Suchergebnisse

Background: Strengthening health research is essential to inform public health policies. However, few research training programs have systematically measured their impact on capacity building and most evaluations have been limited to reporting of individual trainee metrics. Hence, we conducted an evaluation of the impact of a five-year training program focused on building both trainee and institutional research capacity at a public medical college in India.Methods: Quantitative and qualitative methods were used to assess the individual and institutional research capacity building of a five-year HIV-TB research training program at Byramjee Jeejeebhoy Government Medical College in Pune, India, supported by the US National Institutes of Health, Fogarty International Center. In addition to documentation of the number of trainee research projects initiated, the number of research papers produced by the Fogarty Scholars (FSs) available on PubMed was calculated. The institutional impact of this program was assessed by documentation of research training activities conducted by the FSs, as well as by surveys and in-depth interviews conducted at the beginning and end of the program.Results: Twenty-one mid-level BJGMC faculty were provided training in HIV-TB research competencies. Between 1 April 2014 and 1 April 2019, 13 of these FSs designed and implemented new IRB-approved research studies and contributed to 49 PubMed listed research papers, including 11 first-authored manuscripts. FSs also conducted 36 journal club discussions, mentored 58 student research projects and conducted 5 institutional research method workshops. Pre- and-post-program surveys and in-depth interviews documented a perceived increase in institutional research capacity, particularly in TB research (epidemiology, clinical research, laboratory research). The impact of the Fogarty Training Program on institutional scientific output was perceived to be marginally improved.Conclusion: The Fogarty Training Program had a significant impact on building individual research capacity. To sustain this impact beyond the five years of Fogarty support, additional governmental and institutional resources, the establishment of dedicated space for faculty research and protected faculty time for research are needed. These findings can inform the design and implementation of future health research capacity building initiatives.

BACKGROUND: India has the highest number of HIV-infected adolescents in Asia, however, little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents. METHODS: Analysis included adolescents (10–19 years) starting ART, between 2005 and 2014, at BJ Government Medical College, Pune, India. LTFU was defined as missing >3 monthly visits. Competing-risks method was used to calculate sub-distribution hazard ratios (SHR) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. RESULTS: Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male, 80% were perinatally infected, median baseline CD4 was 174 cells/µl. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over six years. Age ≥15 years (adjusted SHR (aSHR) 2.44; 95% CI:1.18 – 5.02), was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over six years. WHO Stage III and IV (aHR: 2.26; 95% CI:1.14 – 4.48) and CD4 count/100 (aHR: 0.59; 95% CI: 0.43 – 0.83) were associated with mortality. CONCLUSIONS: A third of adolescents were LTFU or died by follow-up year 6. Older age, was a risk factor for LTFU and advanced clinical disease for death. Strategies to strengthen retention counselling for older adolescents and closer clinical monitoring of all adolescents, must be considered.

OBJECTIVE: To assess the prevalence and determinants of food insecurity among people living with HIV (PLWH) in Pune, India and its association with biomarkers known to confer increased risks of morbidity and mortality in this population. DESIGN: Cross-sectional analysis assessing food insecurity using the standardized Household Food Insecurity Access Scale (HFIAS). Participants were dichotomised into two groups: food insecure and food secure. Logistic regression models were used to assess associations between socioeconomic, demographic, clinical, biochemical factors and food insecurity. SETTING: Antiretroviral therapy (ART) centre of Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals (BJGMC – SGH), Pune, a large publicly-funded tertiary and teaching hospital in western India. SUBJECTS: Adult (≥18 years) PLWH attending the ART centre between September 2015 and May 2016 who had either received ART≤ 7 days (ART naïve) or ART ≥ 1 year (ART experienced). RESULTS: Food insecurity was reported by 40% of 483 participants. Independent risk factors included monthly family income