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Schneider J.A.,University of Chicago | Dandona R.,Public Health Foundation of India | Pasupneti S.,University of Chicago | Lakshmi V.,Nizams Institute of Medical Sciences | And 3 more authors.
PLoS ONE | Year: 2010

Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP) and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India. © 2010 Schneider et al. Source


Dworkin M.S.,University of Illinois at Chicago | Douglas G.W.,University of Illinois at Chicago | Rani G.P.S.,SHARE India | Chakraborty A.,University of Illinois at Chicago
International Journal of STD and AIDS | Year: 2016

We assessed the barriers and facilitators to highly active antiretroviral therapy adherence and determined their prevalence among HIV/AIDS patients in Hyderabad, India. We conducted a cross-sectional study among HIV-infected adults prescribed highly active antiretroviral therapy and receiving care from nine clinics. Depression was screened using Patient Health Questionnaire 9 and facilitators of HIV medication adherence were assessed using an 11-item scale which yielded a total positive attitude to disease score. Prevalence ratios of non-adherence between different categories of potential risk factors were calculated. We compared mean ‘facilitators to adherence’ scores between the adherent and non-adherent population. Multivariable Poisson regression with robust variance was used to identify independent risk factors. Among the 211 respondents, nearly 20% were non-adherent, approximately 8% had either moderately severe or severe depression and mean score for combined facilitators to medication adherence was 33.35 (±7.88) out of a possible 44 points. Factors significantly associated with non-adherence included older age, female sex worker, moderate-to-severe depression and the combined facilitators to medication adherence score. These data from a broad range of clinical settings in Hyderabad reveal that key groups to focus on for adherence intervention are female sex workers, older persons and those with depression. © 2015, © The Author(s) 2015. Source


Reddy R.,National Institute of Epidemiology | Parasadini G.,Directorate of Health and Family Welfare | Rao P.,Directorate of Health and Family Welfare | Uthappa C.K.,SHARE India | Murhekar M.V.,National Institute of Epidemiology
Journal of Infection in Developing Countries | Year: 2012

Introduction: In August 2011, Chittoor district authorities reported a cluster of suspected human anthrax cases to the Andhra Pradesh state surveillance unit. We investigated this cluster to confirm its etiology, describe its magnitude, identify potential risk factors, and make recommendations for preventing similar outbreaks in the future. Methodology: Suspected cutaneous anthrax was defined as a painless skin lesion (papule, vesicle, or eschar) that appeared in a resident of Musalimadugu between July and August 2011. Clinical details and smears from skin lesions from suspected cases were collected to describe the outbreak by time, place and person. A retrospective cohort study among villagers aged ≥ 15 years was conducted to identify risk factors for acquiring the infection. Results: Sixteen livestock in the village died between 24 June and 7 August 2011. Smears from five animals showed Gram-positive, spore bearing characteristics of Bacillus anthracis. Villagers butchered and skinned the dead animals, sold the skin, and consumed the meat after boiling it for two hours. The outbreak in humans started on 30 July, and nine suspected cases of cutaneous anthrax (attack rate: 2%, no deaths) occurred until 7 August. The attack rate was higher among those aged ≥15 years. All the smears were negative on Gram staining. Individuals, who had handled, skinned, and slaughtered dead livestock were at higher risk of infection. Conclusions: We recommend ciprofloxacin prophylaxis to close family contacts. Vaccination of the livestock in the area and community education on the dangers of handling and slaughtering dead/ill livestock are necessary. © 2012 Reddy et al. Source


Hemmige V.,University of Chicago | Snyder H.,University of Chicago | Liao C.,University of Chicago | Mayer K.,The Miriam Hospital | And 4 more authors.
AIDS Patient Care and STDs | Year: 2011

A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and other attributes on existing HIV risk including previous HIV testing, unprotected anal intercourse (UAI), and HIV serostatus among MSM recruited from drop-in centers and public cruising areas in the twin cities of Hyderabad and Secunderabad, India. A survey was administered by trained research assistants and minimally invasive HIV testing was performed by finger-stick or oral testing. HIV seropositive MSM underwent CD4 + lymphocyte count measurement. In our sample (n=676), 32.6% of men were married to women, 22.2% of receptive only participants were married, and 21.9% of men were HIV seropositive. In bivariate analysis, sex position was associated with previous HIV testing, UAI, HIV serostatus, and CD4 + lymphocyte count at diagnosis. In multivariate analysis with interaction terms, dual unmarried men were more likely to have undergone an HIV test than insertive unmarried men (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.2-6.5), a relationship that did not hold among married men. Conversely, dual married men were less likely than insertive married men to engage in UAI (OR 0.3; 95% CI 0.1-0.6), a relationship that did not hold among unmarried men. Further implementation research is warranted in order to best direct novel biologic and behavioral prevention interventions towards specific risk behaviors in this and other similar contexts. © Copyright 2011, Mary Ann Liebert, Inc. 2011. Source


Allam R.R.,SHARE India | Uthappa C.K.,SHARE India | Duerst R.,University of Illinois at Chicago | Sorley E.,University of Illinois at Chicago | And 3 more authors.
Pediatric Infectious Disease Journal | Year: 2016

Background: India accounts for approximately 72% of reported diphtheria cases globally, the majority of which occur in the state of Andhra Pradesh. The aim of this study is to better understand lack of knowledge on diphtheria vaccination and to determine factors associated with diphtheria and low knowledge and negative attitudes. Methods: We performed a 1:1 case-control study of hospitalized diphtheria cases in Hyderabad. Eligible case patients were 10 years of age or older, resided within the city of Hyderabad and were diagnosed with diphtheria per the case definition. Patients admitted to the hospital for nonrespiratory communicable diseases and residing in the same geographic region as that of cases were eligible for enrolment as controls Results: There were no statistical differences in disease outcome by gender, education, economic status and mean room per person sleeping in the house in case and control subjects. Not having heard of diphtheria (adjusted odds ratio: 3.56; 95% confidence intervals: 1.58-8.04] and not believing that vaccines can prevent people from getting diseases (adjusted odds ratio: 3.99; 95% confidence intervals: 1.18-13.45) remained significantly associated with diphtheria on multivariate analysis. Conclusion: To reduce the burden of diphtheria in India, further efforts to educate the public about diphtheria should be considered. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

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