ABSTRACT
BACKGROUND: In April 2018, the Government of India launched 'Nikshay Poshan Yojana' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients. OBJECTIVE: To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April-September 2017) and after (April-September 2018) implementation of NPY. METHODS: This was a cohort study using secondary data routinely collected by the national TB and HIV programmes. RESULTS: A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%-81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41-165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%-72.8%), while it was 65.0% (95% CI: 61.2%-68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9-1.3). CONCLUSION: Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes.
ABSTRACT
BACKGROUND: A key component of prevention programmes aimed at reducing the risk of HIV and sexually transmitted infections (STI) among high-risk groups such as female sex workers (FSW) is the provision of quality STI services. The attitudes and practices of care providers are critical factors in the provision of services and in achieving better participation of high-risk individuals in accessing services. OBJECTIVES: To assess the attitudes and practices of STI care providers towards FSW, and the perceptions of FSW towards STI services, following training. METHODOLOGY: After an intensive physician capacity building programme, 393 exit interviews of FSW were conducted following clinical encounters, and discussions were held with 131 STI care providers (physicians) across several districts in Karnataka. Focus group discussions were held among FSW to understand the perceptions of non-users of services. RESULTS: 60% of women reported that the clinics were accessible. 76% of the women who visited clinics for STI consultations were offered a speculum examination. 85% received a condom demonstration, but only 52% were advised for partner treatment. 69% of women were referred for HIV testing. 79% of physicians felt that sex workers were responsible for spreading HIV in the community, and 47% believed that sex work should be banned to control HIV. CONCLUSIONS: Following physician training, quality of care appears to be generally acceptable, but it is important to improve further the attitudes of providers towards sex work, and improve practices such as speculum examination and partner referral that can enhance quality of care.
