HIV-AIDS-Prevention & Control


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National AIDS Control Program has achieved a tremendously since its inception in 1992 under name of National AIDS Control Organisation.

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HIV-AIDS-Prevention & Control

  1. 1.  HIV (Human Immunodeficiency Virus) infects cells of the immune system and destroys or impairs their function. HIV Infection progressive deterioration of the immune system breaking down the bodys ability to fight out infections & diseases by opportunistic bacteria, viruses and fungi. AIDS (Acquired Immune Deficiency Syndrome) refers to the most advanced stages of HIV infection and a collection of signs and symptoms caused by more than 20 opportunistic infections or related cancers.
  2. 2. CD4 facts What CD4 cells do? CD4 cells/T-cells/T-helper cells : Organize the immune system’s response to bacterial, fungal and viral infections. CD4 cell counts in people without HIV: HIV-negative man : 400-1600/ml of blood HIV-negative women : 500-1700/ml of blood. Menstruation: Women’s CD4 cell counts go up and down during the menstrual cycle. OCP: Oral contraceptives lowers woman’s CD4 cell count. Smoking: Smokers tend to have higher CD4 cell counts (by about 140). Sleep: A lower CD4 cell count in the early morning which rises in the afternoon.
  3. 3. Modes of Transmission  Vaginal, oral or anal sex with an infected person.  Transfusion of infected blood.  Sharing unclean needles or syringes to take drugs.  Unsterilized needles for tattooing, skin piercing or acupuncture .  From mother to baby in uterus during Pregnancy, childbirth (vertical transmission) or through breastfeeding.  occupational exposure in health care settings.
  4. 4.  33 million people live with HIV/AIDS worldwide, the vast majority of whom are in low & middle-income countries. An estimated 2.7 million people were newly infected with the virus in 2007.
  5. 5. Fact 4  HIV/AIDS is the world’s leading infectious killer.  Claiming—to date—more than 25 million lives.  2 million people die every year from HIV/AIDS (TB deaths: 1.7million).
  6. 6. Disease Burden World Population:7124 million People Living with HIV/AIDS(PLHA): 33 million(Prevalence rate -0.46%) Sub-Saharan Africa remained the most heavily affected by HIV, accounting for 68% of all people living with HIV and for 76% of AIDS deaths 2.7 million new infections every year. India Population: 1210 million(2011). PLHA: 2.4 million(2009:Prevalence Rate-0.36%) . India had approximately 1.2 lakh new HIV infections in 2009, as against 2.7 lakh in 2000. India is 2nd to South Africa in absolute number of HIV cases.
  7. 7. Adults and Children Estimated to Be Living with HIV, 2007 (UNAIDS, 2007 @ Western & Eastern Europe Central Europe & Central AsiaNorth America 730 000 1.5 million East Asia 1.2 million [580 000 – 1.0 million] [1.1 – 1.9 million] 740 000[760 000 – 2.0 million] [480 000 – 1.1 million] Middle East & North Caribbean Africa South & South-East 230 000 380 000 Asia [210 000 – 270 000] [280 000 – 510 000] 4.2 million [3.5 – 5.3 million] Latin America Sub-Saharan Africa Oceania 1.7 million 22.0 million [1.5 – 2.1 million] [20.5 – 23.6 million] 74 000 [66 000 – 93 000] Total: 33 million (30 – 36 million)
  8. 8.  Combination antiretroviral therapy (ART) prevents the HIV virus from multiplying in the body. If the reproduction of the HIV virus stops, then the bodys immune cells are able to live longer and provide the body with protection from infections.
  9. 9.  About 4 million HIV-positive people had access to antiretroviral therapy (ART) in low- and middle- income countries in 2008. This is a 36% increase in treatment coverage compared to 2007 and a 10-fold increase over 5 years. Global coverage of ART is still low, reaching only 42% of the estimated 9.5 million people who need it.
  10. 10.  More than 2 million children are living with HIV/AIDS, according to 2007 figures. Most of the children live in sub-Saharan Africa & were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. 1000 children become newly infected with HIV each day. The number of children receiving ART increased from about 75,000 in 2005 to 2,76,000 in 2008.
  11. 11.  Mother-to-child-transmission is almost entirely avoidable,. Access to preventive interventions remains low in most developing low- & middle-income countries. However, progress has been made. In 2008, 45% of pregnant women living with HIV received antiretrovirals to prevent mother-to-child transmission of the virus, up from 10% in 2004.
  12. 12.  In 2007, more than 4,50,000 deaths from tuberculosis occurred among people living with HIV. This is equal to nearly a quarter of the estimated 2 million deaths from HIV in that year. Majority of people living with both HIV & TB reside in sub- Saharan Africa (about 80% of cases worldwide), of whom around 1 quarter are in South Africa.
  13. 13. Some key ways to prevent HIV transmission: Abstaining from high risk sex or practice of safe sex behaviors like using condoms. Getting tested & treated for sexually transmitted infections, including HIV. Avoiding injecting drugs, or if someone does, should always use new & disposable needles & syringes. Ensuring Safe Blood: Any blood or blood products that some one might need are tested for HIV.
  14. 14. Clades (viral subtypes) of HIV (Harrison’s Principles of Internal Medicine, 17th edition, 2008) HIV has genetic diversity and varies in different geographic regions HIV: 3 strains: M, N, 0 (M responsible for most infections worldwide) Main subtype in North America is subtype B Subtype C is most common worldwide AE, AG, AB are circulating recombinant forms (CRF) greatest diversity occurs in sub-Saharan Africa A key concern for AIDS vaccine researchers is the tremendous genetic diversity of HIV
  15. 15. History of the Disease: African green monkeys to Human injecting blood of green monkeys Haiti Carribean countries USA Whole world.1981 in Los Angeles : Cases of Kaposi sarcoma andP. jiroveci pneumonia in young homosexual males and IV drug abusers.1986 Chennai- first HIV positive case detected.1987 Mumbai - first AIDS patient detected.
  16. 16. Life cycle of HIV (AIDSInfo)1. Binding and fusion2. Reverse transcription3. Integration4. Transcription5. Assembly6. Budding
  17. 17. Modes of transmission: U.S. statistics for 2006 (U.S. Center for Disease Control, CDC, 2008 ) Men who have sex with men (MSM)  Unprotected sex among MSM main mode of transmission in the US and Canada.  HIV incidence has been increasing steadily since the early 1990s. Injection drug use (IDU)  HIV incidence has declined dramatically over last ~15 years Heterosexual intercourse  number of new infections in this population fluctuated somewhat in 1990s and has declined in recent years
  18. 18. Transmission modes of HIV in India Perinatal 5.4%, Blood & Blood Products 1% Homosexuals 1.5% , IDU 1.6%, Others 3.4% Sexual 87.1%
  19. 19. Key populations at risk of HIV: Heterosexuals (developing countries) Men who have sex with men (MSM in developed countries)/Bisexuals. Injection drug users (IDU). Commercial sex workers (CSW), Migrants, Truck drivers. Newborns of infected mothers. Prisoners, transfusion recipients, professionals. Sexually transmitted infections (STI) clinic attendees. Adolescents.
  20. 20. A.Predominant Routes B.Effective Route/of transmission Risk of Transmission 1. Sexual contact: 84.53% 1. Blood transfusion: 90-95% 2. Blood and 2. Perinatal: 20-40% Blood products: 3.37% 3. IDUs : 3.36% 3. Sexual intercourse: 0.1-1.0% 4. Perinatal transmission : 2.14% 5. Others : 6.7% 4. Mucous membrane: 0.09%
  21. 21. HIV is NOT transmitted by• Coughing, sneezing • Public baths• Insect bites • Handshakes • Work or school contact• Touching, hugging • Using telephones• Water, food • Sharing cups, glasses,• Kissing plates, or other utensils
  22. 22. Agent HIV: Family Retroviridae, A lenti virus.
  23. 23. Clinical Spectrum of HIV/AIDS Initial Infection: Acute Retroviral Syndrome Asymptomatic(2-6 weeks upto 36 weeks) 50% have symptoms of acute viral fever like- fever, rash, joint pain, sore throat, diarrhea, swollen lymph nodes. HIV antibodies: not detectable. Window Period but viral multiplication present. Patient is highly infective.
  24. 24. Clinical Spectrum of HIV/AIDS Asymptomatic Carrier State: (Clinical Stage I) Early Asymptomatic Disease(CD4 count>500/ml) & no overt signs. Progressive deterioration in immune system. Some remain Asymptomatic & don’t seek T/t(5-7 years). Signs & symptoms of Persistent Generalised Lymphadenopathy(PGL) HIV antigen & antibodies: Both detectable. Patient is highly infective.
  25. 25. Clinical Spectrum of HIV/AIDS AIDS Related Complex(ARC) State: (Clinical Stage II) Intermediate HIV Infection(CD4 count: 200-500/ml) No Opportunistic Infection. Early signs & symptoms of Recurrent Oral Ulcers, Moderate weight loss(<10% of body weight), Recurrent RTI(Sinusitis, Pharyngitis, Tonsilitis, Otitis Media) Herpes zoster infection, Seborrhoic Dermatitis/pruritus. Herpes zoster Angular Chelitis Pulmonary tuberculosis.
  26. 26. Clinical Spectrum of HIV/AIDS AIDS State: Late Stage HIV Disease/(Clinical Stage III) Signs & symptoms of Opportunistic Infections(CD4 count: 50-200/ml) Unexplained Intermittent/Persistent fever, night sweat, Unexplained chronic diarrhoea (>1 month), Unexplained Severe weight loss(>10% of body weight) Unexplained Anemia, Leucopenia, Thrombocytopenia. Oral Hairy Leukoplakia Severe Infection(empyema, meningitis, pneumonia) OIs: Pneumocystis jeroveci pneumonia, Cerebral Toxoplasmosis, Pulmonary/disseminated Tuberculosis, Cryptococcal Meningitis/ Severe Oropharyngeal Candidiasis.
  27. 27. Clinical Spectrum of HIV/AIDS Advanced State of HIV/AIDS: (Clinical Stage IV) Signs of HIV wasting syndrome(CD4 count:< 50/ml) Neurological manifestations of motor abnormality, cognitive impairement, behavior changes, various types of malabsorption, wasting of muscles. Extra-Pulmonary TB/Milliary TB MAIC infection Kaposi’s Sarcoma/CNS Lymphoma Histoplasmosis Oesophageal Candidiasis(Candidiasis of trachea, bronchi, lungs) Chronic cryptosporidiosis, cryptococcosis, isosporiasis.
  28. 28. Initial Evaluation of the Patient  Full medical and sexual history  Addiction history  History of sexually transmitted diseases (STDs)  History of Blood Transfusion  Immunization history  Previous HIV test  Current state of health including assessment of clinical manifestations of infection  Conditions that may interfere with HIV management (eg. heart disease)  Systems review including other illnesses/ opportunistic infections  Complete physical exam
  29. 29. Opportunistic Infections Associated With AIDS Categories of Opportunistic Infections or Diseases • Bacterial & Mycobacterial • Fungal • Malignancies or cancers • Protozoal • Viral • Neurological conditions
  30. 30. Oppurtunistic infections in HIVCD4+ Lymphocyte count Herpes zoster Oral candidiasis Pneumocystis pneumonia Esophageal candidiasis Mucocutaneous herpes Toxoplasmosis, Cryptococcosis, Coccidioidomycosis Mycobacterium avium complex Cytomegalovirus Cryptosporidiosis time
  31. 31. Herpes zoster
  32. 32. P .jiroveci pneumonia “Ground glass appearance”
  33. 33. Diarrhoea in AIDS Microsporidia Giardiasis Isospora belli cryptosporidia
  34. 34. Toxoplasmosis
  35. 35. Oral Candidiasis
  36. 36. Histoplasmosis
  37. 37. Hairy leukoplakia
  38. 38. Herpes Simplex Virus(HSV)
  39. 39. Varicella-Zoster Virus(Shingles)
  40. 40. Human Papilloma Virus (HPV)
  41. 41. Angular cheilitis
  42. 42. Necrotizing Ulcerative Periodontitis(NUP)
  43. 43. Mucomycosis
  44. 44. Apthous ulcers
  45. 45. Kaposi`s Sarcoma
  46. 46. Non-Hodgkin’s Lymphoma
  47. 47. Course of HIV Disease (Untreated Infection)
  48. 48. HIV Counseling Three time testing of blood to know the HIV status of a person. Tests are available at Integrated Counseling and Testing Center(ICTC). HIV Counseling: Pre-test & Post-test Type. Tremendous social, physical, mental implication on being +ve. Unethical to do testing without informed consent. Privacy of the patient history is maintained Adequate time is given for counseling.
  49. 49. Post-test Counseling Acceptance of sero-status. Education about risks of transmission/high risk behavior(“NO” to : donate blood, share needle, do unsafe sex, have pregnancy). Prevention of Parent-to-Child Transmission (PPCT). Plan for future orphans/wills. Early management of Opportunistic Infections. Preventive therapy like TB prophylaxis, Contraception etc. Improvement in quality of life by ART. Reference to Social Support.
  50. 50. Diagnosis:ELISA (Enzyme Linked Immunosorbent Assay) screening test for HIV antibodies. false-positive test can occur (low specificity). confirm positive test with Western Blot.Western Blot confirmation test (high specificity). positive ELISA test is always followed by a Western blot. Detects viral core protein p-24 & gp-41.Rapid tests (CDC, 2008)HIV antibody alternate screening tests that produce results within ~20 minutes.FDA-approved tests that use blood or oral fluid, approved since 2002.
  51. 51. Diagnosis: Polymerase Chain Reaction (PCR)/ Viral Assay  Viral load test that measures the amount of HIV-RNA in a person’s blood  Identifies infections during the window period Β2 Microglobulin: >3.5 mg% indicates rapid progression of the disease. Absolute CD4 Count: a Non-specific test but important to assess prognosis of the disease. Window period  The time from HIV infection until a test can detect any change in antibody levels (3-4 weeks); can be up to 3-6 months Reflects recent infection. Person is still highly infectious in this period.
  52. 52. FDA-Approved Rapid HIV Antibody Screening TestsCDC, 2008 OraQuick Rapid HIV-1/2 Antibody Test Reveal G3 Rapid HIV-1 Antibody Test Uni-Gold Recombigen HIV Test Multispot HIV-1/HIV-2 Rapid Test Clearview HIV 1/2 Stat Pak Clearview Complete HIV 1/2
  53. 53. Testing in Pregnancy opt-in testing, person cannot be given an HIV test unless specifically requested. opt-out testing, health care providers must inform pregnant women that an HIV test will be included in the standard group of tests pregnant women receive. A woman will receive that HIV test unless she specifically refuses. The CDC currently recommends that health care providers adopt an opt-out approach to perinatal HIV testing .
  54. 54. Prevention & Control of AIDS: Elimination of Reservoir: By Anti-Retroviral Treatment(ART)/ Highly Active ART(HAART). Treatment is life long but not curative but supportive.  Reduce HIV-related morbidity and Improve quality of life & delay onset of AIDS.  Maximally suppress viral load (HIV-RNA) & Restore and preserve immunological functions.  Prevent vertical HIV transmission.  Newer regimens are potent, durable, less toxic, and have simplified regimens (simpler regimens improve adherence).  Non-Nucleoside Reverse Transcriptase Inhibitors, Protease Inhibitors, Nucleoside Analogues are being used.
  55. 55. Clinical Guidelines for ART WHO: 2010 Recent guidelines support earlier treatment and recommend that a CD4 count of 350/μL is the lowest count to begin ART(WHO-2010) Symptomatic Asymptomatic CD4 < 350/μL CD4 > 350/μL Individualized treatment ● High viral load (>1,00,000 copies/mL) ● Rapid CD4 decline (>100/μL per yr) ● Hepatitis B or C co-infection ● HIV-associated nephropathy ● Risk factors for non-AIDS diseases (eg. cardiovascular disease) ART recommended
  56. 56. Treatment Nucleoside Reverse Transcriptase Inhibitors (NRTIs)-Zidovudine, Lamivudine, Stavudine, Abacavir . Non-Nucleosides Reverse Transcriptase Inhibitors (NNRTIs)-Etravirine,Efavirenz, Nevaripine, Delaviridine. Protease Inhibitors(PIs)-Indinavir, Ritonavir, Saquinavir. Nucleotide Analogues-Tenofovir, Emtricitabine. Integrase Inhibitors-Raltegravir. Entry/Fusion Inhibitors-Enfuviritide, Celsentri - CCR5 Inhibitor Combination Medications-lamivudine + abacavir, lopinavir + norvir
  57. 57. Challenges to Disease Management Toxicities or adverse effects. Drug interactions. Clinical manifestations related to the drugs and the HIV infection itself. Maintenance of adherence. Threat of drug resistance. Co-morbid conditions. Pregnancy.
  58. 58. Breaking the Chain of Transmission Abstinence from sex. Having a faithful and uninfected sexual partner. Safe Sex Practice: no sex with unknown partner. Use of condoms in sex with a unknown partner. Use of condom between married couple if one of them has multiple partners. Use of condoms by HIV +ve couple.(Gender Disparity) Condom is not fully protective.
  59. 59. Breaking the Chain of Transmission Proper screening of blood, semen, organ donors. Strict Sterilization practice in health care facilities. Discouraging tatooing, sharing of razors, shaving brushes, bathing brushes,nail cutters. Promoting treatment of STDs and use of disposable syringes.
  60. 60. Protection of Susceptibles Everyone is susceptible. No vaccine against HIV is available. HIV/AIDS awareness: “Know HIV, No AIDS”. Standard Universal Precautions prevents cross infection, safeguards care providers and stops Community infection by proper waste management. Use of protective barriers(gloves, aprons, face mask). Post-Exposure Prophylaxis: As early as possible and within 72 hours of exposure.( 2 NNRTIs+1 PIs).
  61. 61. Post-Exposure Prophylaxis Zidovudine-600 mg every day Lamivudine-150 mg twice a day Indinavir-800 mg every 8 hours Nelfinavir-750 mg three times a day
  62. 62. Treatment Recommendations A large number of antiretroviral drugs are now available:  Nucleoside and nucleotide analogues (NRTIs)  Non-nucleoside reverse transcriptase inhibitors (NNRTIs)  Protease inhibitors (PIs) and boosted protease inhibitors (PI/r) CCR5 antagonists  Integrase inhibitors ART for initial therapy in treatment- naïve patients (Hammer et al., 2008)  Two NRTIs plus either efavirenz (NNRTI) or a ritonovir-boosted protease inhibitor (eg. lopinavir/r) ART available for patients with drug-resistant HIV Prophylaxis for some opportunistic infections: Toxo, PCP, TB, MAC
  63. 63. Medical Complications of ART Cardiovascular disease- eg. abacavir Hyperlipidemia- increased triglycerides/cholesterol Hepatotoxicity- liver damage Hyperglycemia and diabetes Lactic acidosis Lipodystrophy Osteonecrosis, osteopenia, osteoporosis- bone disease Skin rash eg. Stevens-Johnson syndrome eg. Toxic epidermal necrolysis Pancreatitis Renal or kidney failure Bleeding events Suppression of bone marrow
  64. 64. WHO’s HIV/AIDS work for the period2006-2010 is structured around fivestrategic directions:
  65. 65. 1. Enabling people to know their statusthrough confidential HIV testing and counseling.2. Maximizing the health sector’s contribution to HIV prevention.3. Accelerating the scale-up of HIV/AIDS treatment and care.4. Strengthening decentralization and expanding health systems.5. Investing in strategic information to guide a more effective response.
  66. 66. NEEDS Continuous surveillance. Awareness programmes. Increased health care allocations. Identification of high risk groups. Access to treatment for all. Removal of stigma and discrimination. Developing appropriate guidelines.
  67. 67. National AIDS Control Program(NACP-India) 1987: NACP was launched. 1992: NACP-I( To slow down spread, NACO-established, NACB- established). 1999: NACP-II( Focus on behavior change, increased decentralization, NGO involvement) 2002: National AIDS control policy and National Blood Policy adopted. 2004: ART started. 2006-20011: NACP-III, National Council on AIDS, National policy for Pediatric ART. 2012-2017: NACP-IV . One of the four fundamental principles of NACP III was to strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programme at district, state and national levels. NACP IV plans to build on the gains of NACP III.
  68. 68. People Living with HIV/AIDS (PLHA) The total number of people living with HIV/AIDS (PLHA) in India is estimated at 24 lakh in 2009. Children (<15 yrs) account for 3.5% of all infections, while 83% are the in age group 15-49 years. Of all HIV infections, 39% (9.3 lakh) are among women. The four high prevalence states of South India (Andhra Pradesh –5 lakh, Maharashtra –4.2 lakh, Karnataka –2.5 lakh, Tamil Nadu – 1.5 lakh) account for 55% of all HIV infections in the country. West Bengal, Gujarat, Bihar and Uttar Pradesh are estimated to have more than 1 lakh PLHA each and together account for another 22% of HIV infections in India. The states of Orissa, Punjab, Rajasthan & Madhya Pradesh have 50,000 –1 lakh HIV infections each and together account for another 12% of HIV infections.
  69. 69. People Living with HIV/AIDS (PLHA) Manipur has the highest estimated adult HIV prevalence of 1.40%, followed by AndhraPradesh(0.90%), Mizoram (0.81%), Nagaland(0.78%), Karnataka(0.63%) and Maharashtra(0.55%). Besides these states, Goa, Chandigarh, Gujarat, Punjab and Tamil Nadu have shown estimated adult HIV prevalence greater than national prevalence (0.31%). while Delhi, Orissa, West Bengal, Chhattisgarh & Puducherry have shown estimated adult HIV prevalence of 0.28-0.30%. Of the 1.2 lakh estimated new infections in 2009, the six high prevalence states account for only 39% of the cases, while the states of Orissa, Bihar, West Bengal, Uttar Pradesh, Rajasthan,Madhya Pradesh and Gujarat account for 41% of new infections.
  70. 70. People Living with HIV/AIDS (PLHA) While adult HIV prevalence among the general population is 0.31%, high-risk groups inevitably, show higher numbers. Among Injecting Drug Users (IDUs): 8.71 %, Men who have Sex with Men (MSM): 5.69 % and Female Sex Workers (FSWs):5.38%.
  71. 71. Categorization of States Group I: High Prevalence States- HIV infection: >1% in antenatal women- Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, Manipur & Nagaland with >5% in High Risk Groups- Gujarat, Goa & Pondicherry.. Group II: Moderate Prevalence States- HIV infection: <1% in antenatal women with >5% in High Risk Groups- Gujarat, Goa & Pondicherry. Group III: Low Prevalence States- HIV infection: <1% in antenatal women with <5% in High Risk Groups- rest of states.
  72. 72. Categorization of Districts(611) A: > 1% prevalence in ANC/PPTCT centre in any site in a district in last 3 years.(163) B: < 1% prevalence in ANC/PPTCT centre in any site in a district in last 3 years with > 5% prevalence among HRG(High Risk Groups- STD/CSW/MSM/IDU).(59) C: < 1% prevalence in ANC/PPTCT centre in any site in a district in last 3 years with < 5% prevalence among HRG(High Risk Groups- STD/CSW/MSM/IDU), with Hot Spots (Migrants, Truckers, Large aggregation of factory workers/tourists etc.): (278) D: < 1% prevalence in ANC/PPTCT centre in any site in a district in last 3 years with < 5% prevalence among HRG(High Risk Groups- STD/CSW/MSM/IDU), without Hot Spots.(111)
  73. 73. Program Priorities-NACP III Protecting 99% of the population of this country who are uninfected . Highest priority for intervention to Sub-population with highest risk of exposure like- CSW, MSM, IDU, long distance truckers, prisoners, migrant/refugees, street children etc. General population with greater need of care like STI patients. Access to prophylaxis and management of OIs, provision of 1st line ARV/ART drugs to patients on priority.
  74. 74. Program Priorities-NACP III Provision of PPTCT services to infected mother and access to pediatric ART to HIV +ve children. Social Rehabilitation through welfare agencies/NGOs providing nutritional support and opportunities for income generation. Investment on Community Care Centres to provide psycho- social support, out-reach services, referrals and palliative care. NACP-III works with women’s group, youth groups and to integrate HIV Awareness and Prevention into their activities.
  75. 75. Program Activities(NACP-III)-Blood Safety Program:  Prohibiting Professional Blood Donation(1st Jan, 1998).  National Blood Safety Policy: testing each unit of blood for HIV, HBV, HCV, Malaria, Syphillis.  Establishment of Blood Storage Centres in the FRUs, Sub- district level.  1103 blood banks, 130 blood component separation units(BCSU), 10 model blood banks.  Supporting governmental and charitable blood banks for procurement of equipments, reagents and test kits.
  76. 76. Program Activities(NACP-III)-Counseling & HIV Testing:  Establishing ICTCs(5135) for non- coercive, confidential, cost effective counseling and testing through information, education and communication(IEC) of clients to motivate behavior change(2006-07).  Identification of an individual with HIV infection on voluntary basis.  VCT is an important entry point for prevention of infection from mother to child, STD treatment, condom promotion HIV care, support & treatment.  To reduce profound emotional, social, behavioral & medical implications by pre post test counseling.
  77. 77. Program Activities(NACP-III)-Prevention of Parent to Child Transmission(PPTCT/MTCT): 15,089 pregnant women are HIV+ve out of 44 lakhs pregnant women tested(0.34% among pregnant women). Antenatal care, Option for MTP/CS, T/t of STD, HIV Staging & CD4 testing, Couple counseling on safe sex, Family Planning services, Nevirapine prophylaxis, ART if needed, refraining from breast feeding. HIV exposed infant: Nevirapine prophylaxis, Early Infant diagnosis using DNA-PCR, PJP prophylaxis, Growth monitoring, Immunization, Nutrition Support, ART
  78. 78. Program Activities(NACP-III)-STD control:  Syndromic management of STIs without referral to higher centres.  STD/STI clinics(Suraksha Clinic) at all levels of care. Drugs, Good quality condoms, counseling services are provided.  916 NACO designated STD clinics, & Regional STI Training, Reference & Research Centre(RSTRRC).  Pre-packed Color Coded STI/STD Kits.
  79. 79. Program Activities(NACP-III)-Targeted Interventions:  Syndromic management of STIs without referral to higher centres.  Addressing most vulnerable groups like CSW/IDU/Truck Drivers/Street Children/migrant laborers / homosexuals etc.  1033 TI projects are running and they provide treatment for STI, IEC activity for behavior change.
  80. 80. Program Activities(NACP-III)-HIV Surveillance:  HIV Sentinel Surveillance, HIV Sero-Surveillance, AIDS Case Surveillance, STD Surveillance, Behavior Surveillance(BSS) and Integrated Surveillance with TB.  Surveillance among General Population, High Risk Groups, Surveillance among special Groups like STD patients.  Understanding of geographical spread of HIV infection, Prioritization of program resources, Evaluation of program impact, Estimation of HIV burden and in the country.  HIV Sentinel Surveillance Round-2008.
  81. 81. Annual Sentinel Surveillance 2005: 750 sentinel sites. 2006: Additional 434 sentinel sites. 1 sentinel site per district.
  82. 82. Program Activities(NACP-III)-Condom Promotion:  Quality Control of Condoms, Social Marketing of Condoms and involving NGOs and private voluntary organisations for activity.  To increase demand for condoms among high risk groups, bridge and general population.  Condom promotion among men/women with non regular sex partners and HIV+ve married couples to prevent unwanted pregnancies.  New initiatives like Condom Vending Machines(CVM) and Female Condoms(FC).
  83. 83. Program Activities(NACP-III)-School AIDS Education Program Module: Learning for Life - To raise awareness among youth, students towards a safe and responsible life style. University Talks AIDS Project: includes college and university students by State AIDS Control Societies(SACS).
  84. 84. Program Activities(NACP-III)-Family Health Awareness Campaign(FHAC): To raise awareness on HIV/AIDS in rural area, slums, vulnerable marginalised population. To make people aware about services available under public sector for Reproductive Tract Infections/STDs. Early detection and prompt treatment of RTI/STDs. To strengthen capacity of medical & paramedical staff to respond HIV/AIDS epidemic. To make aware public about transmission of the disease from infected mother to her baby during pregnancy, delivery and breast feeding.
  85. 85. Red Ribbon Express Project(2007-08) The Red Ribbon Express has Eight coaches equipped with educational material on HIV/AIDS, interactive touch screens and 3D models, PPTCT services in the context of RCH II, HIV-TB co-infection, an LCD projector and platform for folk performances, counseling cabins and two doctors’ cabins for providing counselling and syndromic treatment for STI and RTI cases, an office, dining area and pantry.
  86. 86. Program Activities(NACP-III)-Anti-Retroviral Treatment: Provision of 1st line anti-retroviral drugs at government hospitals at free of cost in high prevalent states as well as others. To make people aware about services available under public sector for Reproductive Tract Infections/STDs. 306 ART centres give T/t to 4,20,540 patients.
  87. 87. Program Activities(NACP-III)-HIV-TB Coordination: Cross referrals of patients between RNTCP & NACP. ProgramActivities(NACP-IV:2012-17)- Here is the Technical Group Guideline Address which can be read online ( tBYHQE*t0HEjZC*hsbmv3L6vnSYOzqBRu*uPN5cF- k59GToSPHB7IAAny0Cdfoe8wONJNqw0lNnWhD5rTEQ ci/7.NACPIVTechnicalWorkingGroupCapacitybuilding1 1052011Final.pdf)
  88. 88. Achievements of NACP in India Declined Adult HIV prevalence :0.41% (2000) to 0.31% (2009). Generating strategic information towards stronger evidence-based programming and result-oriented action. National AIDS Control Organization enforces quality data generation and utilization by scaling up the surveillance system. Over the previous decade technical expertise of national and international organizations validate the data generated by India under 2008-09 round of Surveillance.
  89. 89. Achievements of NACP in India The 2008-09 HIV surveillance identified potential areas where HIV is increasing and supported effectiveness and coverage of current HIV control. “India’s investments in the AIDS response are producing results. India’s success comes from using an evidence-informed and human rights-based approach that is backed by sustained political leadership and civil society engagement. India must now strive to achieve universal access to HIV prevention, treatment, care and support.”
  90. 90. Support People Living with HIV/AIDS.Know HIV, No AIDS