An improved record system for tracing outcome of "transferred-out" DOTS patients.

This study in Pakistan aimed to develop an improved record-keeping mechanism for the DOTS programme to establish the final treatment status of patients recorded as "transferred-out". In an intervention study in 40 DOTS diagnostics centres in Punjab province, a modification was made to the existing TB03 register. DOTS facilitators were trained to keep proper records of patients who transferred-out and transferred-in. Among 4442 registered cases, 104 patients (2.3%) transferred out of reporting centres. Correct matching of "-out and -in" patients was achieved for 74 (71.2%) patients; the remaining 30 (28.8%) were untraced. By tracing transferred-out cases, the adjusted outcome success rate increased in the intervention period from 89.6% to 90.9%.

HIV/AIDS in Ethiopia: where is the epidemic heading?

OBJECTIVES: A possible decline in prevalence of HIV in some sub-Saharan African countries has been reported recently. The present study aimed to evaluate the prevalence and incidence of HIV and behavioural data to investigate trends in HIV/AIDS in Ethiopia. METHODS: A review was conducted of published reports and literature, raw and modelled (using Epidemic Projection Package and Spectrum software) surveillance data and estimates from antenatal clinics (ANCs) and data from voluntary counselling and testing centres. Observations were restricted to the adult population. RESULTS: Between 2001 and 2003, more ANC sites showed a decline than a rise in HIV prevalence, but most lacked statistical significance. Modelled data suggested a rise in prevalence of HIV in rural areas (2003: 2.6%) and in all Ethiopia (2003: 4.4%), but a stable or declining prevalence in Addis Ababa (2003: 14.6%) and other urban areas (2003: 11.8%). Modelled HIV incidence, inferred from prevalence changes, showed a slowly rising trend in Addis Ababa (2003: 2.0%), other urban areas (2003: 1.7%), and rural Ethiopia (2003: 0.46%). The total burden of HIV/AIDS is expected also to rise substantially due to population growth. In Addis Ababa, crude data on HIV prevalence from ANCs too suggested a falling trend. Voluntary counselling and testing data from 2002 to 2004 supported this trend but indicated a mixed trend pattern for high risk behaviour. No other serial behavioural trend data were available. CONCLUSIONS: Lack of quality data on behavioural trends impedes the interpretation of prevalence and incidence data in Ethiopia. Modelled data suggest an expanding HIV epidemic in rural and all Ethiopia, but a possible decline in some urban areas. Crude site prevalence values may be more sensitive to acute changes, possibly indicating a slowing/reversal of the epidemic's expansion.

Urban to rural routes of HIV infection spread in Ethiopia.

A descriptive survey to identify routes of spread of HIV infection from urban to rural populations was carried out in a rural south-central Ethiopian district. High risk practices for HIV infection and transmission were first documented among rural residing former soldiers, merchants and students. Extramarital intercourse during the previous 3 months was reported by 45-50% of these subgroups. In 25-37%, intercourse with an urban commercial sex worker (CSW) was reported and condom use varied from 10 to 30% among subgroups. The perceived risk for AIDS was low and changes in risk behaviours were minimal. Next, 502 rural males farmers were surveyed. An extramarital sexual contact in the past 3 months was reported by 13.5%, with 7% reporting their most recent contact with an urban CSW. Only 6% of farmers reported using condoms. Awareness of AIDS was reported by 59% and, of these, only 28% perceived they were vulnerable. In this study increased knowledge was associated with more frequent high risk sexual practices. It is concluded that the spread of AIDS into rural communities is occurring as a result of the high frequency of high risk sexual behaviours in specific rural residing subgroups which frequently travel into urban communities in combination with a low background prevalence of high risk practices among the general male farmer population.

PIP: During December 1991-February 1992, in Ethiopia, interviews were conducted with 19 merchants, 20 high school students, 20 recently returned soldiers, and 502 rural farmers to examine movement patterns and the incidence of high risk behaviors for HIV infection and transmission from urban into rural communities. 45-50% of soldiers, students, and merchants had extramarital intercourse in the last three months, mainly with a commercial sex worker (CSW) (45-78%). (HIV prevalence among CSWs exceeds 60% in some instances.) Condom use was highest in students (55%), followed by soldiers (22%). None of the merchants used a condom. Among the men who had had extramarital sex, the mean number of penetrations/contact ranged from 3.7 to 4.9 per subgroup. 90% of soldiers, 40% of students, and 32% of merchants hoped to have sexual intercourse while in town. 13% of farmers had had extramarital sex, usually with a CSW (50%), in town (54%), and without using a condom (94%). All the students knew about AIDS and condoms, yet only 40% considered themselves vulnerable to AIDS and only 10% changed their sex behavior. Most soldiers, merchants, and farmers knew about AIDS (70%, 68%, and 59%, respectively). Knowledge of condoms was lowest among farmers (11% vs. 80% for soldiers and 47% for merchants). Less than 50% of soldiers considered themselves to be vulnerable to AIDS and only 14% had adopted safer sex practices. Only 28% of farmers who knew about AIDS considered themselves at risk of AIDS. Among farmers, high risk sexual practices were related to younger age (p 0.03), literacy (p 0.05), Gurage ethnicity (p 0.008), and Moslem religion (p 0.001). When the researchers controlled for age, literacy, and religion, knowledge about AIDS had a strong positive association with high risk sexual practices (beta = 0.19; 95% confidence interval, 0.01-0.3). These findings indicate that high risk sexual behaviors for HIV infection are common among highly mobile, rural male populations. They suggest that farmers may be the main carrier of HIV into rural Ethiopian communities.