STD control programme

1. NATIONAL STD
CONTROL
PROGRAMME

2. INTRODUCTION• The National SexuallyTransmitted Diseases Control
Programme ( NSTDsCP) WAS STARTED IN 1946, prior to
establishment of independent India, which was in
operation until 1991.
• The programme focused on the health seeking behavior
of individuals with STDs and on combating social stigma
associated with these infections.
• With the emergence of HIV epidemic, the National STD
Control Programme was made on integral part of the
National AIDS Control Programme in 1992.

3. FROM 1946 TO
1991In 1949 – Pilot project for control of venereal disease.
In 1955 - Establishment of at least onVD clinics in every district and
one clinic and laboratory in every state.
In 1957 - A centralVD organization was set up in the Directorate
general of Health Services, New Delhi, for implementing and
coordinating the programme in the country.
Like :-
Free supply of penicillin andVenereal Disease and Research
Laboratory (VDRL) antigen were made available to theVD clinics.
Since 1981, the strategy of the programme has been changed.The
centrally sponsored component of supply of drugs to the state has
been discontinued and focus has been on training, teaching and
research on various aspects of STD.

4. • To provide training facilities to the in-service medical and
paramedical personnel in venereology, the government in running
two training centers, namely, the institute for Study of SID, Madras
Medical College, MADRAS, and STDTraining and Demonstration
Centre, Safdarjung Hospital, New Delhi.
• A regional training centre is being established at Kolkata for the
eastern zone. A regional reference laboratory has been functioning
at the office of the serologist and the chemical examiner to the
government.
• The scheme was converted into a centrally sponsored scheme
during the fourth five year plan and the central government
assistance was limited to:-
–Giving grant-in-aid for establishing new STD clinics.
–Supplying of drugs (Benzathine Benzyl Penicillin) to the STD clinics.

5. • The scheme was again reviewed and during sixth and
seventh five year plan it was decided to establish five
regional STD training, teaching and research centres at
Delhi, Madras, Nagpur, Hyderabad and Calcutta.
• Recognizing STD as one of the major factors for
transmission of HIV infection the programme has been
merged with the AIDS control programme.
The existing components of the programme viz.
teaching, training, research and epidemiology, however
have been retained outside the world bank assisted
activities of the National AIDS control programme.

6. OBJECTIVES
•Reduce the STD cases and there by control of
HIV transmission by minimizing the risk factors.
•Prevent the short term as well as long term
morbidity and mortality due to STD.

7. STRATEGIES
• Development of adequate and effective programme management.
• Prevention of the transmission of STD/HIV infection through IEC and
promotion of safer sexual behavior by the use of condoms.
• Adequate and comprehensive case management including diagnosis,
treatment, individual counseling, partner notification and screening
for other disease.
• Increasing access to health care for STD by strengthening existing
facilities and creating new facilities.
• Early diagnosis and treatment of mostly asymptomatic infections
through case finding and screening.
• The main strategy aimed at achieving the above outlined has been to
integrate STD services into the existing health care system (public &
private) with a special emphasis on integration at primary health care
(PHC) level.

8. ACTION /
ACTIVITIES• Training of health care workers in both public and private
sectors in comprehensive STD case management.
• Development of appropriate laboratory service for the
diagnosis of STD.
• Conduct microbiologist, social behavioral and operation
research.
• Surveillance to assess the epidemiology situation, and
monitor and evaluate on going STD control programme.
• One of the major actions taken along the lines suggested
in the strategies was strengthening the existing facilities
and structure of STD clinics.

9. CONTROL OF
STDs• The aim of the STD control programme is the prevention of ill-
health through various interventions.
These interventions
may have
Primary
prevention
focus
Secondary
prevention
focus
Usually a
combination
of the two.
The prevention of
infection
Minimizing the
adverse health effects
of infection

10. The control of STD may be
considered under the
following heads -
•Initial planning
•Intervention strategies
•Support components
•Monitoring and evaluation

11. INITIAL PLANNING
• Control programmes have to be designed to meet the
unique needs of each country and to be in line with that
country's health care system, its resources and priorities.
• This requires initial planning which comprises the
following steps :-
• Problem definition
• Establishment priorities
• Setting objectives
• Considering strategies

12. INTERVENTION
STRATEGIES
• Case detection ( Screening, Contact tracing and C luster
testing)
• Case holding and treatment
• Epidemiological treatment
• Personal prophylaxis
• Health education

13. SUPPORT
COMPONENTS
•STD clinics
•Laboratory services
•Primary health care
•Information system
•Legislation
•Social welfare measures
MONITORING AND
EVALUATION

14. STDCP NACP
• In 1992, with the emergence of HIV epidemic, the
National STD Control Programme was made on integral
part of the National AIDS Control Programme.
• As perWHO estimate around 10% of all adults are
infected with curable STI each year.
• The department of NACP coordinates RTI and STD at all
levels of the health care : Free standardized STI/RTI
Services provided through 1160 clinics situated at
government health care facilities, at district hospital
level, and above.These clinics named as “ Suraksha
Clinics” provide sexual and reproductive services.

15. FACILITIES IN SURAKSHA
CLINICS
• Standardized training to the medical and paramedical
personnel based on syndromic care management
approach.
• Counseling services from trained counselor in Suraksha
Clinics.
• Color coded syndromic drug kits are being centrally
procured and supplied to these clinics.

16. PRE- PACKED STI / RTI COLOUR CODED KITS : pre- packed color
coded STI/ RTI kits have been provided for free supply to all
designated STI/ RTI clinics.These kits are being procured centrally
and supplied to all State AIDS Control societies.
The color code is as follows :
• KIT 1 – grey, for urethral discharge, ano-rectal discharge and cervicitis.
• KIT2 –green, for vaginitis.
• KIT 3 – white, for genital ulcers.
• KIT 4 – blue, for genital ulcers.
• KIT 5 – red, for genital ulcers.
• KIT 6 – yellow, for lower abdominal pain.
• KIT 7 – black, for inguinal bubo.

17. Kit
number
Syndrome Color Content
1 UD, ARD, Cervicitis Grey Tab. Aazithromycin (1g) 1 stat
Tab. Cefexine 400 mg 1 stat
2 Vaginitis Green Tab. Secnidazole 2 g (1) stat
Cap. Fluconazole 150mg (1) stat.
3 Genito ulcerative
disease (GUD)- non
herpetic
White Benzathine
Penicillin (2.4 MU)- 1 vial
Tab. Azithromycin (1g) single dose
4 GUD – non herpetic
For patients allergic to
penicillin
Blue Doxcycline 100mg BD×15days
Azithromycin 1g (single dose)
5 GUD –non herpetic Red Tab. Acyclovir 400mTDS for 7 days
6 Lower abdominal pain
(LAP)
Yellow Tab. Cefexime 400m OD stat
Tab. Metronidazole BD for 14 days
Deoxcycline 100m BD for 14 days
7 Inguinal Bubo Black Tab. Azithromycin 1g OD stat
Tab. Doxcycline 100m BD for 21 days

19. Requirements to manage
STIs
•Accurate diagnosis
•Treatment at first encounter
•Rapid cure with effective drugs
•Condom promotion
•Partner notification
•Education / counseling

20. Essential Steps in STI
Management
•Contact tracing
•Compliance
•Confidentiality
•Condom use
•Counseling

21. INFORMATION, EDUCATION &
COMMUNICATION ACTIVITIES
– NACP -4
• To raise or create awareness.
• To improve knowledge and understanding.
• Routes of transmission & method of prevention.
• To promotes desirable practice .
• To mobilize all sector of society to integrate message &
programme on AIDS in their existing activities.
• To generate demand for care, support and treatment services
• To make appropriate changes in societal norms.

22. Adolescence Education
Program• This program is mainly conducted with the objectives of
building life skills in adolescents to prepare them cope
with physical and psychological changes that
accompanies while growing up.
Red Ribbon Club Activities
• To encourage peer to peer message on HIV prevention.
• To provide safe space for young people to clarify their
doubts on HIV / AIDS.
• Promotion of blood donation among youth.
• Conduction of blood donation.

23. ACHIEVEMENTS
• As on July 1993, the regional STD centres have trained as
many as 98 medical officers and 112 paramedical
personnel.
• About 56 medical colleges, hospitals, laboratories, public
health laboratories had participated.
• Regional STD five trained centers launched and under
these 274 medical officers were trained.

24. THANK
YOU