Padmanesan Narasimhan

Comorbidities among HIV-infected injection drug users in Chennai, India.

Objectives: To document the natural history of herpes simplex virus type 2 (HSV-2) in relation to HIV and highly active antiretroviral therapy (HAART) in Africa, a longitudinal study was conducted of women in the placebo arms of two randomised controlled trials of HSV-suppressive therapy in Burkina Faso. Methods: 22 HIV-uninfected women (group 1), 30 HIV-1-infected women taking HAART (group 2), and 68 HIV-1-infected women not eligible for HAART (group 3) were followed over 24 weeks. HSV-2 DNA was detected on alternate weeks using real-time PCR from cervicovaginal lavages. Plasma HIV-1 RNA was measured every month. CD4 cell counts were measured at enrolment. Results: Ulcers occurred on 1.9%, 3.1% and 7.2% of visits in groups 1, 2 and 3 (p = 0.02). Cervicovaginal HSV-2 DNA was detected in 45.5%, 63.3% and 67.6% of women (p = 0.11), and on 4.3%, 9.7% and 15.5% of visits in the three groups (p<0.001). Among HIV-infected women, cervicovaginal HSV-2 DNA was detected more frequently during ulcer episodes (adjusted risk ratio (aRR) 2.79, 95% CI 2.01 to 3.86) and less frequently among women practising vaginal douching (aRR 0.60, 95% CI 0.40 to 0.91). Compared with women not taking HAART and with CD4 cell counts of 500 cells/μl or greater, women on HAART had a similar risk of HSV-2 shedding (aRR 0.95, 95% CI 0.52 to 1.73), whereas women with CD4 cell counts of 200–500 cells/μl were more likely to shed HSV-2 (aRR 1.71, 95% CI 1.02 to 2.86). Conclusions: HSV-2 reactivations occur more frequently among HIV-infected women, particularly those with low CD4 cell counts, and are only partly reduced by HAART. HSV therapy may benefit HIV-infected individuals during HAART.

Risk Factors for Tuberculosis

The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli.

HIV Online Provider Education (HOPE): The Internet as a Tool for Training in HIV Medicine

Human immunodeficiency virus (HIV) treatment programs in resource-limited areas are expanding rapidly. Providing training and education to health care providers in these programs is a major challenge. We have employed Internet-based conferencing technology to conduct interactive case-based training conferences with health care professionals in Africa, Asia, and the Caribbean. This online program may be a model for other efforts to provide education to health care providers treating HIV-infected patients in the developing world.

mHealth for the control of TB/HIV in developing countries

mHealth (healthcare using mobile communication technologies) is being strengthened as a new tool to tackle the global crisis in inadequate workforce and patient monitoring, especially in resource-limited settings. High numbers of people living with TB/HIV fail treatment and develop resistance because they cannot maintain a high degree of adherence to their medication regimens. This paper illustrates how a simple and inexpensive SMS-based mHealth application can be used to facilitate the TB/HIV treatment.

Delivery of Multilingual mHealth Service for Control of TB/HIV in Developing Countries

A large number of people living with Tuberculosis/HIV fail treatment and develop resistance to drugs as they fail to maintain proper drug adherence. With the growing crisis of inadequate healthcare workforce in developing countries, mHealth services (healthcare using mobile communication technologies) are gaining support as an effective tool to handle the situation, especially where technological and human resources are limited. This paper illustrates the delivery of one such service where a simple and inexpensive SMS-based mHealth application can e used to assist in TB/HIV treatment.

High rates of latent TB infection in contacts and the wider community in South India

Background We aimed to compare TB transmission rates between case and community households in Vellore, South India. Methods 359 household contacts (HHC) and 363 community contacts (CC) were assessed with tuberculin skin test (TST) and QuantiFERON TB Gold In-Tube test (QFT) between August 2010 and September 2011. Concordance test and multivariate risk factor assessment were conducted using logistic regression adjusted for clustering. Results Latent TB infection (LTBI) positivity was similar between the two groups using both tests, with only moderate concordance observed between QFT and TST. Children of HHC (<15 years) were at a higher risk for LTBI (odds of 2.37 [1.15-4.89] and 3.02 [1.22-7.45] for TST and QFT respectively). Among adults, both age in decades (odds of 1.33 [1.14-1.15] and 1.16 [1.02-1.32] for TST and QFT, respectively) and the interaction of male gender, smoking and alcohol consumption (odds of 4.06 [1.38-11.93] and 2.59 [1.19-5.64] for TST and QFT, respectively), were associated with increased risk of LTBI. Conclusions This study provides estimates of TB infection rates accounting for both community and household exposure that contribute to understanding of TB transmission in this setting. We suggest that assessment of risk factors for infection need increased examination as prophylactic treatment of LTBI are being considered.

Epidemic Varicella Zoster Virus among University Students, India

We investigated a yearlong varicella zoster virus outbreak in a highly susceptible young adult population at a large university in India. Outbreaks of varicella infection among adults are not well described in the literature. Infection control measures and vaccination policy for this age group and setting are needed.

Adherence to anti-vectorial prevention measures among travellers with chikungunya and malaria returning to Australia: comparative epidemiology

ObjectiveCompare the adoption and adherence to health protection behaviours prior to and during travel among international Australian travellers who return to Australia with notified chikungunya or malaria infection. This information could inform targeted health promotion and intervention strategies to limit the establishment of these diseases within Australia.ResultsSeeking travel advice prior to departure was moderate (46%, N = 21/46) yet compliance with a range of recommended anti-vectorial prevention measures was low among both chikungunya and malaria infected groups (16%, N = 7/45). Reasons for not seeking advice between groups was similar and included ‘previous overseas travel with no problems’ (45%, N = 9/20) and ‘no perceived risk of disease’ (20%, N = 4/20). Most chikungunya cases (65%, N = 13/20) travelled to Indonesia and a further 25% (N = 5/20) visited India, however most malaria cases (62%, N = 16/26) travelled to continental Africa with only 12% (N = 3/26) travelling to India. The majority (50%, N = 10/20) of chikungunya cases reported ‘holiday’ as their primary purpose of travel, compared to malaria cases who most frequently reported travel to visit friends and family (VFR; 42%, N = 11/26). These results provide import data that may be used to support distinct public health promotion and intervention strategies of two important vector-borne infectious diseases of concern for Australia.