Arshad Altaf, Safdar Pasha, Sten H Vermund, Sharaf Ali Shah.
A second major HIV outbreak in Larkana, Pakistan.
J Pak Med Assoc Jan ;66(12):1510-1.

The first major outbreak of human immunodeficiency virus (HIV) in Pakistan occurred in 2003 among persons who inject drugs (PWID) in Larkana. At that time, a survey of PWID revealed that 17 out of 175 (9.7%) were confirmed HIV positive, compared to historic data suggesting <0.5% prevalence among PWID.1 The city has now encountered another true HIV outbreak (i.e., a substantial excess of cases over the expected), this time among patients receiving renal dialysis in a dialysis unit of Chandka Medical College. A newspaper report (http://www.dawn.com/news/1289582) from 12 October 2016 reported 50 HIV cases. The National AIDS Control Programme (NACP) subsequently conducted its own investigation. From 27 September to 8 October 2016, dialysis patients were screened using HIV rapid test kits (ImuMedOne Step Diagnostic Test). The name of this kit was not in the WHO approved list available at NACP. Fifty six of 205 (27.3%) tested HIV seropositive. Twenty of these were selected at random and sent to the Referral Laboratory of Sindh AIDS Control Programme in Karachi where 19 out of 20 (95%) were confirmed HIV positive on Western Blot Testing.2 The recognized index case in this outbreak was a patient who went to a local laboratory for HIV testing. He informed the Physician-in-Charge of the Dialysis Unit of his seropositivity who then initiated HIV testing of all other dialysis patients. The NACP report indicates that there were 11 dialysis machines, one medical specialist or internist who is not a trained nephrologist and one technician per shift managing the dialysis unit. Once the physician goes away at the end of the day and patients come for dialysis in the evening or at night, the on duty technician manages the patients as well as the machines in the absence of a supervising physician. The report mentions that infection control practices were few and no machines were dedicated to patients with hepatitis B virus, hepatitis C virus or HIV infections. Interviewed patients indicated that they had purchased blood from unregulated laboratories and blood banks of the area.2

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