Showing papers by "Sanjay Mehendale published in 2015"

On the transmission pattern of Kyasanur Forest disease (KFD) in India

Abstract: Kyasanur Forest disease (KFD), a tick-borne viral hemorrhagic fever, is endemic in five districts of Karnataka state, India. Recent reports of the spread of disease to neighboring districts of the Western Ghats, namely Chamarajanagar district in Karnataka, Nilgiri district in Tamil Nadu, Wayanad and Malappuram districts in Kerala, and Pali village in Goa are a cause for concern. Besides vaccination of the affected population, establishing an event-based surveillance system for monkey deaths in the national parks, wildlife sanctuaries and reserve forests of the Western Ghats would help detect the disease early and thereby help implement appropriate control measures.

Kyasanur Forest disease outbreak and vaccination strategy,Shimoga District, India, 2013-2014.

Abstract: We investigated a Kyasanur Forest disease outbreak in Karnataka, India during December 2013–April 2014. Surveillance and retrospective study indicated low vaccine coverage, low vaccine effectiveness, and spread of disease to areas beyond those selected for vaccination and to age groups not targeted for vaccination. To control disease, vaccination strategies need to be reviewed.

The effects of antiretroviral treatment initiation on cognition in HIV-infected individuals with advanced disease in Pune, India

Abstract: There has been a reduction in the most severe cases of HIV-associated neurocognitive disorders (HAND) with advances in antiretroviral treatment (ART). But the prevalence of milder forms of HAND still remains high. Data from systematically conducted studies on the effects of ART on cognition are scanty in India, where HIV-1 clade C is prevalent. The purpose of the present study was to assess the effect of antiretroviral therapy in HIV-seropositive (HIV+) individuals (n = 92) with CD4 cell counts <200 cells/mm3. The overall and domain-specific levels of cognitive functioning were determined using a locally recruited normative sample, and a change in neurocognitive functioning at the 1-year follow-up visit was analyzed. Results revealed cognitive impairment in 44.6 % of the HIV+ group at baseline. At the 1-year follow-up, the group showed significant improvement in the Learning domain (p < 0.05). HIV+ individuals showing improvement in the global cognitive scores had a significantly lower baseline CD4 cell count compared to others. Overall, the degree of improvement associated with the magnitude of rise in CD4 suggests the possibility that early, mild subclinical deficits may also benefit from treatment.

Relapse and deformity among 2177 leprosy patients released from treatment with MDT between 2005 and 2010 in South India: A retrospective cohort study.

Abstract: Objective: To estimate the incidence of relapse among leprosy patients released after completing multi-drug therapy (MDT) during 2005–2010 under India’s National Leprosy Eradication Programme in South India. Methods: We conducted a retrospective cohort study of leprosy patients who were released from treatment (RFT) with MDT during April 2005 and March 2010 in four purposely selected districts from South India. We clinically examined them for signs of relapse, persistence and deformity. We collected slit skin smears from those reporting signs of relapse or persistence. We computed relapse rate per 1000 person years by dividing the number of relapses by person years of follow-up and 95% confidence intervals (CI) for rates. Findings: We tracked 3791 RFT patients and examined 58% of them. The examined and those who were not examined were similar in terms of leprosy type, year of completing MDT and gender. We identified 58 relapses (relapse rate 6.1 per 1000 person years) among the examined. Majority of these relapses occurred within 3 years post-MDT. Eighteen (31%) of the relapsed patients had deformity. Conclusion: While low level of relapse indicates effectiveness of MDT, the burden of deformity is of concern. For maximizing treatment effectiveness and minimizing transmission, we recommend educating leprosy patients at treatment completion for self-monitoring of signs of relapse and advising them to visit nearby public health facilities or Community health workers for immediate evaluation and intervention.

A surveillance model for sexually transmitted infections in India.

Abstract: The strategy for prevention and control of sexually transmitted infections (STIs) in India is based on syndromic case management delivered through designated STI/reproductive tract infection (RTI) centers (DSRCs) situated in medical colleges, district hospitals, and STI-clinics of targeted interventions programs. Laboratory tests for enhanced syndromic management are available at some sites. To ensure country-level planning and effective local implementation of STI services, reliable and consistent epidemiologic information is required on the distribution of STI cases, rate and trends of newly acquired infections, and STI prevalence in specific population groups. The present STI management information system is inadequate to meet these requirements because it is based on syndromic data and limited laboratory investigations on STIs reported passively by DSRCs and laboratories. Geographically representative information on the etiology of STI syndromes and antimicrobial susceptibility of STI pathogens although essential for optimizing available treatment options, is deficient. Surveillance must provide high quality information on: (a) prevalence of STIs such as syphilis, trichomoniasis, gonorrhea, and chlamydia among high-risk groups; syphilis in the general population and pregnant antenatal women; (b) demographic characteristics such as age, sex, new/recurrent episode, and type of syndromically diagnosed STI cases; (c) proportion of acute infections such as urethral discharge (UD) in men and nonherpetic genital ulcer disease (GUD) in men and women; (d) etiology of STI syndromes; and (e) gonococcal antimicrobial susceptibility. We describe here a framework for an STI sentinel surveillance system in India, building on the existing STI reporting systems and infrastructure, an overview of the components of the proposed surveillance system, and operational challenges in its implementation.

Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008-2011.

Abstract: BACKGROUND Failure of first-line antiretroviral therapy (ART) results in high morbidity and mortality. We identified the predictors of immunological failure and suboptimal CD4 testing among adult people living with HIV (PLHIV) initiated on first-line ART. METHODS The cohort of PLHIV aged ≥ 15 years initiated on first-line ART in Hyderabad city, Andhra Pradesh state, in 2008 was followed-up until 31 December 2011 or until death and/or lost to follow-up (LFU). We estimated cumulative incidence of immunological failure. We explored socio-demographic, clinical, pharmacological and immunological factors to identify the predictors of immunological failure and determinants of suboptimal CD4 testing (<2 tests/year). RESULTS Among the 1431 PLHIV, 275 (19.2%) died and 263 (18.4%) were LFU. Of the remaining 893 (62.3%) patients on follow-up, 193 (21.6%) experienced immunological failure; these patients were more likely to be males, illiterate, with a history of pulmonary TB while on ART and taking stavudine-based regimen. Incidence of suboptimal testing ranged between 41 and 60% over 4 years of follow-up. Suboptimal CD4 testing among PLHIV was associated with history of TB prior to initiation of ART and stage 3 and 4 of HIV disease at enrollment. CONCLUSIONS There was low immunological failure rate but high incidence of suboptimal CD4 testing. The ART centre staff needs to be more vigilant about 6-monthly CD4 testing for timely detection of immunological failure and appropriate case management.

Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers.

Abstract: A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.

Mapping and Size Estimation of Hijras and Other Trans-Women in 17 States of India: First Level Findings. -

Abstract: Background: For effective planning, implementation and evaluation of targeted HIV interventions among trans-women, a large-scale study on mapping and size estimation of diverse subgroups of trans-women (including hijras) was conducted in 17 States of India. Methods: The study was conducted between December 2012 and September 2013. We used geographical community mapping approach and conducted interviews with community and non-community key informants to identify the sites frequented by trans-women (TW) and to estimate their surveyed numbers at those sites. Ten percent of the districts from each of the 17 States of India and a sub-sample of the mapped sites were randomly selected and visited for validation involving trans-community representatives at all levels. Findings: A total of 5821 sites were identified in the 17 Study states: 1664 (28.6%) in rural areas and 4157 (71.4%) in urban areas. Top five states reporting the highest number of TW sites, covering 60% of all sites, were: Maharashtra, Odisha, Tamil Nadu, Uttar Pradesh and West Bengal. The estimated trans-women population across the 17 states was 62 137 (range: 53 280 – 74 297): 21% in rural and 79% in urban areas. Top five states reporting the highest numbers of trans-women, covering 61% of the estimated population, were: Andhra Pradesh, Maharashtra, Odisha, Uttar Pradesh and West Bengal. Validation of the estimates yielded comparable results. Conclusions: The information on the location of the sites and size estimation of trans-women populations in 17 States in India will help in planning and scaling up HIV prevention interventions and social protection programs in various states of India.

Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India.

Abstract: BACKGROUND: Sustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune India. METHOD: Among 14137 STI clinic attendees 8360 HIV sero-negative men were enrolled in a cohort study. The changes in condom usage behavior were studied among 1284 men who returned for first scheduled quarterly follow up 309 reported consistent condom use at the time of enrollment in the cohort. Data pertaining to heterosexual men practicing high risk behavior were analyzed to identify factors associated with change in condom use behavior using logistic regression model. Demographic behavioral and biological factors observed to be associated with condom use were fitted in five Cox proportional hazards models to calculate hazard ratios and their 95% confidence intervals to identify independent predictors of failure to sustain condom use behavior. RESULTS: The univariate analysis showed that men who were 30 years or older in age (p = 0.002) and those who did not have contact female sex worker (FSW) were more likely to fail to sustain consistent condom use. However both these factors did not show significant association in multivariable analysis. Marital status and contact with Hijra (eunuch) in lifetime were associated with failure to change in their condom use behavior [AOR 0.33 (CI 0.13-0.82; p = 0.017)]. During the follow up of 2 years 61 events (15.5 per 100 person years 95% CI 12.3-19.5 years) of failure of condom use were recorded despite counseling. Older age contact with non CSW partner and presence of genital ulcer disease / discharge syndrome were significant predictors of failure to sustain condom use. DISCUSSION: Married monogamous older men who report contact with sex worker and present with genital ulcer disease are at risk of failure to use condom after first exposure to voluntary HIV counseling and testing. This is a scenario of primary prevention program. Condom promotion and counseling needs to be reinforced through follow up counseling among this population.

Depressive Symptoms in Spouses of HIV Infected Individuals: A Study of HIV Uninfected Caregivers in Pune, India

Abstract: Background: HIV infected individuals are at increased risk of developing psychiatric co-morbidi- ties, particularly depression. Coping with a disease associated with significant morbidity, mortali- ty and financial stress is likely to result in psychiatric morbidity even among caregivers, especially family members. However, there is scarcity of such data in HIV uninfected caregiver spouses. Ma- terial and Methods: Beck Depression Inventory (BDI-II), a diagnostic tool that measures depres- sive symptoms, was administered to HIV uninfected caregiver spouses of HIV infected individuals (n = 55) and HIV seronegative individuals from general population (n = 63) with similar demo- graphic profile. Chi-square test was used for categorical data. Results: Caregiver spouses exhibited higher depressive symptoms on the BDI-II (mean score 5.25 vs. 3.03; p = 0.029) as compared to others. The scores tended to be higher on the majority of the items, with sadness (p = 0.032), pu- nishment feeling (p = 0.024) and crying (p = 0.037) being statistically significant. Conclusions: Our results indicate that it is important to address the mental health needs of the spouses of HIV in- fected individuals as they may play a major role in their care and support in the Indian context.

Outbreak of waterborne hepatitis E, Pune, Maharashtra, India, 2013

Abstract: Introduction: Following the report of clustering of jaundice cases from Kolvan village in Pune district, Maharashtra on 16th June, 2013, we investigated the outbreak with objectives to confirm the diagnosis, to describe it and to make recommendations for the control of outbreak. Methods: We defined a suspected case of acute hepatitis as an individual presenting with acute onset of yellow eyes or dark urine with or without fever and other constitutional symptoms in a resident of Kolvan village from 28 May 2013 onwards. Following house to house survey, we prepared a line list of suspected cases. We prepared epi-curve and spot maps of cases and determined the attack rates. We tested blood and water samples and conducted environmental survey. Results: Overall attack rate was 3.3% (n=37); highest in Gavthan area of Kolvan village (14.5%) and in the age group of41-60 years (4.9%). It was more in males (4.3%) than females (2.3%). Hepatitis E IgM antibody was found in 16/ 20 (80%) case patients. Water samples from river, common water source (well) and water storage tanks confirmed presence of coliform bacteria suggesting contamination of drinking water source with faecal matter through newly constructed trench between a well and the river. Conclusions: The continuing common source outbreak occurred possibly due to drinking of faecally contaminated water from the trench. We recommended closure of the trench, temporary alternate water supply arrangement and regular chlorination of drinking water source.We focused on community education regarding safe drinking water and improving sanitation in the village.