The Tamilnadu Dr.M.G.R. Medical University

Research Activities

 

DEPARTMENT OF EXPERIMENTAL MEDICINE

PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV IN  NAMAKKAL DISTRICT

 Chronological stages of the PMTCT Program: 

·        1998-Pilot study on the prevalence of HIV among the antenatal women at Namakkal: 4%.

·        2000-HIV/AIDS Training program for 200 medical doctors and 1000 medical and paramedical students

·        Printing educational pamphlets

·        July 2000-Inauguration of the PMTCT center at Namakkal District Head Quarter Hospital.

·        Placing the Team – Social worker, Counselors, Lab Technician.

·        Training of Maternity Doctors, Nurses, Maternity staff and lab technicians of Namakkal Hospital

·        Village Health Nurses Training (360) in batches.

·        Working Manuals on -  MTCT ( Tamil)

 -  Testing

 -  Breast feeding

 

Services Offered at the PMTCT Center:

 •         HIV counseling

–        Group counseling

–        Individual counseling

–        Pre test & Post test counseling

•         Informed consent

•         Testing

–        Voluntary counseling & Testing( Round the clock-24 hour service)

–        Confidential reporting system

–        For Registered & Unregistered women.

–        Medicines for Opportunistic Infection

 

ARV Prophylaxis:  

  • Short Course AZT – Thai Regimen -2000-02
  • Nevirapine – one dose to the women at the onset of labour & one dose to the Infant within 72 Hrs of Birth -2002

 

PMTCT sites at Namakkal District: 

•         Namakkal Headquarter Government Hospital-June 2000

•         Rasipuram Government Hospital-December  2000

•         Thiruchengode Government. Hospital-October 2002

•         Paramathi velur Government. Hospital-January 2003

•         Sendhamangalam Government. Hospital-January 2003

 

Home Based Care:

•         Counseling at Residences

•         Staff assess the needs of the women

•         Nutritional Counseling

•         If necessary refer them to hospital

•         Provide emotional support

•         Financial support

•         Drug therapy & ARV Counseling

•         Spacing of infants

•         Prevention

Follow up:

•         Seropositive pregnant women returned for subsequent follow up visits

•         Offering medicines for OI’s increase the attendance at the monthly review clinic

•         The women were comfortable in the self help group discussions (along with counsellors and nurses)

•         Increased partnership with local positive network group

 

PMTCT Program Offering Long-Long Regimen:

1. NICHD, NIH, USA for the protocol “A Prospective cohort study of sero prevalence of and reducing the transmission of Mother to child transmission of HIV-1 in Tamilnadu, South India”.  This study consists of Stage I and II.

 Stage I: Registration of eligible women’s, Group councelling, educational videos, HIV screening and Individual Counselling.

Stage 2: Test confirmation by western Blot, enrollment into a prospective cohort group both at NDH& Rasipuram, AZT administration from 28 weeks to labour, AZT syrup to baby at Rasipuram only , 2 dose NVP for mother & Baby at NDH, follow up for 12 months with clinical &Lab Investigations.    

 Study Period 2003-2005, with the sample size of 4000 pregnant women in Stage I and 200 HIV positive women in stageII.

 Stage 2:

Group 1: Women are offered one dose of Nevirapine at the onset of labor and their infants are offered Nevirapine syrup within 72 hours of birth.

Group2: Women are offered AZT from 28th week of pregnancy till delivery and a single dose of Nevirapine at the onset of labor. Their infants are offered AZT syrup for the first 6 weeks of life and one dose of Nevirapine within 24 hours of birth. 

  

Pediatric AIDS Unit: 

A separate unit for pediatric HIV was established at Rasipuram Government Hospital during May 2007. This unit is established in collaboration with University of Washington, Seattle.

 

EXTERNAL QUALITY ASSURANCE PROGRAM: 

This department is recognized as a one of the National Reference Center (NRL) by National AIDS Control Organization (NACO), New Delhi. The External Quality assurance program of Andhra Pradesh state is taken care by this department. These services were offered for Medical Colleges & Public Health Centers in the state of Andhra Pradesh.

 

PEDIATRIC DIAGNOSIS OF HIV: 

This department offers PCR tests for the diagnosis of pediatric HIV-1 infection since 1999. The protocol has been validated Nationally and Internationally.

 

GENETIC DIVERSITY OF HIV-1: 

  • Studies are in progress to identifying HIV-1 variants circulating among the HIV infected patients.
  • Pol gene diversity are studied by Oligo Nucleotide Ligation Assay (OLA)

 

LEPTOSPIROSIS:

 This department offers Diagnostic services to Leptospirosis infection since 1994. Various health care centers in the city use this facility.

 

EDUCATION: 

From this department 6 students were awarded Ph.D. degrees. The studies conducted by theses students cover various aspects of HIV/AIDS such as the role of micronutrients in HIV, HIV/TB serology tests, Viral dynamics in mother to child transmission of HIV, HIV molecular diversity, Breast milk transmission of HIV, Placental role in HIV transmission and biochemical parameters as compared to the progression of disease.

 

External Funded Projects

 

S.No

Title & scope of the Project

Year in which started

Remarks

1

Combination of antiretrovirals in seropositive pregnant women for reduction of MTCT

2001

Completed

2

HIV 1 Viral dynamics in seropositive pregnant women in relation to perinatal transmission

2001

Completed in 2006

3

Genetic variability of HIV in India.

2001

Completed in 2006

4

HIV transmission through breast milk

2001

Completed in 2007

5

External Quality Assurance for (EQAS)HIV Testing for the state of Andhra Pradesh

2002

In progress

6

Brest feeding patterns in South India.

2001

Completed in 2003

7

A study of stigma attached to HIV infection- implications for health care social adjustment

2002

Completed in 2003

8

A study of impact of counseling on copying behavior of HIV positive cases indifferent States

2002

Completed in 2003

9

Multiplex PCR tests for Sexually Transmitted Diseases.

2002

Completed in 2004

10

A research study in collaboration with NIH/NICHD, USA to reduce Mother to Child Transmission HIV-1 in Namakkal

 

2003

Completed in 2006

11

Single dose NVP for mother& infant in district of Namakkal

 

2002

In progress

12

Pediatric AIDS unit to offer antiretroviral therapy at Rasipuram, Namakkal District

2007

In progress

13

HIV-1 NNRTI resistance testing by  OLA technique for pregnant mother at Namakkal

 

2006

In progress

14

To study HIV-1 strains Diversity among IUD’s

2007

In progress

15

HIV-1 Surveillance study among Pediatrics

2007

In progress

 

 

 Department of Epidemiology

            The department undertakes research work in both clinical and field epidemiology since its inception in 1998. The following main areas of research have been identified keeping in mind the interests of the staff and the availability of funds globally. In each of these areas, research is either ongoing or planned. In addition there are some studies that are being carried out in collaboration with other departments or institutions. The department co-ordinates the Nutrition Network studies sponsored by the UNICEF. The studies in progress at the present time are :

               Studies on spirulina and weight gain in children and on control of nutritional anemia in pregnant women.

Completed Projects

           A project to assess the Knowledge of and attitude toward organ donation among medical persons was undertaken and completed last year. This has been accepted for publication in the Indian Journal of Nephrology.

           Source of funds: University.

           A study of the distribution of health manpower in the state of Tamilnadu has been just completed with the help of the Dept. of Humanities, IIT Madras

           Source of funds: University.

On Going Projects

The following projects were initiated last year and are in progress.

Primary prevention of Renal disease in the community
            The purpose of this study is to develop a primary care package to manage diabetes and hypertension in rural communities and thereby prevent renal disease. A population of twenty five thousand (25,000) has been registered. They are screened once a year for diabetes hypertension and renal disease by trained health workers. Those with diabetes and hypertension are managed at minimal cost with simple drugs by a medical officer. Those with renal disease are referred to a consultant. Valuable data on the prevelance and incidence of these diseases are available.
           Source of Funding: Kidney Help Trust.

Maternal Anaemia
            A multi disciplinary operational research project to understand programmatic issues in the National Anaemia Control Program. The aim is to identify lacuna in implementation and suggest ways of improvement.
Disciplines involved:

     Epidemiology (CEU, Madras)
     Sociology/Anthropology – Madras University
     Economics – Madras University
     Programme management TINUS.
     The Department of Epidemiology is the technical coordinator.
     Source of Funding – UNICEF.

Knowledge of Sexual health among the student community
              As the medical problems associated with teenage sexual activities are increasing, including teenage pregnancies and complications from STD, HIV, AIDS, etc.,. The becomes necessary to understand the knowledge of adolescence in this aspect as to design module for the awareness campaign to educate the students on reproductive health or sexual health in the class room either through the curriculum or through religious classes.
Quality of dissertations.
               It aimed at finding out lacuna in the Research Methodology of the PG dissertation and the finding from this study will be transferred to the Post graduate Teaching faculty for better guidance to the students in the future.
 

PROPOSED STUDIES
The following studies have been proposed last year and have been approved by the funding agencies. They will begin in the next year.

Cost effectiveness of different types of providers of supervision in DOTS in the Treatment of TB.
          The strategy of DOTS (Directly observed therapy, short course) widely adopted by the WHO, advocates twice weekly regimen for treatment. However, it is considered that the methodology of supervision, which is vital tuberculosis unit based on local condition.
          This study aims to study the effectiveness of different types of treatment providers in a achieving cure rates in the programs and to estimate the cost effectiveness associated with the treatment.
          This is a nationwide multi centric study that the department will be coordinating.
         Source of Funding : INCLEN

Investigation of risk factors and transmission of Drug Resistant Tuberculosis

          The magnitude of primary and acquired drug resistance to one or more anti-tuberculosis drugs in India is not known. It is essential to have this information in order to assess the National Control Program, and to suggest modifications, if required. There is need for continuous surveillance for drug resistant tuberculosis in India where DOTS strategy is being implemented to cover increasing number of districts. Thus the objectives are to investigate the magnitude of drug resistant pulmonary tuberculosis amongst patients with active sputum positive disease.
          This is also a nationwide multicentric study in which the department will be participating.
          Source of Funding : INCLEN

Diagnosis of pyrexia of unknown origin:

           Pyrexia of unknown origin (PUO) remains one of the major diagnostic challenges for the clinicians. There is no set of routine investigations that patients with PUO should be subjected to. Aim of this study is to describe the spectrum of diseases that may give rise to PUO in patients attending the clinics with fever and to delineate the diagnostic approach of these patients and to standardize the diagnostic technique of these patients.
          Source of funding : University

Immunological Response after BCG Vaccination: (Ph.D Project)
          BCG Vaccination has been the central pillar of TB control activities in most countries. The immunological response of tuberculosis are controlled by cytokines that are secreted by cells involved in immunity. It is necessary to study the antigen recognition pattern of the cytokine profile of vaccinated and non vaccinated individuals in order to understand the protective effect of BCG vaccination. When compared to the effect of exposure to environmental mycobacteria.
         This study is to study the in vitro stimulative response of lymphocyte to mycobacterial antigens in terms of cytokine secretion in BCG vaccinated and non – vaccinated skin test positive and negative individuals..
         Source of funding : WHO

Vitamin A level Recurrent Respiratory Infections in children:
          The factors responsible for causing recurrent respiratory infections are different in different regions and appear to vary with time. Vitamin A has increased mortality rate among children and remains an important factor in maintaining the integrity of the respiratory mucosa. This study will elucidate the role of Vitamin A as a risk factor for recurrent or prolonged respiratory infections in children living in the poorer areas of Madras City.
Gender differentials in Health Care (Ph.D Project)
          This study aims to elucidate the role of gender in access, availability and utilisation of health care among the rural and urban poor. The information gained will be utilised to develope a training programme for health workers in order to minimise the gender gap in health care delivery.
         Source of funding : ICMR

 

   Department  of Transfusion Medicine

                1. Investigation of transfusion reactions.
                2. Quality Control Management in the field of Blood Transfusion

               To serve as a resource body in health care, research and education for Government of Tamilnadu.