A descriptive study of hepatitis C in people who inject drugs.

BACKGROUND OBJECTIVES: The seroprevalence of the hepatitis C virus (HCV) in general population is higher than that of human immunodeficiency virus (HIV) in India. People who inject drugs (PWIDs) constitute a high-risk group for all blood-borne infections. Multiple behavioural surveillance surveys have provided a rich typology of HIV-infected PWIDs, but this information is missing for HCV infection. We describe awareness, transmission risk factors and the treatment continuum for HCV infection among PWID. We also report spatial clustering of HCV infection in PWIDs residing in Bengaluru. METHODS: Information from clinical records was collected and telephonic interviews of retrospectively identified PWIDs who received treatment at a tertiary-level addiction treatment facility between 2016 and 2021 were conducted. RESULTS: We identified 391 PWIDs; 220 (56.26%) received an anti-HCV antibody test (4 th Generation HCV-Tridot). Individuals reporting unsafe injection practices were more often tested than those who did not ( χ2 =44.9, df=1, P <0.01). Almost half of the tested and more than a quarter of the whole sample (109/220, 49.9%; 109/391, 27.9%) were seropositive for HCV infection. The projected seropositivity in this group was between 27.9 per cent (best case scenario, all untested assumed negative) and 71.6 per cent (worst case scenario, all untested assumed positive). Only a minority of participants interviewed were aware of HCV (27/183, 14.7%). HCV infection and its associated risk behaviour (PWID) were clustered in certain localities (Diggle and Chetwynd Test; P =0.001) in Bengaluru in the southern district of Karnataka. INTERPRETATION CONCLUSIONS: Undetected HCV infection is common in PWIDs; awareness and treatment uptake is poor in this group. Spatial clustering of infections in a district shows transmission in close networks and provides opportunities for targeted interventions.

Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial.

BACKGROUND: The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated. OBJECTIVE: Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. METHODS: Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial. RESULTS: Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing. CONCLUSIONS: This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program. TRIAL REGISTRATION: Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41127.

IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S): A protocol for a randomised controlled feasibility trial of a combined behavioural and pharmacological support intervention.

INTRODUCTION: The prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention,i.e., the IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S) intervention that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial. METHODS: We will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice (BA) or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in upto 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. Outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. We will also conduct a process evaluation. RESULTS: Study will address- uncertainty about feasibility and acceptability of delivering smoking cessation interventions, and ability to conduct smoking cessation trials, among adult smokers with SMI in low- and middle-income countries. CONCLUSIONS: This is to inform further intervention adaptation, and the design and conduct of future randomised controlled trials on this topic. Results will be disseminated through peer-review articles, presentations at national, international conferences and policy-engagement forums. TRIAL REGISTRATION: ISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/.

Title of the study: Practice and attitude of doctors towards patients with substance use: A study from south India.

AIM: To evaluate the practice and attitude of doctors towards substance use disorders (SUD) and their management. METHODS: Following stratified proportionate random sampling, selected doctors in the south zone of Bengaluru, India, were interviewed face-to-face using a structured questionnaire. RESULTS: 150 doctors were interviewed. In their practice, a quarter of patients (median of 27.5 (IQR: 11.45-45) use one or other form of Alcohol, Tobacco or Other Drugs of abuse (ATOD). Doctors, in general, enquire about substance use but do not actively intervene. They have mixed attitudes (both positive and negative) towards persons with SUD. A significant positive correlation was noted between the number of years of experience (post-MBBS) with practices related to "brief-intervention" (p = 0.014) and "concerned and sympathetic" attitudes (p < 0.001). However, a significant negative correlation was observed between the number of years of experience and "substance-specific management" practices (p < 0.001). Further, there was a positive correlation between "brief-interventions" practices with the attitude of being "concerned and sympathetic" (p < 0.001). A mediation analysis revealed that nearly a third of the overall effect of the number of years of experience on brief-interventions practices was mediated by a concerned and sympathetic attitude. CONCLUSIONS: Serious efforts must be made to train doctors in the effective management of SUD. Attitudes of the doctors influence practices such as brief interventions. Programs directed towards changing the attitudes of doctors can bring changes in their practices.

Knowledge, attitude, and behaviours on diet, physical activity, and tobacco use among school students: A cross-sectional study in two Indian states.

Background: Non-communicable diseases (NCDs) are escalating in India and can be attributed to behavioural risk factors such as unhealthy diet, physical inactivity and tobacco use that began in early years. Understanding adolescents' knowledge, attitudes and behaviours (KAB) related to NCD risk factors would inform the development of school-based health programmes to prevent NCDs. Methods: Sixth-grade students (n=1026) in 20 schools (10 private, 10 public) from two Indian cities (n=667 from Pune; n=359 from Bengaluru) participated in a KAB survey in 2019. Differences in KAB by gender, school type within cities were investigated. Results: Knowledge about the harms of tobacco use was higher than knowledge about a healthy diet and the importance of physical activity. Only a small proportion of students did not eat breakfast (8.7%) or fruits (11.3%) daily. Only 33.4% of students read nutrition labels before choosing their food. Moderate-to-vigorous physical activity of less than an hour per day was reported by 42.5% of students. Approximately one-third of students had ever tried smoking tobacco (30.1%), smokeless tobacco (30.5%), and e-cigarettes (32.4%). Differences in these behaviours by gender and school type showed that both boys, girls and students of private and public schools are vulnerable. Conclusions: The findings highlight that knowledge is low for thematic areas like diet and physical activity. Low knowledge can be attributed to unfavourable behaviours like lack of reading nutrition labels and indulgence in sedentary activities. To protect India's young population (adolescents), there is a need to amplify health education activities and context-specific health intervention materials for them by engaging parents and communities. Thus, these programmes should be incorporated into the curriculum as part of the regular teaching, as they may induce positive changes in their knowledge and behaviours. In India, school health programmes should dedicate significant time to health promotion and NCD risk prevention.

Suicidal Ideation among Persons with Alcohol Use Disorder: A Cross-Sectional Study.

Background: Suicide is a major threat to public health worldwide. Evidence suggests alcohol use disorders (AUD) are associated with suicide ideation. There is a paucity of studies in India regarding suicidal ideation among individuals receiving in-patient treatment for alcohol dependence. Aim: To assess the suicidal ideation and its severity among persons with alcohol use disorder. Methods: Cross-sectional research design was used. Totally 47 persons with alcohol use disorder receiving in-patient treatment were screened for suicidal ideation using a consecutive sampling technique based on inclusion and exclusion criteria at centre for addiction medicine, tertiary care teaching hospital at Bangalore. An interview schedule was used to collect the data. Tools: Mini+ suicidality was used for screening suicidal ideation and Columbia suicide severity rating scale was used to assess the frequency and severity of the suicidal ideation. Descriptive statistics such as frequency, percentage, mean were used for data analysis. Results & Discussion: Out of 47 patients, 29 reported having suicidal ideations (62%). AUD suicidal ideation was more among persons belong to below poverty line, lower education level, unemployed, married, living with family of origin, nuclear family, urban, using tobacco. Their mean age was 35 years (±6.6). Majority (62%) of them had suicidal ideation in the past one month, 43% reported having thought to kill themselves over the past one month. One-third (35%) able to control suicidal thought with lot of difficulty, 83% reported that deterrents stopped them attempting suicide, 82%wanted to end their life to end or stop the pain that they are enduring. Conclusion: The prevalence of suicidal ideations is high among persons with alcohol use disorder. Socio-demographic factors likely to have an influence on suicidal ideation among persons with alcohol use disorder.

A systematic review and meta-analysis of the prevalence of common mental disorders in people with non-communicable diseases in Bangladesh, India, and Pakistan.

BACKGROUND: The prevalence of mental and physical comorbidities is unknown in South Asia, as estimates of mental ill health in patients with non-communicable diseases (NCDs) have predominantly come from studies based in the United States, Europe and Australasia. This systematic review and meta-analysis summarises evidence and provides pooled estimates of the prevalence of common mental disorders in adults with non-communicable diseases in South Asia. METHODS: We included prevalence studies of depression and anxiety in adults with diabetes, cancer, cardiovascular disease, and chronic respiratory conditions in Bangladesh, India, and Pakistan, published from 1990 onwards in international and country-specific databases. RESULTS: Out of 96 included studies, 83 provided data for random effects meta-analyses. The pooled prevalence of depression was 44% (95% confidence interval (CI) = 26 to 62) for patients with COPD, 40% (95% CI = 34 to 45) for diabetes, 39% (95% CI = 23 to 56) for stroke, 38% (95% CI = 32 to 45) for hypertension, and 37% (95% CI = 30 to 45) for cancer. The pooled prevalence of anxiety based on 28 studies was 29% (95% CI = 22 to 36). Many quality issues were identified in a critical appraisal of included studies, mostly relating to the sampling frame and selection process, the description of the methods and basic data, and the description of non-responders. CONCLUSIONS: Depression and anxiety are prevalent and underdiagnosed in people with physical comorbidities in Bangladesh, India, and Pakistan.

Effectiveness of a structured teaching program (STP) on cessation of tobacco chewing, on knowledge and attitude among female hospital housekeeping personnel - a pilot study.

AIM: To evaluate the effectiveness of a structured teaching program (STP) on: a) improving knowledge of female hospital housekeeping personnel regarding harmful impact of tobacco chewing and how to quit, and b) fostering an unfavorable attitude toward tobacco chewing. METHODS: The STP focused on adverse health effects of tobacco chewing, myths and facts, and tobacco cessation. It was administered in regional language to female hospital housekeeping personnel (N=35) over three days. Post-assessments were conducted at 4 weeks following the last session of the STP. RESULTS: Current tobacco use was reported by 26% of the sample. Tobacco chewers (vs. non-chewers) were more likely to be significantly older, have elementary education, belong to nuclear family, have lesser knowledge regarding harmful effects, and have a more favorable attitude toward the practice of tobacco chewing. At the end of 4 weeks following the STP, participants significantly improved their knowledge regarding the harmful health impact of tobacco chewing and how to quit (p=0.001), and showed a significantly less favorable attitude toward tobacco chewing (p=0.001). Change in participants' knowledge scores was found to be negatively correlated with change in attitude scores, implying that increase in knowledge was associated with less favorable attitude toward tobacco chewing (r=-0.427, p=0.011). CONCLUSION: Findings provide preliminary evidence for the effectiveness of health education on harmful impact of tobacco chewing and how to quit, delivered through a STP, in improving knowledge and fostering an unfavorable attitude toward tobacco chewing, among female hospital housekeeping personnel.

Tamoxifen-induced hypertriglyceridemia causing acute pancreatitis.

Tamoxifen has both antagonistic and agonistic tissue-specific actions. It can have a paradoxical estrogenic effect on lipid metabolism resulting in elevated triglyceride and chylomicron levels. This can cause life-threatening complications like acute pancreatitis. To our knowledge, very few cases of tamoxifen-induced pancreatitis have been reported in the literature. We report a case of severe hypertriglyceridemia and acute pancreatitis following tamoxifen use. A 50-year-old diabetic lady was on tamoxifen (20mg/day) hormonal therapy for breast cancer. Within 3 months of starting therapy, she developed hypertriglyceridemia and acute pancreatitis. Laboratory values include: Serum amylase 778 IU/L, total cholesterol 785 mg/dL, triglycerides 4568 mg/dL and high-density lipoproteins (HDL) 12 mg/dL. Tamoxifen was substituted with letrozole and atorvastatin started. There was a prompt reversal of the adverse effects. Effects on lipid profile must be considered while initiating tamoxifen in predisposed individuals as the consequences are life threatening.