Demographic and Sexual Behavior Characteristics of Men Who Have Sex with Men (MSM) Registered in a Targeted Intervention (TI) Program in India

Background: Men who have sex with men (MSM) contribute substantially to HIV prevalence in India. The targeted intervention (TI) program is the most important link between MSM and the public health system. Hence, we studied the demographic and sexual behavior characteristics of MSM registered in TI program in India. Methods: We used information maintained at TI sites under the program catering exclusively to MSM in India. Demographic characteristics and sexual behavior of MSM over the past two decades were also studied. Risk behaviors included type of partners, alcohol use, sexual acts per week, years of sex work and age at initiation of sex work. Bivariate analysis was carried out to understand the demographic determinants of sexual behavior. Results: In total, data of 6037 MSMs from 14 TI sites were analyzed. Of these 4655 (73.8%) were young adults (<35 years) and 2565 (40.8%) had completed their matriculation. More than half (55.4%) were married. Double-decker was identified as the most common sub-typology among MSM. Average age of initiation of sex was 23.0 years and average number of sexual acts per week was 6.8 (95% CI: 6.8 - 7.0). Irregular partners and alcohol use were observed in 30.5% and 52.8% of MSM respectively. Cohort analysis revealed a statistically significant declining trend in average age of initiation of sex over the past two decades. The sexual behavior of MSM varied significantly by employment status, education, marital status, state of residence, alcohol use and type of sex partner. Conclusion: MSMs registered with the TI program in India were mostly young, educated, and employed. Many MSM also had a history of heterosexual relationships, and thus had the potential of transmitting HIV infection to the otherwise low risk general population. This analysis supports the use of TI program data for understanding the demographic and sexual behavior characteristics of hard to reach and stigmatized population in society.

Introduction of monkeypox virus in Benin,2022

Dear Editor,Monkeypox is an infectious disease that is endemic in a dozen of African countries.Some imported cases have been also reported outside of Africa in the past[1].Since early May 2022,monkeypox infections including human-to-human transmission,were reported in a multi-country outbreak in non-endemic countries and declared Public Health Emergency of International Concern(PHEIC)by the World Health Organization(WHO)in July 2022[2].As of 20 September 2022,a total of at least 62,798 human cases of monkeypox with 20 deaths have been confirmed in 115 countries in five WHO regions[3].

A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia

Objective:To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.Methods:This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage.The review period was from January to December 2008.The sample included twelve lower level health facilities from four districts.The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.Results:Out of 4891 suspected malaria cases recorded at the 12 health facilities,more than 80%of the patients had a temperature taken to establish their fever status.About 67%(CI_(95)66.1-68.7)were tested for parasitemia by either rapid diagnostic test or microscopy,whereas the remaining22.5%(CI_(95)213.1-23.7)were not subjected to any malaria test.Of the 2247 malaria cases reported(complicated and uncomplicated),71%were parasitologicaily confirmed while 29%were clinically diagnosed(unconfirmed).About 56%.(CI_(95)53.9-58.1)of the malaria cases reported were treated with artemether-lumefantrine(AL),35%(CI_(95)33.1-37.0)with sulphadoxine-pyrimethamine,8%(CI_(95)6.9-9.2)with quinine and 1%did not receive any anti-malarial.Approximately 30%of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial,contrary to the guidelines.There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used,and in the choice of anti-malarials for the treatment of malaria confirmed cases.Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not.Gender,in service training on malaria,years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.Conclusions:Malaria case management was characterised by poor adherence to treatment guidelines.The non-adherence was mainly in leans of:inconsistent use of confirmatory tests(rapid diagnostic test or microscopy)for malaria;prescribing anti-malarials which are not recommended(e.g.sulphadoxine-pyrimethamine)and prescribing anti-malarials to cases testing negative.Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.

Revised National Tuberculosis Control Programme (RNTCP) Tribal Action Plan Fund Utilisation: How Does Chhattisgarh State in India Fare?

Background: In India, tuberculosis remains as a major public health problem amongst the tribal population. Poor physical access to diagnosis and treatment under the Revised National TB control programme (RNTCP) still remains the problem for the population. RNTCP implements Tribal Action Plan (TAP) for tribal patients. We conducted the study to determine the trends of financial utilisation for the special provisions available under tribal action plan like patient honorarium, incentive for sputum collection and transport, incentive for programme staff and incentive for vehicle maintenance. Methods: A cross-sectional study based on mixed method study approach was conducted in Chhattisgarh, India during Nov. 16 to Jun. 17. District TB Officers implementing TAP were interviewed telephonically using a semi-structured questionnaire to ascertain and analyse the reasons for low fund utilization in their districts. Retrospective financial data for five financial years from 13 TAP districts for 2012-2013 to 2016-2017 was collected, compiled and analysed. Results: Overall, the trends on states expenditure on tribal action plan in terms of absolute numbers has increased over the past five years;however, in terms of fund utilization against received ranges from 37% - 86% with the utilization rate less than 44% in the recent years (2014-2017). Conclusion: The trends of utilisation of TAP is less than 44% over the recent years. There is an urgent need for the administrators to intervene and improve the efficiency of fund utilisation at State and district levels.

Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?

Introduction: Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). Aim: To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP). Materials and Methods: A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July-December 2012. Results: Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilo-grams—the current weight requirement for receiving drugs under RNTCP. Conclusion: ICF approaches are feasible at NRCs;however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilo-grams.

Active case-finding for tuberculosis by mobile teams in Myanmar:yield and treatment outcomes

Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.