This comprehensive HIV preventive intervention empowering FSW has resulted in striking increases in reported condom use and a concomitant reduction in the prevalence of curable STI. This model should be replicated in similar urban settings across India.

Heterogeneity in the organization and structure of sex work is an important determinant of variations in HIV prevalence among FSW across districts in India, much more so than the districts themselves. This understanding should help to improve the design of HIV preventive interventions.

BackgroundIn the context of AVAHAN, the India AIDS Initiative of the Bill & Melinda Gates Foundation, general population surveys (GPS) were carried out between 2006 and 2008 in Belgaum (northern), Bellary (mid-state) and Mysore (southern) districts of Karnataka state, south India. Data from these three surveys were analysed to understand heterogeneity in HIV risk.MethodsOutcome variables were the prevalence of HIV and sexually transmitted infections (STIs). Independent variables included age, district, place of residence, along with socio-demographic, medical and behavioural characteristics. Multivariate logistic regression was undertaken to identify characteristics associated with HIV and differences between districts, incorporating survey statistics to consider weights and cluster effects.ResultsThe participation rate was 79.0% for the interview and 72.5% for providing a blood or urine sample that was tested for HIV. Belgaum had the highest overall HIV (1.43%) and Herpes simplex type-2 (HSV-2) (16.93%) prevalence, and the lowest prevalence of curable STIs. In Belgaum, the HIV epidemic is predominantly rural, and among women. In Bellary, the epidemic is predominantly in urban areas and among men, and HIV prevalence was 1.18%. Mysore had the lowest prevalence of HIV (0.80%) and HSV-2 (10.89%) and the highest prevalence of curable STIs. Higher HIV prevalence among men was associated with increasing age (p<0.001), and with history of STIs (AOR=2.44,95%CI:1.15-5.17). Male circumcision was associated with lower HIV prevalence (AOR=0.33,95%CI:0.13-0.81). Higher HIV prevalence among women was associated with age (AOR25-29years=11.22,95%CI:1.42-88.74, AOR30-34years=13.13,95%CI:1.67-103.19 and AOR35-39years=11.33,95%CI:1.32-96.83), having more than one lifetime sexual partner (AOR=4.61,95%CI:1.26-16.91) and having ever used a condom (AOR=3.32,95%CI:1.38-7.99). Having a dissolved marriage (being widowed/divorced/separated) was the strongest predictor (AOR=10.98,95%CI: 5.35-22.57) of HIV among women. Being a muslim woman was associated with lower HIV prevalence (AOR=0.27,95%CI:0.08-0.87).ConclusionThe HIV epidemic in Karnataka shows considerable heterogeneity, and there appears to be an increasing gradient in HIV prevalence from south to north. The sex work structure in the northern districts may explain the higher prevalence of HIV in northern Karnataka. The higher prevalence of HIV and HSV-2 and lower prevalence of curable STIs in Belgaum suggests a later epidemic phase. Similarly, higher prevalence of curable STIs and lower HIV and HSV-2 prevalence in Mysore suggests an early phase epidemic.

The use of the WHO criteria for estimating the cost of a new drug based on economic value for a developing country like India is feasible and can be used to estimate a more affordable cost based on societal value thresholds.

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plete cytogenetic and molecular. Prognosis was assigned to each category, according to disease progression and mortality. Prognosis was also assigned to BMT patients. Unit costs were drawn from national databases, and multiplied by resource use (driven by response level and disease status) to estimate total costs. Health benefits were measured using quality-adjusted life years (QALYs), based on the patient's current health status and level of response. Univariate and probabilistic sensitivity analyses were conducted to estimate the confidence around the results. RESULTS: Dasatinib resulted in 6.425 QALYs, at a total cost of £314,413, per patient. QALYs and costs for comparators were as follows: imatinib 400mg, 1.485, £135,326; imatinib 600mg, 2.394, £173,705; imatininb 800mg, 5.910, £350,365; nilotinib, 6.235, £228,576; 1.664, £6,764; BMT, 4.738, £302, 937. Incremental cost-effectiveness ratios (ICER) for dasatinib against competitors were as follows: imatinib 400mg, £36,251; imatinib 600mg, £34,907; imatinib 800mg, dominant; nilotinib, dominant; interferon-a, £38,877; BMT, dominant. CONCLUSIONS: Dasatinib was more effective than imatinib 400mg, 600mg 800mg, nilotinib, interferon-a and BMT in the treatment of chronic-phase imatinib-resistant patients CML. The analysis estimates dasatinib treatment to be less costly than imatinib 800mg, nilotinib and BMT, dominating these treatments in the cost-effectiveness analysis. Dasatinib is therefore a cost-effective treatment option for patients in the CP of CML. OBJECTIVES:Chronic myelogenous leukaemia (CML) is a progressive disease associated with significant health and economic burden. This study estimates the lifetime costs and health outcomes associated with dasatinib in the treatment of imatinib-resistant CML patients who have the accelerated or blast stages of the disease. METHODS: A Markov model was developed to estimate lifetime outcomes based on initial best response, which was defined as: no response, complete haematologic, partial cytogenetic, complete cytogenetic, molecular. Prognosis was assigned to each category, according to disease progression and mortality. Unit costs were drawn from national databases, and multiplied by resource use (driven by response level and disease status) to estimate total costs. Health benefits were measured using quality-adjusted life years (QALYs), based on patients' health status and response. Univariate and probabilistic sensitivity analyses were conducted to estimate confidence around the results. RESULTS: In AP, dasatinib resulted in 2.603 QALYs, at a cost of £170,478 per patient. QALYs and costs for comparators were: imatinib 600mg, 0.583, £88,949; imatininb 800mg, 0.583, £96,552; nilotinib, 1.697, £141,128; BMT, 2.861, £230,277. Incremental cost-effectiveness ratios (ICER) for dasatinib against competitors were: imatinib 600mg, £40,357; imatinib 800mg, £36,594; nilotinib, £32,405, BMT, £231,650. In BP, dasatinib resulted in 0.485 QALYs, at a total cost of £105,103, per patient. QALYs and costs for comparators were: imatini...