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Background Sexually transmitted infections (STIs) are one of the leading causes of health, and economic burdens in the developing world, leading to considerable morbidity, mortality, and stigma. The incidence and prevalence of the four curable STIs viz. syphilis, gonorrhoea, chlamydia, and trichomoniasis vary remarkably across different geographical locations. In India, the prevalence of four curable STI among general populations is in between 0 to 3.9 percent. However, it is assumed that STI prevalence is much higher among subpopulations practicing high-risk behaviour. Like men who have sex with men (MSM), transgender (TG), injecting drug users (IDU), and female sex workers (FSW). Objectives In the present circumstances, a systematic review is necessary to integrate the available data from previously published peer-reviewed articles and published reports from several competent authorities to provide the prevalence and geographical distribution of the four curable STIs among the key population of India. Methods All available articles will be retrieved from PubMed, Google Scholar, Cochrane database, Scopus, Science Direct, and the Global Health network using the appropriate search terms. The data will be extracted through data extraction form as per PICOS (population, intervention, comparison, outcome, study design) framework. Risk of bias and quality assessment will be performed according to the situation with the help of available conventional protocol. Discussion The future systematic review, generated from the present protocol, may provide evidence of the prevalence and geographical distribution of the four curable STIs among the key population of India. We hope that the findings of the future systematic review will strengthen the existing surveillance system in India, to determine the above-mention STIs prevalence among key populations in India. Protocol registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42022346470.

Background: A nationwide lockdown in response to the ongoing coronavirus disease 2019 pandemic has disrupted various health surveys. Limited movements due to restricted public-transports, and the need to maintain social-distancing, make data collection at the field site through conventional methods such as face-to-face interviews challenging. Objectives: The objective of the study was to overcome such issues, we document a complete online survey, using mobile technologies, for public health research, and deployable during disasters. Methods: The survey form was uploaded online, and for the 1st time in India, the participant information page, consent, and assent forms were also deployed online. Informed consent forms from participants were captured electronically as hand-drawn signatures. A structured, electronic-questionnaire was shared to the participants’ smartphones, and the collected data were stored in a server using Research Electronic Data Capture, real-time. Results: Within a short span of 10 days, 1985 participants from 31 states and union territories took part in the survey. Among those, 79% had completed the survey, and the rest quit the survey mostly during the “consenting” phase, especially when they were asked to sign the consent/assent forms (16%). About 62.5% of the participant graded the online survey as “much better” followed by 19.5% suggesting “somewhat better,” indicating a positive public perception regarding the online survey. Conclusion: The real-time online survey in health research was perceived to be better than the conventional method. In the digital era, employing mHealth technologies in health research will be a cost-effective methodological approach to obtain the expected research outcome, in a resource and time-limited setting.

Female sex workers (FSWs) who inject drugs (FSW-IDs) have a higher risk of HIV infection and transmission. Understanding the socio-demographic characteristics and other risk behaviours among FSW-IDs will help in strengthening targeted interventions for HIV prevention and management. In the present study, the HIV prevalence, associated socio-demographic characteristics and risk behaviours among FSWs who injected drugs (FSW-IDs) and those who did not ID (FSW-NIDs) was determined in India.The national cross-sectional, community-based, integrated biological and behavioural surveillance was conducted in 2014-2015 at 73 randomly selected FSW domains across 28 States and Union Territories in India. The sample size was fixed at 400 for each domain, and a probability-based sampling method was followed. The data were analyzed by logistic regression methods.Data from 27,007 FSWs were included in the analysis, of which 802 (3%) were FSW-IDs. HIV prevalence among FSW-IDs was significantly higher than that in FSW-NIDs (4.5 vs. 1.9%). Univariate analysis showed that factors significantly associated with higher HIV prevalence among FSW-IDs were older age, sex work as the only source of income, dissolved marriage, living with a sex worker, urban locality of sex work and consumption of alcohol or oral drugs. In multivariable analysis, factors such as older age of FSW-IDs (35 yr and above), having a dissolved marriage and sex work being the only source of income were observed to be independently and significantly associated with higher HIV prevalence.Scaling up the HIV preventive interventions for FSW-IDs, such as facilitating awareness and improved access to needle and syringe exchange programme (NSEP) and opioid substitution therapy (OST), encouraging safe sex and injecting practices, educating on the harmful effects of alcohol and drugs and providing alternative vocation options to secure their financial needs are several strategies that may reduce HIV transmission among FSWs.

Background: The human immunodeficiency virus (HIV) epidemic in India is generally considered to be more concentrated, with the focus on high-risk groups including female sex workers (FSWs). The Integrated Biological and Behavioral Surveillance (IBBS), the first nationwide surveillance conducted during 2014-2015, collected many key indicators, including indicators related to HIV/STI transmission. The purpose of this study was to develop an index score for each domain surveyed and to identify focus areas for interventions among FSWs. Methods: The study population consisted of 27,007 FSWs. Forty high-risk related covariates of HIV/STI transmission, demographic characteristics, sexual history, condom practices, knowledge of HIV/STI and biological variables were considered. The original data set was examined using the correlation matrix and was reduced to 15 highly-correlated factors using principal component analysis. The factors were further improved using varimax rotation and the percentage of variation was used as weights to obtain the initial score for each domain, which were then standardized for comparison. Bartlett’s test of sphericity was examined before the factor extraction. Results: Six factors were extracted, which together explained about 73% of the total variation. The factors were: (1) more number of clients; (2) younger FSW and started selling sex at younger age; (3) experiencing condom breakage; (4) having occasional clients and poor HIV/AIDS knowledge; (5) illiteracy; and (6) a longer period of sex work. Six domains with an index score of above 80, from the states of Maharashtra, Rajasthan, Arunachal Pradesh, Uttar Pradesh, and Jharkhand need greater intervention. Conclusion and Implications for Translation: FSWs’ current age, age at commencement of sex work, and the number of clients were the indicators most-associated with HIV infection. Therefore, program and policy interventions should focus on FSWs who are younger than 10 clients. Key words: • Female Sex Worker • Kriged Map • Factor Analysis • Principle Component Analysis • HIV • Sexually Transmitted Infections Copyright © 2021 Elangovan 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 unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Background: Targeted interventions (TIs) are one of the most effective strategies to control HIV/AIDS transmission, especially among the high-risk groups (HRGs). Implementation of HIV/AIDS control strategies relies heavily on estimation of the size of HRG population. Size estimation for key populations such as female sex workers (FSWs), men who have sex with men (MSM), and injecting drug users (IDUs) is a crucial component of national HIV strategic planning. Objective: The objective of this study was to estimate the size of FSWs, MSM, and IDUs in various states of India. Methods: The program multiplier method was used to estimate the size of FSWs, MSM, and IDUs across the country using two distinct but overlapping data sources – Integrated Bio-Behavioral Surveillance and TI program from the same geographical area at the same time period. Results: In India, as on 2018–2019, there were nearly 18.2 lakhs estimated FSWs accounting to 0.53% among female population aged 15–49 years, with a highest in West Bengal (4.5 lakhs); 5.7 lakhs estimated MSM accounting to 0.16% among male population aged 15–49 years, with a highest in Gujarat (0.7 lakh); and 3.9 lakhs estimated IDUs accounting to 0.11% among male population aged 15–49 years, with a highest in Uttar Pradesh (0.5 lakh). Conclusions: The current size estimates on HRGs will support the development of projections and estimations of the HIV epidemic at national and state levels. These estimates also help in framing national guidelines such as HIV strategic planning, program design, allocation of resources, prioritizing the interventions, and monitoring and evaluation.

People who inject drugs (PWID) are India's third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.

Background and Objective: Periodic tracking of the trends and the levels of HIV prevalence at regional and district levels helps to strengthen a state’s HIV/AIDS response. HIV prevalence among pregnant women is crucial for the HIV prevalence estimation of the general population. Karnataka is one of the high HIV prevalence states in India. Probing regional and district levels and trends of HIV prevalence provides critical insights into district-level epidemic patterns. This paper analyzes the region- and district-wise levels and trends of HIV prevalence among pregnant women attending the antenatal clinics (ANC) from 2003 to 2019 in Karnataka, South India. Methods: HIV prevalence data collected from pregnant women in Karnataka during HIV Sentinel Surveillance (HSS) between 2003 and 2019 was used for trend analysis. The consistent sites were grouped into four zones (Bangalore, Belgaum, Gulbarga and Mysore regions), totaling 60 sites, including 30 urban and 30 rural sites. Regional and district-level HIV prevalence was calculated; trend analysis using Chi-square trend test and spatial analysis using QGIS software was done. 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, 254,563 pregnant women were recruited. HIV prevalence in Karnataka was 0.22 (OR: 0.15 95% CI: 0.16 - 0.28) in 2019. The prevalence was 0.24, 0.32, 0.17 and 0.14 in Bangalore, Belgaum, Gulbarga, and Mysore regions, respectively. HIV prevalence had significantly (P< 0.05) declined in 26 districts. Conclusion and Global Health Implications: HIV prevalence among pregnant women was comparatively higher in Bangalore and Belgaum regions. Analysis of contextual factors associated with the transmission risk and evidence-based targeted interventions will strengthen HIV management in Karnataka. Regionalized, disaggregated, sub-national analyses will help identify emerging pockets of infections, concentrated epidemic zones and contextual factors driving the disease transmission. Copyright © 2021. Arumugam 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.

Background: The HIV sentinel surveillance (HSS) serves to estimate the levels and trend of HIV prevalence among high-risk, bridge, and general population and monitors HIV management at national, state, and district levels. Data from HSS are valuable in understanding the risk factors associated with HIV transmission with particular demographic characteristics. Objectives: The objective was to analyze the sociodemographic profile of the pregnant mothers attending the antenatal care (ANC) clinics in Karnataka, in order to understand the dynamics of HIV within the general population in Karnataka. Materials and Methods: Study design: this was a cross-sectional study conducted using consecutive sampling method. Study setting: the surveillance was conducted at select antenatal clinics, in Karnataka, India, between January and March, in the years 2013, 2015, and 2017. Methodology: in total, 74,278 eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included in the study. Information on their sociodemographic characteristics and blood samples was collected. Results: HIV prevalence among the ANC clinic attendees has significantly declined, reaching a recent stabilization. The risk factors significantly associated with HIV among pregnant women were age, education, occupation, and marital status. HIV is highly concentrated in the northern and southern districts of Karnataka. Conclusion: Despite the declining trends of HIV prevalence in Karnataka, the epidemic is heterogeneous and concentrated within the state, calling for decentralized region-specific interventions.

Supplemental Digital Content is available in the text, 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

Background: The National AIDS Control Programme provides support for HIV prevention services to pregnant women attending antenatal care (ANC) clinics through testing, kit delivery, counseling, and treatment services. The impact of HIV prevention programs in the general population is assessed by monitoring trends and progress made against the HIV epidemic among pregnant women attending ANC clinics during HIV Sentinel Surveillance (HSS). Objectives: This study explores the association of HIV risk with educational attainment for Indian women across different age groups from four repeated cross-sectional surveillance of antenatal clinics in six states from the southern part of India. Methods: Data collected from the repeated cross-sectional HSS conducted during the year 2010–2011 (baseline) and 2016–2017 (end line) across six states were used for this analysis. The total sample size was 94,266 at baseline and 99,434 at end line. In the logistic regression analysis, we focused on identifying the association between educational attainment, and HIV prevalence adjusting for period effects across two age groups for women attending ANC clinics. Results: The analysis showed an inverse association between education and HIV risk across different age groups. The age-segregated and survey period adjusted analysist showed that for older women (≥25 years), the HIV risk in 2010 ranged from 41% lower among 5th Grade to 80% lower among postgraduates than illiterates. For the

Background: HIV/AIDS is a global public health issue and its transmission in a defined geographic region is influenced by the interplay of sociodemographic and behavioral factors. Better understanding of sociodemographic characteristics of HIV-positive individuals is required to prevent the spread of HIV among the general population. Objectives: The objective of the study was to find the association between HIV prevalence and sociodemographic characteristics of pregnant women aged 15–49 years attending the antenatal clinics (ANCs) in six Southern states of India. Methods: The data from the latest round of HIV sentinel surveillance, a cross-sectional study, conducted during January–March 2017 among ANC attendees were considered for this analysis. Blood samples along with other relevant information were collected from 98,634 pregnant women from 248 sites across the states. The association between HIV prevalence and sociodemographic variables was examined using multivariable logistic regression. Results: The highest HIV prevalence was reported in Karnataka (0.38%) and Andhra Pradesh (0.38%), followed by Telangana (0.33%), Odisha (0.28%), Tamil Nadu (0.27%), and Kerala (0.05%). In all states, the prevalence was highest among illiterate pregnant women exception being Kerala, wherein the prevalence was highest in pregnant women with schooling up to primary education. A significant association was found between HIV prevalence and spouse occupation in Karnataka and Odisha and spouse migration in Andhra Pradesh and Karnataka. Conclusions: Need for improvising the interventions for the young, illiterates, having a migrant spouse, and spouse occupation as truckers/hotel staff is recommended to the stakeholders involved in HIV management of the six southern states of India.

A total number of 15095 ANCs were recruited and blood samples were collected across 13 districts in the state of Andhra Pradesh during the HSS 2014-15. The median ages of respondents were 22 years in the state. The age distribution was 75.6% in the age group 15-24 years and 23.9% in the age group 25-34 years. ��� HIV Prevalence among the age group of 15-24 was 0.27% and the same was 0.52% in 25-49 years age group. ��� The proportion of illiterate ANC was 16.6% at the state level and the HIV prevalence among them was 0.7% ��� At district level, the proportions of illiterates were varied from 6.7% in East Godavari to 25.2% in Prakasam. ��� At the state level, 47.9% of the respondents reported being pregnant for the first time. ��� The state level HIV prevalence among ANC clinic attendees in primi-gravida was 0.4%, second gravida was 0.3%, third gravida was 0.1% and in fourth gravida it was 1.6%. ��� At the district level, the primi-gravida varies between 33.3% in Cuddapah to 60.2% in Srikakulam. ��� Government hospital/ANM/ASHA was identified as the major source of referral to ANC clinics, which accounted for 50.7% of respondents. ��� Referrals from the government service providers were higher in the districts of Vizianagaram (87.8%), Srikakulam (86.1%), Cuddapah (77.8%) and West Godavari (77.0%). ��� Highest HIV prevalence (0.5%) was seen in people of Self Referrals. ��� At the state level, 71.1% of respondents reported to be currently residing in rural areas. ��� The HIV Prevalence among both in Urban and Rural was calculated as 0.3%. The urban district with highest HIV prevalence was Guntur (1.1%) and the rural district with highest HIV prevalence was Cudappah (0.8%). ��� At the state level, the majority of the respondents (73.9%) were housewives. ��� 1% of HIV prevalence was seen among the pregnant mothers whose occupations were reported as Non-Agricultural Labourer and 0.5% was the prevalence seen in Skilled / Semiskilled workers. ��� At the state level, accounting for more than one-fourths (31.9%) spouse occupations were Agricultural Labourers. HIV prevalence among them was calculated as 0.2%. ��� HIV Prevalence among the ANCs having their spouse occupation as Hotel Staff was 2.1% and Truck Driver/helper was 1.1%. ��� At the state level, 2.1% of respondents reported that their spouses were migrants. Among them, the HIV prevalence was 0%., Edited by: Elangovan Arumugam https://orcid.org/0000-0003-4491-7171: Balasubramanian Ganesh https://orcid.org/0000-0002-1978-2650

Background This paper presents an evaluation of Avahan, a large scale HIV prevention program that was implemented using peer-mediated strategies, condom distribution and sexually transmitted infection (STI) clinical services among high-risk men who have sex with men (HR-MSM) and male to female transgender persons (TGs) in six high-prevalence state of Tamil Nadu, in southern India. Methods Two rounds of large scale cross-sectional bio-behavioural surveys among HR-MSM and TGs and routine program monitoring data were used to assess changes in program coverage, condom use and prevalence of STIs (including HIV) and their association to program exposure. Results The Avahan program for HR-MSM and TGs in Tamil Nadu was significantly scaled up and contacts by peer educators reached 77 percent of the estimated denominator by the end of the program’s fourth year. Exposure to the program increased between the two rounds of surveys for both HR-MSM (from 66 percent to 90 percent; AOR = 4.6; p