50 at the start of ART (2.9 months) and patients who had multiple opportunistic infections during treatment (2.5 months). Discussion: Majority (67%) of deaths in our study were due to AIDS-related causes. Tuberculosis has remained the leading cause of death among the HIV patients on ART. Strengthening the linkages and referral between the HIV and TB program will be crucial to reduce the AIDS-related deaths attributed to tuberculosis.展开更多
Background: Although there has been significant reduction in HIV prevalence and new HIV infections in India, some of the low/moderate prevalence states have been showing long term increase in HIV prevalence and new HI...Background: Although there has been significant reduction in HIV prevalence and new HIV infections in India, some of the low/moderate prevalence states have been showing long term increase in HIV prevalence and new HIV infections. Assam, a state in northeast India is one such low HIV prevalence state where HIV prevalence and new HIV infections have almost doubled in the last few years. This study examined the trend of HIV prevalence across districts/regions of Assam and its association with developmental and program indicators. Materials and Methods: A retrospective descriptive analysis of secondary data from the National AIDS Control Program, Census of India-2011, and District Level Household and Facility Survey-3 was conducted. The time period covered under the secondary data analysis was 2007 to 2012. Correlation and Chi-square for trend tests were also used in this paper. Results: During 2007 and 2012, HIV positivity (%) increased relatively in North Assam (46.9%) followed by South Assam (11.5%) while there has been a relative decline in West Assam (﹣51.5%). Correlation analysis showed statistically significant association between HIV prevalence and female literacy, population using mobile phone, population using internet, women (15 - 49 years) seeking treatment for any STI/RTI, proportion of brothel based FSWs, FSWs having <5 clients per week and proportion of condom utilized annually. Conclusion: Program efforts in the state should be focus on the districts with increasing HIV prevalence. Emphasis should be given in planning strategies to address the program gaps among the high risk and vulnerable populations in the state.展开更多
Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities in...Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years;2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately;and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.展开更多
文摘Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of death among HIV-infected individuals registered at selected Anti-Retroviral Therapy (ART) centers in the era of treatment in north-eastern India. Data and Methods: A retrospective chart review of causes of death was undertaken among HIV-infected patients who were treated between January 2006 and November 2012 at three selected ART centers in Assam, a north-eastern state of India. Reported causes of death were coded as per the guidelines of the International Classification of Diseases (ICD-10) to determine the deaths to standard definitions. Results: Among 5612 HIV-infected patients registered over a period of 71 months, 370 deaths have occurred. Tuberculosis (28%) was the leading cause of death followed by death due to AIDS related complex (11%), wasting syndrome and multiple infections (9% each). Deaths due to selected causes were significantly associated with patient’s use of alcohol, WHO clinical stage, CD4 count at the time of diagnosis, presence of opportunistic infections during treatment and ART adherence. Median survival duration was shortest among patients who had CD4 count <50 at the start of ART (2.9 months) and patients who had multiple opportunistic infections during treatment (2.5 months). Discussion: Majority (67%) of deaths in our study were due to AIDS-related causes. Tuberculosis has remained the leading cause of death among the HIV patients on ART. Strengthening the linkages and referral between the HIV and TB program will be crucial to reduce the AIDS-related deaths attributed to tuberculosis.
文摘Background: Although there has been significant reduction in HIV prevalence and new HIV infections in India, some of the low/moderate prevalence states have been showing long term increase in HIV prevalence and new HIV infections. Assam, a state in northeast India is one such low HIV prevalence state where HIV prevalence and new HIV infections have almost doubled in the last few years. This study examined the trend of HIV prevalence across districts/regions of Assam and its association with developmental and program indicators. Materials and Methods: A retrospective descriptive analysis of secondary data from the National AIDS Control Program, Census of India-2011, and District Level Household and Facility Survey-3 was conducted. The time period covered under the secondary data analysis was 2007 to 2012. Correlation and Chi-square for trend tests were also used in this paper. Results: During 2007 and 2012, HIV positivity (%) increased relatively in North Assam (46.9%) followed by South Assam (11.5%) while there has been a relative decline in West Assam (﹣51.5%). Correlation analysis showed statistically significant association between HIV prevalence and female literacy, population using mobile phone, population using internet, women (15 - 49 years) seeking treatment for any STI/RTI, proportion of brothel based FSWs, FSWs having <5 clients per week and proportion of condom utilized annually. Conclusion: Program efforts in the state should be focus on the districts with increasing HIV prevalence. Emphasis should be given in planning strategies to address the program gaps among the high risk and vulnerable populations in the state.
文摘Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years;2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately;and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.
