The document summarizes India's national surveillance system for HIV/AIDS (NACO). It describes how information flows from NACO to state and district levels to monitor patients and communities. It outlines the behavioral surveillance system (BSS) that monitors high-risk populations using structured questionnaires. Key populations surveyed include female sex workers, men who have sex with men, and transgender individuals. The document also describes India's HIV sentinel surveillance (HSS) system, which generates data on epidemic patterns from over 1,000 sentinel sites. HSS monitors trends in HIV prevalence among high-risk and bridge populations through testing at sites like STD clinics, antenatal clinics, and facilities serving injecting drug users.

1. Surveillance System-NACO
National Program for AIDS control
Presented by
Gnanaranjan Das
BOT,MBA, PGDPHM (cont.)

2. Flow of Information
National AIDS Control
Organisation (Vision)
State AIDS Control Societies
(Supervision)
District level (Service delivery)
Patients, Community (Service demand)
45

3. Behavioural Surveillance System(BSS)
• Aim:-Reaching out to most vulnerable HIV
population.
• Objectives:- To provide repeated measures on
behavioural indicators for observing trends in
high risk behaviour among selected key target
population group statewise.
• Methodology:-Quantitative structured
questionnaires
• Source:-Resource Center for Sexual Health &
HIV/AIDS(RCSHA)

4. Population Subgroups
• FSW (18-49) w
• MC (18-49)m
• MSM (18-44)
• MUS (18-24)m
• ML (18-49)
• FML (18-49)
• TD (18-49)
• SM (18-39)
• SW (18-39)w

5. Milestone-HIV Surveillance System
• 1985-HIV SS initiated by ICMR in blood donors
& STD patients
• 1986-NACP under MoH&FW
• 1992-NACO was established
• 1998-180 sentinel sites for sentinel
surveillance
• 1992-1999NACP-I
• 1999-2006 NACP-II
• 2006-2013 NACP-III
Source: Technical Report India HIV Estimates

6. HIV Sentinel Surveillance (HSS)
• Strategic information is the critical pillar for
NACP which comes from HSS, which generate
evidence of epidemic pattern
• 12th round of HSS conducted during 2010-11
• No of sentinel sites increased from 180 (1998)
1223 (2009-10) to 1359 (2010-11) with major
expansion in sites for HRG & bridge
population.
• NACO undertakes estimation of HIV burden
using data from HSS among HRG & ANC

7. Objectives of HIV Estimation
• To estimate of number of PLHIV
• Program indicators i.e. HIV Prevalence &
Incidence, HIV population by age & sex, need
for ART & need for PPTCT
• Epidemic trend analysis & modelling

8. Different HSS sites
• STD
• ANC
• IDU
• FSM
• MSM
• Transgender
• Migrants
• Truckers
Adapted from Dr Tim Brown’s work on the Asian Epidemic
Low risk pop
High risk pop
Bridge pop

9. Criteria for Sentinel site
• STD sentinel site where 150 STD patients
attending the STD clinic and 100 female STD
patients attending OBG clinic. (15-49)MF
• ANC sentinel site where 400 pregnant women
(ANC attendees) are recruited (15-49)F
Source: Operation Manual

10. Sampling Method-Consecutive Sampling
• After the start of surveillance, all individuals
attending the sentinel site facility
(ANC/STD/OBG clinic), who are eligible for
inclusion in surveillance as per the defined
criteria, should be recruited in the order they
attend the clinic.
• This sampling method reduces chances of
selection bias.
Source: Operation Manual

11. HR @ sentinel site=3
• They include a doctor, who is designated as
the sentinel site in-charge,
• Nurse or counselor who assists in data
collection and
• Laboratory technician responsible for
collection of blood specimens.
• Surveillance is carried out over a period of
three months
Source: Operation Manual

12. Documentation at Sentinel site
1. Data form (filled by Nurse/Counselor daily)
2. Data form Transportation Sheet (N/C)
3. Sample Transportation sheet(filled daily by LT)
4. Supervisory visit Register (Nurse/counselor)-SACS
5. Weekly transport of 1&2 forms to RI (Regional
Institutes)
6. Weekly transport of Sample transportation sheet
along with blood sample properly packed &
stored in cold chain to HSS Testing Lab.
Source: Operation Manual

13. Results
• The HIV epidemic in India continues to decline
at the national level with an overall reduction
in adult HIV prevalence, HIV incidence (new
infections) and AIDS-related mortality in the
country. The adult (15–49 years) HIV
prevalence has decreased from 0.4% in 2000
to 0.27% in 2011.
• Reduction of 57% in estimated annual new
HIV infections among adult population from
2.74 lakhs in 2000 to 1.16 lakhs in 2011

14. Reference
• www.naco.gov.in
• Operation Manual
• Technical Report India HIV Estimates
• HSS Technical Brief 2010-11