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Objective: To examine the prognostic factors of progression from HIV to AIDS and AIDS to the death in people living with HIV/AIDS in Iran. Methods: In this registry-based retrospective cohort study, we recruited 28 873 HIV-infected people from 158 Behavioral Diseases Counseling Centers of Iran. Two outcomes of interest included survival rates from HIV diagnosis to AIDS and from AIDS to the death. We used Kaplan-Meier and Cox regression model to investigate survival rate and factors affecting on survival controlling effect of confounding factors. Results: The one, three, five, and ten-year survival rate from HIV to AIDS were 85%, 73%, 61% and 32%, and for AIDS to death were 90%, 81%, 74% and 55%, respectively. Multivariate Cox regression analysis indicated that the risk of progression from AIDS phase toward death in individuals with CD4 less than 200/mm
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Background: Complete and fast diagnosis, registry and treatment programs are the main effective strategies for controlling infectious diseases. In addition, an organized and extended infectious disease surveillance system is crucial in designing and monitoring communicable diseases control programs. The quality of the surveillance system can be evaluated by several indices such as timeliness, completeness and sensitivity. This is an evaluation study to measure the mentioned indices for 3 zoonotic diseases [leishmaniasis, brucellosis and rabies] surveillance system
Methods: The indexes such as completeness, timeliness and sensitivity of surveillance system were measured using the data obtained from population based [door to door] interviews and recorded data obtained at each level of health and medical sectors or administrative centers within the diseases reporting system. Interviews were conducted for 5969 participants and the required information was obtained
Results: The total completeness, timeliness and sensitivity of case reporting for leishmaniasis were 26.9%, 103.2 days and 11.1%, respectively. These indexes forbrucellosiswere14.3 %, 58 days, 12.1% and those for suspected rabieswere100%, 83.4 days and 48.2%, respectively
Conclusion: It seems that so called immediate communicable diseases reporting system is not providing reliable, complete and timely information to the health authorities. Program monitoring and personnel training, especially physicians, are recommended to improve the quality of the surveillance system and the related indexes
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Background: Intensified strategy includes special attention to the symptoms such as cough [more than two weeks], fever [more than three weeks], night sweats [more than three weeks], and weight loss [more than 3 kg per month]. If any of the above symptoms was positive, in suspected individuals for TB, more assessment should be done. The aim of this study was to compare between intensified and routine case finding for a better case selection method for diagnosis of pulmonary tuberculosis among HIV-Infected Persons
Methods: The sample size was calculated 237 patients [474 for the two groups]. In the current study, the patients were divided randomly into two groups: A] intensified case finding group and B] routine case finding group. Considering the sputum culture as the gold standard, we calculated the sensitivity and specificity, Positive predictive value [PPV], Negative predictive value [NPV] for fever, weight loss, coughing more than two week, night sweats, and PPD test
Result: A total of eight positive cases of tuberculosis were detected in the intensified while four were found in the routine case finding group. Sensitivity, specificity, PPV, and NPV for cough in diagnosis of TB were 25%, 87%, 6%, and 97%, respectively. For weight loss, they were 62.5%, 83%, 10.8%, and 98.5% respectively while these amounts were, 7%, 85%, 97.6, 37.5 for night sweats. For fever, they were, 25%, 92.9%, 10.5%, and 97% respectively, and for PPD they were 87.5%, 40%, 4.6%, and 98.9%, respectively
Conclusion: Key symptom screening, such as cough, fever, weight loss and night sweats, has an important role in detecting TB among HIV-infected patients
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The rabies is one of the most important officially-known viral zoonotic diseases for its global distribution, outbreak, high human and veterinary costs, and high death rate and causes high economic costs in different countries of the world every year. The rabies is the deadliest disease and if the symptoms break out in a person, one will certainly die. However, the deaths resulting from rabies can be prevented by post-exposure prophylaxis. To do so, in Iran and most of the countries in the world, all the people who are exposed to animal bite receive Post-Exposure Prophylaxis [PEP] treatment. The present survey aimed to investigate the cost-effectiveness of PEP in southern Iran. The present study estimated the PEP costs from the government's Perspective with step-down method for the people exposed to animal bite, estimated the number of DALYs prevented by PEP in the individuals using decision Tree model, and computed the Incremental cost-effectiveness Ratio. The information collected of all reported animal bite cases [n=7111] in Fars Province, who referred rabies registries in urban and rural health centers to receive active care. Performing the PEP program cost estimated 1,052,756.1 USD for one year and the estimated cost for the treatment of each animal bite case and each prevented death was 148.04 and 5945.42 USD, respectively. Likewise 4,509.82 DALYs were prevented in southern Iran in 2011 by PEP program. The incremental cost-effectiveness ratio for each DALY was estimated to be 233.43 USD. In addition to its full effectiveness in prophylaxis from rabies, PEP program saves the financial resources of the society, as well. This study showed performing PEP to be more cost-effective
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Humans , Female , Male , Cost-Benefit Analysis , Post-Exposure Prophylaxis/economicsABSTRACT
Background: Human Immunodeficiency Virus [HIV] epidemics are largely linked to high-risk populations such as female commercial sex workers [FSWs]. This study assessed sexual behaviors, attitudes and knowledge of this marginalized group
Methods: We conducted a cross- sectional study on 278 selfidentified FSWs by using Respondent Driven Sampling [RDS] method in Shiraz, south of Iran, from June 2010 to March 2011. Volunteer women were interviewed in order to explore issues such as sexual behavior, sexual violence, work conditions, contraceptive methods, HIV/AIDS knowledge, HIV test, and source of HIV information
Results: The majority of participants [95.1%] knew about condoms; however, only 40.6% used condoms consistently. Despite the subject's wide knowledge regarding modes of transmission, 61% and 40% did not use any protection with anal and oral intercourse, respectively. 21% of FSWs experienced sexual violence. Nearly half [45.2%] of them had an HIV test and more than three-quarters knew their test results. The women in our study preferred to receive their information from health workers [63%] and peer group [45.2%]
Conclusion: This study sheds light on the existing knowledge and practices of this high-risk group. Although the majority of FSWs were familiar with HIV/AIDS, risky behaviors such as anal and oral sex are still in practice; this calls for education and HIV prevention campaigns focusing on risk education awareness. Efforts in addressing the problem of inconsistent condom use needs to be directed towards client specific approaches and must be regarded a top priority
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Background: The United Nations has predicted that the population of slum dwellers will have grown from one billion people worldwide to 2 billion by 2030. This trend is also predictable in Iran. In the Iranian metropolis of Shiraz, more than 10% of the residents live in slum areas. There are several problems regarding the delivery of social services in these areas. The aim of this study was to evaluate slums dwellers' access to and coverage of health care
Methods: This cross-sectional face-to-face study included 380 household of slum dwellers via stratified random sampling. Demographics, accessibility of health services, coverage of health care, and route of receiving health services were recorded through interviews
Results: Approximately, 21.6% of the households had no physical access to health centers. The coverage rate of family planning programs for safe methods was 51.4% [95% CI: 48.86-53.9%]. Vaccination coverage among children under 5 years old was 98% [95% CI: 97-99%]. Furthermore, 34% of pregnant women had not received standard health care due to a lack of access to health centers
Conclusion: Limited access to health services along with inadequate knowledge of slum residents about health care facilities was the main barrier to the utilization of the health care in the slums
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As substance abusers are prone for human immunodeficiency virus [HIV] infection, this study was established to estimate the prevalence of HIV infection and related risk factors among injective substance abusers in Shiraz. In this cross sectional descriptive study, we studied 360 male intravenous substance abusers in a random "time location sampling" method all around Shiraz. During September to December 2008, participants were asked by standard structured questionnaire of behavioral study. We obtained three blood spots from their fingers to evaluate HIV infection. Data were analyzed by descriptive statistical methods such as mean, variance, tables and schemas. The mean age of participants were 33 +/- 7.26 years [range 19-64]. The average age of initial substance use and first intravenous substance use were 18.6 +/- 1.63 and 25 +/- 6.32 years. 30.2% of the participants were homeless and the most prevalent method of abuse was injection. The most abused illicit drug in the last month was Tamgizak [41.1%]. During last month, 15% had used contaminated syringes and 15.6% had used shared syringes; 62.8% of participant had sex with permanent partners such as wife, 36.3% had sex to earn money or drugs, 54% had sex with other partners [not for money or drugs] and 49.4% were homosexual. During last year, prevalence of unprotected sexual intercourse without condom in four mentioned sexual patterns were 49.7%, 31.7%, 43.3%, 75.6% respectively. In addition, 24.7% [89 cases] were infected with HIV. The prevalence of HIV[+] cases and high risk behaviors among intravenous drug abusers are high