Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 12, 2024
Date Accepted: Mar 14, 2025
Integrated Behavioral and Biological Surveillance among People Living with HIV/AIDS visiting the ART centers in India: A Cross-sectional Surveillance Protocol
ABSTRACT
Background:
The estimated number of people living with HIV/AIDS (PLHIV) in India was 24.01 (19.92-29.07) lakhs in 2021. With the initiation of ART in 2004, followed by the implementation 'Test and Treat' policy, the number of PLHIV on antiretroviral therapy (ART) in India has considerably increased. The life expectancy of PLHIV has substantially increased with the persistent use of ART drugs, subsequently leading to an increased rate of comorbidities among PLHIV. UNAIDS 2025 targets about 90% of PLHIV to have access to integrated and comprehensive healthcare services, including reproductive and sexual health, communicable diseases, noncommunicable diseases (NCD), mental health and other essential services with a concerted effort to reach the End of AIDS by 2030. Improved surveillance is recommended for integrated care and treatment among PLHIV. Hence, an integrated and enhanced Surveillance and Epidemiology (IESE) framework under the National AIDS and STD Control Programme (NACP) has included PLHIV as one of the surveillance population groups for the national Integrated Bio-behavioral Surveillance (IBBS) for the first time in India.
Objective:
The primary objective of IBBS-PLHIV is to generate evidence on the HIV/AIDS-related behaviors, service uptakes and prevalence of STIs and NCDs among PLHIV.
Methods:
The IBBS-PLHIV will be a cross-sectional biennial surveillance among PLHIV aged 15 years or older. The first round will be implemented at 120 ART centers across 28 states that account for about 95% of total estimated PLHIVs. Consenting, eligible PLHIV will be recruited by consecutive sampling. The overall sample size at each ART center is around 225, and the surveillance period is three months. Behavioral data on demographics, reproductive and sexual health, lifestyle and sexual behaviors, stigma, and discrimination will be collected. Blood samples will be collected to test for STIs and NCDs.
Results:
The data collection was started in February 2024 in a phased manner and will be completed by June 2024.
Conclusions:
IBBS-PLHIV is a surveillance that collects data to help improve care and treatment for people living with HIV (PLHIV). This includes identifying the levels of HIV-related sexual behavioral risks, estimating the prevalence of STIs, understanding the lifestyle behavioral risks associated with NCDs, finding the reproductive and sexual health needs and assessing the prevalence and levels of violence, stigma and discrimination undergone by PLHIV. Eventually, the findings will be insightful to the program managers, policymakers and other stakeholders for informed decision-making and improved management of HIV care and treatment in India.
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