The aim of this review was to conduct a meta-analysis to assess the effectiveness of behavioural interventions to reduce HIV-related risk behaviours among key populations: people who inject drugs, female sex workers, men who have sex with men and transgender in Nepal over the last two decades. Using four electronic databases, we performed a systematic search of the literature on HIV interventions implemented in Nepal and published from January 2001 to December 2016. In addition, grey literature was also scrutinised for potential articles. The search focussed specifically on behavioural interventions (peer education and HIV testing services) targeted for key populations. Random-effects models were used to calculate the pooled odds ratio for dichotomous outcomes (condom use in last sex or unsafe injection practices), pooled HIV prevalence and subgroup analyses by age groups and epidemic zones in Nepal. Forty-three studies with 15,642 participants were included (people who inject drugs: 7105; men who have sex with men and transgender: 2637; female sex workers: 5900). Pooled prevalence showed a higher occurrence of HIV among people who inject drugs (12%) followed by men who have sex with men/transgender (5%) and female sex workers (2%) respectively. There was a significant increase in the odds of condom use among female sex workers, men who have sex with men and transgender who received peer education interventions in both informal and formal setting compared to those who did not. Similarly, the odds of condom use among female sex workers, men who have sex with men and transgender improved significantly among those who received HIV counselling and testing services as compared to those who did not use such services. Subgroup analyses also verified the effectiveness of these interventions for both young and adult key populations and across all three epidemic zones. However, none of the included interventions were found to be effective for reducing unsafe injection practices among people who inject drugs. HIV prevention interventions in Nepal have effectively reduced risky behaviours among female sex workers, men who have sex with men and transgender over the last two decades but not among people who inject drugs. This calls for continued implementation of existing efforts as well as for new interventions adapted to the needs of people who inject drugs.The world has committed to ending the HIV epidemic by 2030. Accomplishments such as a decrease in AIDS-related mortality by 45% since its peak in 2005 and increase in people receiving antiretroviral therapy (ART) by one-third in just two years have inspired global confidence that this target is achievable 1 . Several (the capital city of Nepal), 11 were conducted in the Pokhara Valley (one of the major tourist destinations of Nepal), 11 were conducted in Terai highway districts and 5 were conducted in west to far west Terai highway districts. Amongst the included studies, 42 were nationally representative surveys using a cross-sectional design, and one was a cross-section...
IntroductionHepatitis B and C represent an important co-infection for people living with HIV worldwide. Nepal wants to be part of the international mobilization for viral hepatitis elimination, and has pursued better understanding of the epidemic in its territory through scientific research.MethodsWe performed a systematic review of seroprevalence studies hepatitis B and C in Nepal following the PRISMA 2009 Flow Diagram.ResultsFifty-four scientific publications and reports were selected for this review. Nearly a quarter of these documents have been issued in recent years and many are authored by non-governmental organizations in Nepal. The collective of information displays a wide range of alarming prevalence rates, particularly for girls and women survivors of human trafficking and a progressive participation of civil society in viral hepatitis epidemiology research in the country.ConclusionThis paper presents a most complete review of hepatitis B and C and HIV co-infection prevalence studies in different population groups from 1973 to 2016. A comprehensive analysis of the epidemiology and apparent trends in public health research and policy making in Nepal are also addressed in this document. We expect this to be a most important tool for improvements in future interventions for both epidemics in the country.
BACKGROUND Most low-income settings experiencing concentrated HIV epidemic lack information about key populations (KPs), including people who inject drugs (PWID), men who have sex with men (MSM), male sex workers (MSW), transgender (TG) and female sex workers (FSW) because they are hidden and marginalised in society and frequently undocumented. Out of several approaches to size estimation, mapping and size estimation is particularly useful when local estimates are needed for planning and monitoring of prevention programmes. OBJECTIVE To locate hot spots related to sex work, cruising spots, and injecting drug use, and to estimate the number of sex workers, PWID, MSM, MSW and TG at the district level (adjusting for double-counting, frequency of visiting spots, and low visibility), and at the national level using extrapolation algorithms . METHODS The mapping exercise among MSM, MSW, TG, PWID and FSW was carried out in 44 districts of Nepal between July and November 2016 by collecting relevant information directly from hotspots where KPs members congregate. Districts to be mapped were selected purposively, to both provide data to local programmes in areas with high concentrations of KPs, and inform extrapolation to unmapped districts as part of national estimation procedures. RESULTS Altogether 11056 KPs and 10977 non- KPs informants were interviewed from across the 44 mapped districts to identify the hotspots. District level adjustment factors (mobility adjustment, frequency adjustment and invisibility adjustment) were sequentially applied. The final estimates used all three adjustment factors. We found that the national estimate of FSW in Nepal ranges between 43,829 to 54,207. The national estimate of MSM/TG lies between 88,009 and 112,150, of which a minimum of 18,704 and maximum 24,216 are TG, and a minimum 53,373 and maximum 67,292 are MSM. And finally the national estimate of PWID ranges between 27,248 to 34,487. Among them, a minimum 24,572 and a maximum 30,561 are men, and minimum 2,676 and maximum 3,926 are women. CONCLUSIONS The size of KPs provided through mapping exercise can be utilised for setting benchmarks and measuring program coverage. The major limitation is that mapping may count the majority of KPs who visit hotspots on a very regular basis, while missing the subset who are not “hotspot based” or who visit hotspots less frequently. However, the strength of mapping is that it reflects hands-on knowledge and experience of people who have access to communities that outside researchers may not have, thereby accounting for people who might otherwise be invisible.
Precision medicine promises to transform medicine by utilizing genetic and genomic information to offer personalized care to each patient based on the individual nature of their disease. This relatively new approach in medicine has the potential to greatly improve patient care, however advancing a precision medicine agenda raises significant ethical concerns, particularly in smaller, resource-strapped developing nations like those in the Caribbean basin. Drawing on examples from Trinidad and Tobago, this viewpoint highlights some of these concerns specifically resource allocation, privacy and confidentiality, scientific merit and sociopolitical influence as well as health equity within and between countries. We contend that while precision medicine has extrinsic value, unless a precision medicine agenda complements efforts to address existing systemic pitfalls in the public health system, it will substantially widen the health disparities gap.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.