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Karachi, Pakistan

Samo R.N.,Bridge Consultants Foundation | Altaf A.,Aga Khan University | Memon A.,Enhanced HIV Control Programme | Shah S.A.,Enhanced HIV Control Programme
Journal of the Pakistan Medical Association

Objective: To assess the determinants of HIV sero-conversion among male injection drug users enrolled in needle exchange programme at Karachi. Methods: An unmatched retrospective case control study was conducted among male injection drug users receiving needle exchange services in Karachi. The cases and controls were identified from one drop in center providing needle exchange services. The data for the study participants was collected retrospectively from the programme. Descriptive statistics, univariat analysis, and multivariate regression analysis for determinants of HIV sero-conversion and Hosmer and Lameshow goodness of fit test for model adequacy were performed. Results: Mean age of the study participants was 34.17 ± 10.74 years. Average monthly income of the participants was US$ 125.15±76.32. In unconditional multivariate regression analysis being unmarried (AOR: 3.0 95% CI 1.14-7.9, p=0.02), not living with family (AOR: 2.8 95% CI 1.18-6.79 p=0.02), family history of addiction (AOR: 2.5, 95% CI 1.01- 6.49, p=0.04), injecting drugs in groups (AOR: 2.8, 95% CI 1.12 7.02 p=0.02), not obtaining syringes from the programme (AOR:26.45, 95% CI 2.47-282.8 p=0.007), and history of blood transfusion (AOR: 52.9, 95% CI 1.32- 2118.416 p=0.03) were significantly associated with HIV positive sero-status. Model adequacy was assessed by 'Hosmer and Lameshow goodness of (J: 4.95, p=0.7) indicating that the model was accurate. Conclusion: Social and drug related risky behaviours are important determinants of HIV among male IDUs in Karachi. The situation calls for programmematic initiatives for addressing the risky behaviours among IDUs for effective control of epidemic in the country. Source

Shah S.A.,Bridge Consultants Foundation | Memon A.A.,Civil Hospital | Auwj-E-Shamim,Civil Hospital | Baqi S.,Sindh Institute of Urology and Transplantation | Witzig R.,Tulane University
Journal of the Pakistan Medical Association

Objective: To study the efficacy of a low-cost heating pack device used for thermotherapy in the treatment of cutaneous leishmaniasis.Methods: The study was conducted at the Department of Dermatology, Civil Hospital Sukkur, Pakistan, from April 20, 2012, to January 3, 2013. Thermotherapy with Hand-Held Exothermic Crystallisation Therapy for cutaneous leishmaniasis was performed on each lesion of the participating subjects at an average initial temperature of 51.6°C for 3 minutes daily for 7 days. Patients were followed regularly for 6 months after the therapy. SPSS 20 was used for statistical analysis.Results: Even though all 27 patients completed 1 week of thermotherapy, only 23(85.2%) patients could be evaluated for full treatment response since 4(14.8%) were lost to complete follow-up. By the final 180-day evaluation, 19 (83%) patients had been cured. Applications were well tolerated with no side effects.Conclusion: The devise was a convenient, safe, non-toxic and effective treatment for cutaneous leishmaniasis at a fraction of the cost of standard antimonial treatment. Further studies are needed to certify its safety and efficacy as monotherapy for the condition. © 2014, Pakistan Medical Association. All rights reserved. Source

Siddiqui A.U.R.,Vanderbilt University | Qian H.-Z.,Vanderbilt University | Altaf A.,Vanderbilt University | Cassell H.,Vanderbilt University | And 3 more authors.
BMJ Open

Objective: To describe the prevalence and predictors of condom use and sexual risk in the male clients of Hijra sex workers (HSWs) in Karachi, Pakistan. Design: Cross-sectional study. Setting: Karachi, Pakistan. Participants: Clients of HSWs were recruited with assistance from HSWs and a non-governmental organisation (NGO) focused on men who have sex with men (MSM) during October-November 2010. Measurements: The interviewer administered the questionnaire to each participant to solicit information on demographics, HIV/AIDS knowledge/attitudes and sexual risk behaviours/practices, including condom use in the last sexual act with the HSW. Results: Of the 203 participants, 42.4% reported that they used condoms during their last sexual act with HSW, 40% were married, 18% had ever used drugs or alcohol, and 52% reported also engaging with female sex workers in the last month. Casual HSW clients were more likely to use condoms than regular clients (adjusted OR (AOR), 2.50; 95% CI 1.34 to 4.65), as were persons with a higher education level (AOR 5.8; 95% CI 1.6 to 20.3). Drug/alcohol users and non-users were equally likely to use condoms (AOR 1.11; 95% CI 0.51 to 2.24). Conclusion: Clients of HSWs in Pakistan are at risk of acquiring HIV/STI infections. Concerted efforts are needed to increase condom use in this key bridge population to curtail the spread of HIV in the general population. Source

Samo R.N.,Bridge Consultants Foundation | Samo R.N.,Aga Khan University | Altaf A.,Bridge Consultants Foundation | Agha A.,Aga Khan University | And 7 more authors.

Background: The incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted. Methods: We enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) and PWID were followed for two years. We measured incidence rates and risk factors associated with HIV seroconversion. Results: Incidence of HIV was 12.4 per 100 person-years (95% exact Poisson confidence interval [CI]: 10.3-14.9). We followed 474 of 636 HIV seronegative persons (74.5%) for two years, an annual loss to follow-up of <13 per 100 person years. In multivariable Cox regression analysis, HIV seroconversion was associated with non-Muslim religion (Adjusted risk ratio [ARR] = 1.7, 95%CI:1.4, 2.7, p = 0.03), sharing of syringes (ARR = 2.3, 95%CI:1.5, 3.3, p<0.0001), being homeless (ARR = 1.7, 95%CI:1.1, 2.5, p = 0.009), and daily injection of drugs (ARR = 1.1, 95%CI:1.0, 1.3, p = 0.04). Conclusions: Even though all members of the cohort of PWID were attending risk reduction programs, the HIV incidence rate was very high in Karachi from 2009-2011. The project budget was low, yet we were able to retain three-quarters of the population over two years. Absence of opiate substitution therapy and incomplete needle/syringe exchange coverage undermines success in HIV risk reduction. © 2013 Samo et al. Source

Hasnain J.,Bridge Consultants Foundation | Memon G.N.,Bridge Consultants Foundation | Memon A.,Sindh AIDS Control Program Referral Laboratory | Channa A.A.,Bridge Consultants Foundation | And 2 more authors.
BMJ Open

Objective: To describe feasibility and results of systematic screening of tuberculosis (TB) patients for HIV. Design: Cross-sectional study. Setting: Six selected sentinel sites ( public DOTS clinics) in the province of Sindh, Pakistan. Participants: All TB patients aged 16-60 years registered for treatment from April 2008 to March 2012. Measurement: Demographic information of registered TB patients, screening for HIV through rapid testing and confirmation by referral lab of Sindh AIDS Control Program, according to national guidelines. Results: Of a total of 18 461 registered TB patients, 12 882 fulfilled the inclusion criteria and were given education and counselling. Of those counselled 12 552 (97.4%) were screened for HIV using a rapid test. Men made up 48% of the sample and 76.5% of patients had pulmonary TB. Of the total patients tested, 42 (0.34%) were HIV-positive after confirmatory testing at the Sindh AIDS Control Program Laboratory. Prevalence of HIV among male patients was 0.67% whereas prevalence among female patients was 0.03% (p value <0.001). Prevalence of HIV among pulmonary TB patients was 0.29% and among extrapulmonary TB patients was 0.48% (p value=0.09). Conclusion: In public DOTS clinics in Pakistan it is feasible to test TB patients for HIV. Prevalence of HIV is three times higher among TB patients as compared with the general population in Pakistan. Although the results are not representative of Pakistan or Sindh province they cover a large catchment area and closely match WHO estimate for the country. Routinely screening all TB patients for HIV infection, especially targeting men and ensuring antiretroviral therapy, can significantly improve TB/HIV collaborative activities in Pakistan and identify many cases of HIV, improve health outcomes and save lives. Source

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