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Orne-Gliemann J.,University of Bordeaux Segalen | Orne-Gliemann J.,French Institute of Health and Medical Research | Tchendjou P.T.,Center Pasteur du Cameroun | Gadgil M.,Prayas Health Group | And 10 more authors.
BMC Public Health | Year: 2010

Background. A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India. Methods. Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants. Results. In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services. Conclusions. One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV. © 2010 Orne-Gliemann et al; licensee BioMed Central Ltd.


Orne-Gliemann J.,French Institute of Health and Medical Research | Orne-Gliemann J.,University of Bordeaux Segalen | Balestre E.,French Institute of Health and Medical Research | Balestre E.,University of Bordeaux Segalen | And 12 more authors.
AIDS | Year: 2013

Objective: Couple-oriented posttest HIV counselling (COC) provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. We conducted a randomized trial of the efficacy of COC on partner HIV testing in low/medium HIV prevalence settings (Cameroon, Dominican Republic, Georgia, India). Methods: Pregnant women were randomized to receive standard posttest HIV counselling or COC and followed until 6 months postpartum. Partner HIV testing events were notified by site laboratories, self-reported by women or both combined. Impact of COC on partner HIV testing was measured in intention-to-treat analysis. Socio-behavioural factors associated with partner HIV testing were evaluated using multivariable logistic regression. Results: Among 1943 pregnant women enrolled, partner HIV testing rates (combined indicator) were 24.7% among women from COC group versus 14.3% in standard posttest HIV counselling group in Cameroon [odds ratio (OR) =2.095% CI (1.2-3.1)], 23.1 versus 20.3% in Dominican Republic [OR =1.2 (0.8-1.8)], 26.8 versus 1.2% in Georgia [OR = 29.6 (9.1-95.6)] and 35.4 versus 26.6% in India [OR= 1.5 (1.0-2.2)]. Women having received COC did not report more conjugal violence or union breakups than in the standard posttest HIV counselling group. The main factors associated with partner HIV testing were a history of HIV testing among men in Cameroon, Dominican Republic and Georgia and the existence of couple communication around HIV testing in Georgia and India. Conclusion: A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Darak S.,University of Groningen | Darak S.,PRAYAS Health Group | Darak T.,PRAYAS Health Group | Kulkarni S.,PRAYAS Health Group | And 4 more authors.
AIDS Patient Care and STDs | Year: 2013

Previous research regarding the effect of highly active antiretroviral treatment (HAART) on pregnancy outcomes shows conflicting results and is predominantly situated in developed countries. Recently, HAART is rapidly being scaled up in developing countries for prevention of mother-to-child transmission (PMTCT). This study compared adverse pregnancy outcomes among HIV infected women (N=516) who received either HAART (N=192) - mostly without protease inhibitor - or antepartum azidothymidine (AZT) with intrapartum nevirapine (N=324) from January 2008 to March 2012 through a PMTCT program in western India. We analyzed the effect of HAART on preterm births, low birth weight, and all adverse pregnancy outcomes combined using univariate and multivariate logistic regression models. Women on HAART had 48% adverse pregnancy outcomes, 25% preterm births, and 34% low birth weight children compared to respectively 32%, 13%, and 22% among women on AZT. Women receiving HAART were more likely to have adverse pregnancy outcomes and preterm births compared to women receiving AZT. Preconception HAART was significantly related to low birth weight children. This study demonstrated increased risk of adverse pregnancy outcomes with protease inhibitor excluded HAART. Prospective studies assessing the impact of HAART on MTCT as measured in terms of HIV-free survival among children are needed. © Mary Ann Liebert, Inc.


Panditrao M.,University of California at Berkeley | Darak S.,University of Groningen | Darak S.,PRAYAS Health Group | Kulkarni V.,PRAYAS Health Group | And 2 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2011

Currently, 40% of HIV-infected women enrolled in national prevention of mother-to-child transmission (PMTCT) program in India are loss to follow-up (LTF) before they can receive single dose Nevirapine. To date no study from India has examined the reasons for inadequate utilization of PMTCT services. This study sought to examine the socio-demographic factors associated with LTF of HIV-infected women enrolled during 2002-2008 in a large-scale private sector PMTCT program in Maharashtra, India. Data on HIV-infected women who were enrolled during pregnancy (N = 734) and who reported live birth (N = 770) were used to analyze factors associated with LTF before delivery and after delivery, respectively. Univariate and multivariate analyses were conducted to estimate the associations between being LTF and socio-demographic factors using generalized linear models. Eighty (10.9%) women were LTF before delivery and 151 (19.6%) women were LTF after delivery. Women with less than graduate level education (RR = 6.32), from a poor family (RR = 1.61), who were registered after 20 weeks of pregnancy (RR =2.02) and whose partners were HIV non-infected or with unknown HIV status (RR = 2.69) were more likely to be LTF before delivery. Similarly, the significant factors for LTF after delivery were less than graduate level education (RR = 1.82), poor family (RR = 1.42), and registration after 20 weeks of pregnancy (RR = 1.75). This study highlights the need for innovative and effective counseling techniques for less educated women, economic empowerment of women, better strategies to increase uptake of partner's HIV testing, and early registration of women in the program for preventing LTF in PMTCT programs. This need for innovative counseling techniques is even greater for PMTCT programs in the public health sector as the women accessing care in the public sector are likely to be less educated and economically more deprived. © 2011 Taylor & Francis.


Darak S.,University of Groningen | Darak S.,PRAYAS Health Group | Panditrao M.,University of California at Berkeley | Parchure R.,PRAYAS Health Group | And 4 more authors.
BMC Public Health | Year: 2012

Background: In spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. In India, programs for the prevention of motherto- child transmission (PMTCT) have been scaled up widely since 2005. However, these programs reach only a small percentage of pregnant women, and their overall effectiveness is low. Evidence-based program planning and implementation could significantly improve their effectiveness. This study sought to systematically retrieve, thematically categorize and review published research on PMTCT of HIV in India, focusing on research related to the provision and/or utilization of the cascade of services provided in a PMTCT program, in order to direct further research to enhance program implementation and effectiveness. Methods: A systematic search using MEDLINE, US National Library of Medicine Gateway system (PubMed) and ISI Web of Knowledge resulted in 1,944 abstracts, of which 167 met our inclusion criteria. Results: A huge share of the empirical literature on PMTCT in India (N = 134) deals with epidemiological studies (N = 60). The 46 papers related to utilization/provision of the cascade of PMTCT services were mostly from the four high HIV prevalence states in southern India and from the public sector. Studies on experiences of implementing a PMTCT program (N = 20) show high rates of drop out of women in the cascade particularly prior to receiving ARV. Studies on individual components of the cascade (N = 26) show that HIV counseling and testing is acceptable and feasible. Literature on other components of the cascade - such as pregnant womens access to ANC care, HIV infected womens immunological assessment using CD4 testing, repeat HIV testing among pregnant women, early infant diagnosis and factors related to linking HIV infected women and children to postnatal care is lacking. Conclusions: While the scale of the Indian PMTCT program is large, comprehensive understanding of the contextdriven factors affecting its efficiency is lacking. Systematic and more focused public health research output is needed on the issues related to reduction of drop outs of women in the cascade, role of PMTCT programs in improving maternal and child health indicators and role of private sector in delivering PMTCT services. © 2012 Darak et al.; licensee BioMed Central Ltd.


PubMed | PRAYAS Health Group, Maharashtra University of Health Sciences, University of Oxford and University of Groningen
Type: Journal Article | Journal: PloS one | Year: 2015

HIV infection closely relates to and deeply affects the reproductive career of those infected. However, little is known about the reproductive career trajectories, specifically the interaction of the timing of HIV diagnosis with the timing and sequencing of reproductive events among HIV infected women. This is the first study to describe and typify this interaction.Retrospective calendar data of ever married HIV infected women aged 15-45 attending a HIV clinic in Pune, Maharashtra, Western India (N=622) on reproductive events such as marriage, cohabitation with the partner, use of contraception, pregnancy, childbirth and HIV diagnosis were analyzed using sequence analysis and multinomial logistic regression.Optimal matching revealed three distinct trajectories: 1) HIV diagnosis concurrent with childbearing (40.7%), 2) HIV diagnosis after childbearing (32.1%), and 3) HIV diagnosis after husbands death (27.2%). Multinomial logistic regression (trajectory 1 = baseline) showed that women who got married before the age of 21 years and who had no or primary level education had a significantly higher risk of knowing their HIV status either after childbearing or close to their husbands death. The risk of HIV diagnosis after husbands death was also higher among rural women and those who were diagnosed before 2005.Three distinct patterns of interaction of timing of HIV diagnosis with timing and sequencing of events in the reproductive career were observed that have clear implications for (i) understanding of the individual life planning process in the context of HIV, (ii) formulation of assumptions for estimating HIV infected women in need of PMTCT services, and (iii) provision of care services.


PubMed | MIMER Hospital, Prayas Health Group, National Dairy Research Institute, Hirabai Cowasji Jehangir Medical Research Institute HCJMRI and 2 more.
Type: Journal Article | Journal: BMJ open | Year: 2015

To evaluate cost-effectiveness of second HIV test in pregnancy.Current strategy of single HIV test during pregnancy in India can miss new HIV infections acquired after the first test or those HIV infections that were missed in the first test due to a false-negative HIV test.Between August 2011 and April 2013, 9097 pregnant HIV uninfected women were offered a second HIV test near term (34 weeks or beyond) or within 4 weeks of postpartum period. A decision analysis model was used to evaluate cost-effectiveness of a second HIV test in pregnant women near term.Our key outcome measures include programme cost with addition of second HIV test in pregnant women and quality-adjusted life years (QALYs) gained.We detected 4 new HIV infections in the second test. Thus HIV incidence among pregnant women was 0.12 (95% 0.032 to 0.297) per 100 person women years (PWY). Current strategy of a single HIV test is 8.2 times costlier for less QALYs gained as compared to proposed repeat HIV testing of pregnant women who test negative during the first test.Our results warrant consideration at the national level for including a second HIV test of all pregnant women in the national programme. However prior to allocation of resources for a second HIV test in pregnancy, appropriate strategies will have to be planned for improving compliance for prevention of mother-to-child transmission of HIV and reducing loss-to-follow-up of those women detected with HIV.CTRI/2013/12/004183.


Joshi S.,Jehangir Hospital Premises | Joshi S.,Prayas Health Group | Babu J.M.,Rajiv Gandhi Center for Biotechnology | Jayalakshmi D.,Rajiv Gandhi Center for Biotechnology | And 7 more authors.
Vaccine | Year: 2014

Introduction: Frequency and distribution of HPV types in HIV-infected women with and without cervical neoplasia and their determinants have not been widely studied in India. We report and discuss HPV prevalence and type distribution in HIV-infected women. Methods: HPV genotyping was done using cervical samples from 1109 HIV-infected women in a cross-sectional study. Results: Any HPV was detected in 44.8% and high-risk ones in 41.0% women. Frequency of single and multiple high-risk infections were 26.7% and 14.3%, respectively. Frequencies of high-risk HPV infections in women with and without cervical neoplasia were 73.5% and 37.6%, respectively. HPV16 was the most common genotype, present in 11.5%, and 58.5% of women with cervical intraepithelial neoplasia (CIN) 2 and 3. Other most common high-risk HPV types in CIN 2-3 lesions were HPV 31 (22.6%); 56 (13.2%); 18 and 68a (11.3%) and 33, 35 and 51 (9.4%); and 70 (7.5%). Women under 30 or over 44 years, no abortions, and women with diagnosis of HIV infection within the last 5 years were at high risk of multiple oncogenic HPV infection. Conclusion: We observed a very high frequency of high-risk HPV and multiple infections in HIV-infected women. © 2014 Elsevier Ltd.


Joshi S.,Jehangir Hospital Premises | Sankaranarayanan R.,The Detection Group | Muwonge R.,The Detection Group | Kulkarni V.,Prayas Health Group | And 2 more authors.
AIDS | Year: 2013

OBJECTIVE: To evaluate an accurate, affordable, and feasible method to screen and treat HIV-infected women so that cervical cancer can be prevented among them. DESIGN: A cross-sectional study was conducted in India in which eligible HIV-infected women underwent visual inspection with acetic acid (VIA), visual inspection with Lugol's iodine (VILI), cytology, human papillomavirus (HPV) testing, and colposcopy. METHODS: We screened women with cytology, HPV testing, VIA, and VILI. All screened women had colposcopy and women with colposcopic abnormalities had directed biopsies. Women with suspected cervical intraepithelial neoplasia (CIN) on colposcopy were treated with cold coagulation or loop excision. Sensitivity, specificity, and predictive values of the screening tests were calculated. RESULTS: Among 1128 women screened, 55 (4.9%) had CIN2-3 lesions. Sensitivity for VIA, VILI, cytology at atypical squamous cells of undetermined significance (ASCUS) threshold and HPV testing was 83.6, 89.1, 63.3, and 94.6%, and specificity was 88.8, 89.3, 94.5, and 77.4%, respectively, in detecting CIN2/3 lesions. Cytology had significantly lower sensitivity and higher specificity than VIA, VILI, and HPV testing. Sequential testing with VIA/VILI, HPV testing/VIA, HPV testing/VILI, and HPV testing/VIA/VILI had more balanced sensitivity and specificity than the single tests. Cold coagulation was well tolerated and cured 80% of CIN2-3 based on preliminary results at 6-month to 1-year follow-up periods. CONCLUSIONS: Sequential testing with VIA and VILI is the most feasible screening approach for cervical cancer screening in HIV-infected women in low-resource countries. When HPV testing becomes feasible and affordable, HPV testing followed by VIA/VILI may be considered. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | Prayas Health Group, Jehangir Hospital Premises and Institute for Cytology and Preventive Oncology
Type: | Journal: International journal of women's health | Year: 2015

Female sex workers (FSWs) are at an increased risk of human immunodeficiency virus (HIV) as well as human papillomavirus (HPV) infections and thus have an increased risk of cervical intraepithelial neoplasia (CIN) and cervical cancer. We evaluated the feasibility of screen and treat approach for cervical cancer prevention and the performance of different screening tests among FSWs.Women were screened using cytology, VIA (visual inspection with acetic acid), and VILI (visual inspection with Lugols iodine) and underwent colposcopy, biopsy, and immediate treatment using cold coagulation, if indicated, at the same visit.We screened 300 FSWs of whom 200 (66.67%) were HIV uninfected and 100 (33.34%) were HIV infected. The overall prevalence of CIN 2-3 lesions was 4.7%. But all women with CIN 2-3 lesions were HIV infected, and thus the prevalence of CIN 2-3 lesions in HIV-infected FSWs was 14/100 (14%, 95% confidence interval: 7.2-20.8). All of them screened positive by all three screening tests. Cold coagulation was well tolerated, with no appreciable side effects.Cervical cancer prevention by screen and treat approach using VIA, followed by ablative treatment, in this high-risk group of women is feasible and can be implemented through various targeted intervention programs.

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