Browsing by Author "Nalini Chandra"

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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.
Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India
(Wolters Kluwer Medknow Publications, 2020) Damodar Sahu; Pradeep Kumar; Nalini Chandra; Shobini Rajan; D. Shukla; S. Venkatesh; Saritha Nair; Anil Kumar; Jitenkumar Singh; Srikanth Reddy; Sheela Godbole; A. Elangovan; M. Saha; Sanjay Rai; P.V.M. Lakshmi; T. Gambhir; Savina Ammassari; Deepika Joshi; Amitabh Das; Poonam Bakshi; Sabyasachi Chakraborty; Amol Palkar; S. Singh; D.C.S. Reddy; Shashi Kant; Arvind Pandey; M. Vardhana Rao
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. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
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.
Sustained progress, but no room for complacency: Results of 2015 HIV estimations in India
(Indian Council of Medical Research, 2017) Arvind Pandey; Neeraj Dhingra; Pradeep Kumar; Damodar Sahu; D.C.S. Reddy; Padum Narayan; Yujwal Raj; Bhavna Sangal; Nalini Chandra; Saritha Nair; Jitenkumar Singh; Laxmikant Chavan; Deepika Joshi Srivastava; Ugra Mohan Jha; Vinita Verma; Shashi Kant; Madhulekha Bhattacharya; Pushpanjali Swain; Partha Haldar; Lucky Singh; Taoufik Bakkali; John Stover; Savina Ammassari
Background & objectives: Evidence-based planning has been the cornerstone of India’s response to HIV/AIDS. Here we describe the process, method and tools used for generating the 2015 HIV estimates and provide a summary of the main results. Methods: Spectrum software supported by the UNAIDS was used to produce HIV estimates for India as a whole and its States/Union Territories. This tool takes into consideration the size and HIV prevalence of defined population groups and programme data to estimate HIV prevalence, incidence and mortality over time as well as treatment needs. Results: India’s national adult prevalence of HIV was 0.26 per cent in 2015. Of the 2.1 million people living with HIV/AIDS, the largest numbers were in Andhra Pradesh, Maharashtra and Karnataka. New HIV infections were an estimated 86,000 in 2015, reflecting a decline by around 32 per cent from 2007. The declining trend in incidence was mirrored in most States, though an increasing trend was detected in Assam, Chandigarh, Chhattisgarh, Gujarat, Sikkim, Tripura and Uttar Pradesh. AIDS-related deaths were estimated to be 67,600 in 2015, reflecting a 54 per cent decline from 2007. There were variations in the rate and trend of decline across India for this indicator also. Interpretation & conclusions: While key indicators measured through Spectrum modelling confirm success of the National AIDS Control Programme, there is no room for complacency as rising incidence trends in some geographical areas and population pockets remain the cause of concern. Progress achieved so far in responding to HIV/AIDS needs to be sustained to end the HIV epidemic. © 2017, Indian Council of Medical Research. All rights reserved.