RESUMO
Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.
RESUMO
Prevalence of non-communicable diseases were considered to be rare in children. But they have increased recently in developing countries, with increase in the prevalence of paediatric overweight and obesity. Body Mass Index (BMI) is commonly used to define overweight and obesity. Positive associations have been repeatedly reported between BMI and Hypertension.METHODSWe have conducted an observational cross sectional study of hypertension in 1250 students in the age group of 10-18 years studying in class 6 to 12 during school hours from July 2013 to June 2014. The values were recorded in multiples of 2 mmHg and levels greater than 95th percentile of age and gender were considered using the definition of the fourth report of NHBPEP. The association of risk factors were also evaluated.RESULTSOut of a total 1250 children, 239 (19.1%) had systolic hypertension, and 216 (17.3%) has diastolic hypertension. Prevalence of overweight and obesity were 11.8% and 7.5% respectively. Highly significant statistical association was found between body mass index (BMI) and both systolic and diastolic hypertension (p value 0.001).CONCLUSIONSPrevalence of both systolic and diastolic hypertensions were significantly high in overweight and obese children in comparison to normal weight children. Strong positive association was found between body mass index (BMI) and both systolic and diastolic hypertension. Association of other risk factors such as sex, family history, dietary habits like junk food intake and extra salt intake, were also observed
RESUMO
Background: Retention in care is important for optimal treatment outcomes and effective positive prevention. Reports from India and other countries have mentioned various factors affecting retention but the data on 'opting out' from Antiretroviral Treatment (ART) under the National AIDS Control Programme are scanty. Aim and Objectives: To estimate prevalence and predictors for opting out from Antiretroviral Treatment among HIV infected individuals attending ART center at ICMR-National AIDS Research Institute, Pune. Material and Methods: In this retrospective study, records of individuals taking ART between January 2006 and May 2017 were reviewed. An individual who no longer wished to continue treatment with the national programme because of his/her personal choice and stopped visiting the centre was reported as being 'opted out' from the programme. Results: Of the total 3842 individuals ever initiated on ART, 115 (3%) individuals opted out. The possibility of opting out from ART was 4.9 [95% CI: 1.78-13.6, (p=0.002)] times more in individuals who showed declining trend in their CD4 counts and 8.8 [95% CI: 3.33-23.27, (p<0.001)] times more in individuals who received treatment for less than a year. Sixty four (56%) opted out individuals could not be contacted telephonically. Of the 51 (44%) ndividuals that were contacted, 16 replied that they will visit the clinic as per their convenience. The reasons for opting out from RTin remaining 35 patients were inconvenience for coming to the clinic in terms of distance or financial issues (13), taking treatment from private sector (10), side effects of the drugs (5), death (4) and taking treatment from other government programme clinics (3). Conclusion: Efforts should be taken to address the issues of individuals not willing to continue ART from the programme clinics (opted out). The counseling should be strengthened to prevent the individuals opting out from the treatment. The national operational guidelines for ART services need to address the issues of these individuals so that they can be brought back into the programme.