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International Journal of Community Medicine and Public Health. 2016 Oct; 3(10):2749-2756.Background: Low birth weight is one of the main contributors to very high infant and under-five mortality rates in developing countries. The study aimed to identify the predicting risk factors for LBW in Yemen. Methods: An institutional-based, cross-sectional study was conducted from September 2014 to March 2015 and September 2015 to January 2016. Study procedures have included completing a questionnaire, maternal measurement of mid upper arm circumference, testing for haemoglobin level in mothers and weighing all targeted neonates. Descriptive, cross tabling and binary logistic regression analyses were used. Results: A total of 585 mother-neonate pairs were interviewed and examined for LBW and the associated risk factors. Logistic regression analysis identified three significant independent predicting factors; maternal under-nutrition (odds ratio (OR) 11.4, 95% CI 3.8 - 35.2), maternal anemia (OR 5.3, 95% CI 1.5 - 18.6) and rural residents (OR 0.2, 95% CI 0.1 - 0.7). Conclusions: Incidence of LBW in these communities was high. Maternal under-nutrition, maternal anaemia and rural settlements were significantly associated with babies with low weight at birth. There is a need for continued focus on maternal nutrition at the time of conception and during pregnancy both for the optimum feto-maternal health and national development.
Lancet. Oncology. 2018 Dec; 19(12):e657.Add to my documents.
Increasing cases of HIV/AIDS in the northern region of the Colombia-Venezuela border: The impact of high scale migration in recent years.
Travel Medicine and Infectious Disease. 2018 Sep - Oct; 25:16-17.Add to my documents.
Early diagnosis of HIV infection among men who have sex with men in Lima (Peru). A prospective cohort study.
Clinical Microbiology and Infection. 2018 Jul; 24(7):793-795.Add to my documents.
Bulletin of the World Health Organization. 2018 Sep; 96(9):531-539.Objective: To assess the association between hypertensive disorders in pregnancy and the stillbirth rate. Methods: We obtained all data from China’s National Maternal Near Miss Surveillance System for 2012 to 2016. Associations between hypertensive disorders in pregnancy and stillbirths, stratified by fetus number and gestational age, were assessed using Poisson regression analysis with a robust variance estimator. Findings: For the period, 6 970 032 births, including 66 494 stillbirths, were reported to the surveillance system. The weighted stillbirth rate in women with a hypertensive disorder in pregnancy was 21.9 per 1000 births. The risk was higher in those who had received few antenatal care visits or who were poorly educated. For singleton pregnancies, the adjusted risk ratio (aRR) for a stillbirth among women with hypertensive disorders in pregnancy compared with normotensive women was 3.1 (95% confidence interval, CI: 2.85-3.37). The aRR for hypertensive disorder subtypes was: 6.66 (95% CI: 5.57-7.96) for superimposed preeclampsia; 4.15 (95% CI: 3.81-4.52) for preeclampsia or eclampsia; 2.32 (95% CI: 1.87-2.88) for chronic hypertension; and 1.21 (95% CI: 1.08-1.36) for gestational hypertension. For multiple pregnancies, the association between stillbirths and hypertensive disorders in pregnancy was not significant, except for superimposed preeclampsia (aRR: 1.95; 95% CI: 1.28-2.97). Conclusion: To minimize the incidence of stillbirths, more attention should be paid to chronic hypertension and superimposed preeclampsia in singleton pregnancies and to superimposed preeclampsia in multiple pregnancies. Better quality antenatal care and improved guidelines are needed in China.
International Journal of Community Medicine and Public Health. 2018 Dec; 5(12):5448-5454.Background: Karnataka is one of the six high human immunodeficiency virus (HIV) prevalent states in India. We estimated prevalence among primigravida attending antenatal clinics in Karnataka, assuming this as a proxy for HIV incidence level in the general population. Methods: We tried estimating prevalence among primigravida using cross sectional samples. Data was collected in structured data extraction sheet for the month of September 2011, from all Integrated and Counselling tested Centres (ICTCs) of Karnataka. All the pregnant women were tested as per national protocol. We analysed the basic demographic data, geographical distribution including HIV status of spouse of primigravida. Results: In September 2011, 87580, pregnant women were tested and 238 (0.26%) were found HIV positive of which, 95 (40%) were primigravida. Prevalence among primigravida, was 0.3%. The prevalence among primigravida was highest in Bagalkot (1.6%) district. In Yadgir, Kodagu and Udupi the prevalence was zero. The high prevalent blocks were Jamakhandi, Mudhol, Gokak, Hospet and Muddebihal. 73.7% spouse of positive primigravida were tested for HIV and among those tested, 87.1% were found HIV positive. Conclusions: There is striking difference in the prevalence of HIV among primigravida in different districts of Karnataka probably indicates the difference in effectiveness of preventive interventions in these districts and within blocks. The preventive programs should be reached out to the labourer's and farmers in the general population to prevent the new infections in the general population.
Magnitude and determinants of diarrhea among 0-6 year’s children: a cohort study from central India.
International Journal of Community Medicine and Public Health. 2018 Dec; 5(12):5246-5252.Background: Inspite of efforts of all the stakeholders, diarrhea still remains a cause of significant morbidity and mortality in developing country like India. Methods: A follow up study was done among 305 children of 0-6 year’s age to estimate the incidence and risk factors of diarrhea. Diarrhea was defined as more than 3 stools in one day that were more liquid than usual. At each monthly follow up enquiry was made about the occurrence of diarrhea, health seeking, infant feeding practices and dietary history etc. Cumulative incidence, attack rates and risk ratio was used to estimate the burden and risk factors of diarrhea. Results: The number of diarrhea episodes per child per year was 0.65 (95% CI=0.62-0.67). The cumulative incidence of diarrhea among 0-6 years children was 485.7 per 1000 children per year (95% CI=430.8–540.9). In terms of attack rate, the diarrhea among 0-6 years children was 63.5 percent (95% CI=58.1–68.7). Age of child, birth weight, total duration of breastfeeding, anaemia and season were found to be significant risk factors of diarrhea. Conclusions: Further substantial changes in diarrhea incidence will require action on multiple factors like improvement of birth weight of child by better maternal and child health (MCH) care, continued breastfeeding of child till two year of age, correction of anaemia and provision of safe water supply and sanitation during summer and raining season.
Variation in HIV prevalence and the population-level effects of antiretroviral therapy in reducing tuberculosis incidence in South Africa.
South African Medical Journal. 2018 Jul 25; 108(8):12370.Add to my documents.
African Health Sciences. 2017 Dec; 17(4):i-iv.Add to my documents.
Lancet. 2018 Mar 31; 391(10127):1257-1258.Add to my documents.
Association of Risk for Venous Thromboembolism With Use of Low-Dose Extended- and Continuous-Cycle Combined Oral Contraceptives: A Safety Study Using the Sentinel Distributed Database.
JAMA Internal Medicine. 2018 Nov 1; 178(11):1482-1488.Importance: Continuous/extended cyclic estrogen use (84/7 or 365/0 days cycles) in combined oral contraceptives (COCs) could potentially expose women to an increased cumulative dose of estrogen, compared with traditional cyclic regimens (21/7 days cycle), and may increase the risk for venous thromboembolism (VTE). Objective: To determine, while holding the progestogen type constant, whether the risk for VTE is higher with use of continuous/extended COCs than with cyclic COCs among women who initiated a COC containing ethinyl estradiol and levonorgestrel. Design, Setting, and Participants: Incident user retrospective cohort study of primarily commercially insured US population identified from the Sentinel Distributed Database. Participants were women aged 18 to 50 years at the time of initiating a study COC between May 2007 and September 2015. Using a propensity score approach and Cox proportional hazards regression models, we estimated the hazard ratios of VTE overall and separately by ethinyl estradiol dose and age groups. Exposures: Initiation of continuous/extended or traditional cyclic COCs containing ethinyl estradiol or levonorgestrel of any dose. Main Outcomes and Measures: First VTE hospitalization that occurred during the study follow-up, identified by an inpatient International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 415.1, 415.1x, 453, 453.x, or 453.xx. Results: We identified 210691 initiators of continuous/extended COCs (mean [SD] age, 30.4 [8.6] years) and 522316 initiators of cyclic COCs (mean [SD] age, 28.8 [8.3] years), with a mean of 0.7 person-years at risk among continuous/extended and cyclic users. Baseline cardiovascular and metabolic conditions (7.2% vs 4.7%), gynecological conditions (39.7% vs 32.3%), and health services utilization were slightly higher among continuous/extended cyclic than cyclic COC users. Propensity score matching decreased the hazard ratio estimates from 1.84 (95% CI, 1.53-2.21) to 1.32 (95% CI, 1.07-1.64) for continuous/extended use compared with cyclic COC use. The absolute risk difference (0.27 per 1000 persons) and the incidence rate difference (0.35 cases per 1000 person-years [1.44 vs 1.09 cases per 1000 person-years]) between the 2 propensity score-matched cohorts remained low, which may not translate into a clinically significant risk differences between cyclic and noncyclic estrogen use. Conclusions and Relevance: Holding the progestogen type constant (levonorgestrel), we observed a slightly elevated VTE risk in association with continuous/extended COC use when compared with cyclic COC use. However, due to the small absolute risk difference and potential residual confounding, our findings did not show strong evidence supporting a VTE risk difference between continuous/extended and cyclic COC use.
A Population-Based, Case-Control Evaluation of the Association between Hormonal Contraceptives and Idiopathic Intracranial Hypertension.
American Journal of Ophthalmology. 2018 Sep 21;PURPOSE: To determine if the use of oral contraceptive pills (OCP) and other hormonal contraceptives are associated with a higher incidence of idiopathic intracranial hypertension (IIH). DESIGN: Retrospective, population-based, case-control study METHODS: Setting: Female IIH patients evaluated between January 1, 1990 and December 31, 2016 were identified using the Rochester Epidemiology Project (REP), a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota, residents. STUDY POPULATION: Fifty-three female residents of Olmsted County diagnosed with IIH between 15 and 45 years of age. The use of OCPs and other hormonal contraceptives was compared to controls matched for age, sex and body-mass index. INTERVENTIONS/EXPOSURES: Hormonal contraceptives MAIN OUTCOME MEASURE: Odds of developing IIH RESULTS: Of the 53 women diagnosed with IIH between 15 and 45 years of age, 11 (20.8%) had used hormonal contraceptives within <30 days of the date of IIH diagnosis, in contrast to 30 (31.3%) among the control patients. The odds ratio of hormonal contraceptive use and IIH was 0.55 (95% CI: 0.24-1.23, p=0.146). The odds ratio of OCP use was 0.52 (95% CI: 0.20-1.34, p=0.174). CONCLUSIONS: OCP and other hormonal contraceptives were not significantly associated with a higher incidence of IIH, arguing against the need for women with IIH to discontinue their use. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Lancet. Infectious Diseases. 2017 Aug; 17(8):804.Add to my documents.
Washington, D.C., Palladium, Health Policy Plus, 2018 Aug. 2 p. (HP+ Policy Brief; USAID Agreement No. AID-OAA-A-15-00051)Oral pre-exposure prophylaxis (PrEP) is the use of oral antiretroviral medications by HIV-negative individuals to prevent HIV acquisition. The Mozambican Ministry of Health has been assessing the feasibility of integrating oral PrEP into its national HIV strategic plan, PEN IV, since 2017. To support this, HP+ developed a new mathematical modeling approach to estimate the impact and cost-effectiveness of three rollout scenarios that simulate provision of oral PrEP to progressively broader subpopulations in Mozambique.
Lancet. 2018 Jul 7; 392(10141):2.Add to my documents.
Expanding the Single-Visit Approach for Cervical Cancer Prevention: Successes and Lessons From Burkina Faso.
Global Health, Science and Practice. 2018 Jun 27; 6(2):288-297.BACKGROUND: Cervical cancer accounts for 23% of cancer incidence and 22% of cancer mortality among women in Burkina Faso. These proportions are more than 2 and 5 times higher than those of developed countries, respectively. Before 2010, cervical cancer prevention (CECAP) services in Burkina Faso were limited to temporary screening campaigns. PROGRAM DESCRIPTION: Between September 2010 and August 2014, program implementers collaborated with the Ministry of Health and professional associations to implement a CECAP program focused on coupling visual inspection with acetic acid (VIA) for screening with same-day cryotherapy treatment for eligible women in 14 facilities. Women with larger lesions or lesions suspect for cancer were referred for loop electrosurgical excision procedure (LEEP). The program trained providers, raised awareness through demand generation activities, and strengthened monitoring capacity. METHODS: Data on program activities, service provision, and programmatic lessons were analyzed. Three data collection tools, an individual client form, a client registry, and a monthly summary sheet, were used to track 3 key CECAP service indicators: number of women screened using VIA, proportion of women who screened VIA positive, and proportion of women screening VIA positive who received same-day cryotherapy. RESULTS: Over 4 years, the program screened 13,999 women for cervical cancer using VIA; 8.9% screened positive; and 65.9% received cryotherapy in a single visit. The proportion receiving cryotherapy on the same day started at a high of 82% to 93% when services were provided free of charge, but dropped to 51% when a user fee of $10 was applied to cover the cost of supplies. After reducing the fee to $4 in November 2012, the proportion increased again to 78%. Implementation challenges included difficulties tracking referred patients, stock-outs of key supplies, difficulties with machine maintenance, and prohibitive user fees. Providers were trained to independently monitor services, identify gaps, and take corrective actions. CONCLUSIONS: Following dissemination of the results that demonstrated the acceptability and feasibility of the CECAP program, the Burkina Faso Ministry of Health included CECAP services in its minimum service delivery package in 2016. Essential components for such programs include provider training on VIA, cryotherapy, and LEEP; provider and patient demand generation; local equipment maintenance; consistent supply stocks; referral system for LEEP; non-prohibitive fees; and a monitoring data collection system.
New England Journal of Medicine. 2018 May 17; 378(20):1859-1861.Add to my documents.
Foetal macrosomia: risk factors, maternal and foetal outcomes in N’Djamena Mother and Child Hospital, Chad.
South Sudan Medical Journal. 2018 May; 11(2):40-43.Background: Macrosomia is a birth weight above the 90th percentile corrected for gestational age and sex, or a birth weight of 4000-4500 g. Objective: To determine the incidence of foetal macrosomia and macrosomia-associated maternal and perinatal morbidity and mortality. Method: This was a cross-sectional study covering a period of six months, from January to June 2016 in N’Djamena Mother and Child Hospital, Chad. The sample consisted of two groups: mothers who gave birth to macrosomic babies (the study group) and an equal number of mothers who gave birth to normosomic babies (the control group). Results: Out of a total of 5,284 deliveries, 403 babies weighed 4.0 kg or more giving an incidence of macrosomia of 7.6%. The mean maternal age and mean birth parity of the study group were significantly greater than in the control group. There were significantly more mothers with a previous history of macrosomia in the study group than in the control group. Ninety three babies (23.1%) in the study group were delivered by Caesarean Section, and 76.9% by vaginal delivery. The commonest maternal complications were: postpartum haemorrhage (15.9%), prolonged labour (13.9%) and perineal laceration (4.4%). There were significantly more babies with a poor Apgar score in the first and the fifth minute in the study group than in the control group (P= 0.0009). Other complications among the macrosomic babies were: shoulder dystocia (1.3%), stillbirths (0.7%) and hypoglycaemia (8.4%). Conclusion: Macrosomic neonates are more often delivered by Caesarean Section than normosomic babies. There is a clear need during prenatal care and delivery to minimise maternal and perinatal complications.
Influence of oral contraceptives in the development of post-molar trophoblastic neoplasia--a systematic review.
Gynecologic Oncology. 2006 Mar; 100(3):579-85.OBJECTIVE: Controversy exists regarding the use of oral contraceptives following hydatidiform mole and possible increased risk of persistent trophoblastic neoplasia. The purpose of this study is to perform a systematic review of the literature to assess the evidence for and against a possible link between oral contraceptive use and the need for chemotherapy after molar evacuation. METHODS: We searched the computerized databases MEDLINE, EMBASE, Popline, Web of Sciences, LILACS and the Cochrane Controlled Trials Register, ISI Proceedings, performed a hand search of references and wrote to experts to identify randomized controlled trials and observational studies comparing oral contraceptives with other methods of contraception. Quality assessment included: concealment of allocation; intention to treat analysis; plus attrition bias for trials; confounding factors and selection bias for observational studies. We collected or calculated risk ratios for the incidence of gestational trophoblastic neoplasia and hCG regression time associated with oral contraceptive use. RESULTS: Two randomized controlled trials were included for analysis. The risk ratios for OC use were similar in both studies: 0.69 (0.12-3.98) and 0.71 (0.46-1.10) respectively. No attempt to summarize these results was made because the studies observed different disease stages. In five of the seven observational studies, the risk ratio ranged from 0.57 (CI = 0.14-2.37) to 1.46 (CI = 0.56-3.79). CONCLUSION: No clear evidence for an association between oral contraceptive use during post-molar follow-up period and the incidence of gestational trophoblastic neoplasia was found. Practitioners should no longer avoid their use because of a supposed effect which we have shown here to be unsupported by evidence in the literature.
Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence.
BJOG. 2013 Feb; 120(3):277-85; discussion 86-7.BACKGROUND: Using misoprostol to prevent postpartum haemorrhage (PPH) in home-birth settings remains controversial. OBJECTIVES: To review the safety and effectiveness of oral misoprostol in preventing PPH in home-birth settings. SEARCH STRATEGY: The Cochrane Library, PubMed, and POPLINE were searched for articles published until 31 March 2012. SELECTION CRITERIA: Studies, conducted in low-resource countries, comparing oral misoprostol with a placebo or no treatment in a home-birth setting. Studies of misoprostol administered by other routes were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted by two reviewers and independently checked for accuracy by a third. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were sythesised and meta-analysis was performed where appropriate. MAIN RESULTS: Ten papers describing two randomised and four non randomised trials. Administration of misoprostol was associated with a significant reduction in the incidence of PPH (RR 0.58, 95% CI 0.38-0.87), additional uterotonics (RR 0.34, 95% CI 0.16-0.73), and referral for PPH (RR 0.49, 95% CI 0.37-0.66). None of the studies was large enough to detect a difference in maternal mortality, and none reported neonatal mortality. Shivering and pyrexia were the most common side effects. AUTHOR'S CONCLUSIONS: The finding that the distribution of oral misoprostol through frontline health workers is effective in reducing the incidence of PPH could be a significant step forwards in reducing maternal deaths in low-resource countries. However, given the limited number of high-quality studies in this review, further randomised controlled trials are required to confirm the association, particularly in different implementation settings. Adverse effects have not been systematically captured, and there has been limited consideration of the potential for inappropriate or inadvertent use of misoprostol. Further evidence is needed to inform the development of implementation and safety guidelines on the routine availability of misoprostol. (c) 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology (c) 2012 RCOG.
Male circumcision and HIV: Non-blindedness and biases in RCTs; female preferences; penile sensitivity, satisfaction and ambient stimulation; risk compensation; acceptance of insufficient condom use and personal hygiene and related externalities.
Global Journal of Medicine and Public Health. 2018; 7(1):29 p.Background: Acute respiratory tract infections (ARI) constitute a major cause of morbidity and mortality among under-five children in the developing world. It constitutes one-third of the deaths in under-five in developing countries. The objectives of this study were to determine the prevalence of ARI and risk factors for ARI among under-fives children in rural communities of Ekiti State. Study design: The study was cross sectional descriptive/analytical in nature. A semistructured, pretested and interviewer administered questionnaire was used to obtain information from 436 care givers who were selected using multistage sampling technique. Data was analyzed using SPSS version 20. Descriptive and inferential statistics were generated and level of significance was p < 0.05. Results: Among the under-fives 237 (54.4%) were males while 199 (45.6%) were females with mean age of 28.4 +or- 15.2 months. Numbers of under-fives with ARI were 283 (64.9%). The commonest symptoms of ARI were cough 161 (36.9%), fever 176 (40.4%) and running nose 157 (36.0%). The major risk factors for ARI were second hand smoking (90.9%), cooking with charcoal (79.4%), overcrowding (70.6%) and sleeping on earthen floor (90.8%) The odds of ARI among underfive sleeping with two adults in a room was lower compared to under five sleeping with more than two adults (AOR 1.739, CI 1.123 -2.694, p<0.05). Conclusion: The prevalence and level at which the under-five children were exposed to ARI risk factors in this study were high. Care givers in the rural communities will benefit from public awareness campaign on risk factors for ARI and this will go a long way in reducing mortality and morbidity due to ARI among under-five children.
Incidence and predictors of loss to follow up among HIV-infected adults at Pawi General Hospital, northwest Ethiopia: Competing risk regression model.
BMC Research Notes. 2018; 11(1)Objective: This study was aimed at assessing the incidence of lost-to-follow-up and its predictors among HIV-positive adults after initiation into antiretroviral therapy at Pawi General Hospital, northwest Ethiopia. Results: The overall cumulative incidence of lost-to-follow-up after ART initiation was high, 11.6 (95% CI 9.8-13.7) per 100 adult-years follow-up time. Independent significant predictors of lost to follow up were being aged 15-28 years (aSHR = 0.44; 95% CI 0.24-0.83), being on WHO clinical stage IV (aSHR = 2.09; 95% CI 1.02-3.13); and receiving isoniazid preventive therapy (aSHR = 0.11; 95% CI 0.06-0.18). © 2018 The Author(s).
The Protective Value of Discussing Condom Use: A Study of Young Black Men Attending STI Clinics in the Southern United States.
Health Education and Behavior. 2018 Oct; 45(5):706-713.Young Black men (YBM) experience disparities in both HIV incidence and incidence of bacterial sexually transmitted infections (STIs); thus, developing efficacious behavioral interventions is an especially critical goal. One potential avenue for intervention involves improving sexual health communications among YBM and their partners, before sex occurs. Such discussions may serve several purposes, including improving condom use and facilitating the negotiation of correct and consistent condom use. The aim of the current study was to determine the STI-protective effects of discussing condom use with sex partners, among medically underserved YBM. A total of 702 YBM were recruited from three STI clinics in the Southern United States. YBM completed a self-interview at baseline and again 6 months later. At 12 months postenrollment, a chart review determined incidents of STIs. The majority of YBM participants (61.1%) had recently discussed condom use with partners before sex. Of the 12 assessed outcomes, 7 were significantly associated with this measure. In each case, a protective effect was observed. In controlled analyses, the 12-month incidence of STIs was significantly ( p = .05) greater among YBM not discussing condoms with sex partners. The results of the current study suggest that, among YBM attending clinics, discussing condom use with sex partners may promote safer sex practices. This behavior was also predictive of lower STI incidence in the ensuing 12 months, suggesting that it may be an ideal intervention target for programs designed to protect YBM against STI acquisition, including HIV.
Cohort Study of Psychiatric Adverse Events Following Exposure to Levonorgestrel-Containing Intrauterine Devices in UK General Practice.
Drug Safety. 2018 Oct; 41(10):951-958.INTRODUCTION: Intrauterine devices are implantable contraceptives of which some brands steadily release levonorgestrel over an extended time period. Exposure to a levonorgestrel-releasing intrauterine device has been associated with depression and, more recently, a connection to anxiety, panic attacks, sleep problems and restlessness has been suggested. This study uses data from the THIN database of UK general practice to investigate these suggestions. METHODS: A cohort study was performed to compare the incidence of psychiatric adverse events between groups of women who were new users of levonorgestrel-releasing and non-hormonal intrauterine devices. Hazard ratios for the first occurrence of psychiatric symptoms or prescriptions of disease-specific treatments were calculated on an intention-to-treat basis using a proportional hazards model. RESULTS: Significant associations were found between levonorgestrel exposure and records of anxiety (hazard ratio = 1.18; 95% confidence interval 1.08-1.29) and sleep problems (hazard ratio = 1.22; 95% confidence interval 1.08-1.38) in women without a prior record of these events. No significant associations were found for panic attacks or restlessness. Clear baseline differences in clinical characteristics and age between the groups were present. These were included in the model as potential confounding factors. CONCLUSION: Statistically significant associations of levonorgestrel exposure with anxiety and sleep problems were observed. Substantive differences in baseline characteristics of the treated groups make robust conclusions difficult but the results strongly suggest that additional studies are warranted.
Heterogeneity in geographical trends of HIV epidemics among key populations in Pakistan: a mathematical modeling study of survey data.
Journal of Global Health. 2018 Jun; 8(1):010412.Background: Assessing patterns and trends in new infections is key to better understanding of HIV epidemics, and is best done through monitoring changes in incidence over time. In this study, we examined disparities in geographical trends of HIV epidemics among people who inject drugs (PWIDs), female sex workers (FSWs) and hijra/transgender/male sex workers (H/MSWs), in Pakistan. Methods: The UNAIDS Estimation and Projection Package (EPP) mathematical model was used to explore geographical trends in HIV epidemics. Four rounds of mapping and surveillance data collected among key populations (KPs) across 20 cities in Pakistan between 2005-2011 was used for modeling. Empirical estimates of HIV prevalence of each KP in each city were used to fit the model to estimate prevalence and incidence over time. Results: HIV incidence among PWIDs in Pakistan reached its peak in 2011, estimated at 45.3 per 1000 person-years. Incidence was projected to continue to rise from 18.9 in 2015 to 24.3 in 2020 among H/MSWs and from 3.2 in 2015 to 6.3 in 2020 among FSWs. The number of people living with HIV in Pakistan was estimated to steadily increase through at least 2020. HIV incidence peak among PWIDs ranged from 16.2 in 1997 in Quetta to 71.0 in 2010 in Faisalabad (per 1000 person-years). Incidence among H/MSWs may continue to rise through 2020 in all the cities, except in Larkana where it peaked in the early 2000s. In 2015, model estimated incidence among FSWs was 8.1 in Karachi, 6.6 in Larkana, 2.0 in Sukkur and 1.2 in Lahore (per 1000 person-years). Conclusions: There exists significant geographical heterogeneity in patterns and trends of HIV sub-epidemics in Pakistan. Focused interventions and service delivery approaches, different by KP and city, are recommended.