1. An Overview of HIV/AIDS Epidemic Situation and Programmatic Response in Uttar Pradesh IAPSM Conference Dehradun 30-31 Oct 2010 Dr Pramod Gautam Dr Sudipta Mondal FHI
2. About FHI 1971 - The establishment of Institute for Family Health (IFH) managing research and field activities (North Carolina) 1986 - The establishment of Institute for HIV/AIDS (IHA) managing the work on HIV prevention Programs 1990 - FHI Foundation Established 1993 - HIV Prevention Research and Women’s Studies 1995 - PQC Established 1999 - Pharma Link FHI Established 2001 - Youthnet, IFA and IHA 2004 - Malaria Clinical Trials 2006 - HPV, Avian Flu, Rotavirus and Unification for Greater Impact
5. SAMARTH Project Overview Background: Strengthen Abilities to Manage And Respond effectively To HIV/AIDS (SAMARTH) is a five-year Technical Assistance (TA) grant under the United States Mission to the India Five-Year Strategic Plan for the PEPFAR during 2006-2011 Goal: Improve the effectiveness of the response of the government and civil society for evidence-based HIV policy and programs in India
6. Objectives To enhance capacities of government and civil society for effective management of HIV /AIDS program To strengthen quality of HIV prevention, care and treatment in the public and private sector To improve planning, collection analysis, and use of strategic information (SI) at the national, state, and district levels To foster bold leadership and visibility of USG-supported programs through strategic communication
7. Vulnerability Factors for HIV Epidemic in UP • Population 180-200 million (growth rate 2.5%) • 48 - 50% in reproductive age group • Low literacy (rural 36.66%, state 57.2%) • High incidence of poverty • Low status of women & Gender disparity • Large presence of high risk groups * Migrants : 10 million * Truckers : 50,000 (8 national highways) * FSWs : 20000-25000 * IDUs : 10000-12000 * MSM : 10000-12000 • Long porous Indo - Nepal border
32. Knowledge of HIV/AIDS-MSM Knowledge on transmission of HIV/AIDS among respondents COMPREHENSIVE KNOWLEDGE ABOUT HIV/AIDS 18% - 2009 UP BSS 16% - 2006 UP BSS
50. Challenges and Opportunities Gaps: Being low prevalent state, the number of HSS, ICTC and PPTCT sites are low The quality of services statistics in recording and reporting needs improvement in terms of Consistency Completeness Correctness Changes: Recently attention has been laid on data quality and data use Data Triangulation Exercise Capacity building of all level of staff are being done
52. National AIDS Control Programme Phase III (NACP III) Goal: Halt and reverse the epidemic in India over the next five years Specific Objectives: Reduce new infections by 60% in high prevalence states 40% in vulnerable states
53. NACP III - Four pronged strategy Prevent new infections Increase proportion of PLHA receiving care, support, and treatment Strengthen capacity at district, state and national levels Build strategic information management systems
54. Strategic shift from NACP II to NACP III NACP III NACP II Aims toshift the focus from raising awareness to behavior change Through interventions, particularly for groups at a high risk of contracting and spreading HIV Aims at saturation of coverage of the core target population (80%) Guiding Principles: 3 Ones principle Evidence-based planning A & B districts – more focus Decentralization
114. 56 Pradhans did wall paintings from their development funds
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116. District Wise Distribution of *Core Tis –Uttar Pradesh LEGEND - Distribution of Core TIs FSW MSM & IDU FSW & MSM FSW & IDU FSW (F) IDU (I) MSM (M) Nos. in circles indicates no. of Tis in the respective district Saharanpur Bijnor Muzaffarnagar Meerut I-350 Baghpat 1 1 JP Nagar Rampur 3 Ghaziabad Moradabad I-200 1 Pilibhit (F-500 +M-600 +I-500) GB Nagar (F-500+M-1000+I-200) 2 Bareilly I-250 Bulandshahar Lakhimpur Kheri Budaun Shahjahanpur I-500+I-200 Aligarh Sharwasti Sant Kabir Nagar Bahraich Etah Balrampur Hathras 2 Mathura Sitapur Farrukhabad Siddharthnagar Hardoi Maharajganj F-500+M-300 1 3 Firozabad 1 Gonda Mainpuri Kannauj Kusinagar F-250 Agra 1 Bara Banki 4 Basti F-300+I-250 Etawah Gorakhpur I-750 Lucknow Faizabad Unnao (F-500+M-350+I-300) 1 I-200 Ambedkar Nagar F-250 Kanpur Nagar Auraiya Deoria Kanpur Dehat Rae Bareli F-250 1 1 Sultanpur Jalaun Mau M-550 2 Azamgarh Ballia I-250 Pratapgarh Fatehpur 1 1 M-200 Jaunpur 1 1 Hamirpur Jhansi Ghazipur F-500 Banda I-200 Varanasi Kaushambi Mahoba Bhadohi (F-500+M-400+I-500) 3 Allahabad Chitrakoot 4 Chandauli 1 Mirzapur Lalitpur F-250 (F-500+M-900+I-500+F-250) Total Nos. Of Core Tis 37 (FSW 13, MSM 8, IDU 16) Sonbhadra
117. District Wise Distribution of FSWs Reached & Mapped Saharanpur Legend - Based on FSWs reached Nos. in colour indicates FSWs reached No. Tis in the districts Up to 199 200 to 299 300 to 399 400 & more Nos. in colour indicates FSWs mapped Muzaffarnagar Bijnor Moradabad Meerut JP Nagar Rampur Bagpat Pilibhit Ghaziabad Bulandshahar Bareilly Budaun GB Nagar Bahraich Sant Kabir Nagar Aligarh Lakhimpur Kheri Sharwasti Mathura Shahjahanpur Balrampur Hathras Etah Siddharthnagar Farrukhabad Sitapur Maharajganj Firozabad Hardoi Agra Kannauj Bara Banki Gonda Gorakhpur Unnao Basti Kusinagar Faizabad Lucknow Auraiya Etawah Ambedkar Nagar Deoria Rae Bareli Sultanpur Kanpur Dehat Mau Kanpur Nagar Azamgarh Jaunpur Pratapgarh Ballia Jalaun Fatehpur Hamirpur Jhansi Ghazipur Allahabad Bhadohi Varanasi Mahoba Kaushambi Banda Mirzapur Chitrakoot Chandauli Lalitpur Sonbhdra TSU, UPSACS
118. District Wise distribution of MSMs Reached & Mapped Saharanpur Legend - Based on MSMs reached Nos. in colour indicates MSMs reached No. Tis in the districts Up to 199 200 to 299 300 to 399 400 & more Nos. in colour indicates MSMs mapped Legend - No. Tis in the districts <=200 <=300 <=400 >400 Muzaffarnagar Bijnor Moradabad Rampur Meerut JP Nagar Bagpat Ghaizabad Pilibhit Bulandshahar Bareilly Budaun Shahjahanpur GB Nagar Bahraich Aligarh Lakhimpur Kheri Sant Kabir Nagar Sharwasti Sitapur Mathura Balrampur Etah Hathras Farrukhabad Maharajganj Siddharthnagar Mainpuri Firozabad Hardoi Agra Gonda Kannauj Kusinagar Gorakhpur Basti Unnao Bara Banki Etawah Kanpur Dehat Faizabad Lucknow Auraiya Ambedkar Nagar Deoria Jalaun Sultanpur Kanpur Nagar Rae Bareli Pratapgarh Mau Ballia Azamgarh Kaushambi Fatehpur Jaunpur Jhansi Hamirpur Ghazipur Allahabad Bhadohi Banda Varanasi Mahoba Chitrakoot Mirzapur Chandauli Lalitpur Sonbhadra TSU, UPSACS
119. District Wise distribution of IDUs Reached & Mapped Saharanpur Legend - Based on IDUs reached Nos. in colour indicates IDUs reached No. Tis in the districts Up to 199 200 to 299 300 to 399 400 & more Nos. in colour indicates IDUs mapped Muzaffarnagar Bijnor Moradabad Bagpat Meerut Rampur JP Nagar Ghaziabad Pilibhit GB Nagar Bulandshahar Bareilly Budaun Shahjahanpur Bahraich Aligarh Lakhimpur Kheri Sant Kabir Nagar Mathura Sitapur Balrampur Hathras Sharwasti Etah Farrukhabad Siddharthnagar Maharajganj Hardoi Firozabad Bara Banki Mainpuri Agra Gonda Kusinagar Kannauj Gorakhpur Basti Etawah Unnao Kanpur Dehat Faizabad Lucknow Ambedkar Nagar Auraiya Jalaun Sultanpur Deoria Rae Bareli Mau Kanpur Nagar Pratapgarh Ballia Azamgarh Kaushambi Fatehpur Jaunpur Hamirpur Jhansi Ghazipur Allahabad Banda Bhadohi Varanasi Mahoba Mirzapur Chitrakoot Chandauli Sonbhadra Lalitpur TSU, UPSACS
120. District Wise Distribution of HRGs Reached& Mapped Saharanpur Legend – Nos. in colores indicates HRGs reached Up to 500 501 - 750 751 - 1000 More than 1000 Nos. in colores indicates HRGs mapped Bijnor Muzaffarnagar Moradabad Meerut Rampur Baghpat Pilibhit Ghaziabad Bareilly JP Nagar Lakhimpur Kheri Shahjahanpur Bulandshahar GB Nagar Bahraich Aligarh Budaun Etah Sharwasti Sant Kabir Nagar Balrampur Sitapur Mathura Hardoi Hathras Farrukhabad Maharajganj Siddharthnagar Mainpuri Bara Banki Firozabad Gonda Agra Kannauj Gorakhpur Basti Kanpur Nagar Etawah Kusinagar Faizabad Lucknow Unnao Auraiya Ambedkar Nagar Rae Bareli Deoria Kanpur Dehat Sultanpur Mau Pratapgarh Ballia Jalaun Fatehpur Azamgarh Jhansi Banda Hamirpur Ghazipur Jaunpur Kaushambi Varanasi Mahoba Bhadohi Allahabad Chitrakoot Chandauli Mirzapur Lalitpur Sonbhadra
121. ICTC Govt. ICTC: 250 PPP-ICTC: 27 Mostly ICTCs are in District Hospitals and in Medical Colleges In ‘A’ category districts up to sub-district level
122. Saharanpur Legend - Up to 100 101 - 300 301 – 500 501 - 1000 1001 - 3000 More than 3000 Muzaffarnagar Bijnor Baghpat Moradabad Meerut JP Nagar Rampur Ghaziabad Pilibhit Gautam Buddha Nagar Bareilly Bulandshahar Lakhimpur Kheri Budaun Sant Kabir Nagar Shahjahanpur Bahraich Aligarh Sharwasti Etah Mathura Balrampur Sitapur Hathras Farrukhabad Maharajganj Siddharthnagar Hardoi Firozabad Agra Mainpuri Gonda Agra Kannauj 3570 Kusinagar Bara Banki Basti Lucknow Etawah Gorakhpur Faizabad Unnao Auraiya 5016 Kanpur Dehat 4267 Deoria Ambedkar Nagar Sultanpur Rae Bareli Jalaun Kanpur Nagar Azamgarh Mau Ballia Pratapgarh Fatehpur Jaunpur Hamirpur Ghazipur Jhansi Kaushambi Banda Bhadohi Varanasi Mahoba 8788 Allahabad Chandauli Chitrakoot 4084 Mirzapur Lalitpur Total no. of persons tested HIV Positive 44212 (2002-Aug. 2008) Sonbhadra Cumulative number of persons tested HIV positive in ICTC 2002-2009 Total no. of test found HIV Positive = 55,596
126. STI Total SACS supported STI clinics: 86 In District Hospitals and in Medical Collges Medicine kits received from NACO and distributed through STI Clinics Doctors, paramedic and counselors trained Private Health Care Providers (TI-NGOs) trained - 353
138. AnnualRegistrations in HIV-care - 2005 to 2010 Total Registered till July 2010 – 32,760 Alive and on ART till July 2010– 13,018
139. Number of Patients registered on ART from different district Up to March 2009 Saharanpur Legend - Up to 100 101 - 300 301 – 500 501 - 1000 More than 1000 Muzaffarnagar Bijnor Baghpat Moradabad Meerut Rampur JP Nagar Ghaziabad Pilibhit Gautam Buddha Nagar Bareilly Bulandshahar Lakhimpur Kheri Budaun Sant Kabir Nagar Shahjahanpur Bahraich Aligarh Sharwasti Mathura Etah Sitapur Hathras Balrampur Farrukhabad Hardoi Siddharthnagar Maharajganj Gonda Mainpuri Firozabad Bara Banki Agra Kusinagar Kannauj Basti Lucknow Gorakhpur Etawah Unnao Faizabad Auraiya Ambedkar Nagar Deoria Rae Bareli Sultanpur Kanpur Nagar Kanpur Dehat Jalaun Mau Azamgarh Ballia Pratapgarh Fatehpur Jaunpur Ghazipur Hamirpur Jhansi Banda Kaushambi Varanasi Allahabad Mahoba Bhadohi Chandrali Chitrakoot Mirzapur Lalitpur Sonbhadra Total number of persons registered in HIV Care 17885 ART Centre ‘A’ Category District * Note: Total no. of patients registered in HIV care up to march 09 is 18447 (from CMIS), out of these, 562 patients registered in HIV care but no specification about districts/origin. TSU, UPSACS
140. No. of Patients registered on ART From Different District Up to March 2010 Saharanpur 110 Bijnor 169 Muzaffarnagar 266 Bagpat 106 Rampur 64 Meerut 893 Moradabad 169 JPNagar 72 Gaziabad 358 Pilibhit 26 Bareilly 108 Gautam Buddha Nagar 39 Buland Shahar 178 Lakhimpur Kheri 53 Sant Kabir Nagar 673 Badaun46 Shahjahanpur 49 Aligarh 350 Bhraich 141 Sarawasti 65 Sidharthnagar 631 Hathras 210 Sitapur 84 Mathura 275 Etah 144 Farrukhabad 42 Balrampur 349 Maharajganj 626 Mainpuri 53 Hardoi 43 Gonda 417 Firozabad 170 Kannuaj 68 Kusinagar 829 Agra 1091 Bara Banki 132 Etawah 86 Lucknow 472 Basti 747 Unnao 258 Auraiya 41 Faizabad 262 Kanpur Nagar 515 Gorkhpur 1808 Kanpur Dehat 0 A.N.Nagar 285 Sultanpur 544 Deoria 1238 Rai Bareli 254 Mau 433 Azamgarh 1219 Jalaun 88 Fatehpur 178 Pratapgarh 1048 Gazipur 644 Hamir Pur 41 Jhansi 66 Ballia 434 Varanasi 858 Jaunpur 1505 Kaushambi 215 Banda 148 Allahabad 1734 Mahoba 13 Chandauli 241 Chitrakoot 89 Mirzapur 299 Lalit Pur 24 Sonbhadra 152 25238
143. Support to UPSACS and TSU by FHI/USAID SAMARTH project HRG Mapping and BSS-2009 Training of Govt. Health Care Providers across 71 districts within a short period – 2009 and 2010 Training of UPSACS and TSU staff on Documentation Coordination and facilitation of UPSACS Classroom training and exposure visit Annual report preparation Developing at least one TI in each region which demonstrate good quality program interventionsand process documentation to develop these TIs as learning sites Data Triangulation Developing two Districts Gorakhpur and Agra as learning sites for district-level HIV service decentralization.
144. AAP and % Funds Utilization(Fiscal Year wise 2005 - 2010)
145. Gaps Identified Awareness about disease still low Stigma still persists, though situation is better Awareness about testing and care facilities still low Wide gap between estimates and actual tested Wide gap between tested and enrolled in care Target populations yet to be reached fully
146. Gaps Identified Care and support activities need to be expanded Home based care to be increased Reach for PPTCT can be increased- social and cultural barriers Issues related to Nutrition Outreach activities for patients LFU / Missed Reaching out to young and too young Issue of orphans, infected and affected children