Impact of COVID-19 Pandemic on HIV Testing Uptake Among Key Populations Enrolled in Targeted Intervention Program in Maharashtra, India.

The COVID-19 pandemic posed unprecedented challenges to HIV services globally. We evaluated the impact of the COVID-19 pandemic on the uptake of HIV testing in the Targeted Intervention (TI) program in Maharashtra-a high HIV burden state in India. Annual HIV testing was sustained during the pandemic year (2020-2021), at levels similar to the pre-pandemic year (2019-2020), among Female Sex Workers (FSW), Men having Sex with Men (MSM), Transgender (TG), and Truckers; but not among Migrants and Intravenous Drug Users (IDU). There was an acute decline during the lockdown across all typologies. Sharp recovery was seen among FSW, MSM, and TG during the early months of the un-lockdown. The community-based screening (CBS) approach primarily contributed to this recovery. Among migrants and truckers, recovery was delayed. There was an overall reduction of 58% in annual HIV-positive registrations. The community-based networks, participatory structures, and processes of HIV programs played an essential role in reaching the community during the pandemic.

Increasing sero-discordancy among young HIV infected pregnant women from India: a likely pointer of changing transmission dynamics.

The flat-lining of HIV incidence in India has raised concerns about the presence of emerging risk groups. As HIV prevalence among pregnant women is reflective of the situation in general population, its closer scrutiny provides valuable insights about the evolving epidemic. The present study assesses temporal trends of sero-discordance (where woman is HIV infected and husband is uninfected), among pregnant women living with HIV (pWLHIV) from India. Data of program for prevention of parent to child transmission of HIV was analyzed. Statistical analysis was done using Cochrane-Armitage trend test and logistic regression. Of the 1209 currently married pWLHIV, 302 (25%) were sero-discordant. The proportion increased from 16% in 2007 to 36% in 2016-17 (p = 0.000). The likelihood of sero-discordance was higher for women aged 18-20 (OR: 2.68, CI: 1.30-5.83) and 21-23 (OR: 1.98, CI: 1.01-4.15) years compared to 36-40 years; and for primi-parous women (OR: 1.84, CI: 1.31-2.58) compared to women pregnant for second/third time. The findings are indicative of changing HIV transmission dynamics. Steeper rise in sero-discordance in younger women implies an increasing risk of HIV in unmarried women population. A better understanding of HIV specific vulnerabilities of young women, married and unmarried, is warranted.

Barriers associated with the utilization of continued care among HIV-infected women who had previously enrolled in a private sector PMTCT program in Maharashtra, India.

Prevention of mother-to-child transmission (PMTCT) programs are considered as an entry point to continued care because they provide an opportunity to link an HIV-infected woman, her partner, and child(ren) (if infected) to long-term treatment and care. However, little is known about the factors associated with the utilization of continued care among women who have previously accessed PMTCT services. Better knowledge of the barriers to continued care in HIV-infected women could lead to effective strategies to increase the uptake of post-PMTCT care. This study was designed to examine the factors associated with the utilization of continued care among HIV-infected women enrolled in the PRAYAS PMTCT program in Maharashtra, India, between 2002 and 2011. All consenting women who had completed the receipt of PMTCT services or who were lost to follow-up at least six months prior to the time of data collection were interviewed. Univariate and multivariate analyses were conducted to estimate the associations between not utilizing continued care and hypothesized risk factors using generalized linear models. Of the 688 eligible HIV-positive women, 311 completed a structured interview. Since their exit from the PMTCT program, 59 (19%) had never utilized HIV-related care, 58 (19%) had intermittently utilized HIV-related care, and 194 (62%) had consistently utilized HIV-related care at regular intervals. After adjusting for potential confounders, women with poor HIV-related knowledge (relative risk [RR] = 1.83; 95% CI: 1.15-2.92), women whose partners had never utilized HIV-related care (RR = 4.82; 95% CI: 2.57-9.04), and women who could not afford to travel to the HIV-care facility (RR = 2.36; 95% CI: 1.23-4.53) were less likely to utilize HIV-related care after exiting the PMTCT program. This study highlights the need for enhanced techniques to impart HIV and antiretroviral therapy-related knowledge and underlines the need for improved partner involvement and financial support for travel to HIV facility to increase the uptake of post-PMTCT treatment and care.