CMDN and INPL have been assisting various governmental and non-governmental agencies in research and disease surveillance activities in Nepal. We have not only participated in several rounds of Integrated Bio-behavioral Studies of HIV/ AIDS in Nepal by providing our technical expertise, and mobile screening of pathogens, but also assisted Government health sector and partner non-government organizations on research projects such as Hepatitis B/C prevalence, cholera outbreak investigation and others. Additionally, we have undertaken various research projects in the field of public health and nutrition.
1) OCCURRENCE OF CRYPTOCOCCAL MENINGITIS, A LEADING CAUSE OF DEATH OF PEOPLE LIVING WITH HIV/AIDS
Intrepid Nepal, under the lead of the DoHS and with support from the Global Fund/Save The Children, STIDH and NCASC, implemented research to determine the prevalence of cryptococcal disease among Nepal’s HIV positive patients. Since cryptococcal meningitis is a leading cause of death among AIDS patients in resource limited settings, this study was targeted towards the HIV positive population with CD4 counts less than 100, visiting the ART sites of major hospitals: Sukraraj Tropical and Infectious Disease Hospital (Teku), United Mission Hospital (Palpa), Western Regional Hospital (Pokhara) and Bheri Zonal Hospital (Nepalgunj).
2) MAPPING POPULATION HOTSPOTS OF HIGH-RISK HIV BEHAVIORS IN NEPAL
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Nepal has conducted several rounds of size estimations in order to estimate the number of key population members with specific risk behaviors. Intrepid Nepal, under the direction of a technical committee under the leadership of NCASC comprising different organizations has conducted the third round of size estimation 2016. The main purpose of this mapping and PSE exercise 2016 was to provide district and national level size estimates of key populations at risk of HIV infection, including Female Sex Workers (FSW), Men who have sex with Men (MSM) and People who Inject Drugs (PWIDs). This mapping exercise was focused on collecting information directly from the hotspots where key populations are found.
3) HIV/AIDS RESEARCH ON STREET CHILDREN AND YOUTH OF KATHMANDU
The risk of HIV infection among street children and adolescents may be especially high due to their involvement in number of high-risk behaviors, including intravenous drug use, putting them at significant risk of contracting HIV and other sexually transmitted infections. This sample of street children and youth of Kathmandu showed nearly 20-fold higher prevalence of HIV infection than the general population of Nepal. INPL, in collaboration with UNICEF Nepal conducted study to determine the prevalence of HIV infection among a sample of street children and youth of Kathmandu. The work has now been published in the AIDS Research and Research and Therapy Journal (2012).
4) NATIONAL TUBERCULOSIS PREVALENCE SURVEY 2017-2019
Tuberculosis (TB) is a major health problem that affects thousands of lives each year. In Nepal, TB ranks as one of the most critical public health issues with nearly 45 percent of the total population infected by the pathogen. With the objective to determine the real burden of TB and not rely on estimates, Nepal carried out the first National TB prevalence survey, with population sample of 57,589 individuals, carried throughout the country from 99 clusters. The survey was headed by the National Tuberculosis Center (NTC) with support financial support from Global Fund/ Save The Children and technical support from the World Health Organization (WHO), and implementing agencies Intrepid Nepal Pvt. Ltd and JANTRA.
5) NATIONAL LEVEL HIV DRUG RESISTANCE SURVEILLANCE (HIV-DR) IN NEPAL
HIV drug resistance surveillance (HIV-DR) is a study to estimate the national viral load suppression and levels/patterns of HIVDR in People living with HIV (PLHIV) population who have been on antiretroviral therapy (ART). Nepal carried out the first National level HIV drug resistance surveillance (HIV-DR) among people living with HIV. This study was carried out by the National Center for AIDS and STC Control (NCASC) with Intrepid Nepal as an implementing agency. The study’s aim was also to estimate the national retention of treatment. Approximately 1400 PLHIVs were recruited from 19 ART sites of Nepal. This study expected to obtain estimates for the optimal selection and management of second-line therapies regarding ART and provide insight on the extent to which patients are switching therapies unnecessarily.
6) NATIONAL LEVEL INTEGRATED BIOLOGICAL AND BEHAVIORAL SURVEILLANCE SURVEY FOR HIV/AIDS AMONG PEOPLE WHO INJECT DRUGS (PWIDS) IN NEPAL
Intrepid Nepal carried out the first ever nation-wide Integrated Biological and Behavioral (IBBS) Survey among People Who Inject Drugs (PWIDs) in Nepal. This survey was conducted under the leadership of National Centre for AIDS and STC Control (NCASC) with support from Global Fund/ Save the Children. Intrepid Nepal has successfully conducted several rounds of IBBS among key populations in the past years. However, this was the first nation-wide survey among this population aiming to assess the nation-wide prevalence and incidence of HIV, STI infections, and also their sexual and/or injecting behaviors.
7) CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) SCREENING AND HPV TESTING IN HIV-INFECTED WOMEN IN NEPAL FOR IMPROVED DETECTION AND MANAGEMENT
Cervical cancer is a major type of cancer that affects women of reproductive age. In Nepal, cervical cancer is the most common type of cancer. It is an established fact that cervical lesion incidence and progression in women with HIV is three-fold higher among HIV-infected women as compared to HIV-negative women. However, CA screening for HIV positive women is lagging in Nepal. In order to address the incredible gap in identifying cervical cancer among HIV-infected women, a study was carried out by Intrepid Nepal under the lead of DoHS with support from Global fund/ Save the Children, STIDH and NCASC.