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Lipovsek V.,Population Services International | Mukherjee A.,Population Services International | Navin D.,Population Services International | Marjara P.,National AIDS Control Organisation | And 2 more authors.
Sexually Transmitted Infections

Purpose: As part of the Avahan India AIDS Initiative, a behaviour change communication programme sought to increase consistent condom use (CCU) among male clients of female sex workers (FSWs) in four Indian states through the use of outdoor static promotional materials, interpersonal communication and mid-media activities. This paper presents key findings related to programme coverage levels, trends over time in self-reported condom use, and correlations between levels of exposure to programme activities and self-reported condom use. Methods: Five stratified two-stage cluster sample surveys were conducted between April 2006 and November 2008 (sample sizes ranged from 1741 to 2041). The independent samples were composed of clients of FSWs in selected clusters. Multivariate logistic regression was used to model whether behavioural outcomes varied between baseline and endline, and whether they varied with levels of exposure to the intervention. Results: Over two-thirds of men in each survey round recalled one or two of the main intervention channels. An increase in CCU with FSWs was found between baseline and endline (63.6% vs 86.5; p<0.01). Men exposed to two intervention channels reported higher CCU than men exposed to none or only static outdoor media (89.4% vs 82.0%, p<0.05). This trend was sustained for condom use at last sex (96.2% vs 92.6%, p<0.05). Conclusion: Evaluation suggests that a multi-channel behavioural intervention delivered at sites where FSWs are solicited can increase CCU among male clients of FSWs. Further research is needed on the dynamics of exposure to multiple communication channels and the contributions of complementary interventions. Source

Sgaier S.K.,Bill and Melinda Gates Foundation | Ramakrishnan A.,Bill and Melinda Gates Foundation | Dhingra N.,National AIDS Control Organisation | Wadhwani A.,Bill and Melinda Gates Foundation | And 8 more authors.
Health Affairs

Developing countries face diminishing development aid and time-limited donor commitments that challenge the long-term sustainability of donor-funded programs to improve the health of local populations. Increasing country ownership of the programs is one solution. Transitioning managerial and financial responsibility for donorfunded programs to governments and local stakeholders represents a highly advanced form of country ownership, but there are few successful examples among large-scale programs. We present a transition framework and describe how it was used to transfer the Bill & Melinda Gates Foundation's HIV/AIDS prevention program, the Avahan program, to the Government of India. Essential features recommended for the transition of donor-funded programs to governments include early planning with the government, aligning donor program components with government structures and funding models prior to transition, building government capacity through active technical and management support, budgeting for adequate support during and after the transition, and dividing the transition into phases to allow time for adjustments and corrections. The transition of programs to governments is an important sustainability strategy for efforts to scale up HIV prevention programs to reach the populations most at risk. © 2013 Project HOPE- The People-to-People Health Foundation, Inc. Source

Piot B.,Population Services International | Mukherjee A.,Population Services International | Navin D.,Population Services International | Krishnan N.,Population Services International | And 3 more authors.
Sexually Transmitted Infections

Objectives: This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites. Methods: The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative. Results: A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms. Conclusion: LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets. Source

Neogi U.,Karolinska Institutet | Gupta S.,St Johns Research Institute | Palchaudhuri R.,St Johns Research Institute | Rao S.D.,St Johns Research Institute | And 6 more authors.
Antiviral Therapy

Background: After the rapid scale-up of antiretroviral therapy (ART) in resource-limited settings, surveillance of primary drug resistance mutations (DRMs) among ART-naive individuals has important public health benefits. Although a highly successful national ART programme initiated by the Government of India exists, data on the prevalence of primary DRMs is scarce. The objective of the study is to estimate the prevalence, pattern and spectrum of population-based primary DRMs in therapy-naive HIV-1-infected individuals using clinical strains and database sequences from seven HIV prevalent states of India. Methods: Drug resistance genotyping was performed on either plasma RNA or whole-blood genomic DNA using a validated in-house method on 170 HIV-1-positive therapy-naive individuals. An additional 679 database-derived sequences from four other states were included in the analysis. The WHO-recommended list of mutations (SDRM-2009) for nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) were used for interpretation of DRMs. Trends of primary DRMs before and after the ART rollout were studied. Results: The overall prevalence of primary DRMs was 2.6% in the selected states of India when clinical isolates as well as database-derived sequences were combined. Common mutations included T69D and D67N (NRTI mutations), and L100I, K101E, K103N and Y181C (NNRTI mutations). There was a significant increase in NNRTI mutations over time. Conclusions: The overall DRM prevalence in this study was low. However, an increasing trend in primary NNRTI resistance has been observed during the past decade. Establishment of HIV drug resistance threshold surveillance will be useful in understanding further trends of transmitted resistance. ©2014 International Medical Press Source

Gaffey M.F.,Li Ka Shing Knowledge Institute | Venkatesh S.,National AIDS Control Organisation | Dhingra N.,National AIDS Control Organisation | Khera A.,Ministry of Health and Family Welfare | And 4 more authors.

Heterosexual transmission of HIV in India is driven by the male use of female sex workers (FSW), but few studies have examined the factors associated with using FSW. This nationally representative study examined the prevalence and correlates of FSW use among 31,040 men aged 15-49 years in India in 2006. Nationally, about 4% of men used FSW in the previous year, representing about 8.5 million FSW clients. Unmarried men were far more likely than married men to use FSW overall (PR = 8.0), but less likely than married men to use FSW among those reporting at least one non-regular partner (PR = 0.8). More than half of all FSW clients were married. FSW use was higher among men in the high-HIV states than in the low-HIV states (PR = 2.7), and half of all FSW clients lived in the high-HIV states. The risk of FSW use rose sharply with increasing number of non-regular partners in the past year. Given the large number of men using FSW, interventions for the much smaller number of FSW remains the most efficient strategy for curbing heterosexual HIV transmission in India. © 2011 Gaffey et al. Source

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