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Nacp iv ppt

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AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner

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Nacp iv ppt

  1. 1. NATIONAL AIDS CONTROL PROGRAMME(NACP) –PHASE IV Dr.Meely Panda JR,Dept of Comm.Med PGIMS.Rohtak
  2. 2. CONTENTS  BASICS OF AIDS  MODES & RISKS OF TRANSMISSION  CASE DEFINITION  TRACKING JOURNEY OF AIDS  BURDEN  LESSONS LEARNT FROM PHASE I, II & III  NACP IV-- GOALS, OBJECTIVES, STRATEGIES , GUIDING PRINCIPLES, COMPONENT WISE TARGETS, REPORTS OF INDIA & HARYANA  NACP IV FOR YOUNG  NACP IV FOR CHILDREN  STUDY DONE IN HARYANA  RECOMMENDATIONS
  3. 3. BASICS HIV is the Human Immunodeficiency Virus- lentivirus - retrovirus  Leads to Acquired Immune Deficiency Syndrome, or AIDS. Destroy specific blood cells, called CD4+ Tcells, which are crucial for fighting diseases.  No cure for HIV infection. Currently, people can live much longer - even decades - with HIV before they develop AIDS. “Highly active” combinations of medications that were introduced in the mid 1990s.
  4. 4. MODES OF TRANSMISSION percentage  Fig. 2.3: Routes of Transmission of HIV, India till 2011 Heterosexual 87.4 Parent to Child 5.4 others 3.3 Injecting Drug Use 1.6 Homosexual/ Bisexual 1.3 Blood and Blood Products 1
  5. 5. RISK OF TRANSMISSION percentage transfusion of blood products 90 mother to child transmission 25-30 percutaneous route 0.4 sharing needles & syringes 3-5 mucocutaneous route 0.05 sexual 0.01
  6. 6. CASE DEFINITION OF AIDS CRITERIAS FOR ADULTS & CHILDREN
  7. 7. ADULTS --Positive test for HIV antibody by 2 separate test using 2 different antigens + Any one of the following CHILDREN—At least 2 major signs + 2 minor signs  Weight loss >10% of bw  Chronic diarrhoea >1 month  Chronic cough >1 month  Disseminated ,miliary or extrapulmonary TB  Neurological impairment  Esophageal candidiasis  Kaposi sarcoma  Major –Weight loss,Failure to thrive,Candidiasis,Tuberculosis, Herpes zoster  Minor—Generalised lymphadynopathy,Oropharyngea l candidiasis,Persistant cough for >I month , Generalised dermatitis, Confirmed maternal HIV infection
  8. 8. 1981 first cases of AIDS (Acquired Immune Deficiency Syndrome) were identified among gay men in the United States. Barré- Sinoussi and Luc Montagnier were the discoverer of HIV & were awarded nobel prize for it. 1986 India’s first case of AIDS was diagnosed among sex workers in Chennai 1987 National AIDS Committee(NAC) was established under the Ministry of Health 1989 First HIV +ve case was detected in village Bohar, District Rohtak,Haryana 1992 National AIDS Control organization(NACO) set-up & NACP I launched to slow down the spread of HIV infection. 1999 NACP II launched, State AIDS Control Societies (SACS)established. PPTCT introduced 2002 National Blood Policy adopted 2004 Anti Retro-viral Treatment (ART) initiated 2006 National Policy on Paediatric ART formulated 2006-2011 NACP III launched to halt and reverse the HIV epidemic 2012-2017 NACP IV launched Tracking the journey
  9. 9.  Medium term plan – 1990-92  NACP I – 1992-99  NACP II – 1999-2007  NACP III – 2007 – 2012  NACP IV – 2012 – 2017  Four pronged strategy:  Prevent new infection  Support and treatment  Strengthening infrastructure and human resource  Strengthening nation-wide SIMS (Strategic Information Management System)
  10. 10. People living with HIV/AIDS,India 23 23.5 24 24.5 25 25.5 26 26.5 2000 2001 2002 2003 2004 2005 24.1 25.18 25.82 26.08 26.05 25.8 HIV estimatio
  11. 11. People living with HIV/AIDS 23 23.5 24 24.5 25 25.5 2006 2007 2008 2009 2010 25.39 24.91 24.83 23.95 23.88
  12. 12. ANC HIV prevalence 3% ANC HIV prevalence 2.5-3% ANC HIV prevalence 2-2.5% ANC HIV prevalence 1.5-2% ANC HIV prevalence 1-1.5% ANC HIV prevalence <1% No data available
  13. 13. ANC HIV prevalence 1-1.5 ANC HIV prevalence <1% No data
  14. 14. ANC HIV prevalence 3% ANC HIV prevalence 2.5-3% ANC HIV prevalence 2-2.5% ANC HIV prevalence 1.5-2% ANC HIV prevalence 1-1.5% ANC HIV prevalence <1%
  15. 15. PRIORITISATION OF DISTRICTS FOR PROGRAMME IMPLEMENTATION  Category A: More than 1% ANC prevalence in district in any of the sites in the last 3 years.  Category B: Less than 1% ANC prevalence in all the sites during last 3 years with more than 5% prevalence in any HRG site (STD/FSW/MSM/IDU).  Category C: Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites, with known hot spots (Migrants, truckers, large aggregation of factory workers, tourist etc).  Category D: Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites with no known hot spots OR no or poor HIV data. According to the revised district categorisation, there are 172 Category A districts and 48 Category B districts (Total of 220 districts) that require priority attention.
  16. 16. NACP 1 OBJECTIVE  Slow and prevent the spread of HIV through a major effort to prevent HIV transmission. KEY STRATEGIES  Focus on raising awareness, Blood safety, Prevention among high-risk populations,  Improving surveillance ACHIEVEMENTS  National AIDS response structures at both the national and state levels and provided critical financing.  Strong partnership with the World Health Organisation(WHO) and later helped mobilize additional donor resources.  Established the State AIDS Control Cells  Improved blood safety.  Expanded sentinel surveillance and improved coverage and reliability of data.  Improved condom promotion activities.  National HIV testing policy. NACP 1
  17. 17. OBJECTIVE  Reduce the spread of HIV infection in India through behaviour change and increase capacity to respond to HIV on a long-term basis. KEY STRATEGIES  Targeted Interventions for high-risk groups  Preventive interventions for general populations  Involvement of NGOs  Institutional strengthening ACHIEVEMENT  At the operational level NGOs implemented & 1,033 targeted interventions set up, 875 Voluntary counseling and testing centers (VCTC) and 679 STI clinics at the district level.  Nation-wide and state level Behaviour Sentinel Surveillance (BSS) surveys were conducted  Prevention of parent-to-child transmission (PPTCT) programme was expanded.  A computerized management information system (CMIS) created.  HIV prevention and care and support organizations and networks were strengthened.  Support from bilateral, multilateral, and other partner NACP 2
  18. 18. OBJECTIVE  Reduce the rate of incidence by 60 per cent in the first year of the programme in high prevalence states to obtain the reversal of the epidemic, and by 40 percent in the vulnerable states to stabilise the epidemic. STRATEGIES  Prevention – Targeted intervention (TI), ICTC, blood safety, communication, advocacy and mobilisation, condom promotion.  Care, support and treatment – ART, Pediatric ART, Center for excellence, Community Care Centers.  Capacity building – establishment, support and capacity strengthening, training, managing programme implementation and contracts, mainstreaming/private sector partnerships.  Strategic information management – monitoring and evaluation. NACP 3
  19. 19. ACHIEVEMENTS  There are 306 fully functional ART Centres against the target of 250 by March 2012  Nearly 12.5 lakh PLHIV are registered and 420000 patients are currently on ART.  612 Link ART centre (LAC) have been established wherein, 26023 PLHIV are taking Services  There are 10 Centres of Excellence,  7 Regional Pediatric centres are also functional.  259 Community Care Centres across the Country  6000 condomns & 6000 village information centres established  3000 Red ribbon clubs established  Link Workers training module updated
  20. 20. Lesson learnt from Phase I&II&III  The epidemic continues to progress with the following characteristics  High risk groups to low risk groups  Urban to rural areas  High prevalence states to all states  High vulnerability of young persons and women  MSM and IUDs have not received appropriate attention  Growing number of people living with HIV/AIDS has increased the need for care , support and treatment
  21. 21. The draft strategy paper for NACP IV prepared after consultation with stakeholders. The strategy paper termed as “people’s program” had positive networks,communities, technical experts, and government representatives from state and other central Ministries. TI espc amongst HRG and vulnerable sections of population was stressed The group reiterates commitment to achieving Millennium Development Goals (MDGs). As part of the process of formulation of the XIIth Five Year Plan (2012- 17), planningcommission constituted working group on AIDS Control at NACO. Planning Commision April 2011
  22. 22. The Guiding principles for NACP IV, 2012-2017 Continued emphasis on Three Ones One Agreed Action Framework, One Coordinating Authority and One Agreed M&E System Equity Gender Respect for the rights of the PLHA public private partners hips. Civil society represen tation
  23. 23. NACP IV GOAL: Accelerate Reversal … Integrate Response … OBJECTIVES:  Reduce new infections by 60%  Comprehensive Care, Support and Treatment to all persons living with HIV/AIDS. The targets for NACP IV are being derived from recommendations of working group( 12th April 2011) under chairmanship of Shri Sayan Chatterjee Secretary Department of AIDS Control , analysis of program data and NACP III achievement of targets and projections.
  24. 24. Goal>strategy>5 themes The total budget for the programme works out to be Rs 12,824 crores.
  25. 25. HIV prevention & treatment TI for Migrant National truckers project HIV care & support Blood & safety STI control PPTCT Advocacy Communication & stigma reduction COMPONENT 1 COMPONENT 2
  26. 26. Governance Reference laboratory Capacity building Monitering & evaluation COMPONENT 3
  27. 27. NACP IV envisions to achieve objectives through focus on five cross- cutting themes INTEGRATION INNOVATION LEVERAGING IEC QUALITY HIV CARE , SUPPORT & TREATMENT
  28. 28. The delivery of care and treatment services for people living with HIV/AIDS is provided through a three-tier structure. 1. Centre of Excellence (CoE) & ART Plus Centres 2. ART Centres 3. Link ART Centres & Link ART Plus Centre INNOVATION Increase access and promote programme initiatives through innovations, mechanisms for comprehensive care, support and treatment. ART COELAC PLHIV at ICTCs
  29. 29. ART CENTRES  Medicine Departments of Medical Colleges and District Hospitals.  Based on prevalence of HIV in the region.  Provide free comprehensive services including ART, CD4 testing & drugs required for treatment of Opportunistic Infections.  “306 centres providing freeART to more than 4,12,125 patients in India” 1 ART centre in ward no. 26 , PGIMS, Rohtak,Haryana HOD Medicine-Dr.B.S Gehlaut.
  30. 30. ART centre in Andhra Pradesh
  31. 31. Link ART Centres (LAC)  Main constraints-- Distance, travel time and costs to access ART services and adherence to treatment.  Leads to--Poor drug adherence, lost to follow up and missed cases.  Make -- Accessible and facilitate delivery of ARV drugs, Link ART Centres are established , located at district level hospitals nearer to the patient’s residence.  Located -- Integrated Counseling and Testing Centres (ICTC) which further helped in linkage between ICTC and ART  April 2011-- “612 Link ART Centres facilitate delivery of services nearer to the patients homes”
  32. 32. ART PLUS CENTRES  Patients needed to travel long distance to access the second line treatment. This issue has resulted in low uptake of second line treatment  In View of these, it was decided to expand the number of facilities that can provide second line ART.Previously till 2009 it was given in 2 COE.  For this, some good functioning ART Centres were upgraded & labelled as ‘ART Plus Centres’ NACP IV ---ART Plus Centres have been sanctioned at 13 more ART Centres and shall be further expanded in a need based mannner so as to provide one ART Plus in each state and 4 ‘ART Plus’ in high prevalance states of Karnataka, Andhra Pradesh, Maharashtra and Tamil Nadu.
  33. 33. ART PLUS CENTRES  ART Centre, GMCH, Aurangabad, Maharashtra  ART Centre, GMCH, Nagpur, Maharashtra  ART Centre, Sasoon Hospital & B J Medical College, Pune, Maharashtra  ART Centre, GMCH, Surat, Gujarat  ART Centre, GMCH, Salem, Tamilnadu  ART Centre, KIMS, Hubli, Karnataka  ART Centre, GGH, Vijayawada, Andhra Pradesh  ART Centre, Govt. Medical College, Thrissur, Kerala
  34. 34. COE  Their main responsibilities include, provision of second line and alternative first line ART, training, research work and mentoring of ART centres linked to them.  Assessment of patients with suspected treatment failure to first line ART for initiation of second line ART. 1.Maulana Azad Medical College, Delhi 2. Sir Jamshedjee Jejeebhoy Hospital, Mumbai 3. Byramjee Jeejabhoy Hospital, Ahmedabad 4. Post-Graduate Institute of Medical Sciences, Chandigarh 5.Gandhi Hospital, Hyderabad 6. Bowring and Lady Curzon Hospital, Bangalore 7. School of Tropical Medicine, Kolkata 8. Regional Institute of Medical Sciences, Imphal 9. Govt. Hospital of Thoracic Medicine, Tambaram 10. Banaras Hindu University, Varanasi
  35. 35. Community Care Centre(CCC) Critical role in providing treatment, care and support to PLHIV. Linked with ART Centres and ensure that PLHIV are provided (a)counseling for ARV treatment ,preparedness and drug adherence, nutrition and prevention, (b)treatment of Opportunistic Infections (c) referral and outreach services for follow-up (d) social support services. Presently, there are 259 CCC operational across the country. In Haryana , 1 CCC in PGIMS ,Rohtak Project coordinator –Dr.Nahar singh Biswal
  36. 36. ICTC  An integrated counselling and testing centre is a place where a person is counselled and tested for HIV, on his own free will or as advised by a medical provider.  The main functions of an ICTC include: Early detection of HIV. Provision of basic information on modes of transmission and prevention of HIV/AIDS for promoting behavioural change and reducing vulnerability. Link people with other HIV prevention, care and
  37. 37.  Earlier Voluntary Counselling and Testing Centres (VCTCs) and facilities providing Prevention of Parent-to-Child Transmission of HIV/AIDS (PPTCT) services are now remodelled as a hub to deliver integrated services to all clients under one roof and renamed a “Integrated Counselling and Testing Centres” (ICTCs). STAND ALONE ICTCs Full-time counsellor and laboratory technician who undertake HIV counselling and testing. FACILITY INTEGRATED ICTCs Does not have full-time staff and provides HIV counselling and testing as a service along with other services; usually established in facilities that do not have a very large client load and where it is uneconomical to establish a stand-alone ICTC. MOBILE ICTCs Mobile ICTCs is one way of taking a package of health services into the community
  38. 38. PPTCT +
  39. 39.  IEC is done through newspapers, Radio, Televisions, Cable, Hoardings, street plays, posters, pamphlets, booklets, workshops, meetings, functions. eg: “Kalyani Health Magazine” and TV serial “Kyunki Jeena IssiKaa Naam Hai”.  Haryana AIDS Control Society has extended helpline facility from 20 to 64 Help-line numbers. 60 (One for each ICTC) one for ART Centre, one for CCC and one each for DIC.  Out Reach camps are organized on every Saturday by ICTC’s counselors.  In each district Nukkad Natak are performed before the camps.  For creating HIV/AIDS awareness and to promote ICTCs, ART, and CCC services two spots daily are being relayed on Haryana News Channels. IEC Expanding IEC services for (a) general population and (b) High Risk groups with a focus on behaviour change and demand generation.
  40. 40. Programme Title Days Rural Youth 5 Down MohabbatExpress Monday-Tuesday Rural women Babli Boli Wednesday-Thursaday Migrant Youth Kitney Dur Kitney Pass Saturday -Sunday RADIO PROGRAMMES AIRED BY NACO
  41. 41. RED RIBBON EXPRESS  Conceptualized by the Rajiv Gandhi Foundation.  Implemented by NACO in collaboration with the Ministry of Railways,Ministry of Youth Affairs, Nehru Yuva Kendra Sangathan (NYKS), United Nations Children’s Fund (UNICEF) and other stakeholders in NACP III.  Special 7 bogey train supplemented by two exhibition buses, folk troupes and cycle caravans assembled to create greater impact and wider reach.  The RRE with message, “One Train, One Message, uniting India against AIDS” is theworld’s largest mass mobilisation campaign against HIV/AIDS.  The 3rd round of RRE has started its journey from Delhi on January 12, 2012 & is presently stationed in Guwahati
  42. 42. Description RRE-II (2009-10) RRE-I (2007-08) People reached (includes visitors to the train and outreach activities in villages) 80 lakh ( 19 lakh people visited the train exhibition while 61 lakh were covered through outreach activities) 62 Lakh ( 12 lakh people visited the train exhibition, 40 lakh were covered through outreach) District Resource Persons trained 81,000 68,000 People tested for HIV 36,000 14000
  43. 43. INTEGRATION  Education - Secondary and Primary (on a cost-sharing basis, IEC programmes in private schools through leverage model)  Health (use of parallel policies in other programmes of the health department to supplement NACO/ SACS core activities)  Labour (Involvement of Private Partners for Training)  Panchayati Raj  Railways (Training of Personnel on a cost-sharing basis)  Rural Development (tying-up with Rural Development policies to create a synergy)  Transport (regular check-up in TI projects on a cost- sharing basis)
  44. 44. The India HIV/AIDS Alliance (Alliance India) is a part of the International HIV/AIDS Alliance and was established in India in 1999. Its vision is a world in which people do not die of AIDS. The strategic goal of Alliance India is to reduce the spread of HIV . This is achieved through strong internationally linked,national organisations working effectively together Vasavya Mahila Mandali (VMM):Vijayawada, Palmyrah Workers Development Society(pwds) : Madurai MAMTA Health Institute for Mother and Child: New Delhi LEPRA India: Located in Secuderabad
  45. 45. SCHEMES Catagory Scheme Agency Health Insurance scheme Private Sector &Govt. of Rajasthan Transportation Free Transportation Ministry of Surface Transport+private sector Social Security Pension Schemes Ministry of Social Justice and Empowerment. Housing IAY Ministry of Rural Development and Govt. of Orissa, Karnataka Legal Aid State govt. schemes Ministry of Law and Justice Education Scholarships Private sectors & Govt. of Rajasthan,
  46. 46. Achievements  There are 306 fully functional ART Centres against the target of 250 by March 2012  Nearly 12.5 lakh PLHIV are registered and 420000 patients are currently on ART.  612 Link ART centre (LAC) have been established wherein, 26023 PLHIV are taking services  There are 10 Centres of Excellence, 7 Regional Pediatric centres , 259 Community Care Centres across the Country HIV CARE , SUPPORT & TREATMENT
  47. 47. NACP IV  Target for ART in public sector including children : 800,000 including 50,000 children.  Total number of ARTCs : 600 at the end of NACP IV from the present day figure of ~ 300 Centres.  Optimal number of patients per ARTC: 1000-1500.  Monthly dispensing visit for the patients to ARTC during the first year of ART and then once in 3 months for stable patients (asymptomatic and immunologicalresponse to ART)  Every district of the country needs to have either one ARTC or one LACPlus center  LAC and LAC PLUS centers: 1500 LAC and up- gradation of 50% of LACs into LAC Plus centers in high prevalence places in a phased manner
  48. 48. Total 32 Targeted Interventions are being implemented by NGOs supported by HACS: - 8 TIs with FSW population, 3 TIs with IDUs, 2 TIs with MSM. 10 TIs: composite with FSW & MSMs, 9 TIS with Migrants. Planning to upscale 13 more TIs to saturate the 100% High Risk Groups in the State. High Risk Behaviour Populations are chosen for intervention i.e. Men having sex with Men, Female Sex workers, Intravenous Drug Users, Truckers and Migrant.Behaviour change is brought about in these High Risk Populations so that they become less vulnerable to HIV/AIDS. TARGET INTERVENTI ON
  49. 49. TI DEFINITI ON People who move from their place of origin to a town or city Return to their place of origin at least once in 6- 12 months Definition of IDU – Any person injecting drugs at least once in 3 months Physically male person who engage in various types of same sex activities for money &pleasure and who do not like to reveal the identity for fear of being removed fromsociety STATU S & CONCER N 3.5 million of migrants covered under TI Number of migrant TIs are 244 Mapping done in 22 states to detect migration Current interventions reach out to 80% of IDUs as per current definition . Provision for detoxification not available 274000 population covered 150 MSM TI sites present MIGRANTS IDU MSM
  50. 50. TI NA CP IV GO AL To reduce HIV prevalence from 2.6% to less than 0.5% among migrant population Nothing for us without us. Comprehensive package of services Zero new infections among MSM by 2017 Universal access to care , support & treatment ST RA TE GI C TA RG ET S Increase coverage of migrants from 30% in 2011 to 90% by 2015 Increase consistent condom use among migrants from 25% to over 80% Reduce curable STI incidence among migrants and their sexual partners Increase HIV testing from 6 % in 2011 to 50% and ensure 95% of HIV- positive receive treatment and care Existing definition should be broadened from 3 months to ?12 months Model should be holistic and encompass TI as well as linkages and mainstreaming with other departments All A and B districts covered with at least one MSM TI 100% of anal sex acts protected by condoms 30% of MSM to receive services for female partner or spouses 70% of MSM TIs to be transitioned to CBOs
  51. 51. Scaling up targeted interventions under NACP IV Establish denominator Mapping of HRGs conducted for the first time nationally Reconfigure non-core TIs Contracting new TIs Improving quality of TIs •Supervision •Improving MIS •Enhancing referrals
  52. 52. 1995 2000 2005 2010
  53. 53. NACP IV  It is a mandate to strengthen all public health facilities at and above district level as designated STI/RTI clinics, with the aim to have at least one NACO supported clinic per district.  Presently - 1,033 designated STI/RTI clinics which are providing STI/RTI services based on the enhanced syndromic case management. 90 new clinics to be set up.  Strengthen 7 regional STI training, reference and research centres.  Role of these centres is to provide etiologic diagnosis to the STI/RTI cases, validation of syndromic diagnosis, monitoring of drug résistance to gonococci and implementation of quality control for Syphilis testing.  Safdarjung Hospital acts as the Apex Centre in the country. STI CLINICS
  54. 54. BLOOD BANK NACP IV  National blood transfusion(NBTA) to be set up as an autonomous body.  Establishment of Centre of Excellence in Transfusion Medicine in four metro cities of Delhi, Kolkata, Mumbai and Chennai.  Approval for setting up of one Plasma Fractionation Centre has been obtained, for processing of 1.5 lakh litres of plasma annually. Land for this purpose has been provided at Chennai.  Achieve 90% of the annual requirement of blood by voluntary donation.Presently -79.2%  80% of blood collected to be converted to components for appropiate use.Presently - 155 BCSU with 52% conversion  Standardisation of testing protocol & reagents /kits in use.  Establish blood storage centres in community care centres.  Provide refrigerated vans in 500 districts for networking with blood storage centres.
  55. 55.  Increase condom use during sex with non-regular partner, which is the key to limiting HIV spread through sexual route.  Increase the number of condoms distributed by social marketing programmes.  Increase the number of free condoms distributed through STI and STD clinics, reaching those who are at the highest risk of acquiring or transmitting HIV.  Increase access to condoms, especially to men who have sex with non-regular partners.  Increase the number of non-traditional outlets for socially marketed condoms, e.g., paan shops, lodges, etc. in strategically located hotspots CONDOMS NACP IV Condom promotion continues to be an important prevention strategy.
  56. 56. One of the achievements of NACP is a credible HIV sentinel surveillance system.Information gathered through HIV sentinel surveillance, AIDS case surveillance, Behavioural sentinel surveillance and STD surveillance helps in tracking the epidemic & provides the direction to the programme. MONITER & EVALUATION
  57. 57. SMIS-Strategic information management system The SMIS is a decentralized data collection system using pre- programmed excel files input format from primary data generation units (PDGU).Data entry occurs at the SACS and is forwarded to NACO, where a centralized comprehensive database is maintained.This allows data analysis by program managers, necessary for management.
  58. 58. CMIS REPORTING Devel pome nt of CMIS CMIS installe d in all SACS/ MACS (4.5) 5 regional worksho p organize d to review theCMIS NACO outsour ced the mainte nance of CMIS Installation and training for NACO on new version of CMIS Updation of CMIS (5.5) All SACS started reportin g through CMIS Updation of CMIS (5.6) 2001 2002 2003 2004 2005 2006 2007 Source: NACO summary presentation of CMIS
  59. 59. Programme components Target NACP III Achieved till 2011 Target NACP IV Targeted Interventions among High Risk Groups FSW 8,68,000 709,000 1,000,000 MSM 4,12,000 379,000 445,000 IDU 1,77,000 155,000 180,000 Number of TIs 2,100 1,741 1,800 Truckers 20,00,000 1,480,000 1,600,000 High Risk Migrants 42,00,000 3,670,000 5,600,000 Population accessing ICTCs 22,000,000 15,800,000 28,000,000 Pregnants tested under PPTCT 7,200,000 6800000 14,000,000 ICTC centers established 5,000 8,258 14619 No. adults with STI symptoms accessing syndromic management 150,00,000 1,00,20,000 170,00,000
  60. 60. No of(BCSUs) 162 155 Workin progress No. of Blood Banks 1,177 1,127 1,500 No. of Blood Storage Units (BSU) 3,222 685 2,537 Units of safe blood available for transfusion 10,000,000 8,010,000 12,000,000 Percentage of Voluntary blood donation 90% 78% 90% No. of condoms distributed (Free + Social + Commercial) 3,500,000,00 0 2,694,000,00 0 3,114,000,0 00 PLHIV requiring ART 340000 426,000 800,000 Children requiring First Line ART 40,000 31,391 50,000 Report of the working group on AIDS control for the 12th five year plan
  61. 61. HARYANA REPORT Blood Safety:- At present there are 56 licensed blood banks in the state of Haryana. 16 in Govt. Sector, one in Red Cross at Panipat, 2 in military Hospitals, 37 in Private sector. STD Clinics: 24 STD clinics have been set up in Haryana i.e. 3 in Medical Colleges, 20 in District Hospitals and one in CHC Bahadurgarh (Jhajjar). STD drugs are given free of cost at all STD Clinics. Target Intervention Programmes:- Total 32 Targeted Interventions are being implemented by NGOs supported by HACS: - 8 TIs with FSW population, 3 TIs with IDUs, 2 TIs with MSM. 10 TIs: composite with FSW & MSMs, 9 TIS with Migrants. Planning to upscale 13 more TIs to saturate the 100% High Risk Groups in the State. Integrated Counselling and Testing Centers (ICTCs):- 84 ICTCs have been established in the State of Haryana (4 in Medical Colleges, 20 in District Hospitals and 60 in CHCs and Sub-district hospitals). Anti-Retroviral Centre (ART): An ART center was set up in PGIMS, Rohtak in July 2006. A CD4 Count machine has been installed at this center.
  62. 62. Community Care Center (CCC):- A Community Care Center was established at District Yamunanager in 2005 and was later shifted to District Rohtak in February 2007. This CCC is a 10 bedded indoor facility for HIV positive patients. Total HIV positive Patients registered at CCC upto December are 936. Drop-in-Center: Two Drop-in Centers have been established, one at Gurgaon and one at Hisar. Sentinel Surveillance: Since 1998 Surveillance is carried out every year to determine the estimates of HIV positive people in the State of Haryana. The Sentinel Surveillance report of 2008 estimated the HIV positive at 42,000 in Haryana. In the year 2007-08, 30 sentinel surveillance sites were established and samples collected both from general population and high risk groups. Monitoring & Evaluation: For detailed reporting and monitoring of the project implementation, a computerized management Information System (CMIS) has been
  63. 63. Haryana Financial Commissioner and Principal Secretary, Department of Health, Navraj Sandhu said that a new Sexually Transmitted Infection Clinic at BPS Medical College for Women at Khanpur Kalan in Sonepat would also be opened. She said that seven new targeted intervention projects, including two for truckers and five for migrants, and three new OPIOID substitution therapy centres at Panipat, Faridabad and Jhajjar would be made functional in 2012-13. She said, “With a view to bringing the treatment to the doorsteps of HIV/AIDS patients, six new Link Anti Retroviral Treatment Centres would be set up at Fatehabad, Panipat, Kurukshetra, Yamunanagar, Gurgaon and Faridabad, raising the number to 18.”
  64. 64. Adolescence Education Programme (AEP) Red Ribbon Clubs in colleges (RRC) Progammes for Out-of-School youth through Link workers Nehru Yuvak Kendra Sangathan Youth Clubs National Service Scheme (NSS) Multi-media campaign focussing on youth in North- Eastern India. YOUNG PEOPLE Under NACP-III following efforts were made for prevention of HIV/AIDS among youth aimed at providing adolescents with age appropriate information on the process of growing up during adolescence, HIV/AIDS, STIs and substance abuse.NACP IV aims at upgrading & strengthening them.
  65. 65.  Early diagnosis and treatment for HIV exposed children  Guidelines on paediatric HIV care for each level of the health system  Special training to counsellors for counselling HIV positive children;  Linkages with social sector programmes for accessing social support for infected  Outreach and transportation subsidy to facilitate ART and follow up,  Nutritional, educational, recreational and skill development support; and  By establishing and enforcing minimum standards of care and protection in institutional, foster care and community-based care systems The Balsahyoga & CHAHA programs in 4 states since last 5 years.Others include the Samastha & the Jatan projects in Gujrat for orphans CHILDREN Looking at the current trend of mortality among children i.e. an estimated 50% of HIVpositive children die undiagnosed before the age of 24 months. NACP IV has set up policies for:
  66. 66. EVALUATION OF ANTIRETROVIRAL THERAPY (ART) SERVICES IN HARYANA Dr.Mukesh Nagar  The study was undertaken at ART centre in Pt BD Sharma PGIMS, Rohtak, Haryana. The objectives of study were (1) to evaluate ART services in Haryana (2) to determine patient adherence to ART and associated factors (3) to assess the level of client satisfaction and perceived quality of life  A cross-sectional descriptive study design. A total of 400 HIV patients on ART were interviewed.  Out of total 400 clients, 226 (56.5%) were males and 174 (43.5%) females.  (83%) of respondents were from rural background and 61% of respondents were having nuclear family.  According to WHO staging, more than half of patients (51%) were in stage II, about one third (33.8% )in stage III while only 12% in stage I at the start of ART, whereas at the time of interview majority (56%) were in stage I followed by stage II (31.8%).  At the time of starting ART most of the patients (65%) were having CD4 count less than 200/mm3 while at the time of interview about three fourth of patients (76.5%) having CD4 count more than 200.  (96.3%) of the respondents had disclosed their HIV status to someone else. Majority of patients had disclosed their HIV status to Spouse (61.3%), Parents (49.5%) and/or Brother/Sister (43.5%).
  67. 67.  Satisfaction level was more in clients with longer duration of ART whereas it was reduced in highly educated as compared to those educated upto primary and secondary level.  Most of the study subjects (89.2%) were informed about ART centre by Health professional followed by relatives (5.5%) and friends (3.3%).  About two third of respondents (63%) had to travel more than two hours in arriving at ART centre. About one fourth of the clients had to spend more than Rs 200 per visit.  Considering 95% adherence requirement, 306 (76.5%) of the respondents adhered to their medication and the rest 94 (23.5%) didn‟t adhere to medication in last seven days.  Among those who missed taking their dose 32 (27.6%) attribute their reason to being away from home while 25
  68. 68. RECOMENDATIONS  ART drug supply needs to be streamlined to ensure uninterrupted supply to patients at regular intervals. Drugs for management of opportunistic infections (OIs) also need to be provided  Prescriptions of costly vitamins and nutritional supplements etc. from market need to be discouraged and some provision of such micronutrients if needed be made in the programme itself.  The specialists of various disciplines need to be sensitised to address the needs of the HIV patients properly as at times they have to face a lot of problems in getting their opportunistic infections and other problems treated.  To minimize stigma,need to intensify health education campaigns against stigma and promote family and community support for people living with HIV and AIDS.  Counselling needs to be given more priority and importance and adequate space for privacy etc. be provided.
  69. 69. Red, like love, as a symbol of passion and tolerance towards those affected. Red, like blood, representing the pain caused by the many people that died of AIDS. Red, like the anger about the helplessness by which we are facing a disease for which there is still no chance for a cure. Red as a sign of warning not to carelessly ignore one of the biggest problems of our time."to carelessly ignore one of the biggest problems of our time."
  70. 70. REFERENCES  Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). AIDS epidemic update: December 2009 [document on the Internet]. Geneva: UNAIDS; 2009 [cited 2011 Dec 11]. Available from: http://data.unaids.org/pub/Report/2009/JC1700_Epi_Update_2009_ en.pdf  National AIDS Control Organization, Ministry of Health & Family Welfare,Government of India. HIV/AIDS epidemiological surveillance & estimation report for the year 2005, 2005. Available at:http://www.nacoonline.org  National AIDS Control Organization, Ministry of Health & Family Welfare,Government of India. Annual Report 2002-2003, 2003- 2004. Available at:http://www.nacoonline.org.  National AIDS Control Organization, Ministry of Health & Family Welfare,Government of India. HIV estimates-2004. Available at:http://www.nacoonline.org/facts_hivestimates04.htm  National AIDS Control Organization. National baseline general population behavioral surveillance survey-2007. Available at:http://www.nacoonline.org
  71. 71.  National AIDS Control Organization. National baseline high risk group and bridge population behavioral surveillance survey-2007 Part II- (MSM and IDUs).  Bhattacharya M, National AIDS Control Organization. Annual Sentinel Surveillance for HIV infection in India, 2005: A country report: status of HIV Infection in the country.  National AIDS Control Organization, Ministry of Health & Family Welfare,Government of India. Handbook of Indicators for Monitoring National AIDS Control Programme- II, 2006.  National AIDS Control Organization. National baseline high risk group and bridge population behavioral surveillance survey-2008 Part I- (FSW and their clients).  WHO 2012, Health topics, HIV/AIDS. World Health Organisation. [homepage on the Internet] [cited 2012
  72. 72. THANK YOU

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