Malaria   Blood-Borne Infections   Health System
 
Mother & Child Health   Drug-use & Control    
 

Infectious diseases constitute the major burden of disease in Afghanistan. HPRO conducts research on infectious disease control using publishable scientific protocls. HPRO collaborates with some of the world's leading health research institutions on infectious disease research. In addition, HPRO is unique to Afghanistan in having core capacities for advanced molecular biology.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Afghan National Army and Prevalence of BBVs
 
Project: Knowledge, attitude, and practice, and seroprevalence assessment of HIV, Syphilis, and Hepatitis B And C among Afghan National Army recruits in Afghanistan
Donor: Henry M Jackson Foundation
Duration: February 2010 to January 2011
Objectives:

The research goals of this study are to:

  • Provide biobehavioral information on a general population group in Afghanistan,
  • Determine cost-effective screening practices among ANA military recruits, and to
  • Introduce effective testing technologies suited to low resource settings.
    Additional scientific goals of this study are to:
  • Characterize HIV and HCV subtypes circulating in Afghanistan to inform efforts to improve molecular HIV and HCV surveillance and develop appropriate HIV candidate vaccines and advise appropriate HCV treatment.
Design:

The study is a cross-sectional study of 4750 randomly-selected potential ANA recruits. Participants were consented and enrolled by trained study personnel. Participants completed a confidential survey assessing demographics, high-risk behaviors, and knowledge about blood-borne and sexually transmitted infections (STIs). Participants then received rapid testing for HIV, syphilis, and hepatitis B surface antigen and surface antibody and C antibody with pre- and post-test counselling from trained study staff according to The United Nations Joint Programme on HIV/AIDS (UNAIDS) guidelines. Participants with positive rapid tests had confirmatory testing performed at the Afghan Public Health Institute/ ANA laboratory; follow-up counselling was provided by study staff with referrals provided for treatment/ on-going care.

Findings:

To be published soon; currently receiving clearance for dissemination.

Publication/Links:  
 
Back to Top
 
Blood Safety Study
 
Project: Assessment of safety of donor blood from public, private, and military sources in Afghanistan
Donor: Henry M Jackson Foundation / U.S. Armed Services Blood Program
Duration: June 2010 to May 2011
Objectives:

The overall purpose of the study is to describe quantity and quality of blood donation practices and the safety of the donor blood supply in Afghanistan.
Aim 1: To assess prevalence of HIV, syphilis, and hepatitis B and C in a random sample of units within the Afghan donor blood supply from a mix of public, military, and private sources.
Aim 2: To characterize screening capacity and practices at a representative sample of blood banking facilities in Afghanistan.

Design: This cross-sectional assessment was accomplished in two phases:
Phase 1. Mapping of facilities with blood collection/transfusion services
For the evaluation of facility resources and blood storage practices during the mapping exercise, a short data form was developed with ANBSTS staff and working groups.
Phase 2. Detailed evaluation at 40 hospitals with highest services volume in the past one year. This entailed assessment of screening, storage practices, observation of blood bank staff at work, exit interviews with clients of blood bank services and serologic tests on discarded de-identified serum samples.
Findings: A total of 243 facilities were assessed, with all 34 provinces represented. Public, military, and NGO facilities were substantially more likely to have an established logbook system than were private facilities (See Figure 1).
52.3% of facilities had a functional refrigeration system, with refrigeration more likely in urban settings (70.1% urban vs. 29.9% rural, p=0.02). Screening rapid tests were widely present for most pathogens, including HIV (87.7% of facilities), hepatitis B surface antigen (HBsAg) (93.8%), hepatitis C (90.5%) and syphilis (70.0%). Private facilities were significantly less likely to have syphilis tests available than other facility types (51.4% vs. 84.1%, p=0.0001). Urban areas were less likely to have syphilis tests available (64.3% vs. 79.8%, p=0.017), when private facilities were excluded, syphilis test availability were not different between rural and urban facilities. This reflects the fact that a significantly higher proportion of private facilities are located in urban areas than other type of facilities (i.e. 92% vs 41.3% P <0.001). Of sites with available tests, 7.5% of HIV tests, 0.9% of HBsAg, 2.3% of HCV, and 6.5% of syphilis tests were expired at the time of assessment. Expired tests for HIV and syphilis were more common for private facilities (p=0.07 and P=0.02 for HIV and Syphilis respectively); no associations were explored for expired hepatitis tests due to relatively lower numbers.
Approval of Phase 2 results is pending at this time.
Publication/Links:  
 
Back to Top
 
Afghan National Police and Prevalence of BBVs
 
Project: Knowledge, attitude, and practice and seroprevalence assessment of HIV, Syphilis, and Hepatitis B and C Among Afghan National Police recruits In Afghanistan
Donor: Henry M Jackson Foundation
Duration: July 2011to August 2012
Objectives:

The research goals of this study are to:

  • Provide biobehavioral information on a general population group in Afghanistan,
  • Determine cost-effective screening practices among ANP recruits, and to
  • Introduce effective testing technologies suited to low resource settings.
Additional scientific goals of this study are to:
  • Characterize HIV and HCV subtypes circulating in Afghanistan to inform efforts to improve molecular HIV and HCV surveillance and develop appropriate HIV candidate vaccines and advise appropriate HCV treatment.
Design: This cross-sectional study will recruit a randomly-selected sample of 4750 ANP recruits. Participants will be consented and enrolled by trained study personnel. Participants will complete a confidential survey assessing demographics, high-risk behaviors, and knowledge about blood-borne and sexually transmitted infections (STIs). Participants will then receive rapid testing for HIV, syphilis, and hepatitis B surface antigen and surface antibody and C antibody with pre- and post-test counselling from trained study staff according to The United Nations Joint Programme on HIV/AIDS (UNAIDS) guidelines. Participants with positive rapid tests will have confirmatory testing performed at the Central Public Health laboratory; follow-up counseling will be provided by study staff for participants returning for screening/confirmatory results and be referred for treatment/ on-going care.
Findings: Recruitment initiated July 2011.
Publication/Links:  
 
Back to Top
 
Sero-Prevalence of HIV, HCV,HBV.Syphilis and Herpes simplex type II
 
Project: Prevalence and Correlates of Blood-borne and Sexually-Transmitted Infections among Afghan National Army recruits: Implications for Screening, Vaccination, and Programming
Donor: Henry M. Jackson Foundation
Start Date: Feb 2010
Duration: 2.5 years
Objectives:

To measure the prevalence and correlates of HIV, syphilis, herpes simplex 2 virus (HSV-2), and hepatitis C virus (HCV) among Afghan National Army (ANA) recruits.

Methodology:

Male ANA recruits aged 18-35 years were randomly selected from those receiving medical screening at the Kabul Military Training Center between February 2010 and January 2011 for this cross-sectional study. Participants completed an interviewer-administered questionnaire, pre/post test counseling, and testing for syphilis, hepatitis C virus antibody (HCV Ab) on-site; HIV, HSV-2 screening, and confirmatory testing were performed off-site. Prevalence of each infection was calculated and logistic regression analysis performed to identify correlates.

Results:

Of 5313 recruits approached, 4750 consented to participation. Participants reported prior marijuana (16.3%), alcohol (5.3%), and opium (3.4%) use. Of sexually active recruits (58.7%, N=2786), 21.3% reported paying women for sex, and 4.6% and 18.3% reported sex with adult men or boys, respectively. Prevalence of HIV (0.063%, 95% CI: 0.013- 0.19), syphilis (0.65%, 95% CI: 0.44 – 0.93), and HCV Ab (0.82%, 95% CI: 0.58 – 1.12) were quite low. HSV2 exposure (3.03%, 95% CI:2.56 – 3.57) was independently associated with having a television (AOR=1.57, 95% CI:1.12 – 2.21), and age (AOR=1.05, 95% CI: 1.01 – 1.10) in province-adjusted multivariable models.

Publication/Links: Cross-sectional assessment of prevalence and correlates of blood-borne and sexually-transmitted infections among Afghan National Army recruits.
http://www.biomedcentral.com/1471-2334/12/196
 
Back to Top