Browsing by Author "Chinmoyee Das"

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Augmenting progress on the elimination of vertical transmissions of HIV in India: Insights from Spectrum-based HIV burden estimations
(Public Library of Science, 2023) Pradeep Kumar; Chinmoyee Das; Udayabhanu Das; Arvind Kumar; Nidhi Priyam; Varsha Ranjan; Damodar Sahu; Sanjay K. Rai; Sheela V. Godbole; Elangovan Arumugam; P.V.M. Lakshmi; Shanta Dutta; H. Sanayaima Devi; Arvind Pandey; Dandu Chandra Sekhar Reddy; Sanjay Mehendale; Shobini Rajan
The government of India has adopted the elimination of vertical transmission of HIV as one of the five high-level goals under phase V of the National AIDS and STD Control Programme (NACP). In this paper, we present the data from HIV estimations 2021 for India and select States detailing the progress as well as the attributable causes for vertical transmissions. The NACP spearheads work on mathematical modelling to estimate HIV burden based on the periodically conducted sentinel surveillance for guiding program implementation and pol-icymaking. Using the results of the latest round of HIV Estimations in 2021, we analysed the mother-to-child transmission (MTCT) during the perinatal and postnatal (breastfeeding) period. In 2021, overall, around 5,000 [3,000–7,800] vertical transmissions were estimated nationally with 58% being perinatal infections and remaining during breastfeeding. MTCT at 6 weeks was around 12.95% [9.45–16.02] with the final transmission rate at 24.25% [18.50–29.50]. Overall, 57% of vertical transmissions were among HIV-positive mothers who did not receive ART during pregnancy or breastfeeding, 19% among mothers who dropped off ART during pregnancy or delivery, and 18% among mothers who were infected during pregnancy or breastfeeding. There were significant variations between States. Depending upon the States, the programme needs to focus on the intervention domains of timely engagement in antenatal care-HIV testing-ART initiation as well as programme retention and adherence support. Equally important would be strengthening the strategic information to generate related evidence for inputting India and State-specific parameters improving the MTCT-related modelled estimates. © 2023 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
District-level HIV estimates using the spectrum model in five states of India, 2017
(Lippincott Williams and Wilkins, 2021) Pradeep Kumar; Damodar Sahu; Shobini Rajan; Vishnu Vardhana Rao Mendu; Chinmoyee Das; Arvind Kumar; Nalini Chandra; Bilali Camara; Sanjay Rai; Elangovan Arumugam; Sheela Virendra Godbole; Shri Kant Singh; Shashi Kant; Arvind Pandey; Dandu Chandra Sekhar Reddy; Sanjay Mehendale
AbstractDecentralized response has been the hallmark of the National AIDS Control Programme in India. District-level HIV burden estimates quantifying the distribution of the epidemics are needed to enhance this decentralized response further to monitor the progress on prevention, testing, and treatment interventions. In this paper, we describe the methodology and results of district-level estimates using the Spectrum model piloted in 5 states of India under National AIDS Control Programme.Using state spectrum model for HIV estimations 2017, we disaggregated state results by the district in pilot states. Each district was considered a subepidemic and HIV epidemic configuration was carried out in its general population as well as in key population. We used HIV surveillance data from antenatal clinics and routine pregnant women testing to model the general population's epidemic curve. We used HIV prevalence data available from HIV sentinel surveillance and integrated biological and behavioral surveys to inform the epidemic curve for key population. Estimation and projection packgage classic platform was used for the curve fitting. District-wide estimates extracted from subpopulation summary in Spectrum results section were used to calculate relative burden for each district and applied to approved State HIV Estimations 2017 estimates.No district in Tamil Nadu had an adult HIV prevalence of higher than 0.5% except for one, and the epidemic seems to be declining. In Maharashtra, the epidemic has shown a decline, with all except 5 districts showing an adult prevalence of less than 0.50%. In Gujarat and Uttar Pradesh, few districts showed rising HIV prevalence. However, none had an adult prevalence of higher than 0.50%. In Mizoram, 6 of 8 districts showed a rising HIV trend with an adult prevalence of 1% or more in 5 districts.Disaggregation of state-level estimates by districts provided insights on epidemic diversity within the analyzed states. It also provided baseline evidence to measure the progress toward the goal of end of AIDS by 2030. © 2021 Authors. All rights reserved.
Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks
(Public Library of Science, 2022) Pradeep Kumar; Chinmoyee Das; Arvind Kumar; Damodar Sahu; Sanjay K. Rai; Sheela Godbole; Elangovan Arumugam; P.V.M. Lakshmi; Shanta Dutta; H. Sanayaima Devi; Vishnu Vardhana Rao Mendu; Shashi Kant; Arvind Pandey; Dandu Chandra Sekhar Reddy; Sanjay Mehendale; Shobini Rajan
Background The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS’s recommended metrices. Method The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated. Results National level IPR was 0.029 [0.022–0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754–1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs. Conclusions Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030. © 2022 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010–2011
(SAGE Publications Ltd, 2016) Yujwal Raj; Damodar Sahu; Arvind Pandey; S. Venkatesh; D.C.S. Reddy; Taoufik Bakkali; Chinmoyee Das; Kh Jitenkumar Singh; Shashi Kant; M. Bhattacharya; John Stover; Ugra Mohan Jha; Pradeep Kumar; Ram Manohar Mishra; Nalini Chandra; B.K. Gulati; Sharad Mathur; Deepika Joshi; L. Chavan
This paper provides HIV estimation methodology used in India and key HIV estimates for 2010–2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age–gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35–0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24–0.34%) and 0.27% (0.22–0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions. © 2016, © The Author(s) 2016.
Programmatic mapping and population size estimation of key population in India: Method and findings
(Public Library of Science, 2025) Pradeep Vignesh Kumar; Chinmoyee Das; Bhawani Singh Khushwaha; Saiprasad Prabhakar Bhavsar; Shantanu Kumar Purohit; Arvind Kumar; Subrata Biswas; Nidhi Priyam; Lalit Singh Kharayat; Shajan Mathew; Akhilesh Srivastava; Jyotsana Pal; Shreena Ramanathan; Abhina Aher; Deepika Srivastava Joshi; Rajatashuvra Adhikary; Shajy K. Isac; Hanjabam Sanayaima Devi; Pinnaka Venkata Maha Lakshmi; Elangovan Arumugam; Sanjay Kumar Rai; Sheela V. Godbole; S. K. Singh; Himanshu Kumar Chaturvedi; Dr Shanta Dutta; Shashi Kant; Dandu Chandra Sekhar Reddy; Sanjay Madhav Mehendale; Shobini Rajan
India has the world’s second-largest HIV burden. Key populations of female sex workers (FSW), men who have sex with men (MSM), hijra/transgender (H/TG) people, and people who inject drugs (PWID), are disproportionately affected by the HIV epidemic. A community-led programmatic mapping and population size estimation (PMPSE) was carried out in 651 districts of 32 States and Union Territories of India. The goal was to identify the hotspots, network operators, and estimate the size of key population groups. This involved documenting the known hotspots, visiting them for rapid field assessment through key informants’/ network operators interviews, and identifying additional hotspots/ network operators through the snow-balling approach from the existing hotspots. For each identified hotspot, network operator, and village, size of each key population group was estimated after adjusting for the duplications and overlaps. These estimates were then aggregated to arrive at district, State, and ultimately national-level estimates. PMPSE estimated a total of 9,95,499 (9,02,277–10,88,712) FSWs, 3,51,020 (3,13,860–3,88,175) MSM, 2,88,717 (2,53,024-3,24,407) PWIDs, and 96,193 (85,206-1,07,174) H/TG individuals. The number of FSWs per 1000 adult women in different States/Union Territories (UT) varied from 0.34 to 17.25; MSM estimates ranged from 0.07 to 7.35 per 1000 adult men, H/TG persons ranged from 0.03 to 2.75 per 1000 adult men, and PWIDs ranged from 0.01 to 31.30 per 1000 adult men. Additionally, approximately 14% of FSWs, 7% of MSM, and 8% of H/TG individuals were estimated to operate exclusively through network operators. The community-led PMPSE has updated the size estimates for FSWs, MSM, PWIDs, and H/TG individuals at a granular level. This approach has emphatically quantified the presence of network operators. The methodological simplicity of the present round of PMPSE is likely to encourage and facilitate its periodic implementation for better tracking of population level changes in HIV burden based on more reliable denominators. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Progress and challenges towards eliminating vertical transmission of HIV in India
(Nature Research, 2025) Pradeep Vignesh Kumar; Chinmoyee Das; Vishal Singh Deo; Himanshu Kumar Chaturvedi; Subrata Biswas; Nidhi Priyam; Lalit Singh Kharayat; Sanjay Kumar Rai; Sheela V. Godbole; Elangovan Arumugam; Pinnaka Venkata Maha Lakshmi; Dr Shanta Dutta; Hanjabam Sanayaima Devi; Pankaj Bhardwaj; Arvind Kumar Singh; Rashmi G. Shinde; Damodar Sahu; Shashi Kant; Dandu Chandra Sekhar Reddy; Sanjay Madhav Mehendale; Shobini Rajan
India has intensified efforts towards elimination of vertical transmission of HIV (EVTH) as part of National AIDS and STD Control Programme-V (NACP-V). We present the progress in achieving NACP-V’s EVTH goal as of year 2023-24. We analysed the 2023 state level data using Spectrum model in 2023 to measure the coverage of anti-retroviral treatment among pregnant women, annual paediatric HIV case incidence rate and final vertical transmission rate. UNAIDS and WHO definitions for these indicators were used. In 2023, around 2350 new paediatric infections were estimated by vertical transmission. However, 44% of these transmissions resulted from incident HIV infections among pregnant and breastfeeding women. Overall, paediatric HIV incidence per 100,000 live births decreased from 25.2 (14.7–46.6) in 2019 to 10.4 (6.1–19.3) in 2023. During the same reference period, final vertical transmission rate (inclusive of breastfeeding period) decreased from 25.28% (17.06–37.99) in 2019 to 11.75% (7.93–17.66) in 2023. The 2023 India HIV estimates, using recent data and global modelling tools, highlighted progress in eliminating vertical transmission of HIV. Early identification of HIV-positive mothers and starting them on lifelong ART is crucial. Additionally, generating local evidence is needed on interventions like safe practices, repeat testing, and feeding practices to inform policy decisions. © The Author(s) 2025.
Projected impact of fast-tracking of antiretroviral treatment coverage on vertical transmission of HIV in India
(Public Library of Science, 2024) Pradeep Kumar; Chinmoyee Das; Subrata Biswas; Nidhi Priyam; Lalit Singh Kharayat; Damodar Sahu; Sanjay K. Rai; Sheela V. Godbole; Elangovan Arumugam; P.V.M. Lakshmi; Shanta Dutta; H. Sanayaima Devi; Arvind Pandey; Dandu Chandra Sekhar Reddy; Sanjay Mehendale; Shobini Rajan
One of the five high-level goals under Phase V of the National AIDS and STD Control Programme (NACP) of the Government of India is the elimination of vertical transmission of HIV. In this paper, we estimate the potential impact of maintaining and enhancing the antiretroviral treatment under the NACP in terms of averting new infections and vertical transmission rates vis-à-vis no intervention scenario. We used India’s HIV Estimates 2022 models to create treatment coverage scenarios of no interventions, status quo, business as usual, on-track and fast-track scenarios from 2023 to 2030. Our analysis indicates that fast-tracking scale-up of treatment services would avert almost 41000 child infections from 2023 to 2030 leading to a vertical transmission rate of around 7.70% in 2030 vis-a-vis no interventions scenario. Higher and sustained ART coverage would not only take the country closer to the elimination goals but would also prevent thousands of vertical transmissions, thus bringing a lot of benefits to HIV-positive pregnant women and their families. Supported by efforts for the prevention of new infections in the general population, India is on track for the attainment of elimination of vertical transmission of HIV by 2030. © 2024 Kumar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.