Burden, trend and determinants of various forms of domestic violence among reproductive age-group women in India: findings from nationally representative surveys.

BACKGROUND: Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India. METHODS: Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression. RESULTS: About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence. CONCLUSIONS: One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030.

Socioeconomic and Geographical Inequities in Burden and Treatment seeking Behavior for Hypertension among Women in the Reproductive Age (15-45 years) Group in India: Findings from a Nationally Representative Survey.

BACKGROUND: Socioeconomic disparity changed healthcare seeking and management cascade of hypertension due to inequity in hypertension care cascade pathway. OBJECTIVES: The inequities in burden and treatment-seeking behavior of hypertension among reproductive age group women were studied from National Family Health Survey-4 (NFHS-4) data. MATERIALS AND METHODS: We analyzed the data from NFHS-4 of women of reproductive age group between 15 and 49 years among the selected households contributing to 699,686 women. Socioeconomic inequities were assessed by expenditure quintile. Inequities in burden and treatment-seeking behavior were reported using the concentration curve and concentration index. RESULTS: The prevalence of hypertension in India was 15% (95% confidence interval: 14.9%-15.4%). One-third (32%) of the hypertensive population received treatment and only 28% of the women had controlled blood pressure. Wealth and education-based inequalities were more in high wealth index. The inequity in screening and awareness was in the northern and northeastern regions. CONCLUSION: There was inequity in the overall hypertension care cascade pathway with more inequity in the northern and northeastern region.

Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis.

INTRODUCTION: Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. AIMS AND METHODS: Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). RESULTS: 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. CONCLUSIONS: E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. IMPLICATIONS: This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.

Effectiveness of multiple combined lifestyle interventions in reducing blood pressure among patients with prehypertension and hypertension: a network meta-analysis.

BACKGROUND: Different combinations of lifestyle interventions have been studied with varying results on hypertension control. Hence, this review was done to compare multiple combined lifestyle intervention in reducing blood pressure (BP) among patients with prehypertension or hypertension. METHODS: We conducted systematic search in the following databases: MEDLINE, PubMed Central, CENTRAL, ScienceDirect, Google Scholar from 1964 until November 2020. Estimates of comparative intervention effect from network meta-analyses (random-effects model) were represented as mean difference (MD) with 95% confidence interval. RESULTS: In total, 14 studies with 2451 participants were included. Almost all the studies had high risk of bias. Healthy diet (HD) and physical activity (PA) combination showed highest mean reduction in systolic BP (-9.88 mmHg) and diastolic BP (-6.28 mmHg) followed by HD + PA + smoking cessation + alcohol restriction combination (systolic BP = -6.58 mmHg, diastolic BP = -4.09 mmHg) compared with usual care. HD and PA combination had the highest probability of being the best intervention (82.8% for SBP and 81.7% for DBP). CONCLUSION: We found that HD and PA are the most important combination of lifestyle modifications for prehypertensive and hypertensive patients. Hence, a coordinated approach is required from the clinicians by integrating beneficial effect of these modifications through education, counselling and support.

Prevalence of hypertension and determinants of treatment-seeking behaviour among adolescents and young adults in India: an analysis of NFHS-4.

BACKGROUND: Previous evidences have reported that almost three-fourth of young hypertensives are not seeking care for their condition leading to severe complications. This study was conducted to assess the determinants of treatment-seeking behaviour among the young hypertensives in India. METHODS: The National Family Health Survey-4 data were analysed. Sampling weights and clustering was accounted using svyset command. Screening, awareness, prevalence and control status were reported with 95% confidence interval (CI). Poisson regression was done to identify the determinants of treatment-seeking behaviour. RESULTS: In total, 13.8% of younger adults had hypertension, 51.1% were aware of their status and 19.5% sought treatment. Participants in 15-19 years (adjusted Prevalence Ratio (aPR) = 0.70) and 20-29 years (aPR = 0.63), male gender (aPR = 0.84), Muslim religion (aPR = 1.14), urban region (aPR = 0.87), secondary (aPR = 0.88) and higher education (aPR = 0.86), residing in Northern (aPR = 0.79), Central (aPR = 0.76), Southern region (aPR = 0.65), preferring home treatment, medical shop or any other care (aPR = 0.63) were significant determinants of treatment-seeking behaviour. CONCLUSION: More than 1 in 10 younger adults in India have hypertension and only half of them were aware of their status and one-fifth sought treatment. Adolescents, males, Hindus, urban population, higher education and residing in Northern, Central and Southern region had poor treatment-seeking behaviour.

Effect of treatment adherence on the association between sex and unfavourable treatment outcomes among tuberculosis patients in Puducherry, India: a mediation analysis.

BACKGROUND: A better understanding of the complex interplay between risk factors of tuberculosis (TB) is essential. This study was part of the Regional Prospective Observational Research for Tuberculosis (RePORT) India consortium and includes newly diagnosed TB patients in Puducherry between 2014 and 2018. We employed mediation analysis to identify the effect of treatment adherence on association between sex and unfavourable TB treatment outcomes. METHODS: Required demographic and treatment-related variables were extracted from the RePORT India consortium database and causal mediation analysis using parametric regression models was done. RESULTS: Of the 712 TB patients, ~87 (12.2%) had unfavourable TB treatment outcomes. Total effect of male sex was significantly associated with the unfavourable TB treatment outcomes [adjusted odds ratio (aOR) = 2.48; 95% confidence interval (CI): 1.11-5.55]. However, the overall association between male sex and TB treatment outcomes was dominated by the indirect pathway, as the direct pathway does not show significant association (aOR = 1.67; 95% CI: 0.75-3.75), while the indirect pathway shows significantly higher odds of TB treatment outcomes (aOR = 1.48; 95% CI:1.27-1.73), indicating complete mediation by the treatment adherence. CONCLUSIONS: The study has shown a complete mediation of sexes through TB treatment adherence for unfavourable treatment outcomes. Developing of treatment strategies require better understanding between the biological and social factors related to TB.

Development of prognostic scoring system for predicting 1-year mortality among pulmonary tuberculosis patients in South India.

BACKGROUND: Development of a prediction model using baseline characteristics of tuberculosis (TB) patients at the time of diagnosis will aid us in early identification of the high-risk groups and devise pertinent strategies accordingly. Hence, we did this study to develop a prognostic-scoring model for predicting the death among newly diagnosed drug sensitive pulmonary TB patients in South India. METHODS: We undertook a longitudinal analysis of cohort data under the Regional Prospective Observational Research for Tuberculosis India consortium. Multivariable cox regression using the stepwise backward elimination procedure was used to select variables for the model building and the nomogram-scoring system was developed with the final selected model. RESULTS: In total, 54 (4.6%) out of the 1181 patients had died during the 1-year follow-up period. The TB mortality rate was 0.20 per 1000 person-days. Eight variables (age, gender, functional limitation, anemia, leukopenia, thrombocytopenia, diabetes, neutrophil-lymphocyte ratio) were selected and a nomogram was built using these variables. The discriminatory power was 0.81 (95% confidence interval: 0.75-0.86) and this model was well-calibrated. Decision curve analysis showed that the model is beneficial at a threshold probability ~15-65%. CONCLUSIONS: This scoring system could help the clinicians and policy makers to devise targeted interventions and in turn reduce the TB mortality in India.

Impact of health insurance coverage on health care utilization during COVID-19 pandemic: A propensity score matched survey analysis in a target region in India.

BACKGROUND: Health insurance is considered as a mechanism to accelerate the progress towards universal health coverage and ensure financial risk protection for households throughout the country. There is a growing body of evidence reporting that the health insurance coverage can significantly improve the access and utilization of healthcare services. Hence, we attempted to determine the impact of health insurance on the utilization of healthcare services during COVID-19 pandemic. METHODS: A community-based cross-sectional study was conducted in rural Tamil Nadu. The primary data collection was conducted during November 2021. We employed a multi-stage stratified random sampling technique. Propensity score matching analysis was performed using radius matching method at 0.05 calliper to estimate the following parameters: average treatment effect (ATE), average treatment effect on treated (ATT), and average treatment effect on untreated (ATU). RESULTS: In total, 2390 participants were included. Almost two-third belonged to 18-45 years with almost equal distribution of males and females. Only 13.6% were covered by health insurance. Healthcare utilization was significantly higher among participants with health insurance (55.2%) compared to participants without coverage (42.5%). The ATT values in intervention and control group were 0.55 and 0.46 (p < 0.001). Similarly, the ATU values in intervention and control group were 0.42 and 0.51. The ATE value was 0.08. CONCLUSION: Our study shows that the health insurance coverage had significant impact on utilization of healthcare services during COVID-19 pandemic. Further longitudinal research exploring the effect of different forms of health insurance for improving access and utilization of healthcare services can be undertaken.

Institutional disrespect and abuse during health-care utilization in public health facilities of Tamil Nadu: A facility-based cross-sectional survey.

Background: Disrespect and abuse have a negative impact on the quality of care provided in the public health facilities, thereby impacting the public health-care utilization of the patients. Objectives: This study aims to capture the burden and determinants of disrespect and abuse faced by the patients who seek care from public health facilities in Tamil Nadu. Methods: This study was conducted among 4917 participants at outpatient and inpatient levels in 18 public health facilities across six districts in Tamil Nadu. Institutional disrespect and abuse were reported as proportion with 95% confidence interval (CI). Logistic regression model was done to assess the determinants of institutional disrespect and abuse. Results: Overall, the proportion of participants facing some form of institutional disrespect and abuse was 9.8% (95% CI: 9.0%-10.6%). Elderly patients (≥60 years) (adjusted odds ratio [aOR] = 2.71; 95% CI: 1.27-5.76), widowed/separated/divorced (aOR = 1.99; 95% CI: 1.11-3.57), patients with higher educational qualification (aOR = 1.82; 95% CI: 1.25-2.64), patients belonging to the richest quintile in terms of socioeconomic status (aOR = 4.96; 95% CI: 3.59-6.84), and patients having some form of chronic disease (aOR = 1.37; 95% CI: 1.07-1.75) had significantly higher odds of facing institutional disrespect and abuse. Conclusion: Almost one in ten patients visiting secondary and tertiary care public health facilities in Tamil Nadu had faced some form of disrespect during their hospital visit/stay. The findings from our study should be taken up and further qualitative exploration to identify the reasons for such disrespectful care and corrective solutions should be suggested.

Hypertension in India: Trends in Wealth-related Inequalities from the National Family Health Surveys.

INTRODUCTION: India depicts a very high prevalence of hypertension. We need to learn more about the effect of wealth-related disparities on the prevalence of hypertension. The primary objective of this study was to assess temporal changes in the epidemiology of hypertension and associated wealth-related disparities among adults using two waves of nationally representative datasets from India. METHODS: We did a secondary data analysis of the National Family Health Survey (NFHS) rounds 4 and 5. We included information from the two rounds from 699,686 and 108,791 males and 92,804 and 677,803 females. Weighted analysis and multivariate binomial regression were used to depict the prevalence and predictors of hypertension. Inequalities were estimated using the concentration index (CI) and concentration curves. RESULTS: The weighted prevalence of hypertension among males increased from 14.6% to 16.7% among males, and from 8.8% to 9.9% among females, between NFHS-4 and NFHS-5. Prehypertension rose from 43.3% to 48.3% for males, and females, from 30.2% to 36.2% between the NFHS rounds. Overall, the CI among the males (0.078 and 0.050) and females (0.102 and 0.059) decreased from rounds 4 to 5, depicting a decrease in pro-poor wealth-related inequalities in hypertension prevalence in India. CONCLUSIONS: To conclude, the current analysis depicts that inequalities due to which hypertension was more prevalent in the wealthier classes in India are slowly disappearing. Therefore, we need to target the already exhausted poor patients with limited access to health-care resources to prevent them from further shifting beyond the line of poverty before these differences narrow down further.

Association between behavioural risk factors and metabolic syndrome among adult population in India: A systematic review and meta-analysis of observational studies.

AIMS: The impact of behavioural risk factors on the metabolic syndrome has not been well understood by the researchers. This information is important to the policymakers for developing effective strategies and implement relevant policies or programs. Hence, we undertook this meta-analysis to estimate the effect of behavioural risk factors on the burden of metabolic syndrome. DATA SYNTHESIS: We conducted a search in the databases, such as PubMed Central, EMBASE, MEDLINE, and Cochrane library, and search engines, such as ScienceDirect and Google Scholar, from inception until March 2021. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of published studies. We carried out a meta-analysis with random-effects model and reported pooled odds ratio (OR) with 95% confidence interval (CI). In total, we analysed 30 studies with 41,090 participants. The majority of the studies had good to satisfactory quality as per NOS. Physical activity had a statistically significant association with the prevalence of metabolic syndrome (pooled OR = 1.57; 95%CI: 1.28 to 1.93, I2 = 91%). However, smoking (pooled OR = 0.96; 95%CI: 0.75 to 1.23, I2 = 90.5%) and alcohol (pooled OR = 1.00; 95%CI: 0.75 to 1.33, I2 = 90.8%) did not reveal a statistically significant association with the burden of metabolic syndrome. CONCLUSION: Physical inactivity was found to be a significant risk factor for metabolic syndrome. Given the evidence, it is important that the clinicians and policymakers are alike to recommend regular physical activity among the patients and general population.

Association between indoor air pollution and cognitive function among nationally representative sample of middle-aged and older adults in India-A multilevel modelling approach.

We have used a nationally representative sample of middle-aged and older adults in India to study the association between indoor air pollution and cognitive function. Longitudinal aging study in India (LASI) Wave-I data was utilized for this study. A two-level mixed-effects linear regression model was used to study the association between indoor air pollution and cognitive function and interpreted as adjusted beta coefficient (ꞵ) with 95% confidence interval (CI). In total, 56,179 participants aged ≥45 years were included in the analysis. The proportion of participants living in households with indoor air pollution were 30.6% (95%CI: 30.0%-31.3%). After adjusting for all the potential confounders (age, gender, education, region, religion, separate kitchen, socioeconomic status, marital status, residence, smoking, alcohol consumption, body mass index, self-rated health, and sleep problems), participants living in households with indoor air pollution had significant decline in the cognitive function when compared to those living in households without indoor air pollution (ꞵ = -0.57; 95%CI: -0.69 to -0.45). Since the LASI survey is being conducted as a biennial panel survey, assessing the impact of indoor air pollution on cognitive decline using the follow-up data can provide further insights into the pathogenesis of condition.

Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey.

BACKGROUND: Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. METHODS: Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). RESULTS: In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. CONCLUSION: Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.

Development and validation of questionnaire assessing the perception of hospital patient safety practices in public health facilities of India.

BACKGROUND: In 'To Err is Human' released by the Institute of Medicine Committee on Quality of Health Care, it was emphasized that it is important to establish a safety culture in the hospitals and ensure that patients are not inadvertently harmed by errors. OBJECTIVE: Hence, we developed and validated a questionnaire for assessing the perception of patient safety practices across secondary and tertiary care facilities in India. METHOD: The scale was developed based on the literature review and expert opinion. It consisted of 10 questions, and the responses to these items were based on a five-point Likert scale ranging from 'strongly agree' to 'strongly disagree'. All analysis was performed using STATA version 14.2 software. Exploratory factor analysis (EFA) was run using principal component analysis with oblique promax rotation and confirmatory factor analysis (CFA) using structural equation modelling with maximum likelihood estimation. RESULTS: The entire dataset was split into testing set to run EFA (with 692 participants) and validation set to run CFA (with 645 participants). In EFA, two factors were retained as they had eigenvalue more than one (4.76, 1.09) and the scree plot also showed that the slope flattens off after two factors. Factor loadings were generated using oblique promax rotation. Factor 1 consisted of seven items (Item 1, Item 2, Item 3, Item 4, Item 5, Item 6 and Item 7-questions related to patient-doctor communication, hospital environment and procedures) accounting for 47.6% of variance, and Factor 2 had three items (Item 8, Item 9 and Item 10-infection prevention and control practices in hospital) explaining 10.9% of the variance. Thus, together, the two factors explained 58.5% of the variance. CFA revealed good confirmatory fit indices of 0.85, standardized root mean square residual of 0.07 and acceptable Tucker-Lewis Index of 0.80. The reliability coefficient was 0.88 indicating very good internal consistency. CONCLUSION: This study develops and validates a scale that can be used universally for assessing the patients' perception on hospital safety practices across secondary and tertiary care facilities in India.

Association Between Anthropometric Risk Factors and Metabolic Syndrome Among Adults in India: A Systematic Review and Meta-Analysis of Observational Studies.

INTRODUCTION: Several studies have explored the effect of anthropometric risk factors on metabolic syndrome. However, no systematic effort has explored the effect of overweight and obesity on the prevalence of metabolic syndrome in India. Thus, we undertook a meta-analysis to estimate the effect of anthropometric risk factors on the prevalence of metabolic syndrome. METHODS: We searched databases PubMed Central, EMBASE, MEDLINE, and Cochrane library and search engines ScienceDirect and Google Scholar, from January 1964 through March 2021. We used the Newcastle-Ottawa scale to assess the quality of published studies, conducted a meta-analysis with a random-effects model, and reported pooled odds ratios (OR) with 95% CIs. RESULTS: We analyzed 26 studies with a total of 37,965 participants. Most studies had good to satisfactory quality on the Newcastle-Ottawa scale. Participants who were overweight (pooled OR, 5.47; 95% CI, 3.70-8.09) or obese (pooled OR, 5.00; 95% CI, 3.61-6.93) had higher odds of having metabolic syndrome than those of normal or low body weight. Sensitivity analysis showed no significant variation in the magnitude or direction of outcome, indicating the lack of influence of a single study on the overall pooled estimate. CONCLUSION: Overweight and obesity are significantly associated with metabolic syndrome. On the basis of evidence, clinicians and policy makers should implement weight reduction strategies among patients and the general population.

COVID-19 Severity and Mortality Among Chronic Liver Disease Patients: A Systematic Review and Meta-Analysis.

INTRODUCTION: Pre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver disease (CLD), a comorbid condition, with severity of disease and death among COVID-19 patients. METHODS: We searched for studies reporting COVID-19 outcomes among CLD and non-CLD patients in databases including Medline, EMBASE, ScienceDirect, Google Scholar, and Cochrane Library from inception of the pandemic until February 2022. Risk of bias assessment was conducted by using the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. We conducted a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% CIs. RESULTS: We included 40 studies with 908,032 participants. Most studies were conducted in China and the US. COVID-19 patients with CLD had significantly higher odds of having a severe form of COVID-19 (pooled OR = 2.44; 95% CI, 1.89-3.16) and death (pooled OR = 2.35; 95% CI, 1.85-3.00) when compared with COVID-19 patients without CLD. CONCLUSION: The presence of CLD is significantly related to adverse clinical outcomes among COVID-19 patients in terms of severity and mortality. Clinicians should develop a comprehensive intervention plan to manage these high-risk patients and reduce COVID-19-related deaths.

Access-Watch ratio based on access, watch, and reserve classification of antibiotics in public health facilities of Tamil Nadu.

The rise in cases of antibiotic resistance can be mainly attributed to the overuse and misuse of antibiotics. To address this issue, the WHO launched Access, Watch, and Reserve (AWaRe) classification of antibiotics in 2017 as a surveillance tool. Many countries have adopted it to monitor and optimize their antibiotic usage. However, implementation of it is yet not seen at a very appreciable level. Through this survey, we tried to explore the prescribing pattern of antibiotics based on the WHO AWaRe classification in selected secondary and tertiary care health facilities of Tamil Nadu. In-patient case sheets were audited in selected departments across 18 health facilities in six districts. Proportionately higher use of the watch group of antibiotics was found in all the districts. A lower access-watch ratio suggests the need for judicious implementation of such tools to safeguard this life-saving good and ensuring its sustainability.

Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16).

OBJECTIVE: To assess the spatial pattern and determinants of HIV infection in India. METHODS: We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. RESULTS: 230 213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR = 2.58, 95% CI: 1.22-5.40), living in an urban area (aOR = 2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR = 4.25, 95% CI: 2.60-6.93), Southern (aOR = 3.13, 95% CI: 1.99-4.91) or Western region (aOR = 2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR = 1.99, 95% CI:1.42-2.79), a suspected STI (aOR = 2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR = 7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. CONCLUSION: HIV infection among adults aged 15-54 years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.

Prevalence and risk factors associated with latent tuberculosis infection among household contacts of smear positive pulmonary tuberculosis patients in South India.

OBJECTIVE: We aimed to determine the prevalence and find the risk factors associated with latent tuberculosis infection (LTBI) among the household contacts (HHC) of pulmonary TB patients. METHODS: This cohort study was conducted from 2014 to 2019. Pretested standardised questionnaires and tools were used for data collection. The prevalence of LTBI among HHCs of TB patients was summarised as proportion with 95% confidence interval (CI). Mixed-effects generalised linear modelling function (meglm) in STATA with family Poisson and log link was performed to find the factors associated with LTBI. RESULTS: In total, 1523 HHC of pulmonary TB patients were included in the study. Almost all HHC shared their residence with the index case (IC) for more than a year; 25% shared the same bed with the IC. The prevalence of LTBI among the HHC of TB patients was 52.6% (95% CI: 50.1-55.1%). In an adjusted model, we found that among HHC belonging to the age group of 19-64 years (aIRR = 1.2; 95% CI: 1.1-1.3; p-value: 0.02), to the age group >65 years (aIRR = 1.4, 95% CI: 1.1-1.9, p-value: 0.02) and sharing the same bed with the IC (aIRR = 1.2, 95% CI: 1.1-1.3, p value: 0.04) were independent determinants of LTBI among the HHC. CONCLUSION: One in two household contacts of TB patients have latent tuberculosis infection. This underscores the need of targeted contact screening strategies, effective contact tracing and testing using standardised methods in high TB burden settings.

Effectiveness of Financial Incentives in Achieving UNAID Fast-Track 90-90-90 and 95-95-95 Target of HIV Care Continuum: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Financial incentives influence behavioural changes and the current review was done to assess the effectiveness of this intervention in improving HIV care continuum. We conducted systematic searches in MEDLINE, Cochrane library, ScienceDirect and Google Scholar from inception until July 2019. We carried out a meta-analysis with random-effects model quantifying inconsistency (I2) for heterogeneity and reported pooled Risk Ratios (RR) with 95% confidence intervals (CIs). A total of 22 studies with 38,119 participants were included. All the six outcomes showed better results in financial incentive arm compared to standard care with statistical significance in three outcomes-HIV testing uptake (pooled RR: 2.42; 95%CI 1.06-5.54; I2 = 100%), antiretroviral therapy (ART) adherence (pooled RR: 1.30; 95%CI 1.13-1.50; I2 = 44%), and continuity in care (pooled RR: 1.24; 95%CI 1.09-1.41; I2 = 86%). To summarize, financial incentives can be helpful in improving the uptake of HIV testing, ART adherence and continuity of care while it was better for achieving viral load suppression among studies conducted in high-income countries.