Profile of adults seeking voluntary HIV testing and counseling in rural Central India: results from a hospital-based study

Rural India has an undetected load of HIV-positive individuals. Few rural adults present for HIV testing and counseling due to stigma, discrimination, and fear of social ostracization. In this rural hospital clinic-based study, we document profiles of rural adults seeking voluntary testing and counseling, and analyze correlates of HIV seropositivity. This cross-sectional study was conducted in 450 participants presenting to the outpatient clinics of Mahatma Gandhi Institute of Medical Sciences, Sevagram, Central India. After informed consent, pre- and post-test counseling, HIV testing, and face-to-face interviews were conducted. Data were collected using a structured questionnaire. The median age of the 450 study participants was 34 years (range 18-88 years); the majority (74%) was married. The overall proportion of HIV seropositivity was 32% [95% CI 28%, 37%]. The proportions of HIV seropositivity in married women, married men, and single men were 41%, 37%, 18%, respectively. No single woman was found seropositive in the study. Very few married women were aware of their husbands' HIV status. In a multivariate analysis, correlates of HIV seropositivity in men were: age 30-39 years, being married, having sex with multiple partners, use of alcohol before sex, and testing positive for HIV in the past. In married women, the only predictor of seropositivity was being married. Although limited by the non-random nature of the sampling method, this pilot study is unique in that it is the first from this rural region of Central India. It provides baseline data on marginalized, largely unstudied populations that may aid in designing probabilistic community-based surveys in this neglected population.

Renal abscess in a child with sickle cell anemia

Renal abscess is rare in children and the usual presenting features include fever, lumbar pain, abdominal pain and occasional flank mass. Renal ultrasonography facilitates an early diagnosis and helps in percutaneous drainage. We herewith report on a child with sickle cell anemia who developed a renal abscess.

Peak expiratory flow rate of rural school children from Wardha district, Maharashtra in India

BACKGROUND

Peak expiratory flow rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children. The PEFR can be measured by a simple instrument--peak expiratory flow meter. The aim of this study was to determine the normal PEFR in rural school children from Wardha district of Maharashtra state, India.

METHODS

The PEFR was measured in 1078 healthy rural school children, living in Wardha district, Maharashtra using the Mini-Wright peak flow meter. All measurements were obtained in a standing position and the best out of three trials was recorded. Anthropometric measurements, weight, height, and mid-upper-arm circumference (MAC) were recorded, and body surface area (BSA) and body mass index (BMI) were calculated.

RESULTS

Positive correlation was seen between age, height, weight and PEFR. The regression equations for PEFR were determined for boys and girls separately. The boys had higher values than the girls at all heights. The prediction equation for PEFR based on height was PEFR = 3.64 height (cm) - 257.86 (R=0.47, R2=0.22) for female; PEFR = 4.7 height (cm) - 346.51 (R=0.62, R2 =0.38) for male.

CONCLUSION

PEFR is a reliable measurement, which can be used routinely and regularly in rural areas for assessment of airway obstruction and prediction formula derived for use in this population.

Predictor of low birth weight babies by anthropometry

OBJECTIVE

The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies.

STUDY DESIGN

Hospital-based cross-sectional study.

PARTICIPANTS

Newborn babies born in KHS hospital, Sevagram.

RESULTS

In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying < or =2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies.

CONCLUSION

HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.

Sensitivity of a whole-blood interferon-gamma assay among patients with pulmonary tuberculosis and variations in T-cell responses during anti-tuberculosis treatment

BACKGROUND

Interferon-gamma (IFN-gamma) assays are new tests for tuberculosis (TB) infection, and T-cell responses may be correlated with antigen burden. However, it is unclear if IFN-gamma assays can be used to monitor response to TB treatment.

MATERIALS AND METHODS

We measured T-cell responses to TB specific antigens in 60 Indian patients with microbiologically confirmed active pulmonary tuberculosis, before, during, and after TB treatment. Most patients were hospitalized and had moderate to advanced disease. IFN-gamma responses were measured using the commercial whole-blood Quanti-FERON-TB Gold In Tube (QFT-G) assay at three time-points: at diagnosis (N = 60), after 2 months of intensive treatment (N = 47), and at 6 months (treatment completion) (N = 39).

RESULTS

At baseline, 44 of 60 (73%) patients were positive by QFT-G. At the second time-point, 38 of 47 (81%) patients were positive. At treatment completion, 31 of 39 (79%) patients were positive. Changes in IFN-gamma responses over time were highly inconsistent--some individuals showed increases, while others showed decreases or no changes. Although the average IFN-gamma levels decreased slightly during treatment (not significant), the QFT-G sensitivity remained mostly unchanged during therapy.

CONCLUSIONS

Our data suggest that the QFT-G assay has modest sensitivity in patients with moderate to advanced pulmonary disease, but our results do not show a clear correlation between antigen burden and T-cell responses. Further research is needed to understand the kinetics of T-cell responses during TB treatment.

Evaluation of diagnostic accuracy, feasibility and client preference for rapid oral fluid-based diagnosis of HIV infection in rural India

Background

Oral fluid-based rapid tests are promising for improving HIV diagnosis and screening. However, recent reports from the United States of false-positive results with the oral OraQuick® ADVANCE HIV1/2 test have raised concerns about their performance in routine practice. We report a field evaluation of the diagnostic accuracy, client preference, and feasibility for the oral fluid-based OraQuick® Rapid HIV1/2 test in a rural hospital in India.

Methodology/Principal Findings

A cross-sectional, hospital-based study was conducted in 450 consenting participants with suspected HIV infection in rural India. The objectives were to evaluate performance, client preference and feasibility of the OraQuick® Rapid HIV-1/2 tests. Two Oraquick® Rapid HIV1/2 tests (oral fluid and finger stick) were administered in parallel with confirmatory ELISA/Western Blot (reference standard). Pre- and post-test counseling and face to face interviews were conducted to determine client preference. Of the 450 participants, 146 were deemed to be HIV sero-positive using the reference standard (seropositivity rate of 32% (95% confidence interval [CI] 28%, 37%)). The OraQuick test on oral fluid specimens had better performance with a sensitivity of 100% (95% CI 98, 100) and a specificity of 100% (95% CI 99, 100), as compared to the OraQuick test on finger stick specimens with a sensitivity of 100% (95% CI 98, 100), and a specificity of 99.7% (95% CI 98.4, 99.9). The OraQuick oral fluid-based test was preferred by 87% of the participants for first time testing and 60% of the participants for repeat testing.

Conclusion/Significance

In a rural Indian hospital setting, the OraQuick® Rapid- HIV1/2 test was found to be highly accurate. The oral fluid-based test performed marginally better than the finger stick test. The oral OraQuick test was highly preferred by participants. In the context of global efforts to scale-up HIV testing, our data suggest that oral fluid-based rapid HIV testing may work well in rural, resource-limited settings.

Left ventricular systolic and diastolic functions in patients with sickle cell anemia

BACKGROUND

Sickle cell anemia is a formidable problem in India, and is more prevalent in Maharashtra. Cardiovascular involvement in this condition has not been well studied. The present study therefore sought to investigate the systolic and diastolic left ventricular function of children with sickle cell anemia.

METHODS AND RESULTS

This prospective controlled study comprised of 25 cases of sickle cell anemia, 25 cases of anemia (hemoglobin <11 gm/dl) with 'AA' types of hemoglobin electrophoresis and 25 non-anemic controls (hemoglobin >11 gm/dl) with normal hemoglobin electrophoresis pattern. M-mode, 2-dimensional and Doppler echcardiographic measurements of patients and controls were performed according to criteria of the American Echocardiography Society. In the study cases, age ranged from 5 years to 15 years with the mean age of 9.91 years. There were 14 males and 11 females in the study cases. Patients with sickle cell anemia had significantly larger left atrial (23.26 +/- 3.6 mm, 22.9 +/- 2.56 mm, 20.72 +/- 2.79 mm; p < 0.05), left ventricular (34.88 +/- 4.53, 33.28 +/- 3.28, 30.72 +/- 3.68: p < 0.05) and aortic root (19 +/- 2.7, 18.91 +/- 2.24, 17.56 +/- 1.44; p < 0.05) dimensions. They also had higher indexed end-diastolic left ventricular volumes (101.84 +/- 22.74 ml/m2 v. 65.05 +/- 10.81 ml/m2; p < 0.001), and higher stroke volume (29.32 +/- 11.32 ml, 27.12 +/- 7.82 ml, 22.4 +/- 6.67 ml; p < 0.05). Left ventricular mass (62.24+/- 18.44 gm, 52.53 +/- 16.23 gm, 50.2 +/- 15.68 gm; p < 0.05) was greater in sickle cell anemia patients than in controls. No statistically significant differences were detected in the Doppler finding of patients with or without anemia. No statistically significant correlation was found between echocardiographic parameters (M-mode and Doppler) and the hemoglobin in the sickle cell patients.

CONCLUSIONS

Echocardiography is a useful non-invasive technique to study the changes in cardiac structure and function. In spite of left ventricular volume load and dilation in sickle cell anemic patients, left ventricular contraction was good and systolic function was normal, and there was no correlation between the echocardiographic findings and hemoglobin level.

Pain response of neonates to venipuncture

OBJECTIVE

To study the physiological and behavioral response to pain.

METHODS

80 healthy neonates requiring bilirubin estimation, blood sugar etc, were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR. HR, NIBP and O2 saturation observed on Datex-Ohmeda multimonitor.

RESULTS

After the venepuncture, heart rate (p<0.001) and blood pressure (p<0.001) were significantly increased in both the groups but more significant increase was present in Group I (>2.5 kg) as compared to Group II (>2.5 kg). Respiratory rate was also increased but more significant in Group II (p<0.001) whereas oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001).

CONCLUSION

The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.