Effect of public-private partnership in treatment of sexually transmitted infections among female sex workers in Andhra Pradesh, India.

Background & objectives: Providing sexually transmitted infection (STI) services to female sex workers (FSWs) in rural and resource constrained settings is a challenge. This paper describes an approach to address this challenge through a partnership with government health facilities, and examines the effect of this partnership on the utilization of STI services by FSWs in Andhra Pradesh, India. Methods: Partnerships were formed with 46 government clinics located in rural areas for providing STI treatment to FSWs in 2007. Government health facilities were supported by local and State level non-government organizations (NGOs) through provision of medicines, training of medical staff, outreach in the communities, and other coordination activities. Data from programme monitoring and behaviour tracking survey were used to examine the accessibility and acceptability in utilization of STI services from partnership clinics. Results: The number of FSWs accessing services at the partnership clinics increased from 1627 in 2007 to over 15,000 in 2010. The average number of annual visits by FSWs to these clinics in 2010 was 3.4. In opinion surveys, the majority of FSWs accessing services at the partnership clinics expressed confidence that they would continue to receive effective services from the government facilities even if the programme terminates. The overall attitude of FSWs to visit government clinics was more positive among FSWs from partnership clinic areas compared to those from non-partnership clinic areas. Interpretation & conclusions: The partnership mechanism between the NGO-supported HIV prevention programme and government clinic facilities appeared to be a promising opportunity to provide timely and accessible STI services for FSWs living in rural and remote areas.

Re-emergence of tuberculosis in the Caribbean: how ready are the Caribbean laboratories in 1997

WHO declared tuberculosis a "Global Emergency" in 1994. The incidence of tuberculosis is increasing in the English speaking Caribbean. Sporadic occurrence of multiple drug resistance M. tuberculosis has been reported in a few countries in this region. It is well recognized that the laboratory plays an important role in the control of tuberculosis through rapid detection, isolation, idenfification of and drug susceptibility testing of M. tuberculosis. Twenty one laboratories were surveyed to assess the current practices and capabilities that exist in laboratories for the detection isolation and drug susceptibility testing of M. tuberculosis in the Caribbean. Sixteen laboratories perform laboratory diagnosis of tuberculosis. Microscopic examination of sputum for acid fast bacilli (AFB) is being performed in 12 laboratories by the direct method. The most commonly used method is the Kinyoun technique (10/16). Only one laboratory is practising fluorochrome methods for the rapid detection of AFB in sputum and other clinical specimens. Only five laboratories culture for mycobacteria. None of the laboratories perform either nucleic acid probes or BACTEC NAP for the identification of mycobacteriae other than tuberculosis (MOTT). Only three laboratories perform antimicrobial susceptibility testing in the Caribbean. All susceptibility testing for M. tuberculosis is done on solid media (LJ slants). The major antibiotics test are rifampicin, isoniazid, ethambutol and stretomycin. Sixty three percent of laboratories do not have a policy on monitoring of laboratory personnel by tuberculosis testing. The use of disposable bacteriological loops and bacticinerator as a minimal safety procedure is 57 percent and 63 percent respectively. Centrifuges with safety carriers are being used in only 13 percent of laboratories. Eight laboratories (50 percent) use Level 2 containment biological safety cabinet while processing of all specimens for mycobacterial infections. Reporting of smear results to hospital, physician or the ministry of health/public health department is mainly done by telephone; but some laboratories report by writing and telephone. Thirty seven percent (6/16) laboratories do not report positive smear AFB results to the public health department. The time required to report AFB smear microscopy results take on an average of over 48 hrs in 75 percent of laboratories

Dengue haemorrhagic fever/dengue shock syndrome: an unwelcome arrival in Trinidad

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 33 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2 and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicans should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHS/DSS associated mortality in Trinidad and Tobago.

Evaluation of methods for the laboratory diagnosis of malaria in Guyana

When 297 blood samples taken from patients attending a fever clinic in Georgetowm Public Hospital were examined microscopically, after thick and thin blood films had been stained with Giemsa, one hundred and forty-two (47.8 per cent ) were microscopically positive for malaria. After processing the patients' serum samples by the Indirect Fluourescent Antibody (IFA) technique, specific IgG and IgM antibodies were detected in 239 (81.3 per cent ) and 179 (60.1 per cent ), respectively, of the sera. Based on the microscopical findings, the IFAT gave positive and negative values of 54.4 per cent and 81.8 per cent (IgG), and 57.5 per cent and 67.8 per cent (IgM), suggesting that the IgM would be more useful than the IgG in the diagnosis of current malaria. An odds ratio analysis showed that the presence of symptoms, IgG or IgM antibodies, as well as visits to endemic regions, could be good indicators of current malaria. Age and occupation are not. The microscopical method will continue to be the gold standard - the best available criterion for the validation of our tests - for our diagnosis of acute malaria.