A Pilot Randomized Controlled Trial of an Integrated In-person and Mobile Phone Delivered Counseling and Text Messaging Intervention to Reduce HIV Transmission Risk among Male Sex Workers in Chennai, India.

Men who have sex with men (MSM) are at increased risk for HIV infection in India, particularly those who engage in transactional sex with other men (i.e., male sex workers; MSW). Despite the need, HIV prevention efforts for Indian MSW are lacking. As in other settings, MSW in India increasingly rely on the use of mobile phones for sex work solicitation. Integrating mobile phone technology into an HIV prevention intervention for Indian MSW may mitigate some of the challenges associated with face-to face approaches, such as implementation, lack of anonymity, and time consumption, while at the same time proving to be both feasible and useful. This is a pilot randomized controlled trial to examine participant acceptability, feasibility of study procedures, and preliminary efficacy for reducing sexual risk for HIV. MSW (N = 100) were equally randomized to: (1) a behavioral HIV prevention intervention integrating in-person and mobile phone delivered HIV risk reduction counseling, and daily, personalized text or voice messages as motivating "cognitive restructuring" cues for reducing condomless anal sex (CAS); or (2) a standard of care (SOC) comparison condition. Both groups received HIV counseling and testing at baseline and 6-months, and completed ACASI-based, behavioral and psychosocial assessments at baseline, 3, and 6 months. Mixed-effects regression procedures specifying a Poisson distribution and log link with a random intercept and slope for month of follow-up was estimated to assess the intervention effect on the primary outcomes: (1) CAS acts with male clients who paid them for sex, and (2) CAS acts with male non-paying sexual partners-both outcomes assessed over the past month. The intervention was both feasible (98% retention at 6-months) and acceptable (>96% of all intervention sessions attended); all intervention participants rated the intervention as "acceptable" or "very acceptable." A reduction in the reported number of CAS acts with male clients who paid them for sex in the past month was seen in both study conditions. MSW in the intervention condition reported a faster rate of decline in the number of CAS acts with male clients in the past month from the baseline to both the 3-month (B = -1.20; 95% CI -1.68, -0.73; p < 0.0001) and 6-month (B = -2.44; 95% CI -3.35, -1.53; p < 0.00001) assessment visits compared to the SOC condition. Post-hoc contrasts indicated that, at 3 months, participants in the intervention condition reported 1.43 (SD = 0.29) CAS acts with male clients in the past month compared to 4.85 (SD = 0.87) in the control condition (p = 0.0003). Furthermore, at 6 months, the intervention condition participants reported 0.24 (SD = 0.09) CAS acts with male clients in the past month compared to 2.79 (SD = 0.79) in the control condition (p < 0.0001). Findings are encouraging and provide evidence of feasibility and acceptability, and demonstrate initial efficacy (for reducing sexual risk for HIV) of a behavioral HIV prevention intervention for Indian MSW that combines daily, personalized text or voice messages with mobile phone-delivered sexual risk reduction counseling and skills building. Future testing of the intervention in a fully powered randomized controlled efficacy trial is warranted.

Transactional sex and the challenges to safer sexual behaviors: a study among male sex workers in Chennai, India.

Male sex workers (MSW) are a significant but invisible population in India who are at risk for HIV/sexually transmitted infections (STIs). Few studies from India have documented HIV risk factors and motivations for sex work in this population. Between 2013 and 2014, a community-based convenience sample of 100 MSW in Chennai (south India) completed a baseline risk assessment as part of a behavioral intervention. Participants were ≥18 years, and reported current sex work. We report medians and proportions, and Wilcoxon-Mann-Whitney and chi-square tests are used to examine differences between sex work and sexual behavior measures by income source. Participants were engaged in sex work for 5.0 years (IQR = 2.3-10.0), and earned 3000 (IQR = 2000-8000) Rupees (<50 USD) per month from sex work. Sixty-four percent reported ever testing for HIV and 20.2% for any STI. The most common reasons for starting sex work were money (83.0%) and pleasure (56.0%). Compared to participants with an additional source of income, those whose only source of income was sex work reported more male clients in the past month (10.0 vs. 6.0, p = .017), as well as more condomless anal sex acts with male clients (8.0 vs. 5.0, p = .008). Nearly 70.0% were offered more money not to use a condom during sex with a client, and 74.2% reported accepting more money not to use a condom. Three-quarters reported having experienced difficulty using condoms with clients. MSW in India engage in high levels of sexual risk for HIV/STIs. Money appears to be a driving factor for engaging in sex work and condomless sex with clients. HIV prevention interventions with MSW should focus on facilitating skills that will support their ability to negotiate sexual safety in the context of monetary disincentives.

Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India.

In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6 months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100 %. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention.

Prevalence of chest symptoms amongst brick kiln migrant workers and care seeking behaviour: a study from South India.

BACKGROUND: Early detection and treatment of tuberculosis (TB) have been key principles of TB control. However, this can be a challenge with 'hard to reach' populations such as migrants. Brick kiln workers are one such group of migrants who are exposed to smoke, heat and dust from brick kilns which are one of the major causes of respiratory illnesses. METHODOLOGY: A cross-sectional community based study was carried out in Thiruvallur, Tamil Nadu, South India, from August 2011 to June 2012. A total of 4002 individuals from 55 brick kiln chambers were interviewed to determine the prevalence of chest symptoms and care seeking behaviour patterns. RESULTS: Three hundred and seventy-seven (9.4%) chest symptomatics were identified. The most significant variables associated with chest symptoms were illiteracy, alcohol abuse and heavy smoking. Of the chest symptomatics identified, 50.4% took action to get relief from their symptoms. The duration of over 6-month stay in the chamber was significantly associated with taking action (OR, 5.5, 95% CI: 2.3, 13.3). CONCLUSIONS: The TB control programme needs to further explore how to extend its services to such 'hard to reach' groups. Active case finding to ensure early diagnosis and treatment initiation amongst such groups needs consideration.

Electrochemical behavior, structural, morphological, Calf Thymus-DNA interaction and in-vitro antimicrobial studies of synthesized Schiff base transition metal complexes.

New tetradentate Schiff base transition metal complexes have been derived from salicylidene-4-imino-2,3-dimethyl-1-phenyl-3-pyrazolin-5-one and histidine were characterized by CHN analysis, magnetic susceptibility measurements, molar conductance, FAB-MS, IR, 1H-NMR, UV, CV, EPR, Fluorescence emission, AFM and Powder XRD techniques. AFM images and Powder XRD data endure that the complexes are nano-size grains with polycrystalline structure. The spectral evidences showed that all the metal chelates are square planar geometry except [VOL] complex which exist square-pyramidal geometry. Electrochemical data (CV) for [CuL] and [VOL] complexes in acetonitrile solution indicates that the redox potential of metal ions is affected by the coordinated ligand. Electron Spin Resonance (ESR) spectra of [CuL] and [VOL] complexes were well coinciding with proposed geometries and other reported complexes. CT-DNA interaction studies of [CuL] complex reveals that an intercalation binding mode occurs between complex and DNA base pairs. The in vitro antimicrobial activity of complexes has been tested against the growth of some fungal and bacterial species persist that chelates have better control than ligand.

Performance of Indian diabetic risk score as a screening tool of diabetes among women of industrial urban area.

INTRODUCTION: Hyderabad, the capital hub of Diabetes mellitus type 2 due to the epidemiological transition and varied lifestyle of urbanization. Indian Diabetes Risk Score (IDRS)is used to detect undiagnosed Type 2 diabetes. AIM: This study was taken up with an aim to assess the performance of IDRS as a screening tool to detect undiagnosed cases of type 2 Diabetes mellitus among women in Industrial urban area. SETTING AND DESIGN: A Community based cross sectional study was undertaken at urban field practice area attached to our medical college, Hyderabad. METHODS AND MATERIAL: Women with already diagnosed type 2 Diabetes mellitus and those who were unwilling to give informed consent were excluded from the study. IDRS was used to to detect undiagnosed diabetes. Diabetes was confirmed using blood sugar levels on fasting venous sample. STATISTICAL ANALYSIS USED: Data was entered in Microsoft excel 2010 and was analysed as frequency, Mean+ Standard deviation along with sensitivity and specificity of the test. RESULTS: As per the classification of IDRS 22% were at low risk, 40% medium risk and 38% at high risk. Components of IDRS noted majority about 45.4% with waist circumference > 90cms, no exercise among 66.6% and one parent having diabetes among 26%. Sensitivity was 59.4% and specificity was 37.3% of IDRS with the gold standard test (Fasting blood glucose) to assess the performance. CONCLUSION: IDRS is a cost effective tool which can be used for screening among undiagnosed cases.

Efficacy of saccharides bio-template on structural, morphological, optical and antibacterial property of ZnO nanoparticles.

Mono, di and polysaccharides of glucose (C6H12O6), sucrose (C12H24O12) and starch (C6H12O6)n bio-template ZnO nanoparticles (NPs) has prepared by chemical precipitation method. Saccharides bio-template ZnO (SBts-ZnO) NPs were efficiently prepared for their structural and optical properties were examined by using XRD, FE-SEM, AFM, FTIR, UV and PL techniques. All the samples are polycrystalline nature with a preferential orientation depending on the (1 0 1) plane. The reduction of crystalline size by utilizing glucose, sucrose and starch bio-template of ZnO NPs. FE-SEM images revealed that the spherical and nano-rods like morphologies for ZnO and SBts-ZnO NPs respectively. AFM recorded images shows spherical features that confirmed and also the morphological changes were noticed with the addition of polymers. Interaction of bio-templated saccharides (glucose G1, sucrose S2 & starch Sn) molecules was proved by FTIR study. Optical absorbance and emission behaviours were investigated using UV-Vis and photoluminescence techniques. The antibacterial study revealed that SBts-ZnO have excellent antibacterial effect than ZnO. The Sn-ZnO sample has potent antibacterial activity against the Proteus vulgaris followed by Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus.

Enhanced Antibacterial effect using carbohydrates biotemplate of ZnO nano thin films.

Carbohydrate biotemplates of glucose (C6H12O6) and starch (C6H12O6)n in to Zinc oxide (ZnO) nano thin films (NTFs) prepared for enhanced antibacterial activity by Successive Ionic Layer Adsorption Reaction (SILAR). X-ray diffraction (XRD) patterns revealed that the crystalline size values were decreased by the incorporation of carbohydrate molecules. Scanning electron microscope (SEM) and Field emission scanning electron microscope (FESEM) confirmed that the different morphologies by the addition of glucose and starch. The interactions of carbohydrate molecules with ZnO were identified by using FTIR and EDAX. Energy band gap of samples was calculated by UV absorption spectra. The emission property of Zinc oxide, Glucose/ZnO and Starch/ZnO was studied by photoluminescence (PL) spectra. The antibacterial activity of carbohydrate biotemplates (Cbts-ZnO) results showed that enhanced effect than pure ZnO for the selected pathogenic bacteria's.

Effectiveness of TB sensitization initiatives in improving the involvement of self help group members in rural TB control in south India.

Background: The 'End TB strategy' has highlighted the importance of inter-sectoral collaboration and community mobilization for achieving zero TB deaths by 2020. Objective: The aim of the study was to develop and test a model TB sensitization programme involving self help groups (SHGs). Methodology: This experimental study was conducted in two blocks (intervention and control), in Tiruvallur district. The intervention content included short-lecture, musical story telling activity, role play, short film on TB. The impact was compared at baseline, third and sixth months in terms of SHGs' awareness, promotion of awareness, identification and referral of presumptive TB cases and provision of TB treatment. Results: A total of 764 vs 796 SHGs were enrolled in control and intervention groups, respectively. The knowledge attitude, and practice score (lower score indicated a better attitude and practice), from baseline to 6 months was significantly reduced (29 to 24) in the intervention group. Similarly, a significant difference was observed in identification and referral of chest symptomatics in the intervention group at 3 and 6 months. During the 3 month follow-up a significantly higher proportion of SHG members were involved in TB awareness activities in the intervention (623/748 [83.3%]) vs control group (471/728 [64.7%]; p<0.001). Conclusions: Findings from this study highlight the feasibility of involving SHGs through a model TB sensitization program for strengthening TB prevention and control activities.