Building communities of practice through case-based e-learning to prevent and manage TB among people living with HIV-India.

BACKGROUND: Co-management of HIV-TB coinfection remains a challenge globally. Addressing TB among people living with HIV (PLHIV) is a key priority for the Government of India (GoI). In 2016, GoI implemented single-window services to prevent and manage TB in PLHIV. To strengthen HIV-TB service delivery, case-based e-learning was introduced to health care providers at Antiretroviral Therapy centres (ARTc). METHODS: We implemented a hub and spoke model to deliver biweekly, virtual, case-based e-learning at select ARTc (n = 115), from four states of India-Delhi, Uttar Pradesh, Andhra Pradesh and Tamil Nadu. We evaluated feasibility and acceptability of case-based e-learning and its impact on professional satisfaction, self-efficacy, knowledge retention using baseline and completion surveys, session feedback, pre-and post-session assessments. We reviewed routine programmatic data and patient outcomes to assess practices among participating ARTc. RESULTS: Between May 2018 and September 2020, 59 sessions were conducted with mean participation of 55 spokes and 152 participants. For 95% and 88% of sessions ≥ 80% of respondents agreed that topics were clear and relevant to practice, and duration of session was appropriate, respectively. Session participants significantly improved in perceived knowledge, skills and competencies (+ 8.6%; p = 0.025), and technical knowledge (+ 18.3%; p = 0.04) from baseline. Participating ARTc increased TB screening (+ 4.2%, p < 0.0001), TB diagnosis (+ 2.7%, p < 0.0001), ART initiation (+ 4.3%, p < 0.0001) and TB preventive treatment completion (+ 5.2%, p < 0.0001). CONCLUSION: Case-based e-learning is an acceptable and effective modus of capacity building and developing communities of practice to strengthen integrated care. E-learning could address demand for accessible and sustainable continuing professional education to manage complex diseases, and thereby enhance health equity. We recommend expansion of this initiative across the country for management of co-morbidities as well as other communicable and non-communicable diseases to augment the existing capacity building interventions by provide continued learning and routine mentorship through communities of practice.

Gender-based violence programming in times of COVID-19: Challenges, strategies and recommendations.

Gender-Based Violence (GBV) remains the most challenging and threatening manifestation of gender inequality in Indian society. The outbreak of COVID-19 in India increased the risk of exposure to GBV, often compared to the "shadow pandemic". Girls suffered disproportionally compared to boys during the pandemic -from being pulled out of schools, facing movement restrictions, and being more susceptible to forced marriage and household violence. Pre-existing gender inequalities and regressive gender norms, along with economic instability, also contributed to creating a milieu for violence to thrive. Additionally, the pandemic also challenged GBV service provision and program implementation at the community level. To meet the increasing needs of women and girls during the crisis, national and local civil society organizations attempted to adapt GBV programming and promote innovative approaches to tackle GBV. The secondary review provides insight on the GBV impact due to the COVID-19 pandemic and provides an overview of various challenges at the level of individual, community, institution, and policy. The literature review also highlights strategies adopted to combat GBV in private, public and cyberspace.

Cultural and Social Bias Leading to Prenatal Sex Selection: India Perspective.

Globally, 23.1 million missing female births have been documented, resulting in an imbalanced sex ratio at birth (SRB) between the late 1990s and 2017, with India accounting for almost half of this missing women population. While the country is progressively taking measures to enhance women's position in society and implementing policies toward augmenting the value of a girl child, some deeply rooted cultural and social beliefs propel a strong son preference, resulting in active daughter discrimination. The continuance of patriarchal norms and inequitable gender roles, resulting in son preference, fertility decrease, and reduction in preferred family sizes, and technical breakthroughs that allow for the identification of the sex of the fetus, is all connected to distortions in the sex ratio at birth. Son preference is a well-documented phenomenon in India, and its implications for skewed gender ratios, female feticide, and higher child mortality rates for girls have piqued researchers' and policymakers' interest. The fundamental factors of son preference as an ideology are less widely investigated. With this objective, an extensive secondary review was conducted of the socio-cultural norms and biases leading to increased prenatal sex selection in India despite the laws against it. The study findings suggest that it is imperative to emphasize the necessity for consistent and collective efforts from all stakeholders: changing the social perception of the value of girls requires collective effort and the equal participation of all stakeholders, including civil society organizations and the local community.

Hitting the bull's eye of ending tuberculosis goal: The challenge of addressing tuberculosis in human immunodeficiency virus positive population in India.

Eradicating tuberculosis in human immunodeficiency virus is all the more important to realise India's ambitious goal of tuberculosis free India by 2025. Although, continuous efforts are being made to address tuberculosis in human immunodeficiency virus co-infection, it is imperative to closely monitor the implemented strategies, encourage and validate disease notification system in the country, and bring about societal change to view this disease as an ailment only and not as a stigma.

Co-peptin: Role as a novel biomarker in clinical practice.

BACKGROUND: Arginine vasopressin (AVP) is a key regulator of water balance, but its instability makes reliable measurement difficult and precludes its routine use. Co-peptin is the C-terminal part of the AVP precursor which plays an important role in the correct structural formation of the AVP precursor and its efficient proteolytic maturation. Because of its stoichiometric generation, co-peptin mirrors the release of AVP and measurement of more stable co-peptin may be an indicator of AVP levels. METHOD: A comprehensive literature search was conducted from the websites of the National Library of Medicine (http://www.ncbl.nlm.nih.gov) and Pubmed Central, the US National Library of Medicine's digital archive of life sciences literature (http://www.pubmedcentral.nih.gov/). The data was assessed from books and journals that published relevant articles in this field. RESULT: Recent and ongoing research indicates the diagnostic and prognostic roles of co-peptin in various clinical settings especially in critically ill patients. CONCLUSION: Co-peptin levels are altered in various physiological and pathological conditions indicating its possible role as a biomarker. However, further research using co-peptin in various clinical settings will prove its cost-effectiveness and clinical usefulness.