Prevalence of HIV among pregnant women in three HIV-affected districts in Sindh, Pakistan.

OBJECTIVE: To conduct a community-based cross-sectional survey to determine the prevalence of human immunodeficiency virus (HIV) among pregnant women in taluka Ratodero, Larkana, and two adjacent talukas: Sajawal, district Kambar Shahdadkot and Garhi Yasin, district Shikarpur. METHODS: The study was conducted among pregnant women in the three talukas of rural Sindh: Ratodero, Garhi Yasin, and Sajawal, from October 16, 2020 - December 23, 2020. A total of 1,157 pregnant women were interviewed at their homes and tested using the AlereTM HIV Combo rapid finger prick test. The study captured women's sociodemographic, economic, and health characteristics, including age, education, employment, number of children, home or hospital delivery, antenatal care use, antenatal trimester, history of blood transfusion, and HIV test result. Descriptive statistics were calculated: percentages for categorical variables and mean ± standard deviation (SD) for continuous variables. RESULTS: It was found that 0.35% (4/1,157) of women were HIV-positive, of which 3 were in Ratodero, Larkana, and 1 was in Garhi Yasin, Shikarpur. The average age of women was 28.7 ± 4.0 years. Most of the women (n=1067; 92.2%) did not attend a school, and 99.0% (n=1145) had never had a formal job. The average gestational age was 7.6 (±2.2) months. More than three-quarters of the women participating in the study (n=894; 77.3%) were not registered with a formal healthcare facility for antenatal care. CONCLUSIONS: Considering several HIV sub-epidemics in Larkana in the past decade, HIV infection among pregnant women has remained low in Larkana and adjacent districts.

Results of community-based TB and HIV screening among transgender women and male sex workers in Pakistan.

In Pakistan and globally, a large proportion of people with TB who are not receiving treatment are key populations with poor access to diagnosis and care. Transgender women and male sex workers (MSW) are heavily stigmatized and marginalized groups. While HIV rates are well documented among these key populations, little such data exists for TB. We engaged local organizations working with transgender women and MSW communities in Karachi and five urban cities in Sindh Province. People from the communities served as screening facilitators and treatment supporters. Verbal screening was followed by testing with Xpert MTB/RIF and HIV testing was offered. People with TB were supported through treatment. We screened 18,272 transgender women and 24,253 MSW. 8,921 (21.0%) individuals had presumptive TB and 7,472 (83.8%) provided sputum samples. We detected 438 (5.9%) people with positive results including 140 transgender women and 298 MSW. Including people diagnosed clinically, 625 people with TB were identified and 98.1% initiated treatment. Overall, 1.5% of people screened had TB, 1.7% among MSW and 1.1% among transgender women. Of 1,508 people tested for HIV, 243 had HIV infection (HIV+). The rates of TB among HIV+ transgender women (8.8%) were slightly lower than among MSW (10.3%). Previously, few attempts have been made to address TB in transgender women and MSW. Our work shows that these groups carry a significant burden of both TB and HIV in Pakistan and do not regularly access services. Effective interventions should include the engagement of community leaders and peers.