HIV in Pakistan: Challenges, efforts and recommendations

Shaeen, Sean Kaisser; Butt, Malaika Saeed; Vohra, Laiba Imran; Hashmi, Taleen; Salman, Yumna

doi:10.1016/j.amsu.2022.104797

Cited by 5 publications

(4 citation statements)

References 15 publications

(17 reference statements)

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“…Lastly, the data was collected during 2017–2018 before COVID-19 and as a result does not include information about how ICU is impacted by the pandemic, subsequent nationwide lockdowns and launching of Pre-Exposure Prophylaxis Program (PrEP) in Pakistan. PrEP was introduced in Karachi on June 7, 2022, by the Health Department of the Government of Sindh in cooperation with the United Nations in Pakistan and currently there are no studies on PrEP and its impact on condom use among sex workers from Pakistan [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Inconsistent condom use for prevention of HIV/STIs among street-based transgender sex workers in Lahore, Pakistan: socio-ecological analysis based on a qualitative study

2023

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Background A large amount of new HIV infections worldwide is observed amongst key populations which include e.g., commercial sex workers or transgender people and their respective sexual partners. Therefore, this study examined the multi-level context of inconsistent condom use (ICU) in sexual interactions of transgender street-based workers (KSWs) with commercial and non-commercial sexual partners in Lahore. Methods We conducted 20 in-depth interviews with street-based KSWs to investigate challenges to consistent condom utilization with sexual partners. The qualitative data was analyzed using reflexive thematic analysis to produce an initial set of codes and identify broader themes through a recursive exploration of the text. Results Within a socio-ecological analysis we identified factors influencing ICU among KSWs at three levels. At the individual level, we identified knowledge and awareness, age, pleasure and pain, and mental health issues impacting on ICU. perceived characteristics of sexual partners, dynamics of cruising spots and places of sexual interactions, competition in sex trade, violence and lack of safety nets in street-based sex work, and condom use with lovers were factors associated with ICU. Risk factors at community level were changing urban geography of sex work, discrimination, harassment and regular evictions, networks with non-governmental organizations and the influence of gurus and Dera culture. Conclusions Until now, HIV prevention efforts in Pakistan have primarily focused on HIV risk factors at the level of individual behaviors within specific networks of target populations. However, our study points towards both the effectiveness and the urgency of interventions that address macro-level risk factors specific to key populations in Pakistan, in addition to behavioral interventions.

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Section: Discussionmentioning

confidence: 99%

Inconsistent condom use for prevention of HIV/STIs among street-based transgender sex workers in Lahore, Pakistan: socio-ecological analysis based on a qualitative study

2023

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“…In Pakistan, HIV prevalence is estimated to be 0.1% in the general population, but is known to be much higher among people who inject drugs (PWID), with estimates as high as 40% of PWID in the country living with HIV (1,2). This considerable burden is attributable to the marginalization of PWID due to contextual factors, including illiteracy, poverty, homelessness, and criminalization (3)(4)(5), which constrain access to both harm reduction programs and antiretroviral therapy (ART) (6). Further, the requirement of individuals actively injecting drugs to undergo a two-week drug detoxification prior to ART initiation (7) and lack of a national opioid substitution therapy program in Pakistan presents structural barriers which might contribute to higher rates of HIV transmission among PWID overall, hindering effective HIV management and posing challenges to overall HIV epidemic control efforts in the country (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

Melnychuk,

Thompson,

Archibald

et al. 2024

Preprint

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Transmission of drug-resistant HIV strains to treatment-naïve patients can compromise antiretroviral therapy (ART) effectiveness and lead to treatment failure. In Pakistan, transmitted HIV drug resistance among people who inject drugs (PWID) is fuelled by a lack of ART, poor drug adherence, and unsafe injection practices, resulting in efficient transmission in large injecting networks. A cross-sectional study was conducted among PWID recruited in the Pakistani cities of Karachi, Larkana, Peshawar, Quetta and Hyderabad (August 2014 to January 2015). A portion of the HIV pol gene was amplified from HIV-reactive dried blood spot specimens (n=282/367) and sequenced using an in-house Sanger sequencing assay for HIV drug resistance mutation genotyping. Drug resistance mutations (DRMs) were identified using the Stanford University HIV Drug Resistance Database HIVdb algorithm (https://hivdb.stanford.edu/hivdb). Overall, HIV subtype A1 was dominant (78.0%; n=220), followed by CRF02_AG (15.6%; n=44), CRF35_AD (2.5% n=7), recombinants (3.5%; n=10), and subtype C (0.4% n=1). DRM analysis identified over half (63.8%) of participants harbored at least one DRM, of which 28.9% reported using help from a professional injector. Nearly all (99.4%) participants were not actively receiving ART because most (88.7%) had never undergone HIV testing and were unaware of their status. Findings suggest significant transmitted HIV drug resistance present among PWID, exacerbated by unsafe injection practices, particularly professional injection. Low testing rates signal a need for more comprehensive testing programs to improve HIV status awareness and ART coverage in Pakistan. Given most treatment-naïve participants had evidence of drug resistance, drug resistance genotyping prior to ART initiation might aid in ensuring effective treatment to prevent transmission of resistant HIV strains.

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“…To strategize and develop the skills, abilities, and resources of Pakistan's healthcare system and to provide better HIV care, sustainable processes need to be formed based on partnerships between local academic institutions and antiretroviral treatment (ART) centers [19]. In Pakistan, national and provincial AIDS control programs have established more than 51 HIV treatment centers throughout the country [20].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Training Program to Train HIV Treatment Center Staff in Pakistan

Shah,

Abidi,

Soomro

et al. 2024

Cureus

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IntroductionIn Pakistan, HIV training programs, especially for health professionals working in HIV treatment centers, are limited. Consequently, there is little data about HIV awareness among physicians and allied health workers and how it may affect their care for people living with HIV (PLWH). Recently, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) grant Principal Recipient UNDP engaged an NGO experienced in HIV/AIDS training, on a competitive basis, to develop a training manual and conduct training of all categories of HIV treatment centers staff. The goal of this study was to assess the training program's influence on trainees' (both physicians and allied health staff) knowledge and abilities and describe its major lessons. MethodologyThis was a one-group pre-post test study, carried out between January 17 and February 22, 2023. The study was carried out in three phases. In the first phase, a team of experts developed an antiretroviral treatment (ART) training manual. In the second phase, 9-and three-day training workshops were conducted in six different cities of Pakistan, which were attended by physicians and allied health staff working in different HIV treatment centers across Pakistan. The workshops had plenary lectures, discussions, role plays, video cases, and case studies. In the third phase, a quiz, comprising multiple/best choice questions (MCQs/BCQs) and true and false questions, was administered before (pre) and after the workshop (post) to assess the impact of these training sessions in enhancing the level of HIV knowledge, especially related to ART. The workshop was attended by a total of 256 health workers from different cities in Pakistan. The participants had backgrounds in medical science, psychology, laboratory science, nursing, and computer science. Preand post-test responses were statistically analyzed to determine the impact of the training program on participant's knowledge. For this, the Shapiro-Wilk test was applied to test data normality, followed by the application of paired t-test or Wilcoxon Signed Rank Test for normally and non-normally distributed data, respectively. Finally, a chi-square test was applied to examine the significant (p<0.05) association between training workshops and improvement in the participant's level of understanding of HIV. In all statistical tests, p<0.05 was considered significant. ResultsThe results from our study showed that before the training session, both physicians and allied staff possessed limited knowledge about HIV-related domains. After the workshops, participants from all cities demonstrated a uniform enhancement of knowledge related to different HIV-related domains, evident from the improvement in post-test scores compared to pre-test scores (p<0.0001). The chi-square test showed a significant association between training workshops and improvement in the participant's level of understanding about HIV (p-values for BCQ, MCQ, and true and false: 0.001, 0.0047, and 0.0024, respectively). ConclusionsPre-and post-test evaluation ...

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HIV in Pakistan: Challenges, efforts and recommendations

Cited by 5 publications

References 15 publications

Inconsistent condom use for prevention of HIV/STIs among street-based transgender sex workers in Lahore, Pakistan: socio-ecological analysis based on a qualitative study

Inconsistent condom use for prevention of HIV/STIs among street-based transgender sex workers in Lahore, Pakistan: socio-ecological analysis based on a qualitative study

Notable transmitted HIV drug resistance among people who inject drugs in Pakistan

Evaluation of the Training Program to Train HIV Treatment Center Staff in Pakistan

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