Face mask use in the city of Chennai, India: Results from three serial cross-sectional surveys, 2021.

INTRODUCTION: The Government of Tamil Nadu, India, mandated wearing face masks in public places to combat the COVID-19 pandemic. We established face mask surveillance and estimated the prevalence of appropriate mask use (covering the nose, mouth, and chin) in the slums and non-slums of Chennai at different time points in 2021. METHODS: We conducted three serial cross-sectional surveys in the outdoors and indoors of Chennai in March, July, and October 2021. We observed the mask wearing among 3200 individuals in the outdoors and 1280 in the indoors. We divided the outdoor and indoor locations into slums and non-slums. In October 2021, we also surveyed 150 individuals from each of the 11 shopping malls in the city. We calculated the proportions and 95% confidence interval (95%CI) for the appropriate mask use in the outdoor, indoor, and malls by age, gender, region, and setting (slum and non-slum). RESULTS: We observed 3200 individuals in the outdoor and 1280 individuals in the indoor setting, each from a slum and non-slum, during the three rounds of the study. In outdoor and indoors, males comprised three-fourths and middle-aged individuals were half the study population. Mask compliance changed significantly with time (p-value <0.001). Males consistently demonstrated better compliance in all rounds. The south region had the highest mask compliance in slums indoors and outdoors in rounds 4 and 5. Young adults had the highest mask compliance in both outdoor slums and non-slums in all rounds. Overall mask compliance in shopping malls was 57% (95% CI: 48-65). CONCLUSION: The mask compliance in Chennai outdoors during the COVID-19 pandemic was less than 50%, with variations across time points by gender, age groups, and geographical locations. We must develop more effective communication strategies for older age groups and crowded indoor settings.

Prevalence of Selected Cardiovascular Risk Factors and Their Associated Factors among People Living with HIV/AIDS in India.

Background: Low- and middle-income countries face the dual problem of infectious and non-infectious diseases. Persons living with HIV/AIDS (PLHIV) are also at risk of cardiovascular diseases. Hence, we did this study to determine the prevalence of cardiovascular risk factors (CVRF) among PLHIV and to find the factors associated with it. Methods: We carried out a cross-sectional analytical study among all adults aged ≥18 years registered at a facility-integrated anti-retroviral therapy center in Puducherry, India, from September 2016 to February 2018. After obtaining informed consent, we interviewed the participants to assess physical activity, alcohol, and tobacco use. We measured weight, height, abdominal circumference, and blood pressure, with biochemical investigations such as blood glucose and lipid profile. Results: Of the total 316 adults PLHIV studied, the most common cardiovascular risk factor found was dyslipidemia (82.7%), followed by inadequate physical activity (74.4%). Other behavioral risk factors studied, such as current tobacco use and current alcohol use, showed a prevalence of 12.8% and 5.4%, respectively, among male participants. The prevalence of hypertension among adult PLHIV studied was 15.8%, and diabetes was 12.3%. In the multivariate analysis, diabetes, and hypertension were significantly associated with age and literacy. Obesity was found to be associated with diabetes and abdominal obesity with dyslipidemia. Conclusion: Dyslipidemia was the most common cardiovascular risk factor, followed by inadequate physical inactivity among PLHIV. Regular screening with blood glucose, blood pressure, and lipid profile, and timely cross-referrals can help in the early detection of CVRF among PLHIV and hence improve their quality of life through appropriate treatment.

India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022.

Background: Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented. Methods: We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment. Results: Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%-81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline. Conclusion: Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.

Effect of life skills education on socio-emotional functioning of adolescents in urban Puducherry, India: A mixed-methods study.

BACKGROUND: We wanted to assess the effect of life skills education (LSE) and regular curriculum on the self-esteem, self-efficacy, adjustment, and psychosocial functioning of students from co-educational government schools, compared to those receiving only the regular curriculum. The secondary objectives were to study the feasibility of such sessions and identify the factors affecting the effectiveness of the sessions. MATERIALS AND METHODS: We conducted a mixed-methods study in government schools of urban Puducherry, India in 2018-2019. The quantitative component was a cluster-randomized trial with activity-based learning methods delivered over 10 sessions in the intervention arm (IA). Differences in outcome variables (self-esteem, self-efficacy, adjustment, psychosocial behavior) between baseline and after intervention in each of the groups were calculated, and the difference-in-differences (DID) technique was applied to account for any natural change in scores over time. Qualitative data were collected through focused group discussions (FGDs) among students and teachers. Analysis was founded on a positivist paradigm with inducto-deductive methodology. RESULTS: The mean (SD) age of 258 participants was 13 (1) years in both arms. The mean (SD) difference between baseline and end-line for IA and control arm (CA) was 0.3 (4.4) and - 0.1 (4.0), for self-esteem (P = 0.38), 0.03 (6.0) and - 1.1 (6.1) for self-efficacy (P = 0.12), and - 0.04 (3.5) and - 0.05 (4.3) for adjustment (P = 0.73), respectively. Similarly, the median (interquartile range [IQR]) difference in the conduct problems scale of the Strengths and Difficulties Questionnaire was - 1 (-2, 1) and 0 (-1, 1) (P < 0.01). Five FGDs revealed multiple positive effects on anger management, conduct, self-awareness, and responsible behavior. All 10 teachers viewed life skills education (LSE) positively. CONCLUSIONS: LSE positively affects adolescents' socio-emotional functioning, but more extended periods of exposure are needed to demonstrate discernible change. The feasibility of implementation depends on the syllabus and based on health policies.

The Need for Nicotine De-addiction Services among Newly Diagnosed Tobacco-Related Head and Neck Cancer Patients, South India.

OBJECTIVES: This study aimed to determine the proportion of tobacco-related head and neck cancer patients in need of nicotine de-addiction services at the time of diagnosis and factors associated with it. METHODS: Facility-based cross-sectional study was conducted in a tertiary care center. Tobacco-related head and neck cancer patients with a past and present history of tobacco usage registered in cancer clinic from March 2016 to February 2017 were recruited. Participants were interviewed using a pretested and semi-structured questionnaire to gather information on the socio-demographic, clinical characteristics, and tobacco usage. Data were entered in EpiData v3.1 and analyzed using STATA v14. RESULTS: Among 220 participants recruited in the study, 83% were males, 47% were >60 years of age, and 40% had no formal education. Around 49% were smoking tobacco during the treatment period, 41% used smokeless tobacco, and 10% used both smoking and smokeless. The majority (56%) of them had stage T4 tumors. Around 71% of participants required de-addiction services. Those of age more than 70 years (aRR (95%CI) 1.43 (1.1-1.9)), currently employed (aRR (95%CI) 1.5 (1.2-1.9)), living alone (aRR (95%CI) 1.6 (1.0-2.5)) or in a nuclear family (aRR (95%CI) 1.5 (1.2-2)), who initiated tobacco use at a younger age (aRR (95%CI) 1.5 (1.0-2.2) were in higher need of de-addiction services. CONCLUSION: The majority of tobacco-related head and neck cancer patients required nicotine de-addiction treatment. Hence de-addiction services should be established as an integral unit of cancer clinics.

Knowledge, attitude, and practice towards face mask use among residents of Greater Chennai Corporation, India, March 2021.

Background: Wearing a mask is one of the simplest ways to reduce the spread of COVID-19. Studies reported poor mask compliance in Greater Chennai Corporation, India. Hence, we described the knowledge, attitude, and practice regarding mask use among adults (≥18 years) in Greater Chennai Corporation, Tamil Nadu, India. Methods: We conducted a cross-sectional survey among residents of Greater Chennai Corporation in March 2021. We estimated the sample size to be 203 per strata (slum and non-slum). We used a simple random sampling technique to select 20 locations using a digital map in the slum and non-slum areas. After reaching the location chosen, we selected 10 consecutive households and one adult (≥18 years of age) from each household. We used a validated, semi-structured questionnaire for collecting data regarding knowledge, attitudes, and practices for mask use. We estimated proportions and 95% CI for key variables and compared the variables between slums and non-slums. Results: Of 430 participants included in the study, 51.4% were males. The mean (S.D.) age of the participants is 41.1 (14.6) years. The majority (86.7%) of the participants felt that wearing a mask helped in reducing the spread of coronavirus and the knowledge differed (p-value < 0.05) between the slum (81.4%) and non-slum (92.3%). Nearly half (46.5%) of the participants did not like being forced to wear the mask. About 63.9% of the participants reported the practice of mask use while going out which was similar across slums and non-slums. Conclusion: Although the knowledge regarding mask use was good among the public, the attitude was unfavorable. We suggest continuous reinforcement by spreading awareness and educating the community on the appropriate use of the mask.

Effectiveness of the ChAdOx1 nCoV-19 Coronavirus Vaccine (CovishieldTM) in Preventing SARS-CoV2 Infection, Chennai, Tamil Nadu, India, 2021.

We estimated the effectiveness of two doses of the ChAdOx1 nCoV-19 (Covishield) vaccine against any COVID-19 infection among individuals ≥45 years in Chennai, Tamil Nadu, India. A community-based cohort study was conducted from May to September 2021 in a selected geographic area in Chennai. The estimated sample size was 10,232. We enrolled 69,435 individuals, of which 21,793 were above 45 years. Two-dose coverage of Covishield in the 18+ and 45+ age group was 18% and 31%, respectively. Genomic analysis of 74 out of the 90 aliquots collected from the 303 COVID-19-positive individuals in the 45+ age group showed delta variants and their sub-lineages. The vaccine's effectiveness against COVID-19 disease in the ≥45 age group was 61.3% (95% CI: 43.6-73.4) at least 2 weeks after receiving the second dose of Covishield. We demonstrated the effectiveness of two doses of the ChAdOx1 vaccine against the delta variant in the general population of Chennai. We recommend similar future studies considering emerging variants and newer vaccines. Two-dose vaccine coverage could be ensured to protect against COVID-19 infection.

SARS-CoV-2 cluster among security guards, Chennai, Tamil Nadu, India, June-July 2020.

Congregate work settings are at increased risk for SARS-CoV-2 transmission and predispose to super spreader events. We investigated a COVID-19 outbreak among security guards to identify the risk factors and propose recommendations. We defined a COVID-19 case as a laboratory-confirmed reverse transcription polymerase chain reaction-positive case. We traced the contacts actively and described the cases by time, place, and person. We conducted a case-control study and collected data on potential exposures. We identified 20 (27%) COVID-19 cases among 75 security guards. Among the cases, 17 (85%) were male and 12 (60%) were symptomatic. We recruited all the 20 COVID-19-confirmed cases and 55 COVID-19-negative controls for the case-control study. SARS-CoV-2 infection was higher among those had high-risk exposure (60%, [12/20]) than who did not (16%, [9/55], adjusted odds ratio = 5.9, 95% confidence interval = 1.6-22.1). Having had high-risk exposure with COVID-19 cases led to COVID-19 outbreak among the security guards. We recommended avoiding the activities predisposed to high-risk exposure.

Epidemiology of COVID-19 and effect of public health interventions, Chennai, India, March-October 2020: an analysis of COVID-19 surveillance system.

OBJECTIVES: To describe the public health strategies and their effect in controlling the COVID-19 pandemic from March to October 2020 in Chennai, India. SETTING: Chennai, a densely populated metropolitan city in Southern India, was one of the five cities which contributed to more than half of the COVID-19 cases in India from March to May 2020. A comprehensive community-centric public health strategy was implemented for controlling COVID-19, including surveillance, testing, contact tracing, isolation and quarantine. In addition, there were different levels of restrictions between March and October 2020. PARTICIPANTS: We collected the deidentified line list of all the 192 450 COVID-19 cases reported from 17 March to 31 October 2020 in Chennai and their contacts for the analysis. We defined a COVID-19 case based on the real-time reverse transcriptase-PCR (RT-PCR) positive test conducted in one of the government-approved labs. OUTCOME MEASURES: The primary outcomes of interest were incidence of COVID-19 per million population, case fatality ratio (CFR), deaths per million, and the effective reproduction number (Rt). We also analysed the surveillance, testing, contact tracing and isolation indicators. RESULTS: Of the 192 450 RT-PCR confirmed COVID-19 cases reported in Chennai from 17 March to 31 October 2020, 114 889 (60%) were males. The highest incidence was 41 064 per million population among those 61-80 years. The incidence peaked during June 2020 at 5239 per million and declined to 3627 per million in October 2020. The city reported 3543 deaths, with a case fatality ratio of 1.8%. In March, Rt was 4.2, dropped below one in July and remained so until October, even with the relaxation of restrictions. CONCLUSION: The combination of public health strategies might have contributed to controlling the COVID-19 epidemic in a large, densely populated city in India. We recommend continuing the test-trace-isolate strategy and appropriate restrictions to prevent resurgence.

Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey - 4.

Background: ">Breast and cervical cancers are the two leading causes of cancer-related morbidity and mortality in India. Early diagnosis of these cancers through screening offers the best chance to achieve successful treatment outcomes. Hence, the current study was done to determine the prevalence and predictors of breast and cervical cancer screening among women aged 30-49 years in India. Methods: We have analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from Demographic Health Survey program. Stratification and clustering in the sample design were accounted using svyset command. Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was reported. Results: In total, 336,777 women aged 30-49 years were included. Proportion of women aged 30-49 years with history of breast cancer examination in their lifetime was 12.9% (95% CI: 12.6-13.2%), while it was 29.8% (95% CI: 29.3-30.3%) for cervical cancer. It was found that women aged 45-49 years (aPR=1.09), married (aPR=2.18), higher educational level (aPR=1.28), richest quantile (aPR=1.96), no history of pill use (aPR=1.24), obese (aPR=1.06), and healthy dietary habits (aPR=1.47) were more likely to be screened for breast cancer. Predictors for cervical cancer screening were higher age group (aPR=1.06), married (aPR=2.94), secondary educational level (aPR=1.05), richest quantile (aPR=2.24), nonpill user (aPR=1.24), nontobacco user (aPR=1.07), and lower parity (aPR=1.09). Conclusion: A total of 1 out of 10 women in reproductive age group were screened for breast cancer while less than one in three for cervical cancer. Hence, it is important to spread awareness and increase access to screening services to achieve early diagnosis and better treatment outcomes.

Secondary attack rate of COVID-19 among contacts and risk factors, Tamil Nadu, March-May 2020: a retrospective cohort study.

OBJECTIVE: To describe the characteristics of contacts of patients with COVID-19 case in terms of time, place and person, to calculate the secondary attack rate (SAR) and factors associated with COVID-19 infection among contacts. DESIGN: A retrospective cohort study SETTING AND PARTICIPANTS: Contacts of cases identified by the health department from 14 March 2020to 30 May 2020, in 9 of 38 administrative districts of Tamil Nadu. Significant proportion of cases attended a religious congregation. OUTCOME MEASURE: Attack rate among the contacts and factors associated with COVID-19 positivity. RESULTS: We listed 15 702 contacts of 931 primary cases. Of the contacts, 89% (n: 14 002) were tested for COVID-19. The overall SAR was 4% (599/14 002), with higher among the household contacts (13%) than the community contacts (1%). SAR among the contacts of primary cases with congregation exposure were 5 times higher than the contacts of non-congregation primary cases (10% vs 2%). Being a household contact of a primary case with congregation exposure had a fourfold increased risk of getting COVID-19 (relative risk (RR): 16.4; 95% CI: 13 to 20) than contact of primary case without congregation exposure. Among the symptomatic primary cases, household contacts of congregation primaries had higher RR than household contacts of other cases ((RR: 25.3; 95% CI: 10.2 to 63) vs (RR: 14.6; 95% CI: 5.7 to 37.7)). Among asymptomatic primary case, RR was increased among household contacts (RR: 16.5; 95% CI: 13.2 to 20.7) of congregation primaries compared with others. CONCLUSION: Our study showed an increase in disease transmission among household contacts than community contacts. Also, symptomatic primary cases and primary cases with exposure to the congregation had more secondary cases than others.

Surveillance for face mask compliance, Chennai, Tamil Nadu, India, October-December, 2020.

PURPOSE: Government of Tamil Nadu, India, mandated the face mask wearing in public places as one of the mitigation measures of COVID-19. We established a surveillance system for monitoring the face mask usage. This study aimed to estimate the proportion of the population who wear face masks appropriately (covering nose, mouth, and chin) in the slums and non-slums of Chennai at different time points. METHODS: We conducted cross-sectional surveys among the residents of Chennai at two-time points of October and December 2020. The sample size for outdoor mask compliance for the first and second rounds of the survey was 1800 and 1600, respectively, for each of the two subgroups-slums and non-slums. In the second round, we included 640 individuals each in the slums and non-slums indoor public places and 1650 individuals in eleven shopping malls. We calculated the proportions and 95% confidence interval (95%CI) for the mask compliance outdoors and indoors by age, gender, region, and setting (slum and non-slum). RESULTS: We observed 3600 and 3200 individuals in the first and second surveys, respectively, for outdoor mask compliance. In both rounds, the prevalence of appropriate mask use outdoors was significantly lower in the slums (28%-29%) than non-slum areas (36%-35%) of Chennai (p<0.01). Outdoor mask compliance was similar within slum and non-slum subgroups across the two surveys. Lack of mask use was higher in the non-slums in the second round (50%) than in the first round of the survey (43%) (p<0.05). In the indoor settings in the 2nd survey, 10%-11% among 1280 individuals wore masks appropriately. Of the 1650 observed in the malls, 947 (57%) wore masks appropriately. CONCLUSION: Nearly one-third of residents of Chennai, India, correctly wore masks in public places. We recommend periodic surveys, enforcement of mask compliance in public places, and mass media campaigns to promote appropriate mask use.

Perceived Stress and Its Determinants among Postmenopausal Women in Urban Puducherry.

BACKGROUND: Menopause characterized by a gradual decline in ovarian hormones takes its toll on the women both physically and mentally. These health problems can negatively impact the mental status. Hence, the current study was done to determine the level of stress and its associated factors among postmenopausal women in urban Puducherry, India. MATERIALS AND METHODS: A facility-based cross-sectional study was done among 219 postmenopausal women attending the outpatient department in urban primary health center during May 2017-June 2017. Information regarding sociodemographic profile was collected using pretested semi-structured questionnaire and Cohen's Perceived Stress Scale was used to assess the stress level. We calculated adjusted prevalence ratios (aPRs) to identify the determinants of stress. RESULTS: Among 219 participants, 46.6% were in the age group of 60-74 years; 32.9% had primary to secondary level of education; 56.2% were unemployed; 42.5% belonged to lower socioeconomic class; and 32.9% had both diabetes mellitus and hypertension. The prevalence of stress among the postmenopausal women was 26.0% (95% confidence interval: 20.7-32.2). Postmenopausal woman with higher education (aPR - 2.18), belonging to nuclear family (aPR - 1.93), lesser parity (aPR - 1.18), and current alcohol/tobacco users (aPR-2.32) were found to have a significant association with stress among the study participants. CONCLUSION: The current study showed that more than one-fourth of the postmenopausal women had high to very high level of stress. Education, religion, parity, and substance abuse were the significant determinants of stress. However, further longitudinal research needs to be done to determine whether the factors informed in the current study are truly associated with stress and develop interventions accordingly.

Secular trends of grossly underreported snakebite burden in India, 2009-2018: analysis of data from India's National Health Profile.

BACKGROUND: India's National Health Profile (NHP) documents snakebite cases and deaths based on hospital-based reports, hence underrepresenting the actual burden. We describe secular trends of NHP data using population denominators for 2009-2018. METHODS: We abstracted the data on snakebite cases and deaths and calculated incidence and case fatality rate (CFR) by gender and by states using population denominators. We estimated the change in incidence and CFR over time by using a Poisson regression model. We computed the incidence rate ratio (IRR) and 95% confidence interval (CI) using Stata 14.0. RESULTS: The incidence of snakebites ranged from 89 to 141 per million population and without any specific pattern during 2009-2018 as per NHP reports. The incidence increased by 3% per year (IRR 1.03 [95% CI 0.99 to 1.07]). The incidence was higher among males (range 97-163) than females (range 71-115) and there was no difference in trends by gender (IRR 1.07 [95% CI 0.37 to 3.12]). The CFR was 5-13 deaths per 1000 cases, with an annual decline of 12% (IRR 0.88 [95% CI 0.85 to 0.92]). The CFR did not differ by gender (male 5-12, female 6-13; IRR 0.48 [95% CI 0.20 to 1.17]). CONCLUSION: India's NHP snakebite data, representing an underestimate of the actual burden, suggests no specific secular trend and points to areas documenting consistent and significant burden.

Time to reach health-care facility and hospital exit outcome among road traffic accident victims attending a tertiary care hospital, Puducherry.

BACKGROUND: In India, most of the deaths due to road traffic accidents (RTAs) occur within 24 h of the accident. Hence, this study aimed to assess the proportion of RTA victims reaching the health-care facilities within the golden hour. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care center in South India between August and September 2017. All RTA victims who were admitted for treatment in the emergency department during the study period were included. Data were collected using structured, pretested, and validated pro forma. Hospital exit outcomes between those who reached within 1 h and those who did not were expressed as proportion with a 95% confidence interval (CI). The factors associated with hospital exit outcomes were analyzed using a Chi-square test. RESULTS: Among 626 RTA victims, the mean (standard deviation) age was 37.4 (2.6) years, and about 83% (n = 521) were male. More than one-third (37%) of the RTAs occurred on urban roads (n = 235, 37.5%). A total of 424 (67.7%) were referred from other hospitals. The mean time taken for RTA victims to reach any health-care facility was 3 h. More than half (n = 346, 55% [95% CI: 51.3-59.2]) of the RTA victims had reached a health-care facility within the golden hour. Among those who reached beyond the golden hour, one-fourth (n = 77, 27.5%) were delayed due to the unavailability of transporting vehicles. Delay in communication (n = 59, 21.1%), prolonged travel (n = 41, 14.6%), lack of knowledge about nearby facilities (n = 39, 13.9%), nonavailability of attenders (n = 35, 12.5%) and financial issues (n = 29, 10.4%) were the other reasons for the delay. CONCLUSION: Almost half of the RTA victims reached the health-care facilities after the golden hour. Unavailability of ambulances or vehicles for transport and delay in communication were the important factors that played a role in the delay.

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.

Entry and initial spread of COVID-19 in India: Epidemiological analysis of media surveillance data, India, 2020.

BACKGROUND: India reported first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) on 30 January from Kerala. Media surveillance is useful to capture unstructured information about outbreaks. We established media surveillance and described the characteristics of the COVID-19 cases, clusters, deaths by time, place, and person during January-March 2020 in India. METHODS: The media surveillance team of ICMR-National Institute of Epidemiology abstracted data from public domains of India's Central and State health ministries, online news and social media platforms for the period of January 31 to March 26, 2020. We collected data on person (socio-demographics, circumstances of travel/contact, clinical and laboratory), time (date/period of reported exposures; laboratory confirmation and death) and place (location). We drew epidemic curve, described frequencies of cases by age and gender. We described available details for identified clusters. RESULTS: As of March 26, 2020, India reported 694 (Foreigners = 45, 6%) confirmed COVID-19 cases (Attack rate = 0.5 per million population) and 17 deaths (Fatality = 2.5%) from 21 States and 6 Union Territories. The cases were higher among 20-59 years of age (60 of 85) and male gender (65 of 107). Median age at death was 68 years (Range: 38-85 years). We identified 13 clusters with a total of 63 cases and four deaths among the first 200 cases. CONCLUSION: Surveillance of media sources was useful in characterizing the epidemic in the early phase. Hence, media surveillance should be integrated in the routine surveillance systems to map the events specially in context of new disease outbreaks.

Willingness to quit alcohol use and its associated factors among male outpatients attending urban primary health centers in Delhi.

CONTEXT: Harmful use of alcohol has led to 1.7 million deaths from noncommunicable diseases and 1 million injury deaths including road traffic accidents, self-harm, and interpersonal violence. The opportunistic screening can be used to screen for substance abuse in outpatient department (OPD) attendees of primary health-care (PHC) settings in India. AIMS: This study was conducted to determine the prevalence of willingness to quit alcohol use among alcohol users and factors associated with it. SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in urban PHCs and willingness to quit alcohol was assessed among the alcohol users. Alcohol Use Disorder Identification Test (AUDIT) scale was used to assess the alcohol use disorder score. Data were entered using Epidata version 3.1 and analyzed using STATA version 14. RESULTS: It is found that two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education (adjusted prevalence rate ratio [aPR] = 1.9; 95% confidence interval [CI]: 1.2-2.9), occupation (aPR = 1.4; 95% CI: 1.1-1.8), higher AUDIT scores (aPR = 2.7; 95% CI: 2.2-3.5), frequency of alcohol use (aPR = 1.6; 95% CI: 1.2-2.0), and positive family history of alcohol-related illness times (aPR = 1.6; 95% CI: 1.3-2.0) were significantly associated with willingness to quit alcohol. CONCLUSION: Two-third of the male OPD patients are using alcohol and 59% of the alcohol users were willing to quit alcohol. Education, occupation, higher AUDIT scores, frequency of alcohol use, and positive family history of alcohol-related illness were significantly associated with willingness to quit alcohol.