Reaching endpoints for lymphatic filariasis elimination- results from mass drug administration and nocturnal blood surveys, South Gujarat, India.

BACKGROUND: Following the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4-6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat. METHODS: Independent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round. RESULT: Post MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015. CONCLUSIONS: The findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.

Knowledge and practices related to sexually transmitted infections and HIV among sex workers in an urban area of Gujarat, India.

This study is a part of STD prevalence study done in Gujarat amongst sex workers (SWs) of urban red light area during the year 2000. In the clinic specially set up in their area, after an informed consent from the participants, knowledge, attitude and practices (KAP) questionnaire schedule was administered to 125 SWs; 2/3rds of them were below the age of 30 years, 81.5% had never gone to school and 76.6% of them had their first sexual intercourse before the age of 20 years. Majority of SWs. (83.1%) has joined the profession before the age of 25 years; 60.5% were having 3-5 sexual partners on an average; 94.4% reported using condom all the time during a sexual encounter; 91.9% of them had suggested the use of condom to their client themselves, and 79.8% of them made it sure by helping the client to put on the condom. Out of 29 SWs who had regular partners, 44.8% use condom all the times with their regular partner, 92% had never seen female condom; 85 to 90% were aware about various symptoms/diseases transmitted by unsafe sexual practice in male and female; 23.4% took treatment from the health workers for such problems; 87.9% SWs were aware that HIV is transmitted by unprotected sex with an infected partner and 88.7% were aware that consistent use of condom could protect her from HIV infection. However, they did not know other measures, 65.3% don't perceive the risk of getting HIV infection. Out of those 39 who perceived this risk, 48.7% attributed it to having many clients, 30.8% to irregular use of condom and only 2.6% to non-treatment of STD. Fifty-eight per cent are not aware about any behavioural change needed to reduce the risk.