HIV/AIDS outbreak investigation in Jalalpur Jattan (JPJ), Gujrat, Pakistan

Ansari, J. A.; Salman, Muhammad; Safdar, Rana Muhammad; Ikram, Nadeem; Mahmood, Tabassum; Zaheer, Hassan; Walke, Henry; Asghar, Rana Jawad

doi:10.1016/j.jegh.2013.06.001

Cited by 20 publications

(22 citation statements)

References 10 publications

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“…By 4 December 2019, 952 children with HIV had been identified (personal communication: Sindh AIDS Control Program (SACP)). Although there have been several HIV outbreaks over the past two decades, none has ever been so large nor significantly affected children 4–8…”

Section: Introductionmentioning

confidence: 99%

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case–control study

et al. 2020

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IntroductionIn April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology.Methods and analysisA matched case–control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants’ addresses will be collected to investigate concordance between the genetic and spatial epidemiology.Ethics and disseminationEthical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.

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Section: Introductionmentioning

confidence: 99%

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case–control study

et al. 2020

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“…There is no doubt that there is significant potential for an HIV epidemic expansion beyond the key populations across many parts of Pakistan, considering the high HIV prevalence among PWID, low condom usage, risky injecting practises and large population densities of transgender, male and female sex workers in certain cities in Pakistan. 4,46 The outbreak in a small village in Kot Momin, Sargodha district in Punjab province found a prevalence of 1•3% (35 of 2717 tested) in June 2018. 47 By March 2019 the prevalence had risen to 13•4% (669 of 5000 tested) with reported prevalence higher in women and children although no figures are specified.…”

Section: Discussionmentioning

confidence: 99%

HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak

Mir

Mahmood

Siddiqui

et al. 2020

The Lancet Infectious Diseases

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Background: In April 2019, an HIV screening camp for all ages was established in response to a report of an unusually large number of paediatric HIV diagnoses in Larkana, Pakistan. A cross-sectional study to understand the clinical profile of children who registered for HIV care was performed. Methods: Age-and sex-stratified HIV prevalence among individuals screened was estimated. Data on children who registered for HIV care including clinical history, HIV disease stage, Hepatitis B and C status and CD4 count was abstracted from clinical records and analysed using percentages and chi square tests. Findings: Between April-July 2019, 31,239 individuals underwent HIV testing of whom 930 tested HIV-positive. Of these, 763 (82•0%) were aged <16 years. Estimated HIV prevalence was 3.0% overall; 7.4% (283/3803) in children aged 0-2 years, 5.9% (321/5412) in children aged 3-5 years, and 1•3% (148/11251) in adults aged 16-49 years. Of the 591 children who registered for HIV care, 80.9% (478/591) were ≤5 years, 64•1% (379/591) were male and 53•4% (315/590) had a weight-forage Z-score <-3. Hepatitis B surface antigen and Hepatitis C antibody positivity was 8•4% (48/574) and 2•6% (15/574) respectively. Of children whose mothers tested for HIV, only 39/371 (10•5%) had HIV-positive mothers. Most children (89•2%, 404/453) reported multiple previous injections and 40/453 (8•8%) reported blood transfusions. Interpretation: This is an unprecedented HIV outbreak among children in Pakistan: a 54% increase in paediatric HIV diagnoses over the past 13 years. Epidemiological and molecular studies to understand the full extent of the outbreak and its drivers are needed to guide HIV control strategies.

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“…In contrast, similar outcomes have been reported in other massive (>100 cases) injection-related outbreaks among other populations at higher risk of HIV, such as: paid blood donors, as reported in Mexico (1986) [18], India (1988) [19], and China (1990–95) [20]; hospitalized children, as described in Romania (1987–92) [21, 22], Russia (1988–1989) [23], and Libya (1997–1999) [24, 25]; and persons who inject drugs, as established in Kazakhstan, Kyrgyzstan, Uzbekistan (2007–2008) [26], Pakistan (2008–09) [27], and Indiana, US (2014–2015) [28, 29]. We hypothesize that the Roka outbreak might not be an isolated incident.…”

Section: Discussionmentioning

confidence: 99%

Massive Iatrogenic Outbreak of Human Immunodeficiency Virus Type 1 in Rural Cambodia, 2014–2015

Raffi

Nouhin

Zheng

et al. 2017

Clinical Infectious Diseases

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Background In 2014–2015, 242 individuals aged 2–89 were newly HIV-1 diagnosed in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C and B viruses (HCV, HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV, and HBcIgM Ab for HBV. We performed evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed health care practitioner were obtained from 193 cases and 1499 controls during interviews. Results Cases were co-infected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (<130 days) HIV infections. Phylogeny of 202 HIV env C2V3 sequences showed a 198-sample CRF01_AE strains cluster, with time to most recent common ancestor (tMRCA) in September 2013 (95% highest posterior density, August 2012–July 2014), and a peak of 15 infections/day in September 2014. Three geospatial HIV hotspots were discernible in Roka and correlated with high exposure to the practitioner (P=0.04). Fifty-nine (38.6%) of 153 tested cases showed recent (<180 days) HCV infections. Ninety HCV NS5B sequences formed three main clades, one containing 34 subtypes 1b with tMRCA in 2012, and two with 51 subtypes 6e and tMRCAs in 2002–2003. Conclusions Unsafe injections in Cambodia most likely led to an explosive iatrogenic spreading of HIV, associated with a long-standing and more genetically-diverse HCV propagation.

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HIV/AIDS outbreak investigation in Jalalpur Jattan (JPJ), Gujrat, Pakistan

Cited by 20 publications

References 10 publications

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case–control study

Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan: protocol for a matched case–control study

HIV infection predominantly affecting children in Sindh, Pakistan, 2019: a cross-sectional study of an outbreak

Massive Iatrogenic Outbreak of Human Immunodeficiency Virus Type 1 in Rural Cambodia, 2014–2015

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