Publications by authors named "Shobini Rajan"

12 Publications

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A national level estimation of population need for blood in India.

Transfusion 2021 May 15. Epub 2021 May 15.

National AIDS Control Organization (NACO), New Delhi, India.

Background: The population need for blood is the total volume required to transfuse all the individuals who need transfusion in a defined population over a defined period. The clinical demand will arise when people with a disease or condition who require transfusion, access healthcare services, and subsequently the clinicians request blood. Essentially, the conversion of need to demand must be maximum to avoid preventable mortality and morbidity. The study estimated the population need for blood in India.

Methods: The methodology included a comprehensive literature review to determine the diseases and conditions requiring transfusion, the population at risk, and prevalence or incidence; and Delphi method to estimate the percentage of people requiring transfusion, and the quantum.

Results: The estimated annual population need was 26.2 million units (95% CI; 17.9-38.0) of whole blood to address the need for red cells and other components after the separation process. The need for medical conditions was 11.0 million units (95% CI:8.7-14.7), followed by surgery 6.6 million (95% CI:3.8-10.0), pediatrics 5.0 million (95% CI:3.5-7.0), and obstetrics and gynecology 3.6 million units (95% CI:1.9-6.2). The gap between need and demand which depends upon the access and efficiency of healthcare service provision was estimated at 13 million units.

Conclusion: The study brings evidence to highlight the gap between need and demand and the importance of addressing it. It cannot be just the responsibility of blood transfusion or health systems, it requires a multi-sectoral approach to address the barriers affecting the conversion of need to clinical demand for blood.
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http://dx.doi.org/10.1111/trf.16369DOI Listing
May 2021

Substance use and risk of HIV infection among Men who have Sex with Men in India: Analysis of National IBBS data, India.

Medicine (Baltimore) 2020 Aug;99(35):e21360

ICMR-National Institute of Epidemiology, TNHB, Ayapakkam, Chennai, Tamil Nadu, India.

HIV prevalence is higher among Men who have Sex with Men (MSM), owing to their unsafe sexual behavior. Further, MSM indulge in behaviors such as consumption of alcohol/oral drugs and/or injecting during/before sex that poses the risk of unsafe behaviors, thereby increasing their vulnerability to HIV. The study aims to analyze the factors associated with HIV infection among the multi-risk MSM using any substances with those MSM who do not use substances.Community-based cross-sectional survey design using probability-based sampling between October 2014 and November 2015.For the nation-wide Integrated Biological and Behavioral Surveillance (IBBS), 23,081 MSM were recruited from 4067 hotspots in 108 districts across India. Information on demographics, sexual behaviors, substance use, sexual partners, and awareness on HIV and its management was collected from the consented respondents using computer-assisted personal interview (CAPI) by trained personnel. Blood samples were tested for HIV. Statistical analyses were done, to study the associations between substance use and its influence on high-risk sexual behaviors and HIV infection.One in 3 MSM (33.88%) in India were substance users, thus exhibiting "multi-risk" (MR) behaviors. Significantly higher HIV prevalence (3.8%, P < .05) was reported among MR-MSM, despite 97.2% of them being aware of HIV. Higher HIV prevalence among MSM exhibiting homosexual behavior for ≤1 year is of specific concern, as this accounts to recent infections and indicates the increased vulnerability of the infection among the new entrants.Substance-use resulting in high-risk sexual behavior was significantly associated with higher HIV prevalence among MR-MSM. Integrated targeted interventions focusing on safe sex and safe-IDU practices among MR-MSM are required to end the disease transmission.
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http://dx.doi.org/10.1097/MD.0000000000021360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458168PMC
August 2020

Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India.

Indian J Med Res 2020 06;151(6):562-570

ICMR-National Institute of Medical Statistics, Chennai, Tamil Nadu, India.

Background & Objectives: The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels.

Methods: Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015.

Results: The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed.

Interpretation & Conclusions: With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.
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http://dx.doi.org/10.4103/ijmr.IJMR_1619_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602920PMC
June 2020

Possible role of plasma Galectin-9 levels as a surrogate marker of viremia in HIV infected patients on antiretroviral therapy in resource-limited settings.

AIDS Res Ther 2020 07 16;17(1):43. Epub 2020 Jul 16.

ICMR-National AIDS Research Institute, 73-G Block, M.I.D.C, Bhosari, Pune, India.

Background: Early detection of viremia in HIV infected patients on anti-retroviral therapy (ART) is important to prevent disease progression as well as accumulation of drug resistance mutations. This makes HIV viral load (VL) monitoring indispensable in HIV infected patients on ART. However VL, being an expensive test, results in heavy financial burden on health services. Hence, cheaper surrogate markers of viremia are desired to reduce overall cost of management of HIV infected patients.

Methods: We enrolled aviremic (n = 63, M:F = 31:32) and viremic (n = 43, M:F = 21:22) HIV infected patients at 1 year after ART initiation. Viremic individuals were identified as those having a plasma VL of more than 1000 copies/µl and aviremic individuals as less than 40 copies/µl. The study participants also included immuno-virologically discordant patients as they demonstrate differential degrees of immune-reconstitution and are likely to harbour concomitant infections influencing levels of immune-activation markers screened as the surrogate markers. Immune activation markers viz. plasma hs-CRP, soluble-CD14 and Galectin-9 levels were estimated by ELISA, IL-6 by luminex assay and percentages of CD38+ CD8+ cells were determined by flow cytometry. The levels were compared between viremic and aviremic patients and correlated with plasma viral load. Receiver operated curve (ROC) analysis was done for plasma Galectin-9 levels.

Results: Viremic patients had significantly higher levels of Galectin-9 and %CD38+ CD8+ cells (p values < 0.0001) than aviremic patients. Levels of the other activation markers did not differ between viremic and aviremic individuals. Galectin-9 levels (r = 0.76) and %CD38+ CD8+ cells (r = 0.39) correlated positively with VL. Area under curve for Galectin-9 levels for distinguishing between viremic and aviremic individuals was 0.98. Youden index, sensitivity, specificity, positive predictive value and negative predictive value for Galectin-9 levels were 0.87, 0.97, 0.90, 0.87 and 0.98, respectively, at the cut-off value of 5.79 ng/ml.

Conclusions: Plasma Galectin-9 levels could identify viremic individuals with sensitivity and specificity of more than 90%. Thus, they showed a potential to serve as a surrogate marker of viremia in HIV infected patients on ART and would have cost implications on HIV management especially in resource-limited settings. However, the findings need to be confirmed in the patients on ART for different durations of time.
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http://dx.doi.org/10.1186/s12981-020-00298-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364535PMC
July 2020

Aging of HIV epidemic in India: Insights from HIV estimation modeling under the national aids control programme.

Indian J Public Health 2020 Apr;64(Supplement):S76-S78

Assistant Director General, Strategic Information Management Division, National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India,, India.

People living with HIV are gradually getting older as a result of better survival with increased uptake of antiretroviral treatment in India. We aimed to quantify the aging HIV-infected population in India by undertaking a mathematical model analysis of 2017 rounds of HIV burden estimations under the National AIDS Control Programme. Our analysis projects that the mean age of HIV-infected people will increase from 38.4 years in 2005 to 45.5 years in 2025 with the proportion of HIV-infected people aged 50 years or older increasing from 19% in 2005 to 37% in 2025. This aging HIV epidemic is anticipated to lead to more non-AIDS morbidities, increased treatment complexity, and an inevitable need for multidisciplinary health-care services to ensure continued high-quality survival.
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http://dx.doi.org/10.4103/ijph.IJPH_127_20DOI Listing
April 2020

Did Inclusion of informed consent affect the observed hiv prevalence rate among injecting drug users during hiv sentinel surveillance 2017 in Delhi, Uttar Pradesh, Uttarakhand, and Jharkhand States of Central Zone of India?

Indian J Public Health 2020 Apr;64(Supplement):S67-S70

Assistant Director General, National AIDS Control Organization, MoHFW, GOI, New Delhi, India.

Background: In 2017, the sampling procedure for HIV sentinel surveillance (HSS) among all high-risk groups was changed from the consecutive sampling to random sampling along with the introduction of linked anonymous testing strategy with informed written consent.

Objective: The objective of this study was to assess whether the inclusion of informed consent affects the HIV positivity rate among the participants and nonparticipants injecting drug users (IDU) in HSS 2017 in four states of Central Zone of India.

Methods: This study was a cross-sectional study. All sentinel sites from Delhi, Uttar Pradesh, Jharkhand, and Uttarakhand located at targeted intervention facilities in 2017 were included in the study. Information about the participation and nonparticipation of each high-risk individual at the sentinel site was gathered from the master list, respective registers, and website portal of the National AIDS Control Organization. A total of 8639 individuals were included in the analysis.

Results: Overall, 16 sites in four states were included in the study. Overall, the nonparticipation rate of IDUs was 14.3%; highest being for Delhi (17.2%), followed by Uttar Pradesh (14.6%), Uttarakhand (10.9%), and Jharkhand (4.4%). Overall, the HIV-positivity rate among nonparticipants (9.6%) was significantly higher (P = 0.009) compared to the participants (6.7%).

Conclusion: Change in methodology and seeking written informed consent might have an effect on the nonparticipation in all four states. This, in turn, could have led to the underestimation of HIV-positivity rates among IDU in the states.
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http://dx.doi.org/10.4103/ijph.IJPH_35_20DOI Listing
April 2020

Factors associated with human immunodeficiency virus infection and self-assessed risk to human immunodeficiency virus among injecting drug users in Manipur, India.

Indian J Public Health 2020 Apr;64(Supplement):S61-S66

Assistant Director General, Strategic Information and Surveillance, National AIDS Control Organization, Ministry of Health Family Welfare, Government of India, New Delhi, India.

Background: The proximity of Northeast India to the Golden Triangle facilitates easy accessibility to illicit drugs, resulting in a higher proportion of injecting drug users (IDUs) in the states of Northeast India. The estimated human immunodeficiency virus (HIV) prevalence among IDU in Manipur which is 1.43% is higher than that of the national figure.

Objectives: The objectives of the study were to find the factors associated with HIV infection and correlate the association between HIV status and self-assessed risk to HIV among IDUs in Manipur.

Methods: National Integrated Biological and Behavioral Surveillance (2014-2015) data were used for the study; all analyses done were weighted. In Manipur, information was collected from 1594 IDUs during the surveillance between 2014 and 2015 across four domains, namely Chandel (396), Imphal East (397), Thoubal (401), and Senapati (400). Chi-square test was performed to test the association between the independent and dependent variables. Multivariable logistic regression was performed to identify risk factors associated with HIV positivity.

Results: Higher age, unsafe injecting practice, low education status, and low-income status were significantly (P < 0.05) associated with HIV infection among IDUs in Manipur. Self-assessed risk of HIV infection by IDU was significantly associated with HIV positivity.

Conclusion: Interventions among IDUs in Manipur should focus on emphasizing safe injecting practices along with creating awareness on HIV prevention and management.
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http://dx.doi.org/10.4103/ijph.IJPH_61_20DOI Listing
April 2020

HIV/AIDS-Related risk behaviors, HIV prevalence, and determinants for HIV prevalence among hijra/transgender people in India: Findings from the 2014-2015 integrated biological and behavioural surveillance.

Indian J Public Health 2020 Apr;64(Supplement):S53-S60

Former Senior Advisor, Strategic Information Division, The Joint United Nations Programme on HIV/AIDS (UNAIDS), New Delhi, India.

Background: Hijra or transgender (H/TG) people are significantly affected by HIV in India. HIV prevalence among H/TG is the second highest after people who inject drugs. Effective interventions require understanding about various risk behaviors and associated factors for high prevalence.

Objectives: This study analyzes the known risk behaviors and vulnerabilities of HIV-positive and HIV-negative H/TG people to identify the determinants of HIV seropositivity in this high-risk group.

Methods: Using secondary data from India's 2014 to 2015 Integrated Biological and Behavioural Surveillance survey, this analysis was conducted among 3325 H/TG people across seven states. Probability-based sampling methods were used to recruit H/TG people. Informed consent was obtained for the collection of behavioral information and blood samples for HIV testing. Multivariable binary logistic regression analysis was undertaken to identify the determinants of HIV seropositivity.

Results: HIV prevalence for this group of respondents was 9.5%. Multivariable analysis of survey data revealed higher odds of HIV infection if H/TG had regular male partners (adjusted odds ratio [AOR]: 1.81, confidence interval [CI]: 1.07-3.06), were living in the states of Maharashtra (AOR: 6.08, CI: 3.02-12.22) and Odisha (AOR: 2.91, CI: 1.05-8.06), and were members of self-help groups (AOR: 2.08, CI: 1.04-4.14). None of the demographic or behavioral correlates of risk were found to be associated with HIV infection.

Conclusion: The findings suggest that community and structural factors, which are inadequately covered in surveys such as IBBS, play a more important role than individual behavioral factors.
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http://dx.doi.org/10.4103/ijph.IJPH_55_20DOI Listing
April 2020

Human immunodeficiency virus prevalence and high-risk behavior of home-based and nonhome-based female sex workers in three high-prevalent North-Eastern States of India.

Indian J Public Health 2020 Apr;64(Supplement):S46-S52

Scientist F, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India.

Background: Female sex workers (FSWs) have been identified as an important target group for human immunodeficiency virus (HIV)/sexually transmitted infections prevention.

Objectives: This study aimed to describe sociodemographic and sex work characteristics and to identify the risk factors for HIV infection with special focus on the variations between home-based (HB) and non-HB (NHB) FSWs in three high-prevalent North-Eastern states of India: Manipur, Mizoram, and Nagaland.

Methods: Data from the National Integrated Bio-Behavioural Surveillance (IBBS) conducted in India during 2014-2015 were utilized in the study. IBBS is a quantitative survey conducted among identified high risk sub within India. Logistic regression analyses were performed using SAS 9.3.2 to determine the distribution and associations of sociodemographics and risk behaviors with HIV seropositivity of HB and NHB FSWs.

Results: HIV prevalence was found higher among NHB FSWs compared to HB FSW (7.3% vs. 4.6%). The proportions of FSW among HB (66.7%) were in sex work for longer duration are significantly higher than for NHB (60.2%) while risk of HIV infection due to injecting drug use was higher in NHB FSW (11.7% vs. 8.7%). Reference to FSW who were currently married, those who were widowed/divorced/separated had 2.73-fold risk of HIV. FSW who did not have any other income source were associated with 1.73 times more risk of HIV infection. Injecting drugs user among FSW respondents had four times higher likelihood to be HIV positive.

Conclusion: A substantial proportion of NHB FSWs is mobile in nature. Targeted interventions are required urgently to minimize HIV risk among those FSWs especially the widowed/divorced/separated, sex work is only income source and who used injecting drugs for nonmedical purpose.
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http://dx.doi.org/10.4103/ijph.IJPH_100_20DOI Listing
April 2020

High IL-5 levels possibly contributing to HIV viremia in virologic non-responders at one year after initiation of anti-retroviral therapy.

Microb Pathog 2020 Jun 3;143:104117. Epub 2020 Mar 3.

ICMR-National AIDS Research Institute, 73-G block, M.I.D.C, Bhosari, Pune, India.

Lack of viral monitoring in HIV infected patients on anti-retroviral therapy in low income countries may result in missing virologic non-responders (VNR) who show immunologic recovery in spite of unsuppressed viral replication. Biomarkers and drug resistance patterns in these discordant patients in comparison to the concordant treatment failure group need to be studied to understand possible risk factors associated with this condition. HIV infected patients on anti-retroviral therapy for one year were enrolled under three categories namely VNRs (n = 25), treatment failures (n = 18) and treatment responders (n = 40). They were assessed for HIV drug resistance by sequencing, plasma cytokines by luminex assay, T cell activation status by flow cytometry and total IgE levels by ELISA. VNR and failure patients had significantly lower median baseline CD4 counts than the responders. VNRs had significantly higher CD4 counts but lower viral load than treatment failures at one year of ART. VNRs had the highest eosinophil counts and the highest IL-5 levels among all the groups. IL-5 levels in them correlated with their viral load values. Frequency of Treg cells was also highest among the VNR group participants. More than 60% of the viremic patients irrespective of their groups harboured multiple HIV drug resistance mutations and mutation pattern did not differ between the groups. Low baseline CD4 counts and presence of multiple drug resistance mutations in the viremic groups highlighted the importance of early ART initiation and viral load monitoring irrespective of presence of immunologic failure. High IL-5 levels in VNR group indicated a need for investigating causal relationship between IL-5 and viral replication to devise therapeutic strategies to control viremia.
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http://dx.doi.org/10.1016/j.micpath.2020.104117DOI Listing
June 2020

Towards elimination of parent-to-child transmission of syphilis in India: a rapid situation review to inform national strategy.

WHO South East Asia J Public Health 2015 Jul-Dec;4(2):197-203

TBC India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India.

In February 2015, India's National AIDS Control Organisation, Ministry of Health and Family Welfare, launched a national strategy towards elimination of parent-to-child transmission (E-PTCT) of syphilis, with a goal to reduce the incidence of congenital syphilis to 0.3 cases per 1000 live births by 2017. As part of the development of the national strategy, a rapid situation analysis was undertaken to ascertain the current practices, challenges and barriers for E-PTCT of syphilis in India. The analysis was conducted during February and March 2014 in five states selected from five different regions of India. Key informant interviews were conducted with key stakeholders at facility, state and district level. Content analysis was used to identify the themes. Key barriers identified for E-PTCT of syphilis were: low priority for antenatal syphilis testing among providers, limited access to testing, untrained human resources, shortage of test kits and benzathine penicillin, nonadherence to the national protocol for syphilis testing, and poor recording and reporting of antenatal syphilis data. The analysis also identified opportunities for functional integration of E-PTCT within existing maternal and child health programmes. Health-care providers and programme managers expressed a need for training in the programme for E-PTCT of syphilis. The situation analysis identified that, for successful implementation of E-PTCT of syphilis, it is essential that state and district programme managers adopt this initiative; coordinate the programme; plan for an adequate budget in their programme implementation plan; ensure an uninterrupted supply of standardized diagnostics kits and drugs at all levels of health care; and adhere to E-PTCT guidelines when implementing the programme.
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http://dx.doi.org/10.4103/2224-3151.206690DOI Listing
June 2017