Perceptions and practice of physicians treating HIV patients in the private sector in India: A cross sectional study.

Objectives: To understand the perceptions of the private HIV physicians regarding HIV case management and reporting practices followed by the National AIDS Control Programme, India. Methods: We conducted this cross-sectional study among 142 private practitioners attending Chennai ART Symposium 2017, from five south Indian states. We used a pre-structured questionnaire to collect information on demography, qualification, the number of HIV patients treated, ART regimen, and the reporting practices. EpiInfo 7.2 was used for data analysis. Results: Out of the 142 private practitioners, 89 (63%) responded. All respondents had diagnosed and/or treated at least 10 HIV patients in the past 12 months. About 42% of respondents reported attending an orientation program on ART by the State AIDS Control Society (SACS). Seventy percent of respondents were aware of the National AIDS Control Organization's (NACO) Public Private Partnership (PPP) initiative for private clinics, and 44% (39) reported sharing monthly reports with SACS. However, 77% of physicians were not interested to enroll due to increased paperwork and complicated reporting mechanisms. Conclusion: Private sector physicians treating People Living with HIV (PLHIV) are aware of NACO guidelines and reporting mechanisms. A simplified reporting process and an engaging platform are needed to facilitate reporting.

Molecular epidemiology of HBV among HIV infected individuals in Chennai, south India.

Hepatitis B is a major co-infection among people with HIV (PWHIV) worldwide. There is a paucity of data on HBV genetic diversity in India, which would be useful for targeted preventive and management interventions. To characterize the distribution of HBV genotypes and sub-genotypes, samples of 180 HIV-HBV co-infected individuals from a study previously conducted to estimate the prevalence of HBV co-infection were analyzed. Nested PCR using type-specific primers was used to identify the various HBV genotypes. Partial HBV S sequences were generated for a subset of samples using Sanger sequencing. Mutation analysis was done using the online HBVseq program. PCR based genotyping documented D (69.4 %) and A (5.6 %) to be the major genotypes in the study population. Infection with multiple genotypes was observed in 25 % co-infected individuals. D2, D5, A2, and A1 were the sub-genotypes detected. Mutations 184K and 173L were identified. HBV genotypes/ sub-genotypes play a pivotal role in the clinical outcome of chronic hepatitis B (CHB). Therefore, monitoring of CHB cases is needed to track disease progression, including early detection of hepatocellular carcinoma.

Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study.

INTRODUCTION: Pruritic papular eruption (PPE) remains as one of the most common cutaneous manifestations in HIV-infected patients. Proper knowledge about understanding the risk factors associated with this disease may help to decrease the prevalence of PPE. OBJECTIVE: The present study was conducted to determine the prevalence of PPE in HIV-infected patients and to correlate between the severity of PPE and individual CD4 count. MATERIALS AND METHODS: This was a cross-sectional study, conducted in Palakkad Antiretroviral Therapy Centre, Kerala, between March 2017 and April 2017. A total of 100 HIV patients with evidence of multiple itchy skin lesions of 1-month duration were included in the study. Severity of lesion was evaluated using an objective "rash severity scale" for PPE. Data were coded and analyzed. RESULTS: Prevalence of PPE was 11.35% in our study. The mean age of the study population was 41.17 ± 12. Male-to-female ratio was 1:2. In our study, 97% of the patients were giving history of mosquito bite. Most of the patients (40%) had moderate type of PPE. In our study, majority (86%) had a CD4 count of more than 200, and the incidence of PPE was more frequently seen in patients with CD4 count more than 200 cells which was statistically significant. CONCLUSION: PPEs are unique dermatosis, which is having a devastating impact on the quality of life, stigmatizing them in their communities. Thus, recognizing those lesions helps in allowing better treatment of this distressing condition.

Loss to follow-up among children in pre-ART care under the National AIDS Programme, Tamil Nadu, South India.

Setting: Children aged <15 years constitute 7% of all people living with the human immunodeficiency virus (HIV) in India. A previous study from an antiretroviral therapy (ART) centre in south India reported 82% loss to follow-up (LTFU) among children in pre-ART care (2006-2011). Objective: To assess the proportion of LTFU within 1 year of registration among HIV-infected children (aged < 15 years) registered in all 43 ART centres in the state of Tamil Nadu, India, during the year 2012. Design: This was a retrospective cohort study involving a review of programme records. Results: Of 656 children registered for HIV care, 20 (3%) were not assessed for ART eligibility. Of those remaining, 226 (36%) were not ART eligible and entered pre-ART care. Among these, at 1 year of registration, 50 (22%) were LTFU, 40 (18%) were transferred out and 136 (60%) were retained in care at the same centre. The child's age, sex, World Health Organization stage or occurrence of opportunistic infection were not associated with LTFU. Conclusion: One in five children registered under pre-ART care were lost to follow-up. Stronger measures to prevent LTFU and reinforce retrieval actions are necessary in the existing National HIV Programme.

Contexte: Les enfants âgés de <15 ans constituent 7% de toutes les personnes vivant avec le virus de l'immunodéficience humaine (VIH) en Inde. Une étude précédente émanant d'un centre de thérapie antirétrovirale (TAR) d'Inde du Sud a rapporté 82% de pertes de vue (LTFU) parmi les enfants en soin pré-ART (2006­2011).Objectif: Evaluer la proportion de LTFU dans l'année suivant l'enregistrement parmi les enfants (âgés de <15 ans) infectés par le VIH enregistrés dans les 43 centres du TAR de l'état du Tamil Nadu, Inde, pendant l'année 2012.Schéma: Une étude rétrospective de cohorte impliquant une revue des dossiers du programme.Résultats: Sur 656 enfants enregistrés pour une prise en charge du VIH, 20 (3%) n'ont pas été évalués pour leur éligibilité au TAR. Parmi les autres, 226 (36%) n'ont pas été éligibles au TAR et sont entrés en soins pré-TAR. Parmi eux, à une année de l'enregistrement, 50 (22%) ont été LTFU, 40 (18%) ont été transférés et 136 (60%) sont restés en soins dans le même centre. L'âge de l'enfant, le sexe, le stade de l'Organisation mondiale de la santé et la survenue d'infections opportunistes n'ont pas été associés avec le LTFU.Conclusion: Un enfant sur cinq enregistré en prise en charge pré-TAR a été LTFU. Les mesures de prévention des LTFU et les efforts de localisation doivent être renforcés au sein du programme national VIH existant.

Marco de referencia: Los niños < l5 años de edad representan el 7% de todas las personas positivas frente al virus de la inmunodeficiencia humana (VIH) en la India. En un estudio anterior realizado en un centro de tratamiento antirretrovírico (TAR) en el sur del país, se notificó una tasa de pérdida durante el seguimiento de 82% en los niños que acudían a la atención pre-TAR (del 2006 al 2011).Objetivo: Evaluar la proporción de pérdidas durante el seguimiento durante el primer año después del registro de los niños infectados por el VIH (<15 años de edad) en todos los 43 centros de suministro de TAR en el estado de Tamil Nadu, en la India, en el año 2012.Método: Un estudio retrospectivo de cohortes a partir de los registros del programa.Resultados: De los 656 niños registrados en la atención de la infección por el VIH, en 20 no se evaluó su aptitud para recibir el TAR (3%). De los niños restantes, 226 no cumplían los requisitos del TAR (36%) y se inscribieron en la atención pre-TAR. De este grupo, un año después del registro, 50 niños se habían perdido durante el seguimiento (22%), 40 se habían transferido a otro centro (18%) y 136 permanecían en la atención en el mismo centro (60%). La edad de los niños, el sexo, el estadio clínico de la enfermedad según la escala de la Organización Mundial de la Salud y la aparición de una infección oportunista no se asociaron con la pérdida durante el seguimiento.Conclusión: Uno de cada cinco niños registrados en la atención pre-TAR se perdió durante el seguimiento. Es preciso fortalecer las medidas que prevengan estas pérdidas y las intervenciones de recuperación de los pacientes en el programa nacional contra el VIH que existe en el país.

Profile and prevalence of HBV among HIV affected individuals attending the largest public HIV care center in India.

A large number of people living with HIV/AIDS residing in HBV endemic regions such as in India are highly susceptible to acquire co-infections like HBV but also transmit them to other due to their high risk behaviours. The present study aimed to estimate HBV prevalence and distribution of various HBV serological markers among HIV infected individuals. This cross sectional survey covered HIV infected individuals attending the largest HIV care center in India. Socio-demographic details and blood samples to screen for HBV seromarkers using commercial ELISA kits were collected. Among 1160 HIV infected patients, prevalence of HBcAb, HBsAb, HBsAg and HBeAg was 66, 29.4, 16.6 and 5.8 % respectively. Overall, 28.9 % individuals had no evidence of any of the four markers, indicating lack of previous exposure and future risk of acquiring HBV infection. Presence of anti-HBsAg in a mere 0.9 % of individuals reflected low levels HBV vaccine conferred immunity which could be due to poor HBV vaccine coverage in this high risk population. With high prevalence and evidence of exposure to HBV as well as considering the growing literature on increase in hepatic complications in HIV-HBV co-infected individuals, the need for mandatory HBV screening of all HIV infected individuals cannot be over-emphasised. The policy makers and HIV programme managers must consider HBV vaccination for newly detected HBV naive HIV infected individuals and also focus on creating public awareness on HBV and HIV prevention.

Implementation and Operational Research: High Loss to Follow-up Among Children on Pre-ART Care Under National AIDS Program in Madurai, South India.

BACKGROUND: Information on the follow-up of HIV-infected children enrolled into preantiretroviral therapy (Pre-ART) care under routine program settings is limited in India. Knowledge on the magnitude of loss to follow-up (LFU) and its reasons will help programs to retain children in HIV care. We aimed to assess the proportion of LFU among children in Pre-ART care and its associated factors. METHODS: In this retrospective cohort study, we reviewed the records of all HIV-infected children (aged <15 years) registered from 2005 to 2012 at an ART center, Madurai, South India. LFU during Pre-ART care was defined as having not visited the ART center within a year of registration. RESULTS: Of 426 children enrolled in Pre-ART care, 211 (49%) were females and 301 (71%) were in the 5- to 14-year age group. At 1 year of registration, 348 (82%) were lost to follow-up. Of 348, 81 returned to care after 1 year of enrollment, whereas 267 (63% of all children) were permanently lost to follow-up. The proportion of LFU remained high from 2005 to 2012. WHO staging, CD4 count, and opportunistic infection were the significant factors associated with lost to follow-up on multivariate analysis. CONCLUSIONS: LFU was alarmingly high indicating poor clinical and programmatic monitoring among HIV-infected children enrolled in Pre-ART care. A system for active tracing of those missing a clinic appointment intensified supervision, and monitoring along with qualitative research is urgently needed. This will help to understand the exact reasons for LFU based on which effective interventions may be planned for reducing such losses.

Impact of house-hold food insecurity on nutritional status of HIV-infected children attending an ART centre in Tamil Nadu.

We studied the level of food insecurity among households with HIV-infected children and its relationship with childhood nutritional indicators. Among the 147 children assessed, food insecurity was present in 59% of households. Majority of children with stunting belonged to-food insecure families. Stunting and Underweight were more prevalent among children >5 years of age.