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Introduction HIV Sentinel Surveillance (HSS) among pregnant women is a key indicator to estimate the HIV prevalence in the general population, as nearly 85% of HIV transmission in India is linked to the heterosexual route. Tracking the levels and trends of the HIV prevalence at state, regional, and district levels help to prioritize and facilitate a tailor-made intervention. Here, we analyze the region and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Tamil Nadu. Methods Eleven rounds of HSS data collected from pregnant women in Tamil Nadu, from 2003 to 2019 were analysed. Consistent sites were grouped into four geographical regions (North, Central, West and South), a total of 67 sites including 33 urban 31 rural, and 3 private sites. Chi-square trend test used to find linear trends and spatial analysis used to understand the geographical distribution of HIV prevalence over the years. Results In total, 2,77,444 blood samples were collected during HSS from 2003 to 2019. In 2019, the state HIV prevalence was 0.18 (95% CI: 0.13–0.23); region-wise prevalence was 0.21, 0.07, 0.32 and 0.12 in North, Central, West and South respectively. HIV prevalence in Tamil Nadu had significantly declined since 2003, which however, was not significant in all districts; with inter-district fluctuations. Conclusion HIV interventions have to be strengthened in the districts with inconsistent trends, specifically the West region. This requires a more detailed analysis of region-specific contextual factors associated with the transmission risk.

Background HIV Sentinel Surveillance among pregnant women attending antenatal care clinics, ANC-HSS, is used to estimate HIV prevalence among the general population. Despite the declining trend, HIV prevalence among the general population in Karnataka is still higher than the national average (0.22%), with a recent, noticeable stabilization. Demographic analysis on concentrated HIV infection among pregnant women could be potential indicators for targeted HIV interventions among general population as well as and prevention of parent to child transmission (PPTCT). Objectives To analyse the demographics of HIV-positive pregnant mothers in Karnataka, thereby identifying the most-at-risk populations (MARP) within the general population. Methods In total, 24800 eligible pregnant women aged 15–49 attending the ANC clinic for the first time during the surveillance period (Jan–Mar, 2017) were enrolled. Demographic data and blood samples were collected, recorded and tested for HIV. Age-specific factors associated with HIV prevalence, besides the demographics of the HIV positive pregnant women, were analysed to identify the MARP for targeted HIV interventions. Results Comprehensively, none of the demographic factors was significantly associated with HIV prevalence. Nevertheless, analysis of demographics, HIV test history and ART status of HIV-positive pregnant women reveals prominent prevalence patterns. The epidemic was majorly confined within young, less educated, primigravida and rural mothers of low economic status. Conclusion ANC-HSS is designed to estimate the HIV prevalence among general population at national, state and district levels and is not reflective of the concentrated epidemic confined to MARP. Identifying the disease pattern specific to MARP is essential for effective targeted interventions and disease management.

Background and Objectives: The purpose of this study was to analyze trends in HIV prevalence and risk factors associated with HIV infection among pregnant women attending antenatal clinics in Odisha State, India. Methods: Data were from the HIV Sentinel Surveillance (HSS) among pregnant women, a descriptive cross-sectional study using consecutive sampling method and conducted in India. Data and samples were collected from pregnant women attending select antenatal clinics that act as designated sentinel sites in Odisha State, India, during the three months surveillance period and in three surveillance years: 2013, 2015, and 2017. All eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included. Information on their socio-demographic characteristics and blood samples were also collected. Results: In total, 38,384 eligible pregnant women were included in the survey. Of these, 107 women were HIV positive, with an overall prevalence of 0.28%. HIV prevalence indicated a stabilizing trend between 2013 and 2017. However, pregnant women whose spouses were non-agricultural laborers, truck drivers, or migrants were significantly at higher risk of being infected. Likewise, HIV prevalence significantly increased over the years among pregnant women whose spouses were in the service sector (government or private). District-wise fluctuations in HIV prevalence was observed, with the district of Cuttack recording the highest prevalence among the districts. Conclusion and Global Health Implications: Women who are spouses of non-agricultural laborers, truck drivers or migrants need focused interventions, such as creating awareness on HIV and its prevention. Migration, due to poverty and its impact on sexually transmitted diseases among migrants from low and middle-income countries, have been documented globally. Single male migrant specific interventions are recommended to halt the disease progression among pregnant women and general population in Odisha, India. Key words: • HIV sentinel surveillance • Pregnant women • HIV prevalence • Socio-demographic factor • Odisha • India Copyright © 2020 Santhakumar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unre-stricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

The nationwide lockdown implemented due to COVID-19 drastically affected the working pattern of people. Only limited staff were allowed to Work At Office (WAO) while the rest were asked to Work From Home (WFH). Employees of both the categories faced challenges due to restricted movements and safety policies. The study was planned to assess and compare the lifestyle changes of WAO and WFH employees during the lockdown. An online cross-sectional study was designed which included employees of both Government and private sectors. Electronic Data Capture method was used to collect the data after obtaining their online consent and/assent forms by circulating a web-page developed using Research Electronic Data Capture software system. Multinomial logistic regression analysis revealed that the employees of WFH were at a higher risk than WAO with respect to their food intake and eating patterns. Our analysis indicated that the risk of weight gain was higher (OR: 1.51, P < 0.005) in WFH group besides, a significant (P

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.

The 16th round of HSS among pregnant women in 2019 was implemented at 39 sites across 13 districts in Andhra Pradesh collecting a total of 15600 complete data forms and biological specimens following consecutive sampling method and linked anonymous strategy as in previous round. The median age of respondents were 22 years in the state and ranged between 15 and 46 years across the districts. The overall HIV prevalence among ANC clinic attendees in Andhra Pradesh in 2019 was low at 0.30%. District-wise, Chittoor (0.58 %), East Godavari (0.50%), Anantapur (0.44%) and West Godavari (0.42%), recorded higher HIV prevalence than that of the state average (0.30 %). Vizianagaram, Visakhapatnam, Prakasam, Nellore and Krishna recorded a prevalence of 0.25%, whereas it was 0.17% in Kurnool and Guntur and 0.13% in Srikakulam and Cuddapah. HIV prevalence among ANC clinic attendees exhibits a declining trend at the state level as well as in most districts. A rising trend in recent past has been noted in Chittoor and West Godavari. In general, HIV prevalence was higher among older group women and those at higher order pregnancies and urban residents. Higher the literacy status, lower was the prevalence. Prevalence was the highest among pregnant women who were non-agricultural labours. Pregnant women with migrant spouses or spouses working as trucker, hotel staffs, large business owners or local transport workers also have higher prevalence. Findings from 2019 round of ANC HSS corroborates with previous rounds showing a low and declining trend at the state level, with persistent geographical diversity at district level. Sustained declining trend among ANC clients nationally and at the state-level, is positive indicator of the successful response of the National AIDS Control Programme (NACP). However, district-level fluctuating trends is a continuing challenge. The findings will be used as a compass by the policy makers and programme managers towards achieving ���End of AIDS��� as a public health threat by 2030., Edited by: Elangovan Arumugam https://orcid.org/0000-0003-4491-7171 Balasubramanian Ganesh https://orcid.org/0000-0002-1978-2650

Introduction: Analysis of local risks at sub-national levels and tailored interventions are being emphasized for effective HIV management. Andhra Pradesh (AP) is a high HIV prevalence state in India, with the second-highest number of people with HIV (PWH) and a consistent decline in HIV prevalence at the state level. Probing further into the region and district-wise levels and trends of HIV prevalence will provide critical insights into sub-regional epidemic patterns. Hence, this paper analyzes the regional and district-level trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in AP, South India. Methods: HIV prevalence data collected from pregnant women in AP during HIV sentinel surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into three regions (Coastal Andhra, Rayalaseema and Uttar Andhra), totaling 39 sites, including 21 rural and 18 urban sites. Regional and district-level HIV prevalence was analyzed using the Chi-square trend test, and spatial analysis was done using QGIS software. For the last three HSS rounds, HIV prevalence based on sociodemographic variables was calculated to understand the factors contributing to HIV positivity in each region. Results: In total, 143,211 pregnant women were recruited. HIV prevalence in AP was 0.30% (95% CI: 0.22 - 0.39) in 2019. The prevalence was 0.31%, 0.35% and 0.22% in Coastal Andhra, Rayalaseema and Uttar Andhra, respectively. HIV prevalence had significantly (P < 0.05) declined in all regions. The overall trend indicated that the HIV prevalence was higher among older pregnant women and in urban regions. However, recent trends consistently report HIV positivity among young and new pregnant mothers, illiterates, and rural regions. Conclusion: The overall trend indicated that the HIV prevalence was higher among older pregnant women and in urban regions. However, recent trends consistently report HIV positivity among young and new pregnant mothers, illiterates, and rural regions. Identifying the contextual risk patterns associated with HIV transmission will further improve HIV preventive and management programs among the general population.

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the causative etiology of ‘Corona Virus Disease-2019' (COVID-19); formerly referred as ‘novel-Coronavirus-2019'. It was originated in Wuhan city, Hubei province, China in early December 2019. The World Health Organization (WHO) declared it as ‘Public Health Emergency of International Concern' due to their rapid transmission and causing public and health-care-related casualties worldwide. This review provides an updated overview of COVID-19 (SARS-CoV-2), in comparison with the etiologies of the same group viz. SARS and MERS and also its future perspectives for planning appropriate strategies for prevention, control and treatment modalities to avert similar catastrophe in near future.

The total sample of ANC analysed was 15460 across 13 districts in Andhra Pradesh. The median age of respondents was 22 years in the state and ranged between 16 and 42 years across different districts. State-level HIV prevalence among ANC respondents (n=15460) was 0.38%. HIV Prevalence among the age group of 15-24was 0.38%, followed by the age group of 25-34 (0.365). At the same time, the remaining age groups (35-44, 45-49) showed zero prevalence at the state level. The proportion of illiterate ANC was 13% at the state level, and the HIV prevalence among them was 0.60%. Whereas the majority of respondents were falls under the category of 6th to 10th standard, and the HIV prevalence among them was 0.42%. At the state level, 42.85% of the respondents reported being pregnant for the first time, and 44.29% of respondents were reported as second-time pregnancies. The state-level HIV prevalence among ANC clinic attendees in primigravida was 0.50%, the second gravida was 0.25%, the third gravida was 0.43%, and in the fourth gravida, it was 0.29%. At the state level, 16% of the respondents belonged to the First trimester, followed by 40% were belonged to the second trimester, and 44.1% of respondents belonged to the Third trimester. The highest HIV prevalence (0.53%) was seen in respondents in the first trimester. At the state level, 74.5% of the respondents reported that they received ANC services during their current pregnancy. At the state level, Govt. service providers (including ASHA/ANM) was identified as the primary source of referral to ANC clinics, accounting for 55.3% of respondents, followed by family /relatives/neighbour/friends (25.5%) and self-referral (15%). The highest HIV prevalence (3.85%) was seen in people referred by ICTC/ART Centre, followed by family/relatives/neighbour/friends (0.43%). At the state level, 73.3% of respondents reported being currently residing in rural areas. The HIV Prevalence in Urban was 0.41%, and Rural was calculated as 0.36%. At the state level, the majority of the respondents (77.2%) were housewives and 13% of respondents reported to be agricultural labourers, and non-agricultural labourer were accounted for 4% of respondents, followed by Service (Govt./Pvt.) (2.1%) and Agricultural cultivator (1.4%). The highest HIV prevalence (1.06%) was seen in the student category, followed by non-agricultural labourers (0.65%), and housewives (0.39%). At the state level, the spouses of ANC attendees accounting for 29.7% were in agricultural labourers, 18.1% were in non-agricultural labourers, and 16.1% were in service (Govt./Pvt.). HIV Prevalence was high in the category of never-married/ widowed/ divorced/ separated women (8.33%), followed by Hotel staff (1.18%) and local transport workers (0.89%). At the state level, 2.3% of respondents reported that their spouses were migrants. HIV Prevalence Among migrants was 1.12% and among non-migrants was 0.35%. At the state level, 34.2% of respondents were tested for HIV during the current pregnancy, whereas 23.7% were tested before the current pregnancy, and 42.1% were never tested for HIV previously, Edited by: Elangovan Arumugam https://orcid.org/0000-0003-4491-7171 Balasubramanian Ganesh https://orcid.org/0000-0002-1978-2650

Background: The SARS-CoV-2 virus with the emergence of new highly transmissible variants at sporadic intervals has bought unparallel damage to global health not only by its direct effect on mortality but also through its impact on lifestyle diseases. This study aimed to understand the lifestyle changes that have occurred among people across India during the period of nationwide lockdown.Methods: The present cross-sectional study was conducted among a large cross-section of people across India (n=1559) with mHealth technology using research electronic data capture (Redcap) platform. The online tool was pre-tested and validated and was disseminated through an easily accessible online social media platform. The online survey form was incorporated with a participant information sheet, an informed consent/assent form with an electronic signature capture method.Results: Among the 1559 participants, 292 (18.72%) were of age less than 25 years, 724 (46.4%) were of age between 25 to 39 years, 384 (24.63%) were 40-54 years of age and 159 (10.19%) were of 55 years and above. The study results showed a significant change in weight across different age groups (p=0.041) and gender (p

Coronavirus disease (COVID-19) caused by SARS-CoV-2 was notified from Wuhan city, Hubei province, China in the mid of December 2019. The disease is showing dynamic change in the pattern of COVID-19 confirmed cases and death toll in these low and middle-income countries (LMICs). In this study, exponential growth (EG) method was used to calculate the reproductive rate (Rt) for initial and current stage of epidemic in South Asian Association for Regional Cooperation (SAARC) member countries (April 2020 – December 2020). Time dependent (TD) method was used to calculate the weekly reproduction number. We also presented the observations on COVID-19 epidemiology in relation with the health expenditure, poverty, and BCG vaccination, literacy, in comparison with the reproduction number, population density for understanding the current scenario, trends, and expected outcome of the disease in SAARC countries. A significant positive correlation was noticed between COVID-19 deaths and health expenditure (% GDP) (r = 0.58, P

Background Avahan, the India AIDS Initiative, a large-scale HIV prevention program, using peer-mediated approaches and STI services, was implemented for high-risk groups for HIV in six states in India. This paper describes the assessment of the program among female sex workers (FSWs) in the southern state of Tamil Nadu. Methods An analytical framework based on the Avahan impact evaluation design was used. Routine program monitoring data, two rounds of cross-sectional biological and behavioural surveys among FSWs in 2006 (Round 1) and 2009 (Round 2) and quality assessments of clinical services for sexually transmitted infections (STIs) were used to assess trends in coverage, condom use and prevalence of STIs, HIV and their association with program exposure. Logistic regression analysis was used to examine trends in intermediate outcomes and their associations with intervention exposure. Results The Avahan program in Tamil Nadu was scaled up and achieved monthly reported coverage of 79% within four years of implementation. The cross-sectional survey data showed an increasing proportion of FSWs being reached by Avahan, 54% in Round 1 and 86% in Round 2 [AOR=4.7;p=0.001]. Quality assessments of STI clinical services showed consistent improvement in quality scores (3.0 in 2005 to 4.5 in 2008). Condom distribution by the program rose to cover all estimated commercial sex acts. Reported consistent condom use increased between Round 1 and Round 2 with occasional (72% to 93%; AOR=5.5; p=0.001) and regular clients (68% to 89%; AOR=4.3; p=0.001) while reactive syphilis serology declined significantly (9.7% to 2.2% AOR=0.2; p=0.001). HIV prevalence remained stable at 6.1% between rounds. There was a strong association between Avahan exposure and consistent condom use with commercial clients; however no association was seen with declines in STIs. Conclusions The Avahan program in Tamil Nadu achieved high coverage of FSWs, resulting in outcomes of improved condom use, declining syphilis and stabilizing HIV prevalence. These expected outcomes following the program logic model and declining HIV prevalence among general population groups suggest potential impact of high risk group interventions on HIV epidemic in Tamil Nadu.