Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

In the context of AVAHAN, the India AIDS Initiative of the Bill & Melinda Gates Foundation, general population surveys (GPS) were carried out between 2006 and 2008 in Belgaum (northern), Bellary (mid-state) and Mysore (southern) districts of Karnataka state, south India. Data from these three surveys were analysed to understand heterogeneity in HIV risk.

To estimate the burden of active infection and anti-SARS-CoV-2 IgG antibodies in Karnataka, India, and to assess variation across geographical regions and risk groups. A cross-sectional survey of 16,416 people covering three risk groups was conducted between 3-16 September 2020 using the state of Karnataka's infrastructure of 290 healthcare facilities across all 30 districts. Participants were further classified into risk subgroups and sampled using stratified sampling. All participants were subjected to simultaneous detection of SARS-CoV-2 IgG using a commercial ELISA kit, SARS-CoV-2 antigen using a rapid antigen detection test (RAT) and reverse transcription-polymerase chain reaction (RT-PCR) for RNA detection. Maximum-likelihood estimation was used for joint estimation of the adjusted IgG, active and total prevalence (either IgG or active or both), while multinomial regression identified predictors. The overall adjusted total prevalence of COVID-19 in Karnataka was 27.7% (95% CI 26.1-29.3), IgG 16.8% (15.5-18.1) and active infection fraction 12.6% (11.5-13.8). The case-to-infection ratio was 1:40 and the infection fatality rate was 0.05%. Influenza-like symptoms or contact with a COVID-19-positive patient were good predictors of active infection. RAT kits had higher sensitivity (68%) in symptomatic people compared with 47% in asymptomatic people. This sentinel-based population survey was the first comprehensive survey in India to provide accurate estimates of the COVID-19 burden. The findings provide a reasonable approximation of the population immunity threshold levels. Using existing surveillance platforms coupled with a syndromic approach and sampling framework enabled this model to be replicable.

Background Migrant sex workers are known to be vulnerable to HIV. There is substantial female sex worker (FSW) mobility between the borders of Maharashtra and Karnataka, but little programming emphasis on migrant FSWs in India. We sought to understand the individual/cultural, structural, and contextual determinants of migration among FSWs from Karnataka. Methods A cross-sectional face-to-face interview of 1567 FSWs from 142 villages in 3 districts of northern Karnataka, India was conducted from January to June 2008. Villages having 10+ FSWs, a large number of whom were migrant, were selected following mapping of FSWs. Multinomial logistic regression was conducted to identify characteristics associated with migrant (travelled for ≥2 weeks outside the district past year) and mobile (travelled for <2 weeks outside the district past year) FSWs; adjusting for age and district. Results Compared with nonmigrants, migrant FSWs were more likely to be brothel than street based (Adjusted Odds Ratio (AOR): 5.7; 95% confidence interval: 1.6–20.0), have higher income from sex work (Adjusted Odds Ratio (AOR): 42.2; 12.6–142.1), speak >2 languages (AOR: 5.6; 2.6–12.0), have more clients (AOR_{per client}: 2.9; 1.2–7.2), and have more sex acts per day (AOR_{per sex act}: 3.5; 1.3–9.3). Mobile FSWs had higher income from sex work (AOR: 13.2; 3.9–44.6) relative to nonmigrants, but not as strongly as for migrant FSWs. Conclusion Out-migration of FSWs in Karnataka was strongly tied to sex work characteristics; thus, the structure inherent in sex work should be capitalized on when developing HIV preventive interventions. The important role of FSWs in HIV epidemics, coupled with the potential for rapid spread of HIV with migration, requires the most effective interventions possible for mobile and migrant FSWs.

Youth focused Life Skills Education and Counseling Services (YLSECS) program, trained teachers/National Service Scheme (NSS) officers to deliver Life Skills Education (LSE) and counseling services to college going youth in the state of Karnataka in India. Available evaluation of life-skills training program have neglected the recording and or reporting of outcome among those trained to implement life-skills training program. Present paper highlights the quality of YLSECS training program and change in perception among teachers/NSS-officers trained in-terms of improvement in their cognitive/affective domains. YLSECS program focused on World Health Organization identified ten essential domains of life-skills. Participants of the YLSECS program were trained by adopting facilitatory approach based on the principles of Kolb’s learning theory. Quasi experimental study design was used to evaluate the outcome of training among participants. Quality of the training was assessed using scoring system and change in perception was assessed using Likert scale. Statistical significance of change in perception before and after training was assessed by paired‘t’ test for proportion. Overall, 792 participants rated the quality of training as either “good” or “excellent”. Post-training, significant (p < 0.001) proportion of the participants reported improved awareness about life-skills (before training 49.9 to 74.4% vs post-training range from 91.6 to 95.1% for various domains). There was statistically significant (p < 0.001) increase in participants reporting “very confident” in teaching various life skill domains (before training from 22.7 to 34.2% for various domains and post-training it ranged from 65.2 to 74.7% for various domains). There was modest increase in participants reporting perceived ability to conduct life-skills workshop “without assistance” post-training (before training from 16.8 to 22.9% for various domains vs post-training ranged from 29.8 to 36.8% for various domains). Interestingly, considerable proportion of participants who prior to training reported being confident in providing life skills training (without any assistance), later (i.e post training) reported they need some/more assistance for the same. YLSECS training program significantly improved participants knowledge and confidence in imparting life-skills and highlight the need for continued handholding of participants for effective implementation of LSE and counseling service program.

Objective: To assess the population-level impact of “Avahan,” the India AIDS Initiative of the Bill & Melinda Gates Foundation, between 2003 and 2008 in Karnataka state, India. Design: Secondary data analysis using all consistent data collection sites from antenatal clinic (ANC) sentinel surveillance data from 2003 to 2008 in Karnataka. Methods: A multilevel logistic regression model considering individual- and district-level variables was developed to compare time trends in HIV prevalence among young ANC women (younger than 25 years of age) between Avahan (18) and non-Avahan (9) districts. District-level random effects were considered for the intercept and time. The impact was assessed using interaction terms between district type (Avahan vs. non-Avahan) and time. The number of cases averted was estimated, comparing predicted ANC HIV prevalence in the presence versus the absence of Avahan. Data from the National Family Health Survey Round 3 (2006) were used to extrapolate these numbers to the general population. Results: HIV prevalence among young ANC women declined from 1.46% (2003) to 0.83% (2008). The HIV prevalence trend was significantly different between Avahan and non-Avahan districts (P = 0.046). Overall, 87,035 cases of HIV infection were estimated to have been averted in the Karnataka general population because of Avahan during the 2003–2008 period (range under varying assumptions: 55,160–150,784). Conclusions: Our results suggest that Avahan has had a significant impact on the HIV epidemic in the general population of Karnataka. These results suggest that targeted interventions similar to Avahan should be implemented and scaled up in all concentrated and mixed HIV epidemics.