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Article: Assessment of population-level effect of Avahan, an HIV-prevention initiative in India

TitleAssessment of population-level effect of Avahan, an HIV-prevention initiative in India
Authors
Issue Date2011
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet
Citation
The Lancet, 2011, v. 378 n. 9803, p. 1643-1652 How to Cite?
AbstractThe aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003-08). Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan. 80 (61) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24-432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100 178 HIV infections (95 CI 25 897-207 713) were averted at the population level from 2003 up to 2008 as a result of Avahan. The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries. Bill & Melinda Gates Foundation. © 2011 Elsevier Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/143392
ISSN
2015 Impact Factor: 44.002
2015 SCImago Journal Rankings: 14.638
ISI Accession Number ID
Funding AgencyGrant Number
Bill & Melinda Gates Foundation
Funding Information:

Funding Bill & Melinda Gates Foundation.

References

 

DC FieldValueLanguage
dc.contributor.authorNg, Men_HK
dc.contributor.authorGakidou, Een_HK
dc.contributor.authorLevinRector, Aen_HK
dc.contributor.authorKhera, Aen_HK
dc.contributor.authorMurray, CJLen_HK
dc.contributor.authorDandona, Len_HK
dc.date.accessioned2011-11-24T10:05:06Z-
dc.date.available2011-11-24T10:05:06Z-
dc.date.issued2011en_HK
dc.identifier.citationThe Lancet, 2011, v. 378 n. 9803, p. 1643-1652en_HK
dc.identifier.issn0140-6736en_HK
dc.identifier.urihttp://hdl.handle.net/10722/143392-
dc.description.abstractThe aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003-08). Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan. 80 (61) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24-432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100 178 HIV infections (95 CI 25 897-207 713) were averted at the population level from 2003 up to 2008 as a result of Avahan. The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries. Bill & Melinda Gates Foundation. © 2011 Elsevier Ltd.en_HK
dc.languageengen_US
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lanceten_HK
dc.relation.ispartofThe Lanceten_HK
dc.subject.meshAmbulatory Care Facilities-
dc.subject.meshHIV Infections - epidemiology - prevention and control-
dc.subject.meshHealth Planning Support-
dc.subject.meshIndia - epidemiology-
dc.subject.meshSentinel Surveillance-
dc.titleAssessment of population-level effect of Avahan, an HIV-prevention initiative in Indiaen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0140-6736&volume=378&issue=9803&spage=1643&epage=1652&date=2011&atitle=Assessment+of+population-level+effect+of+Avahan,+an+HIV-prevention+initiative+in+Indiaen_US
dc.identifier.emailNg, M: marieng@hku.hken_HK
dc.identifier.authorityNg, M=rp01451en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0140-6736(11)61390-1en_HK
dc.identifier.pmid21993161-
dc.identifier.scopuseid_2-s2.0-80555122879en_HK
dc.identifier.hkuros197742en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-80555122879&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume378en_HK
dc.identifier.issue9803en_HK
dc.identifier.spage1643en_HK
dc.identifier.epage1652en_HK
dc.identifier.eissn1474-547X-
dc.identifier.isiWOS:000296768300029-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridNg, M=36155754200en_HK
dc.identifier.scopusauthoridGakidou, E=6507025547en_HK
dc.identifier.scopusauthoridLevinRector, A=35332622100en_HK
dc.identifier.scopusauthoridKhera, A=24824309400en_HK
dc.identifier.scopusauthoridMurray, CJL=7402491787en_HK
dc.identifier.scopusauthoridDandona, L=7007017243en_HK

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