Rajiv Gandhi University of Health Sciences, Bangalore, Karanataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

BRIEF RESUME OF THE INTENDED WORK: 6.1 Need for the study: Sexually transmitted diseases (STDs) are relatively common during pregnancy. Education, screening, treatment and prevention are important components of prenatal care.1 Since the perinatal transmission of Human Immuno deficiency Virus (HIV) is very high viz., approximately 30%, one important means of early detection of disease is by estimation of seroprevalence of HIV infection among asymptomatic antenatal women.2 The rate of infection in pregnant women is an indicator of percolation of the HIV in general public. World health organization estimated 13.2 million HIV orphans in the year 2000.3 HIV seropositivity among antenatal mothers in India varies between 0 to 4%.4 Spread of infection from hepatitis–B (HBV) carrier mothers to their babies is the major mode of transmission of HBV. If pregnant women who are hepatitis-B surface antigen (HBsAG) positive are identified before delivery, it is possible to prevent HBV infection in their neonates by passive or active immunization or both.5 Syphilis is a serious cause of maternal and infant morbidity and mortality. Syphilis during pregnancy is associated with still birth, spontaneous abortion, preterm birth and intrauterine growth restriction.6 Survey of 15, 752 women attending antenatal clinics (ANC) in Aurangabad by VDRL test, showed prevalence of 2.4%. Another survey in Kerala showed prevalence of 1.4%.7 Hence this study is undertaken to estimate the seroprevalence of HIV, HBV, and syphilis in antenatal cases. 6.2 Review of Literature Study was conducted on 3000 pregnant women (600 consecutive women attending antenatal clinic at each of the five tertiary level hospitals in the different parts of country-Mumbai, Chandigarh, Calcutta, Pune, Pondicherry) from 1996 to 1997. Prevalence of HBV was 3.4%, HIV was 1.2%, syphilis was 1%.8

Government Medical College Surat conducted a study in 1998 on 800 antenatal cases. HBs Ag seropositivity was 2.66%.5

VDRL seropositivity among pregnant women attending ANC in tertiary level hospital in Delhi in 1998 was 2.5%, with 10% of the cases being HIV-positive.9

Vitoria Municipality, Brazil conducted a study from Jan to Dec 1999 on 1608 pregnant women seroprevalence of HBV was 1.1%, HIV was 0.8% syphilis was 3%.10

A study was conducted from June 2003 to Dec 2004 on 8309 women attending ANC of Government Medical College, Surat. Seroprevalence of HIV was 1.09%.11

In a study conducted at Motilal Nehru Medical College, Allahabad from Dec 2003 to Nov 2004 on 1000 antenatal women showed HIV seropositivity of 0.4%.2

6.3. Objectives of study: i) To estimate seroprevalence of HIV infection in antenatal cases. ii) To estimate seroprevalence of HBV infection in antenatal cases. iii) To estimate seroprevalence of syphilis infection in antenatal cases.

7. MATERIAL AND METHODS: 7.1 Source of data: Study of 100 antenatal cases attending outpatient and inpatient department of obstetrics of Chigateri General Hospital and Bapuji Hospital attached to JJM Medical College, Davangere and also blood samples of antenatal cases coming to Microbiology Department JJM Medical College, Davangere.

7.2 Method of collection of data (including sample procedure if any) Inclusion criteria : Antenatal cases attending outpatient and inpatient department of Chigateri General Hospital and Bapuji Hospital attached to JJM Medical College, Davangere, whose sera was sent for routine investigations and also blood samples of antenatal cases coming to Microbiology Department JJM Medical College, Davangere.

Exclusion criteria : Women who are not pregnant.

Specimen collection : 5 ml of blood collected by venepuncture with strict aseptic precautions, sera separated and stored at – 200C.

Procedure : All the test sera are tested for anti – HIV IgG antibodies by Enzyme Immuno Assay (EIA), HBs Ag by EIA, and VDRL slide flocculation test. The tests are performed according to manufacturers instructions.

Statistical analysis : Study results (prevalence) will be estimated to general population by proportions and 95% confidence interval.

7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so describe briefly. Yes Blood is collected by Venepuncture.

7.4 Has ethical clearance been obtained from your institution in case of 7.3? Yes 8. LIST OF REFERENCES:

1. Cunningham FG, Keneth JL, Steven LB, Hauth JC, Gilstrap L, Wenstrom KD. Sexually transmitted diseases. Williams obstetrics. 22nd ed. United state of America : MC Graw Hill ; 2005:p.1302. 2. Mehrotra R, Pourush S, Bhargava A, Varma M, Ghosh UK. Seroprevalence of HIV in antenatal women. J Obstet Gynecol India 2005;55(4):333-35. 3. Shyamala G, Kushtagi P, Madhushree VB. Seropositivity for HIV in pregnancy in a tertiary care hospital in South-West India. The Indian practitioner 2004; 57(!0):649-52. 4. Aggarawal A, Jindal N. HIV infection in pregnant women in Amritsar - A five years study. Indian J Pathol Microbiol 2002;45(4):437-38. 5. Anvikar AR, Gaikwad AA, Deshmukh AB, Damle AS, Ather J. HBV carriage rate in women attending antenatal clinic. Ind J Med Microbiol 2000;18(4):193. 6. Potter D, Goldenberg RL, Read JS, Wang J, Hoffman IF, Saathoff E et al. Correlates of syphilis seroreactivity among pregnant women : The HIV NET 024 Trial in Malawi, Tanzania and Zambia. Sexually transmitted diseases. 2006;33(10):604-9. 7. Park K. Sexually transmitted diseases. Park’s textbook of preventive and social medicine. 19th ed Japalpur, India : M/S Banarsidas Bhanot; 2007:p.279. 8. Datey S, Bedi N, Gaur LN, Saxena NC, Saxena BN. Sexually transmitted infections among antenatal women at five tertiary hospitals in India. J Obstet Gynecol India 2003;53(1):53-8. 9. Sharma VK, Khandpur S. Epidemiology of sexually transmitted diseases. Sharma VK, sexually transmitted diseases and AIDS. 1st ed. India : Vinod Vasishtha ; 2003:p.20. 10. Miranda AE, Alves MC, Neto RL, Areal KR, Gerbase AC. Seroprevalence of HIV, HBV and syphilis in women at their first visit to public antenatal clinics in vitoria, Brazil. Sexually transmitted diseases 2001;28(12):710- 13. 11. Nandita M, Kavishvar AB, Archana D, Desai VA. Antenatal HIV testing. J Obstet Gynecol India 2006;56(1):56-8.