Hindawi Publishing Corporation AIDS Research and Treatment Volume 2011, Article ID 650321, 7 pages doi:10.1155/2011/650321 Research Article Prevalence and Risk Factors of HIV Infection among Clients Attending ICTCs in Six Districts of Tamilnadu, South India Rajeswari Ramachandran,1 V. Chandrasekaran,1 M. Muniyandi,1 K. Jaggarajamma,1 Anasua Bagchi,2 and Supriya Sahu2 1 Tuberculosis Research Centre, Indian Council of Medical Research, Chennai 600 031, India 2 Tamilnadu State AIDS Control Society, Health and Family Welfare Department, Chennai 600 008, India Correspondence should be addressed to Rajeswari Ramachandran, [email protected] Received 22 January 2011; Accepted 15 May 2011 Academic Editor: Guido Poli Copyright © 2011 Rajeswari Ramachandran et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To assess the HIV serostatus of clients attending integrated counseling and testing centres (ICTCs) in Tamilnadu, south India (excluding antenatal women and children), and to study its association with demographic, socioeconomic, and behavioral risk factors. Design. In a prospective observational study, we interviewed clients attending 170 ICTCs from six districts of Tamilnadu during 2007 utilizing a standard pretest assessment questionnaire. All the clients were tested for HIV with rapid test kits. Multiple logistic regression analysis was used to identify determinants of HIV infection. Results. Of 18329 clients counseled, 17958 (98%) were tested for HIV and 732 (4.1%; range 2.6 to 6.2%) were tested positive for HIV. Median age of clients was 30 years; 89% had never used condoms in their lives and 2% gave history of having received blood transfusion. In multivariate analysis HIV seropositivity was associated with HIV in the family (adjusted odds ratio) (AOR 11.6), history of having sex with sex workers (AOR 2.9), age ≥31 years (AOR 2.8); being married (AOR 2.5), previously tested for HIV (AOR 1.9), illiteracy (AOR 1.7), unemployment (AOR 1.5), and alcoholism (AOR 1.5). Conclusion. HIV seroprevalence being high in ICTC clients (varied from 2.6 to 6.2%), this group should also be included in routine programme monitoring of sero-positivity and risk factors for better understanding of the impact of the National AIDS Control Programme. This would help in evolving appropriate policies and strategies to reduce the spread of HIV infection. 1. Background care. The concept of integrating the preventive and care services was initiated through the initiation of Integrated India today stands at the crossroads in its battle against Counselling and Testing Centres (ICTCs) in Tamilnadu Human Immunodeficiency Virus/Acquired Immune Defi- from 2005. The ICTCs provide pretest counseling, test- ciency Syndrome (HIV/AIDS). Responding to the immense ing, retesting, posttest counseling, and support services. challenge of the HIV/AIDS threat, National AIDS Control Clients (including general population, high risk groups, and Programme (NACP) has articulated a clear and effective referrals) utilize the services of these centres on voluntary response to increase access to services and communicate basis. effectively for behaviour change. The overall goal of NACP Tamilnadu has been one of the 6 states in India with high is to halt and reverse the epidemic in India over the prevalence of HIV among the antenatal care (ANC) cases next five years by integrating programmes for prevention, (>I%, Figure 1). The major drivers of the epidemic in the care and support, and treatment. In Tamilnadu, Voluntary state are highways connecting neighboring high prevalent Counselling and Testing Facilities (VCTFs) were established states, multiple truckers halt points with hub of commercial in healthcare facilities to promote access to HIV counselling sexual activities, industrial belts encouraging in migration and testing from the year 2004. Voluntary counselling and from multiple states, and traditional sex trade in some testing services provide an entry point for prevention and districts. Tamilnadu AIDS Control Society (TANSACS), first 2 AIDS Research and Treatment Vellore 0.75 0.13 0.13 0 Dharmapuri Erode 1.13 0.38 0.38 Coimbatore 0.25 0.75 2.25 0.38 0 1.75 0.75 1.2 1.13 0.25 1 0.58 0.88 1 1.13 0.38 0 0.87 0.38 0.75 0.8 0.75 Sivaganga 0.5 0.65 1.13 0.25 0.6 Madurai (%) 0.5 0.13 0.13 0.4 0.375 0.25 0.25 0.25 0.2 0.08 0 2000 2001 2002 2003 2004 2005 2006 2007 0 to 0.5 1 to 1.5 Source: TANSACS sentinel surveillance 2007 0.5 to 1 1.5 to 2.25 (a) (b) Figure 1: HIV prevalence among Ante Natal cases in Tamilnadu. state AIDS cell established in India that was set up in test was done to confirm HIV serostatus. Three rapid HIV 1989, has come a long way in its effort to control the HIV test kits (COMB. AID HIV 1/2, HIV TRI DOT, and HIV epidemic in the state. Strong political will and bureaucratic COMB) were used for the purpose of diagnosis of HIV, every commitment to halt and reverse the epidemic with continued positive result was reconfirmed by using two more rapid test evidence-based strategic planning has established Tamilnadu kits before giving final result to the person. as a trend-setter in combating HIV AIDS in India and in All ICTCs participate in an external quality assessment achieving the goals of National AIDS Control Program Phase scheme (EQAS). Each ICTC is assigned a “State Reference III. It is estimated that there are 0.14 million people living Laboratory” (SRL). EQAS involves sending of “coded” with HIV in the state. With continued focused Prevention samples from the reference laboratories to the ICTCs twice and Care Program in the state, Tamilnadu has achieved a a year for testing. In addition, ICTCs send 20% of all positive decline in the HIV prevalence in the state to 0.25% of ANC, samples and 5% of all negative samples collected in the first which also contributes to the apparent reduction in HIV week of every quarter for cross-checking to the SRL once prevalence in south India as a whole [1]. The decline in HIV every quarter. prevalence in Tamilnadu (John, 2006) [2] is supported by the program data as well HSS conducted over the years. 2.2. Study Area. This study was carried out in six selected Information on HIV prevalence among patients attend- districts of Tamilnadu state, namely, Coimbatore, Erode, ing STD clinics, commercial sex workers, MSM, and also Vellore, Dharmapuri, Madurai, and Sivaganga (based on the among general population is available in India [3–5]. clients attended). These districts covered a total population However, there are very few reports about the seroprevalence of 17.1 million (ranging from 1.2 to 4.3), and total number of HIV among clients attending the ICTCs [6]. The objective of ICTCs functioning were 170 (ranging from 14 to 45 per of this present study is to assess the rate of HIV seropositivity district; Figure 2). and risk factors of HIV infection among these clients attending ICTCs, excluding antenatal women and children, in six districts of Tamilnadu, south India. 2.3. Study Population. All clients attending ICTCs for HIV screening on a voluntary basis or referred basis for a period of one month during May to December 2007 formed the study 2. Methodology population (each district approximately 4–6 weeks), exclud- 2.1. Setting. As of December 2007, a total of 760 ICTCs ing pregnant women and children. Study procedures were were operational in Tamilnadu state with trained counselors, approved by Institutional Ethics Committee of Tuberculosis laboratory technicians, and outreach workers. All the ICTC Research Centre (TRC). counsellors were trained for counselling the clients for HIV screening and filling-up standard pretest assessment forms. 2.4. Tools Used for Data Collection. Semistructured and After proper counseling and getting written consent blood precoded standardized National AIDS Control Organization AIDS Research and Treatment 3 Erode district Coimbatore district Anthiyur N Karamadai Avinashi Annur N Tiruppur Talavadi Ammapet Periyanayakkanpalayam T.N.Palaiyam Sulur Palladam Thondamuthur Pongalur Madukkarai Sultanpet Bhavani Satyamangalam Kinathukadavu Bhavanisagar Gopi Pollachi (North) Gudimangalam Erode Nambiyur Perundurai Pollachi (South) Madathukulam Chennimalai Modakurichi Udumalaipettai Annamalai Kodumudi (a) (b) Vellore district Arakkonam Dharm apuri district N Sholinghur Gudiyattam Kaveripakkam Karimangalam Katpadi Palakkodu Nemili Peranambattu Vellore N Arcot Anaicut Timiri Madhanur Kaniyambadi Morappur Pennagaram Dharmapuri Harur Natrampalli Alangayan Nallampalli Jolarpet Ti r u p p a t t u r Pappireddipatti Kandili (c) (d) Sivaganga district S Pudur N Singampunari Madurai district N Sakkottai Kottampatti Kallal Vadipatti Alanganallur Kannangudi Usilampatti Melur Madurai West Sivaganga Devakottai Chellampatti Madurai East Thiruppuvanam Kalayarkoil ThirumangalamTirupparangunram Sedapatti Manamadurai T.Kallupatti Kallikudi Ilaiyankudi (e) (f) Figure 2: Distribution of ICTCs in the Districts—Coimbatore, Erode, Vellore, Dharmapuri, Madurai, and Sivaganga. (NACO) approved “Pretest Assessment Form” implemented The interviewer told about the confidentiality of data and the by Tamilnadu AIDS Control Society (TANSACS) was used data management at TRC. for the study. The interview schedule included demographic, socio- economic characteristics (education, occupation), history of risk behaviour, history of HIV in the family, and life style 2.5. Information Collected. All clients were informed in their indicators like smoking and alcoholism. We also collected the local language about the purpose of the study and written information on HIV status of the clients screened from the consent was obtained before proceeding to the interviews. ICTCs records. 4 AIDS Research and Treatment Table 1: Study participants from different ICTCs in six districts of Tamilnadu and HIV seropositivity (excluding antenatal women and children). Name of the districts Populationin million No.