Will an innovative connected AideSmart! app-based multiplex, point-of-care screening strategy for HIV and related coinfections affect timely quality antenatal screening of rural Indian women? Results from a cross-sectional study in India.

OBJECTIVES: In rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women's preference for home delivery and health illiteracy affect health service delivery. To address these issues, we developed AideSmart!, an innovative, app-based, cloud-connected, rapid screening strategy that offers multiplex screening for STBBIs and anaemia at the point of care. It offers connectivity, integration, expedited communications and linkages to clinical care throughout pregnancy. METHODS: In a cross-sectional study, we evaluated the AideSmart! strategy for feasibility, acceptability, preference and impact. We trained 15 healthcare professionals (HCPs) to offer the AideSmart! strategy to 510 pregnant women presenting for care to outreach rural service units of Christian Medical College, Vellore, India. RESULTS: With the AideSmart! screening strategy, we recorded an acceptability of 100% (510/510), feasibility (completion rate) of 91.6% (466/510) and preference of 73%. We detected 239 infections/conditions (239/510, 46.8%) at the point-of-care, of which 168 (168/239; 70%) were lab confirmed, staged and treated rapidly. Of the 168 confirmed infections/conditions, 127 were anaemia, 11 Trichomonas and 30 hepatitis B virus (HBV) (25 resolved naturally, 5 active infections). Four infants (4/5; 80%) were prophylaxed for HBV and were declared disease-free at 9 months. Recruited participants were young; mean age was 24 years (range: 17-40) and 74% (376/510) were in their second trimester. Furthermore, 95% of the participants were retained throughout their pregnancy. CONCLUSION: The AideSmart! strategy was deemed feasible to operationalise by HCPs. It was accepted and preferred by participants, resulting in timely screening and treatment of HIV/STIs and anaemia, preventing mother-to-child transmission. The strategy could be reverse-innovated to any context to maximise its health impact.

Cholera outbreak in a village in south India - Timely action saved lives.

Cholera remains a public health concern in developing countries because of its high morbidity and mortality. This study was designed to assess the magnitude of and factors responsible for an outbreak in a South Indian village and to implement measures for containing and preventing the recurrence of such outbreaks. Data was obtained by surveying households in the village to identify cases and assess factors responsible for the outbreak. A sanitary survey of the water supply system was performed to identify the cause of the outbreak. Preventive measures were implemented by setting up a rapid response team to manage cases and provide safe drinking water and health education regarding the prevention of such outbreaks. A total of 73 cases were reported during the outbreak, an attack rate of 17.5%. Attack rates were similar among males and females, and the highest rates were observed among the elderly (33.3%), while the lowest rates were observed among adults (14.7%). There were no deaths reported due to cholera in the village. Most households (81%) surveyed did not use any method of water purification, 79.7% practiced open field defecation and 58.2% practiced inadequate hand washing, indicating poor sanitary practices. Cases were most commonly observed in houses which did not practice any method of water purification (p<0.001) and among people living below the poverty line (p=0.02). Despite the high attack rate, no deaths were reported, largely thanks to timely medical and preventive interventions.