Background:The nutritional status of under fi ve children in urban slums is an important health indicator for assessing the health status of entire population and one of the major predictors of child survival. Objective: A nutritional survey was carried out in September-October 2012 in the fi eld practice area of a medical college in Pimpri, Pune area with an objective to assess the nutritional status of under-fi ve children. Materials and Methods: All the under fi ve students in the fi eld practice area of the medical college were examined. A total of 658 children were examined. Results and Conclusion: It was observed that the prevalence of under weight 34.3% (226/654) (30.7 to 38.0 C.I.), stunting 58.7% (386/654) (54.9 to 62.4 C.I.) and wasting was 16.9%(109/654) (14.0 to 19.7 95% C.I.). The prevalence of under weight 37.6% (114/303) and stunting 61.4% (186/303) was more in girls whereas wasting was more in boys 18%. (64/355)

IntroductionThe HIV sentinel surveillance [HSS] conducted in 2010–11 among female sex workers [FSW] in the state of Maharashtra, India provided an opportunity to assess characteristics of different types of FSWs and their HIV risk. It is important for India’s National AIDS Control Program, to understand the differences in vulnerability among these FSW, in order to define more specific and effective risk reduction intervention strategies. Therefore, we analyzed data from HSS with the objective of understanding the HIV vulnerability among different types of FSW in Maharashtra.Material and methodsCross sectional data collected as a part of HSS among FSWs in year 2010–11 from 21 sentinel sites in the state of Maharashtra were analyzed to understand the vulnerability and characteristics of different types of female sex workers based on their place of solicitation using multinomial logistic regression.ResultsWhile the HIV prevalence was 6.6% among all FSWs, it was 9.9% among brothel based [BB], 9% among street based [SB] and 3.1% and 3.7% among home based [HB], and bar based [Bar-B] sex workers respectively. SB FSWs were least likely to be located in HIV low burden districts [ANC] [ARRR: 0.61[95% CI: 0.49, 0.77]], but were 6 times more likely to be recently [<1 year] involved in sex work [ARRR: 6.15 [95% CI: 3.15, 12.0]]. The number of clients of SB FSWs in the preceding week were lower than 11% [ARRR: 0.89 [95%CI: 0.87, 0.90]] as compared to the BB FSWs denoting lesser client load. The duration since last paid sex was shorter [ARRR: 0.94[95%CI: 0.91, 0.96]] as compared to the BB FSWs.ConclusionStreet based FSWs have emerged as one of the most vulnerable types of FSW with a high HIV prevalence similar to BB FSWs. Our study reveals that they have more frequent sex acts despite lower client loads, and are more likely to be located in districts highly affected by HIV (ANC prevalence >1%). We identify them as a group to be focused on for prevention interventions and it is likely that they would be easily amenable to novel interventions due to their higher literacy rate as compared to other typologies.

Background Metformin, by reducing intracellular Mycobacterium tuberculosis growth, can be considered as an adjunctive therapy to anti-tuberculosis treatment (ATT). We evaluated whether metformin with standard ATT reduces time to sputum culture conversion and tissue inflammation in adults with pulmonary tuberculosis (PTB). Methods In a randomized 8-weeks clinical trial, newly diagnosed, culture positive PTB patients were randomized to standard ATT (HREZ = Control arm) or standard ATT plus daily 1000mg metformin (MET-HREZ = METRIF arm) for 8-weeks, during 2018-2020 at five sites in India. The primary endpoint was time to sputum culture conversion by liquid culture during 8 weeks of ATT. Plasma inflammatory markers were estimated in a subset. Cox proportional hazard model were used to estimate time and predictors of culture conversion. Results Of the 322 patients randomized, 239 (74%) were male, 212 (66%) had bilateral disease on chest radiograph with 54 (18%) showing cavitation. The median time to sputum culture conversion by liquid culture was 42 days in the METRIF arm and 41 days in the Control arm [HR 0.8, 95% CI (0.624 – 1.019)]. After 8-weeks of ATT, cavitary lesions on x-ray [7 (5.3%) vs 18 (12.9%), RR 0.42 (0.18, 0.96), p=0.041] and inflammatory markers were significantly lower in METRIF arm. Higher BMI and lower sputum smear grading were associated with faster sputum culture conversion. Conclusion The addition of metformin to standard ATT did not hasten sputum culture conversion, but diminished excess inflammation thus reducing lung tissue damage as seen by faster clearance on x-ray and reduced inflammatory markers.

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BackgroundHIV-specific Antibody Dependent Cell Cytotoxicity (ADCC) has shown to be important in HIV control and resistance. The ADCC is mediated primarily by natural killer cell activated through the binding of FcγRIIIa receptor to the Fc portion of antibody bound to the antigen expressed on the infected cells. However, no data is available on the influence of the polymorphism in FcγRIIIa receptor on HIV-specific ADCC response.MethodsThe Sanger’s method of sequencing was used to sequence the exon of FcγRIIIa receptor while the ADCC activity was determined using NK cell activation assay. The polymorphism in FcγRIIIa receptor was assessed in HIV-infected Indian individuals with or without HIV-specific ADCC antibodies and its influence on the magnitude of HIV-specific ADCC responses was analyzed.ResultsTwo polymorphisms: V176F (rs396991) and Y158H (rs396716) were observed. The Y158H polymorphism is reported for the first time in Indian population. Both, V176F (V/V genotype) (p = 0.004) and Y158H (Y/H genotype) (p = 0.032) were found to be significantly associated with higher magnitude of HIV-specific ADCC response.ConclusionThe study underscores the role of polymorphism in the FcγRIIIa receptor on HIV-specific ADCC response and suggests that the screening of the individuals for FcγRIIIa-V176F and Y158H polymorphisms could be useful for prediction of efficient treatment in monoclonal antibody-based therapies aimed at ADCC in HIV infection.

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Background India plans elimination of HIV-Mother-to-Child-Transmission in 2020. Targets include &gt;95% coverage of Antenatal-care (ANC) and HIV-testing. In 2015-16, while 43% of the estimated Indian pregnant-women (PW) received HIV-tests, one state reported &gt;95% testing. Indian public-health-care is a three-tiered system from primary-level sub-centres (population-5000) to tertiary-level hospitals. ANC involves multiple-visits per pregnancy at different care-levels and data are aggregated in the Health-Management-Information-System (HMIS) at all levels. We validated (public and private-sector data from this state, for duplication in ANC registration and HIV-testing using mixed methods. Methods In the absence of guidelines for assessing aggregate-data duplication, we used mixed-methods, including surveys among 9845 PW and providers from 240 facilities in 10/36 representative districts; in-depth-interviews; case-studies and analysis of HMIS and HIV-program data (April 2015-Mar 2017). Interviews and case-studies highlighted inadvertent duplicate data-capture. Surveys quantified levels of duplication and adjustment factors (public and private-sector) were developed. Results Twenty-four% PW, visited multiple facilities for ANC, while 81% providers reported all the PW coming to their facilities as new ANC registrations (irrespective of lower-tier registration); identifying a minimum duplication of 19% (24%*81%) in ANC coverage. Twenty-nine% and 28% PW from public and private-facilities reported &gt;1 HIV-test; while 75% and 36% reported visiting another public-facility where HIV test was likely to be reported again. Minimum duplication of 22% and 10% in HIV testing was noted in public and private-sectors respectively. Conclusions We report methods to quantify repeat HIV-testing and duplicate-reporting, due to inherent processes in ANC in public-healthcare in India. Modification of data-capture was recommended and adopted across India. Key messages Assessing duplication in aggregate health data is key to developing robust datasets for disease elimination