Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India

An analysis of clinical records from six states

Anup Gurung, Prakash Narayanan, Parimi Prabhakar, Anjana Das, Virupax Ranebennur, Saroj Tucker, Laxmi Narayana, Radha, K. Prakash, Touthang, Collins Z. Sono, Teodora Wi, Guy Morineau, Graham Neilsen

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Background: Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods. The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results: A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period. Conclusions: The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

Original languageEnglish
Article numberS10
JournalBMC Public Health
Volume11
Issue numberSUPPL. 6
DOIs
Publication statusPublished - 01-12-2011

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Sexually Transmitted Diseases
India
Sex Workers
Ambulatory Care
Transgender Persons
Drug Users
Proctoscopes
Therapeutics
HIV
Surgical Instruments
Population
Health Services
Acquired Immunodeficiency Syndrome
Health

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Gurung, Anup ; Narayanan, Prakash ; Prabhakar, Parimi ; Das, Anjana ; Ranebennur, Virupax ; Tucker, Saroj ; Narayana, Laxmi ; Radha ; Prakash, K. ; Touthang ; Sono, Collins Z. ; Wi, Teodora ; Morineau, Guy ; Neilsen, Graham. / Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India : An analysis of clinical records from six states. In: BMC Public Health. 2011 ; Vol. 11, No. SUPPL. 6.
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abstract = "Background: Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods. The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results: A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4{\%} in 2005 to 26{\%} in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39{\%} in 2005 to 11{\%} in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12{\%} to 3 {\%} (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12{\%} to 48{\%} (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period. Conclusions: The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.",
author = "Anup Gurung and Prakash Narayanan and Parimi Prabhakar and Anjana Das and Virupax Ranebennur and Saroj Tucker and Laxmi Narayana and Radha and K. Prakash and Touthang and Sono, {Collins Z.} and Teodora Wi and Guy Morineau and Graham Neilsen",
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Gurung, A, Narayanan, P, Prabhakar, P, Das, A, Ranebennur, V, Tucker, S, Narayana, L, Radha, Prakash, K, Touthang, Sono, CZ, Wi, T, Morineau, G & Neilsen, G 2011, 'Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India: An analysis of clinical records from six states', BMC Public Health, vol. 11, no. SUPPL. 6, S10. https://doi.org/10.1186/1471-2458-11-S6-S10

Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India : An analysis of clinical records from six states. / Gurung, Anup; Narayanan, Prakash; Prabhakar, Parimi; Das, Anjana; Ranebennur, Virupax; Tucker, Saroj; Narayana, Laxmi; Radha; Prakash, K.; Touthang; Sono, Collins Z.; Wi, Teodora; Morineau, Guy; Neilsen, Graham.

In: BMC Public Health, Vol. 11, No. SUPPL. 6, S10, 01.12.2011.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India

T2 - An analysis of clinical records from six states

AU - Gurung, Anup

AU - Narayanan, Prakash

AU - Prabhakar, Parimi

AU - Das, Anjana

AU - Ranebennur, Virupax

AU - Tucker, Saroj

AU - Narayana, Laxmi

AU - Radha,

AU - Prakash, K.

AU - Touthang,

AU - Sono, Collins Z.

AU - Wi, Teodora

AU - Morineau, Guy

AU - Neilsen, Graham

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Background: Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods. The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results: A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period. Conclusions: The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

AB - Background: Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. Methods. The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. Results: A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period. Conclusions: The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

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