Browsing by Author "P.V.M. Lakshmi"

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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.
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.
Factors associated with unexplained sudden deaths among adults aged 18-45 years in India – A multicentric matched case–control study
(Wolters Kluwer Medknow Publications, 2023) Manickam Ponnaiah; Tarun Bhatnagar; Rizwan Suliankachi Abdulkader; Rajalakshmi Elumalai; Janani Surya; Kathiresan Jeyashree; Muthusamy Santhosh Kumar; Ranjithkumar Govindaraju; Jeromie Wesley Vivian Thangaraj; Hari Krishan Aggarwal; Suresh Balan; Tridip Dutta Baruah; Ayan Basu; Yogita Bavaskar; Ajeet Singh Bhadoria; Ashish Bhalla; Pankaj Bhardwaj; Rachana Bhat; Jaya Chakravarty; Gina Maryann Chandy; Bal Kishan Gupta; Rakesh Kakkar; Ali Hasan Faiz Karnam; Sushila Kataria; Janakkumar Khambholja; Dewesh Kumar; Nithin Kumar; Monaliza Lyngdoh; M. Selva Meena; Kedar Mehta; M.P. Sheethal; Subhasis Mukherjee; Anuj Mundra; Arun Murugan; Seetharaman Narayanan; Balamurugan Nathan; Jutika Ojah; Pushpa Patil; Sunita Pawar; A. Charles Pon Ruban; R. Vadivelu; Rishabh Kumar Rana; S. Nagendra Boopathy; S. Priya; Saroj Kumar Sahoo; Arti Shah; Mohammad Shameem; Karthikeyan Shanmugam; Sachin K. Shivnitwar; Abhishek Singhai; Saurabh Srivastava; Sudheera Sulgante; Arunansu Talukdar; Alka Verma; Rajaat Vohra; Rabbanie Tariq Wani; Bhargavi Bathula; Gayathri Kumari; Divya Saravana Kumar; Aishwariya Narasimhan; N.C. Krupa; Thirumaran Senguttuvan; Parvathi Surendran; Dharsikaa Tamilmani; Alka Turuk; Gunjan Kumar; Aparna Murkherjee; Rakesh Aggarwal; Manoj Vasant Murhekar; Anjan Jyoti Talukdhar; Raj Prathim Das; Pranab Jyoti Bhattacharyya; Pankaj Jyoti Barman; Partha Pratim Das; P.V.M. Lakshmi; Naveen Panday; Ashok Kumar Pannu; Debaprasad Dhibar; Pankaj Kumar Kanauje; Satyajit Singh; Sabah Siddiqui; Nitin Bhajandas Borkar; Mayur Adalja; Sandip Shah Varsha Godbole; Rikin Raj; Nehal Shah; Nilay Suthar; Hemang Purohit; Bhargav Patel; Rutika Pathkjee; Niraj Pandit; Siddharth Shah; Bhavesh Patel; Anuja Agrawal; Deepak Jain; Manish Bansal; Vikas Deswal; Pooja Sharma; Farhana Siraj; Aamir Rashid; Anjum Bashir Fazili; Pradip Kumar Bhattacharya; Hirendra Birua; Manoj Kumar Prasad; Shashi Bhushan Singh; Umendra Kumar Ojha; Ravi Ranjan Jha; L.M. Manuja; S.K. Raghavendra; Vijay Hugar; R. Radha; Pallavi Kesari; Sunil Tapse; Ambrish Avate; Prasanna Kumar; Bhaskaran Unnikrishnan; T. Rekha; A. Basavaprabhu; Mithun Rao; Prithvishree Ravindra; Chythra R. Rao; Jayaraj Mymbilly Balakrishnan; Vikram Palimar; S. Ashwini; Bhavana Hiremath; Rajnikanth Malapur; Ankur Joshi; Manoj Nagar; Atul S. Keche; Arjun Lal Kakrani; Shubhangi Kanitkar; Srikanth Tripathy; Savita Mahajan; Akshada Shinde; Sunil Patil; Vijay Gaikwad; Ganesh Lokhande; Astha Ganeriwal; Ramesh Wasnik; Ashwini Kalantri; Dhiraj Bhandari; Preetam Salunkhe; Abhishek Raut; Star Pala; K.G. Lynrah; Nari Lyngdoh; Rajani Thabah; Manish Kapoor; Sadananda Barik; Chitta Ranjan Mohanty; Sonu Hangma Subba; Satyabrata Guru; Manu Ayyan; Sitanshu Sekhar Kar; Nanda Kishore Maroju; Naveen Kumar; Roselin Mohandas; Charulatha Tamilselvan; Saranya Rajaram; Ankita Kankaria; Moonis Mirza; Preeti Singh Dhoat; Jaspreet Shergill; Manoj Kumar Gupta; Akhil Dhanesh Goel; Amit Kumar Rohila; Durga Shankar Meena; Archana Paliwal; Niti Gahlot; Nikita Sharma; Harkesh Kumar; Dinesh Choudhary; Shyam Lal Meena; Dinesh Bhambhu; Jigyasa Gupta; G. Priya; Sonia Samuel; S. Bagyalakshmi; Sathish Kumar T; Aazmi Mohamed; G. Rathna Kumar; A. Rajesh; V. Rajendran; M. Soorya; P.N. Sridevi; A. Karthika; K. Santha Sheela Kumari; K. Sathish Kumar; Pavithra Gnanavel; Dasarathan Ramesh; Aravind Gunasekaran; R. Kaverikannan; Madhumitha Manohar; P. Sofia; R. Abishek; Jeevithan Shanmugam; Mohan Kumar; Aparnavi Periyasamy; Dhilipan Kumar; G. Selvarani; Thirukumaran Ramasamy; N. Suresh; Kannan Muthuraman Alagappan; Mathavasami Vijayageetha; Sudha Ramalingam; Petchiappan Velammal; Yamini Subramani; Lakshmi Marappa; Viswanathan Pandurangan; T.R. Muralidharan; M. Rajkumar; Senthil Murugan Ramasamy; Bodhare Trupti; Bharath Rajh; Duvuru Amareswar Reddy; Rashmi Upadhyay; Anurag Srivastava; Rakesh Gupta; Ranjan Bhattnagar; Manaswi Chaubey; Soumik Ghosh; Nilesh Kumar; Mohammad Azharuddin; Nafees A. Khan; Mohammad Aslam; Asad Mahmood; R.K. Singh; Priyank Yadav; Aditya Kapoor; Om Prakash Sanjeev; Shyam Sundar; Prasan Kumar Panda; Mukesh Bairwa; Mahendera Singh Gehlot; Pooja Bhadoria; Arup Chakravorty; Sarmistha Chakravorty; Arindam Ray; Aparup Dhua; Amitava Pal; Priyanka Ghosh; Yogiraj Roy; Sinjita Dutta; Subhro Samujjal Basu
Background & objectives: In view of anecdotal reports of sudden unexplained deaths in India’s apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case–control study. Methods: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1st October 2021-31st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). Results: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. Interpretation & conclusions: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death. © 2023 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research.
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.
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.