Oral HIV self-testing among men who have sex with men in New Delhi, India: Perceptions & apprehensions: A qualitative study

Background & objectives: The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM. Methods: MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants’ awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified. Results: A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing. Interpretation & conclusions: Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM

Adherence to medications among patients with diabetes mellitus (Type 2) at ballabgarh health and demographic surveillance system: A community based study

Burden of diabetes mellitus in India is on rise. Adherence to treatment is essential to diabetes control and prevention of complications. Objectives: To study the adherence to treatment of diabetes mellitus and its determinants among rural population Material and methods: A cross-sectional study was conducted in a rural community of north India. From a list of all self-reported diabetics (aged ≥18 years), 400 were randomly selected. Information about drug prescription and intake, socio-demographic factors, health seeking behaviors and disease status were obtained from the participants. Height, weight and blood pressure were recorded. Blood samples were collected to measure HbAlc levels Results: Out of 371 self-reported diabetic patients, 113 (30.4%) did not take any medication since last one month of the interview. Amongst 258 patients, who were taking treatment, 146 (39.4, 95%CI: 34.5-44.4) were found to have 100% drug adherence rate. Tobacco (p=0.03) and alcohol (p=0.04) use were significantly associated with drug adherence on bi variate analysis. Drug adherence rate was higher in group with HbA1c level more than 6.4gm%. Conclusion: A high proportion of diabetic patients were not adhering to the treatment prescribed to them by their consulting doctors. There is urgent need for awareness generation about diabetes treatment adherence and developing adherence monitoring mechanisms at community level.

Prevalence of nonalcoholic fatty liver disease in an adult population in a rural community of Haryana, India.

Background: Though nonalcoholic fatty liver disease (NAFLD) is increasingly becoming prevalent in the Indian population, knowledge regarding the burden and risk factors of NAFLD is limited, more so from rural areas. This study was thus conducted to estimate the prevalence of NAFLD among adults in a rural community of Haryana, India and to measure the association of diet, physical activity, and other selected risk factors with NAFLD. Materials and Methods: The present study was conducted in a rural community of Haryana, India among resident adults ≥35 years of age. Eight out of 28 villages were selected by probability proportion to size sampling. The number of eligible and consenting participants randomly selected from each village was 27. Out of 216 participants thus recruited, 184 participants reported for undergoing ultrasonography (USG) of the liver, anthropometry, blood pressure recording, and blood sample collection. Finally, 176 participants were analyzed. Results: Prevalence of NAFLD was 30.7%. There was no significant difference in the calorie intake and average total physical activity between participants with and without NAFLD. On multivariate analysis, hypertension [adjusted odds ratio (OR): 2.3, 95% confidence interval (CI): 1.1-5.0, P 0.03] and an increased waist circumference (adjusted OR: 4.9, 95% CI: 1.5-7.0, P < 0.001) were independently associated with NAFLD. A normal high-density lipoprotein (HDL) level was protective against NAFLD (adjusted OR: 0.4, 95% CI: 0.2-0.8, P 0.001). Conclusions: The high prevalence of NAFLD is already a public health problem, even in the rural parts of India. Urgent public health interventions are required to prevent its development by controlling the cardiometabolic risk factors associated with it.

Prevalence and Determinants of Sexually Transmitted Infections (STIs) among Male Migrant Factory Workers in Haryana, North India.

Background: Male migrant workers display high risk sexual behavior and have been shown to have higher prevalence of sexually transmitted infections (STIs), which make them more vulnerable to HIV infection. We aimed to estimate the prevalence of self-reported STIs and delineate their determinants among male migrant factory workers in Faridabad, Haryana. Materials and Methods: Male workers in two selected factories, who were aged ≥18 years, were born outside Haryana (destination), and who had migrated to Haryana after the age of 15 years were eligible. Sociodemographic information, HIV/AIDS knowledge and behavior, and self-reported STI symptoms in the last 1 year were ascertained by face-to-face interview. Determinants of STIs were identifi ed by regression analysis. Results: Totally 755 eligible workers participated. Mean ± SD age was 31.4 ± 8.2 years and migration duration was 9.5 ± 6.7 years. At least one STI symptom was reported by 41.7% of the participants (burning micturition- 35%, inguinal bubos-5.2%, genital ulcers- 2.6%, urethral pus discharge- 1.3%). Factors associated with STIs were higher age at migration, lower HIV/AIDS knowledge, paid sex in the last year, non-use of condoms during the last non-spousal sex, and unfavorable intention to use condom. Conclusion: Prevalence of self-reported STIs among these migrant men was high. Targeted Interventions among migrant workers need to be strengthened for control and prevention of STIs.

Making a postgraduate journal club an effective learning opportunity: Experience from the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi

A journal club (JC) is defined as a group of individuals who meet regularly to critically discuss the applicability of current peerreviewed articles published in medical journals.1 The memoirs of Sir James Paget, a surgeon at St Bartholomew’s Hospital, London, UK (1835–54), contain the earliest mention of a JC. Sir Paget described ‘a kind of club in a small room over a baker’s shop near the hospital gate where we could sit and read journals and play cards’.2 There is evidence of the existence of the first formal JC in 1875, when William Osler of McGill University, Montréal, Canada found a way of making expensive periodicals affordable by purchasing expensive journals with fellow students at a group rate.

A community-based study of menstrual hygiene practices and willingness to pay for sanitary napkins among women of a rural community in northern India.

Background. Hygiene-related practices of women during menstruation are of paramount importance. There is a lack of sizeable literature on menstrual practices from northern India. We documented the menstrual hygiene practices of rural women and assessed their willingness to pay for sanitary napkins. Methods. A cross-sectional study was done in villages under the Comprehensive Rural Health Services Project (CRHSP), situated in Ballabgarh, Haryana. The study participants were women in the age group of 15–45 years. Nine villages were selected randomly while the number of respondents in each selected village was decided through the probability proportionate to size sampling method. The households were selected using systematic sampling. One woman was interviewed in each household using a pre-tested questionnaire. Results. A total of 995 women were interviewed. A majority of them (62%) were unaware of the reason(s) for menstruation. The role of the health sector in providing information regarding menstruation was low as only a few women (1.5%) had got information from the auxiliary nurse midwife (ANM)/health worker (HW). For the majority of women, besides religious activities, other routine activities did not suffer during menstruation. Only 28.8% of women were using sanitary napkins and of those who did not use napkins, only one-fourth (25.3%) were willing to buy them. The mean (SD) price per napkin that these women were ready to pay was `0.54 (0.43), equivalent to US$ 0.01. Conclusion. Women in the reproductive age group should be provided with appropriate information about menstruation, and they should be told about the advantages of using sanitary napkins. Health sector functionaries should play a proactive role in the delivery of such information.

Causes of death in rural adult population of North India (2002-2007), using verbal autopsy tool.

Background: With the on-going epidemiological transition, information on the pattern of mortality is important for health planning. Verbal autopsy (VA) is an established tool to ascertain the cause of death in areas where routine registration systems are incomplete or inaccurate. We estimated cause-specific mortality rates in rural adult population of 28 villages of Ballabgarh in North India using VA. Materials and Methods: During 2002-2007, trained multi-purpose health workers conducted 2294 VA interviews and underlying cause of death was coded by physicians. Proportional mortality (%) was calculated by dividing the number of deaths attributed to a specific cause by the total number of deaths for which a VA was carried out. Findings: 61% of deaths occurred among males and 59% occurred among those aged ≥60 years. The leading causes of death were diseases of the respiratory system (18.7%) and the circulatory system (18.1%). Infectious causes and injuries and other external causes, each accounted for around 15% of total deaths followed by neoplasms (6.8%) and diseases of the digestive system (4%). Among those 45 years of age, more than half of deaths were attributed to non-communicable diseases (NCDs) alone. Accidents and injuries were responsible for one-fourth of deaths in 15-30 years age group. Conclusion: NCDs and injuries are emerging as major causes of death in this region thereby posing newer challenges to public health system.

Public health approach to address maternal mortality.

Reducing maternal mortality is one of the major challenges to health systems worldwide, more so in developing countries that account for nearly 99% of these maternal deaths. Lack of a standard method for reporting of maternal death poses a major hurdle in making global comparisons. Currently much of the focus is on documenting the "number" of maternal deaths and delineating the "medical causes" behind these deaths. There is a need to acknowledge the social correlates of maternal deaths as well. Investigating and in-depth understanding of each maternal death can provide indications on practical ways of addressing the problem. Death of a mother has serious implications for the child as well as other family members and to prevent the same, a comprehensive approach is required. This could include providing essential maternal care, early management of complications and good quality intrapartum care through the involvement of skilled birth attendants. Ensuring the availability, affordability, and accessibility of quality maternal health services, including emergency obstetric care (EmOC) would prove pivotal in reducing the maternal deaths. To increase perceived seriousness of the community regarding maternal health, a well-structured awareness campaign is needed with importance be given to avoid adolescent pregnancy as well. Initiatives like Janani Surakhsha Yojna (JSY) that have the potential to improve maternal health needs to be strengthened. Quality assessments should form an essential part of all services that are directed toward improving maternal health. Further, emphasis needs to be given on research by involving multiple allied partners, with the aim to develop a prioritized, coordinated, and innovative research agenda for women's health.