IntroductionHIV self-testing can increase coverage of essential HIV services. This study aimed to establish the acceptability, concordance and feasibility of supervised HIV self-testing among pregnant women in rural India.MethodsA cross-sectional, mixed methods study was conducted among 202 consenting pregnant women in a rural Indian hospital between August 2014 and January 2015. Participants were provided with instructions on how to self-test using OraQuick® HIV antibody test, and subsequently asked to self-test under supervision of a community health worker. Test results were confirmed at a government-run integrated counselling and testing centre. A questionnaire was used to obtain information on patient demographics and the ease, acceptability and difficulties of self-testing. In-depth interviews were conducted with a sub-sample of 35 participants to understand their experiences.ResultsIn total, 202 participants performed the non-invasive, oral fluid-based, rapid test under supervision for HIV screening. Acceptance rate was 100%. Motivators for self-testing included: ease of testing (43.4%), quick results (27.3%) and non-invasive procedure (23.2%). Sensitivity and specificity were 100% for 201 tests, and one test was invalid. Concordance of test result interpretation between community health workers and participants was 98.5% with a Cohen's Kappa (k) value of k=0.566 with p<0.001 for inter-rater agreement. Although 92.6% participants reported that the instructions for the test were easy to understand, 18.7% required the assistance of a supervisor to self-test. Major themes that emerged from the qualitative interviews indicated the importance of the following factors in influencing acceptability of self-testing: clarity and accessibility of test instructions; time-efficiency and convenience of testing; non-invasiveness of the test; and fear of incorrect results. Overall, 96.5% of the participants recommended that the OraQuick® test kits should become publicly available.ConclusionsSelf-testing for HIV status using an oral fluid-based rapid test under the supervision of a community health worker was acceptable and feasible among pregnant women in rural India. Participants were supportive of making self-testing publicly available. Policy guidelines and implementation research are required to advance HIV self-testing for larger populations at scale.

The objectives of the present study were to look into the frequency of oligohydramnios and pregnancy outcome in these cases. Analysis of outcome of prospective cases of pregnancy beyond 28 weeks with oligohydramnios over 2 years and cases admitted over the previous 5 years was done. The incidence of oligohydramnios over 7 years was 4.45%, 4.9% in retrospective and 4% in prospective cases: 38% retrospective and 31.5% of prospective cases were complicated by intrapartum meconium. Abruptio placenta had occurred in 9.8% retrospective and 8.3% prospective cases. Labour was induced in 18.2% of retrospective cases and 13.9% prospective cases. The caesarean section rate (CSR) with spontaneous labour was 42.4% in the retrospective and 50.4% in the prospective cases and with induced labour 38.5% in the retrospective, 29.3% in the prospective cases. Perinatal mortality rate (PMR) in cases of oligohydramnios was 87.7 and 4.15% babies had congenital anomalies. Overall labour induction was needed more often, and abruptio placenta, CSR, PMR and congenital anomalies were high in oligohydramnios. More studies about the causes and effects of oligohydramnios and preventive modalities are needed.

BackgroundIn India, 3.6 million pregnancies are affected by preterm birth annually, with many infants dying or surviving with disability. Currently, there is no simple test available for screening all women at risk of spontaneous PTB in low income setting, although high resource settings routinely use cervical length measurement and cervico-vaginal fluid fetal fibronectin for identification and care of women at risk due to clinical history. In rural India, where the public health system has limited infrastructure, trained staff and equipment, there is a greater need to develop a low-cost screening approach for providing early referral, treatment and remedial support for pregnant women at risk of preterm birth. There is interest in the use of a salivary progesterone test as a screening tool preliminary evidence from India, Egypt and UK has shown promise for this type of test. The test requires further validation in a low resource community setting.MethodsThe Promises study aims to validate and test the feasibility of introducing a low-cost salivary progesterone preterm birth prediction test in two rural districts in India with high rates of prematurity. It is a prospective study of 2000 pregnant women recruited from Panna and Satna in Madhya Pradesh over approximately 24 months. Demographic and pregnancy outcome data will be collected, and pregnancies will be dated by ultrasound sonography. Saliva progesterone will be measured by ELISA in samples obtained between 24–28 weeks of gestation. The association between salivary progesterone and preterm birth will be determined and the utility of salivary progesterone to predict preterm birth < 34, as well as < 30 and < 37 weeks assessed. Additional qualitative data will be obtained in terms of acceptability and feasibility of saliva progesterone testing and knowledge of PTB.DiscussionA validated cost-effective saliva test, which has potential for further adaptation to a ‘point of care’ setting will allow early identification of pregnant women at risk of preterm birth, who can be linked to an effective pathway of care and support to reduce preterm birth and associated adverse consequences. This will reduce both economic and emotional burden on the affected women and their families.

Antepartum amnioinfusion is a useful procedure to reduce complications resulting from decreased intra-amniotic volume. It is especially useful in preterm pregnancies, where the procedure allows for a better perinatal outcome by prolonging the duration of pregnancy.

The response of sexual behavior to HIV is an important input to predicting the path of the epidemic and to focusing prevention efforts. Existing estimates suggest limited behavioral response, but fail to take into account possible differences across individuals. Transmission through sexual contact is estimated to accounts for 75 to 85% of cumulative cases of HIV/AIDS to date. Mode of transmission is important predictors of risk. The statistical risk of infection through vaginal intercourse is notably low regardless of which partner is infected. Anal intercourse has higher infectivity due to the likelihood of damage to epithelial integrity. Generally, the environment for men who have sex with men (MSM), lesbians and transgender individuals is unsupportive and unsafe. They are usually victims of discrimination or more subtly as indifference. The stress on these individuals face as they cope with sexual orientation stigma may help to explain higher rates of risky sexual behaviors and injected drug use. Very little research has focused on Asian youth with altered sexual orientation. These individuals are at a higher risk of contracting the HIV virus than their heterosexual counterparts. Until we acknowledge these behaviors and work with people involved with these behaviors, we are not going to halt and reverse the HIV epidemic. Scaling up services adequately for key populations at higher risk for HIV infection globally, particularly in concentrated epidemics, is essential to halt and reverse epidemics at the population level. It is essential that the expansion of MSM HIV prevention and care services across Asia be driven by an agreed upon set of quality standards and guidelines.