Effectiveness of interventions for changing HIV related risk behaviours among key populations in low-income setting: A Meta-Analysis, 2001-2016.

The aim of this review was to conduct a meta-analysis to assess the effectiveness of behavioural interventions to reduce HIV-related risk behaviours among key populations: people who inject drugs, female sex workers, men who have sex with men and transgender in Nepal over the last two decades. Using four electronic databases, we performed a systematic search of the literature on HIV interventions implemented in Nepal and published from January 2001 to December 2016. In addition, grey literature was also scrutinised for potential articles. The search focussed specifically on behavioural interventions (peer education and HIV testing services) targeted for key populations. Random-effects models were used to calculate the pooled odds ratio for dichotomous outcomes (condom use in last sex or unsafe injection practices), pooled HIV prevalence and subgroup analyses by age groups and epidemic zones in Nepal. Forty-three studies with 15,642 participants were included (people who inject drugs: 7105; men who have sex with men and transgender: 2637; female sex workers: 5900). Pooled prevalence showed a higher occurrence of HIV among people who inject drugs (12%) followed by men who have sex with men/transgender (5%) and female sex workers (2%) respectively. There was a significant increase in the odds of condom use among female sex workers, men who have sex with men and transgender who received peer education interventions in both informal and formal setting compared to those who did not. Similarly, the odds of condom use among female sex workers, men who have sex with men and transgender improved significantly among those who received HIV counselling and testing services as compared to those who did not use such services. Subgroup analyses also verified the effectiveness of these interventions for both young and adult key populations and across all three epidemic zones. However, none of the included interventions were found to be effective for reducing unsafe injection practices among people who inject drugs. HIV prevention interventions in Nepal have effectively reduced risky behaviours among female sex workers, men who have sex with men and transgender over the last two decades but not among people who inject drugs. This calls for continued implementation of existing efforts as well as for new interventions adapted to the needs of people who inject drugs.

Seroprevalence of hepatitis B and C in Nepal: a systematic review (1973-2017).

INTRODUCTION: Hepatitis B and C represent an important co-infection for people living with HIV worldwide. Nepal wants to be part of the international mobilization for viral hepatitis elimination, and has pursued better understanding of the epidemic in its territory through scientific research. METHODS: We performed a systematic review of seroprevalence studies hepatitis B and C in Nepal following the PRISMA 2009 Flow Diagram. RESULTS: Fifty-four scientific publications and reports were selected for this review. Nearly a quarter of these documents have been issued in recent years and many are authored by non-governmental organizations in Nepal. The collective of information displays a wide range of alarming prevalence rates, particularly for girls and women survivors of human trafficking and a progressive participation of civil society in viral hepatitis epidemiology research in the country. CONCLUSION: This paper presents a most complete review of hepatitis B and C and HIV co-infection prevalence studies in different population groups from 1973 to 2016. A comprehensive analysis of the epidemiology and apparent trends in public health research and policy making in Nepal are also addressed in this document. We expect this to be a most important tool for improvements in future interventions for both epidemics in the country.

Epidemiology of HIV, programmatic progress and gaps in last 10 years in Nepal.

BACKGROUND AND OBJECTIVES: Nepal has made progress with the control of HIV infection in recent years. There have been changes in epidemiology, programme interventions in different population groups, and changes in policies over the last 10 years, particularly in diagnosis and treatment. Therefore, this review was conducted to identify the effectiveness of different interventions/policies in different sub-populations at risk, targeted towards epidemiology and treatment outcomes for those with HIV infection in Nepal. METHODS: This review was prepared based on a review of published and unpublished documents from the Nepalese HIV infection control programme, published articles in different journals, different survey reports including integrated bio-behavioural surveillance (IBBS) survey reports. RESULTS: The prevalence of HIV infection among adults in 2014 was 0.20% with a progressive decreasing trend from 2005. The prevalence of HIV infection among injecting drug users (51.7% in 2005 and 6.4% in 2015 in Kathmandu valley) was relatively high in all years as compared to other risk groups. HIV infection prevalence among women attending antenatal clinics was higher in the year 2006 (0.25%) but there was a decreasing trend in the following years to 2015, when prevalence was 0.077%. Although different interventions were conducted to cover key populations at risk, the coverage in some risk population was very low. HIV testing status among the general population was very low (7.5% among males and 2.9% among females) in 2011. Only one-third of HIV-infected individuals were on ART in 2015, although this proportion has increased since 2005. The share of domestic budget among the total expenditure on HIV control program is below 15%. CONCLUSIONS: There is the need for implementation of control programmes more efficiently and effectively with expanding geographical and population coverage. Surveillance systems should be strengthened to get up-to-date information for evidence-based planning and developing strategies. The domestic budget for HIV control programme should be increased to improve their sustainability.