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BackgroundAvahan, the India AIDS Initiative, a large-scale HIV prevention program, using peer-mediated approaches and STI services, was implemented for high-risk groups for HIV in six states in India. This paper describes the assessment of the program among female sex workers (FSWs) in the southern state of Tamil Nadu.MethodsAn analytical framework based on the Avahan impact evaluation design was used. Routine program monitoring data, two rounds of cross-sectional biological and behavioural surveys among FSWs in 2006 (Round 1) and 2009 (Round 2) and quality assessments of clinical services for sexually transmitted infections (STIs) were used to assess trends in coverage, condom use and prevalence of STIs, HIV and their association with program exposure. Logistic regression analysis was used to examine trends in intermediate outcomes and their associations with intervention exposure.ResultsThe Avahan program in Tamil Nadu was scaled up and achieved monthly reported coverage of 79% within four years of implementation. The cross-sectional survey data showed an increasing proportion of FSWs being reached by Avahan, 54% in Round 1 and 86% in Round 2 [AOR=4.7;p=0.001]. Quality assessments of STI clinical services showed consistent improvement in quality scores (3.0 in 2005 to 4.5 in 2008). Condom distribution by the program rose to cover all estimated commercial sex acts. Reported consistent condom use increased between Round 1 and Round 2 with occasional (72% to 93%; AOR=5.5; p=0.001) and regular clients (68% to 89%; AOR=4.3; p=0.001) while reactive syphilis serology declined significantly (9.7% to 2.2% AOR=0.2; p=0.001). HIV prevalence remained stable at 6.1% between rounds. There was a strong association between Avahan exposure and consistent condom use with commercial clients; however no association was seen with declines in STIs.ConclusionsThe Avahan program in Tamil Nadu achieved high coverage of FSWs, resulting in outcomes of improved condom use, declining syphilis and stabilizing HIV prevalence. These expected outcomes following the program logic model and declining HIV prevalence among general population groups suggest potential impact of high risk group interventions on HIV epidemic in Tamil Nadu.
PurposeWe describe here a multicentric community-dwelling cohort of older adults (>60 years of age) established to estimate incidence, study risk factors, healthcare utilisation and economic burden associated with influenza and respiratory syncytial virus (RSV) in India.ParticipantsThe four sites of this cohort are in northern (Ballabgarh), southern (Chennai), eastern (Kolkata) and western (Pune) parts of India. We enrolled 5336 participants across 4220 households and began surveillance in July 2018 for viral respiratory infections with additional participants enrolled annually. Trained field workers collected data about individual-level and household-level risk factors at enrolment and quarterly assessed frailty and grip strength. Trained nurses surveilled weekly to identify acute respiratory infections (ARI) and clinically assessed individuals to diagnose acute lower respiratory infection (ALRI) as per protocol. Nasal and oropharyngeal swabs are collected from all ALRI cases and one-fifth of the other ARI cases for laboratory testing. Cost data of the episode are collected using the WHO approach for estimating the economic burden of seasonal influenza. Handheld tablets with Open Data Kit platform were used for data collection.Findings to dateThe attrition of 352 participants due to migration and deaths was offset by enrolling 680 new entrants in the second year. All four sites reported negligible influenza vaccination uptake (0.1%–0.4%), low health insurance coverage (0.4%–22%) and high tobacco use (19%–52%). Ballabgarh had the highest proportion (54.4%) of households in the richest wealth quintile, but reported high solid fuel use (92%). Frailty levels were highest in Kolkata (11.3%) and lowest in Pune (6.8%). The Chennai cohort had highest self-reported morbidity (90.1%).Future plansThe findings of this cohort will be used to inform prioritisation of strategies for influenza and RSV control for older adults in India. We also plan to conduct epidemiological studies of SARS-CoV-2 using this platform.
A stark difference in the profiles of defective viral transcripts between SARS-CoV-2 and SARS-CoV Dear Editor, Recently, Fantini et al. reported that mutations in the Nterminal (NTD) and receptor binding (RBD) domains of the SARS-CoV-2 spike protein act synergistically to optimize virus infection 1 . However, genomic variants beyond the coding region of spike protein is poorly understood, especially the large structural variants within a single or between closely related coronaviruses. References 1. Jacques Fantini, Nouara Yahi, Fodil Azzaz, Henri Chahinian. Structural dynamics of SARS-CoV-2 variants: a health monitoring strategy for anticipating Covid-19 outbreaks.
Background: India is endemic for viral hepatitis A (HAV) infection with 66% of states reporting at least one outbreak from 2011 to 2013. Following media reports in January 2015, we investigated a jaundice outbreak in Kangra town of Himachal Pradesh Valley with the following objectives: (1) assess the magnitude, (2) identify the source, and (3) initiate preventive measures.Methods & Materials: An active case search was done in Kangra to identify case-patients who had acute onset of jaundice during 1 st November 2014 to 23 rd January 2015. We conducted a 1:1 case-control study; data on exposures were collected using a structured questionnaire. Serum specimens from five cases were tested for IgM anti-HAV and IgM anti-hepatitis E virus. End-point water specimens from households of case-patients were tested for faecal coliforms using most probable number method.Results: The overall attack rate was 1.6 (149/ 9528). There were no deaths. Illness began on November 3 rd , 2014 and persisted through January 21 st , 2015. Among 149 patients, 62% were in 5-14 age-group with no gender differences. All five serum samples tested positive only for IgM anti-HAV; no contamination was detected in water samples. Contact with jaundice patients in previous two weeks (OR 1.6; 95% CI 1.03-2.6; p<0.01), drawing water by dipping ladle in storage containers (3.2; 95% CI 2-5.2; p<0.001), storing drinking water in narrow necked containers (16.9; 95% CI 7.7-36.9; p<0.001), past history of jaundice (OR 15.3; 95% CI 1.9-118; p<0.001) and not washing hands with soap before meals (OR 3.8; 95% CI 2.0-7.1; p<0.001) were associated with illness. Conclusion:The findings suggested that this was an outbreak of hepatitis A. Promotion of personal hygiene and sanitation among residents of Kangra was recommended.
Background & objectives: Vaccination against SARS-CoV-2 is a recommendation from the World Health Organization as the foremost preference in the current situation to control the COVID-19 pandemic. BBV152 is one of the approved vaccines against SARS-CoV-2 in India. In this study, we determined SARS-CoV-2-specific antibody levels at day 0 (baseline, before vaccination), day 28 ± 2 post-first dose (month 1) and day 56 ± 2 post-first dose (month 2) of BBV152 whole-virion-inactivated SARS-CoV-2 recipients, and compared the antibody responses of individuals with confirmed pre-vaccination SARS-CoV-2 infection to those individuals without prior evidence of infection. Methods: Blood samples were collected from 114 healthcare professionals and frontline workers who received BBV152 vaccine from February to May & June 2021. Prior infection with SARS-CoV-2 was determined at baseline. Serum samples were used to estimate SARS-CoV-2 nucleoprotein-specific IgG [IgG (N)], spike protein-specific IgG [IgG (S)] and neutralizing antibodies (NAb). Results: Participants with previous SARS-CoV-2 infection after a single vaccine dose elicited IgG (N) and IgG (S) antibody levels along with NAb binding inhibition responses levels were similar to infectionnaïve vaccinated participants who had taken two doses of vaccine.Interpretation & conclusions: Our preliminary data suggested that a single dose of BBV152-induced humoral immunity in previously infected individuals was equivalent to two doses of the vaccine in infection-naïve individuals. However, these findings need to be confirmed with large sized cohort studies.
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