Trends and sub-national disparities in TB notifications in India: Insights from HMIS data.

BACKGROUND/OBJECTIVES: Tuberculosis (TB) is a public health crisis across the globe, especially in the developing world including India. Around 27% of 10 million TB cases and 33% of 1.2 million TB deaths were contributed from India alone during 2018. Present study aims to estimate TB notification rates at national and sub-national levels up to District administrative blocks, which is very important with policy perspective. METHODS: The study mainly uses data from India's Health Management Information System (HMIS) for three consecutive years, 2017-18, 2018-19 and 2019-20. TB notification rates were calculated for India up to the lowest administrative level of health Districts. GIS maps were being used for mapping District-wise TB notification rates for 2017-18 and 2019-20. RESULTS: Results show that TB notification rates have increased from 152/lakh population in 2017-18 to 197 in 2019-20, an increase of 30%. Similarly, the increasing trends in TB notification rates were also observed at State as well as District level. However, wide rural-urban and public-private differences were observed in TB notification rates. Further, results illustrated huge inter-State and inter-District variations; and half of the TB cases in India were contributed only by six larger States. CONCLUSIONS: The findings of the study shows the increasing notification in India since 2017-18, which is a clear indication of the efforts put in the TB program to achieve targets and goals committed to end TB by 2025. In this regard present estimates based on HMIS data significantly contributes to the policy formulation even at the lowest administrative level of health Districts.

The hub-and-spoke model of national STEMI programme of India: An investigation of STEMI-Goa project.

INTRODUCTION: Government of Goa initiated ST Elevation Myocardial Infarction(STEMI) - Goa project for achieving the objectives of Ayushman Bharat and Sustainable Development Goals to reduce the premature mortality from non-communicable diseases by one-third with adopting advanced health practices and modern technology. The project handles the escalating STEMI cases in Goa since December 2018. METHODS: Mix-method was used for data collection in this study and service statistics was collected from the hub and spoke hospitals. Additionally, staff engaged in the implementation of STEMI model were interviewed. We have visited 13 public health facilities including Goa Medical College where the 'Hub-and-Spoke' model of STEMI has institutionalized. The data was collected during October 2019 by employing the pre-designed checklist. RESULTS: All patients who reached the hub-hospital undergone with angiography followed by angioplasty if required. Since the initiation of the project total of 546 patients were diagnosed with the STEMI and 85 percent of patients admitted with a STEMI were thrombolized, - subsequently, 64 percent of them undergone for angiography. Considering the mortality, around 6 percent of deaths have occurred during the past six months. Our study highlights the positive effect of the Hub-and-Spoke model on the treatment of patients with STEMI. The hub-and-spoke model is functioning effectively under the continuous monitoring of expert cardiologists. Additionally, the model has a review committee to investigate deceased cases, advanced cardiac care ambulances and modern ECGs technology. CONCLUSION: The model can be implemented at a larger scale in other parts of India with the required human resource and advanced technology.

Acceptability and adherence of a candidate microbicide gel among high-risk women in Africa and India.

Vaginal microbicides currently under development are substances that may prevent the transmission of HIV. Qualitative, in-depth post-trial interview data from a Phase III clinical trial of 6% Cellulose Sulfate microbicide gel in two sites in Africa (Uganda and Benin) and two in India (Chennai and Bagalkot) were examined in order to better understand factors that influence microbicide acceptability and adherence in a clinical trial setting. Women found the gel relatively easy to use with partners with whom there were no expectations of fidelity, in situations where they had access to private space and at times when they were expecting to engage in sexual intercourse. Adherence to gel seemed significantly more difficult with primary partners due to decreased perceptions of risk, inconvenience or fear of partner disapproval. Findings suggest that women in a variety of settings may find a microbicide gel to be highly acceptable for its lubricant qualities and protective benefits but that adherence and consistent use may depend greatly on contextual and partner-related factors. These findings have important implications for future trial designs, predicting determinants of microbicide use and acceptability and marketing and educational efforts should a safe and efficacious microbicide be found.