Declining HIV Incidence Among Patients Attending Sexually Transmitted Infection Clinics in Pune, India

Mehendale, Sanjay; Gupte, Nikhil; Paranjape, Ramesh; Brahme, Radhika; Kohli, Rewa; Joglekar, Neelam; Godbole, Sheela; Joshi, Smita; Ghate, Manisha; Sahay, Seema; Kumar, B Kishore; Gangakhedkar, Raman; Risbud, Arun; Brookmeyer, Ron; Bollinger, Robert C.

doi:10.1097/qai.0b013e3180d0a6ba

Cited by 22 publications

(11 citation statements)

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“…Studies in Pune district in Maharashtra have indicated a nearly similar trend in HIV prevalence among FSWs. A study among FSWs attending STI clinics in Pune reported stable HIV prevalence (between 46% to 50%) among FSWs over a 10-year period [42] while a prospective cohort study also in Pune found declining incidence of FSWs and males with STIs attending STI clinics over a 10-year period [43]. …”

Section: Discussionmentioning

confidence: 99%

“…HIV prevalence among pregnant women attending antenatal clinics (ANCs) in sentinel surveillance sites in Maharashtra has been declining steadily from about 1% in 2004 to 0.64% in 2008 [44,45] similar to changes seen in other parts of India and at the national level [45]. Similarly, in districts where Avahan interventions were implemented, the prevalence among ANC attendees declined from about 1.2% in 2003 to 0.98% in 2007 [43] and further down to 0.75% in 2008 [33,53]. Data from pregnant women attending prevention of parent-to-child transmission of HIV (PPTCT) clinics also showed a declining trend [54].…”

Section: Discussionmentioning

confidence: 99%

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Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

et al. 2011

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BackgroundAvahan, the India AIDS Initiative has been a partner supporting targeted interventions of high risk populations under India’s National AIDS Control Organisation (NACO) since 2004 in the state of Maharashtra. This paper presents an assessment of the Avahan program among female sex workers (FSWs) in Maharashtra, its coverage, outcomes achieved and their association with Avahan program.MethodsAn analytical framework based on the Avahan evaluation design was used, addressing assessment questions on program implementation, intermediate outcomes and association of outcomes with Avahan. Data from routine program monitoring, two rounds of cross-sectional Integrated Behavioural and Biological Assessments (IBBAs) conducted in 2006 (Round 1- R1) and 2009 (Round 2 – R2) and quality assessments of program clinics were used. Bi-variate and multivariate analysis were conducted using the complex samples module in SPSS 15® (IBM, Somers NY).ResultsThe Avahan program achieved coverage of over 66% of FSWs within four years of implementation. The IBBA data showed increased contact by peers in R2 compared to R1 (AOR:2.34; p=0.001). Reported condom use with clients increased in R2 and number of FSWs reporting zero unprotected sex acts increased from 76.2% (R1) to 94.6% (R2) [AOR: 5.1, p=0.001].Significant declines were observed in prevalence of syphilis (RPR) (15.8% to 10.8%; AOR:0.54; p=0.001), chlamydia (8% to 6.2%; AOR:.0.65; p=0.010) and gonorrohoea (7.4% to 3.9; AOR:.0.60; p=0.026) between R1 and R2. HIV prevalence increased (25.8% to 27.5%; AOR:1.29; p=0.04). District-wise analysis showed decline in three districts and increase in Mumbai and Thane districts.FSWs exposed to Avahan had higher consistent condom use with occasional (94.3% vs. 90.6%; AOR: 1.55; p=0.04) and regular clients (92.5% vs. 86.0%; AOR: 1.95, p=0.001) compared to FSWs unexposed to Avahan. Decline in high titre syphilis was associated with Avahan exposure.ConclusionThe Avahan program was scaled up and achieved high coverage of FSWs in Maharashtra amidst multiple intervention players. Avahan coverage of FSWs was associated with improved safe sexual practices and declines in STIs. Prevalence of HIV increased requiring more detailed understanding of the data and, if confirmed, new approaches for HIV control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

et al. 2011

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“…In 2002-2003, limited data pointed to several sizeable and growing concentrated HIV epidemics in the south and north-east parts of India, largely driven by core and bridge group interactions [21][22][23][24][25][26]. Internationally, there were projections of a massive HIV epidemic in India [27,28].…”

Section: Avahan the India Aids Initiativementioning

confidence: 99%

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Chandrasekaran¹,

Dallabetta²,

Loo³

et al. 2008

Aids

112

114

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“…In India, women comprise 40% of HIV-positive adult individuals [4], and sex with an infected husband is considered to represent women's greatest risk for HIV [5,6]. Recent evidence suggests a stable rate of HIV among married women attending STI clinics [7] and an increasing proportion of women among reported HIV cases in India [4]; thus, understanding HIV risk factors for married men and among couples is key to addressing spousal transmission of HIV in India.…”

Section: Introductionmentioning

confidence: 99%

Male Migration/Mobility and HIV Among Married Couples: Cross-Sectional Analysis of Nationally Representative Data from India

Saggurti

Nair

Malviya³

et al. 2011

AIDS Behav

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This paper examines the associations between male migration and mobility with HIV among married couples in India. Cross-sectional analyses of a nationally representative household survey conducted across all 29 states of India from 2005 to 2006 via the National Family Health Survey-3 (NFHS-3) included a subsample of 27,771 married couples who were tested for HIV as a part of their participation. Both bi-variate and multi-variate analyses were conducted. About 0.5% of the total married couples in the current study included an HIV-infected partner; 0.11% were HIV concordant and 0.38% were HIV serodiscordant couples. Adjusted logistic regression analyses demonstrated that HIV infection in couples (seroconcordant or serodiscordant) was significantly more likely among those couples where the man was migrant but not mobile and those couples where the man was migrant as well as mobile, relative to those couples where the man was neither migrant nor mobile. Male migration increases the risk for HIV among married couples in India, largely in the form of serodiscordance in which men are HIV infected. These findings document the need for not only primary prevention efforts to reduce HIV acquisition among migrant male workers, particularly more mobile migrants, but also efforts are needed to reduce subsequent transmission to their wives.

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Declining HIV Incidence Among Patients Attending Sexually Transmitted Infection Clinics in Pune, India

Abstract: We report the first direct evidence for a decline in HIV incidence rates in FSWs and male patients with STIs over time. The lack of change in HIV infection risk among non-sex worker women highlights the need for additional targeted HIV prevention interventions.

Cited by 22 publications

References 14 publications

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India

Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative

Male Migration/Mobility and HIV Among Married Couples: Cross-Sectional Analysis of Nationally Representative Data from India

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