The document provides information about an orientation programme for doctors on the National AIDS Control Programme (NACO) in India. It will take place on December 26-27, 2013 at the Government Thiruvarur Medical College and Hospital in Thiruvarur, India. The programme will provide an overview of the current HIV situation in India, NACO's objectives and approaches, national guidelines for detecting HIV, and NACO's comprehensive HIV care and antiretroviral therapy (ART) services.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
INTRODUCTION
HISTORY OF TUBERCULOSIS
NATIONAL TB CONTROL PROGRAMME
REVISED NATIONAL TB CONTROL PROGRAMME I (RNTCP- I)
DIRECTLY OBSERVED TREATMENT SHORT COURSE (DOTS)
STOP TB STRATEGY
REVISED NATIONAL TB CONTROL PROGRAMME II (RNTCP- II)
BACKGROUND FOR NSP (2012-2017)
NATIONAL STRATEGIC PLAN (2012-2017)
END TB STRATEGY
BURDEN OF TB IN INDIA – 2017
NATIONAL STRATEGIC PLAN (2017-2025)
RECENT ADVANCES IN TB CONTROL
RNTCP guidelines for tuberculosis management: Extended versionRxVichuZ
This presentation is an extension of the already made presentation before, that deals with RNTCP guidelines for some special aspects encountered during tuberculosis management, other than management of individual diagnoses alone.
Have a look!
Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
INTRODUCTION
HISTORY OF TUBERCULOSIS
NATIONAL TB CONTROL PROGRAMME
REVISED NATIONAL TB CONTROL PROGRAMME I (RNTCP- I)
DIRECTLY OBSERVED TREATMENT SHORT COURSE (DOTS)
STOP TB STRATEGY
REVISED NATIONAL TB CONTROL PROGRAMME II (RNTCP- II)
BACKGROUND FOR NSP (2012-2017)
NATIONAL STRATEGIC PLAN (2012-2017)
END TB STRATEGY
BURDEN OF TB IN INDIA – 2017
NATIONAL STRATEGIC PLAN (2017-2025)
RECENT ADVANCES IN TB CONTROL
RNTCP guidelines for tuberculosis management: Extended versionRxVichuZ
This presentation is an extension of the already made presentation before, that deals with RNTCP guidelines for some special aspects encountered during tuberculosis management, other than management of individual diagnoses alone.
Have a look!
Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi...Anil Gupta
We are still using SD NVP prophylaxis even though there is enough evidence that multi-drug regimens are much better. NACO, MoHFW, Govt of India is implementing new PMTCT strategy in Delhi in 2013-14 which will eliminate Pediatric HIV infections in the coming years.The presentation highlights key features of the New PMTCT Strategy of the country.
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
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Sophocles Chanos
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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current hiv situation in india and national aids control programme an overview
1. NACO HCP - ORIENTATION
PROGRAMME FOR DOCTORS
Venue : Government Thiruvarur Medical College
and Hospital, Thiruvarur
Date : 26-12-2013 & 27-12-2013
Resource Persons :
Dr. Asika Beham, M.D., H.O.D. - Microbiology, GTMCH, Thiruvarur
Dr. T.S. Santhi, M.D., H.O.D. – Medicine, GTMCH, Thiruvarur
Dr. A. Annamalai Vadivoo, M.B.B.S., F.H.M., ART Medical Officer, Thiruvarur
2. Current HIV Situation in India
and
National AIDS Control Programme
An Overview
National AIDS Control Programme
3. National AIDS Control Programme
Session Objectives
By the end of the session, we will be able to
Learn current HIV situation in India
Understand NACO’s objectives and approaches to
control HIV India
Know the National guidelines in detecting HIV in adults
and children (including infants)
Discuss NACO’s comprehensive HIV care and initiation
of first line ART in adults & children
Learn the linkages and referral in the National
Programme to retain PLHIV under Care, Support and
Treatment fold
Understand NACO’s efforts to scale up CST services
2
4. Estimated Range
People living with HIV 34.2million 31.8–35.9million
New HIV infections in 2011 2.5million 2.2–2.8million
Deaths due to AIDS in 2011 1.7million 1.6–1.9million
Global estimates for Adults and Children
2011
3National AIDS Control Programme
5. Disease Burden of HIV in India
Provisional estimates place the number of people
living with HIV in India in 2011 at 20.9 lakhs with
an estimated adult HIV prevalence of 0.27 percent
Available evidence on HIV epidemic in India shows
a declining trend at national level
The epidemic is concentrated among high risk group
populations and is heterogeneous in its spread
Heterosexual route of transmission accounts for
87% of HIV cases detected
Source: HIV Estimations,2008-09
National AIDS Control Programme 4
6. Declining Trends of HIV Epidemic in India
Control Programme
Female: 39% of PLHIV; Children: 7% of PLHIV
National AIDS Source: TechnicalReport India HIV Estimates 2012, NACO & NIMS
7. Category NACP-IIIDefinition
A >1%ANC prevalence in any of the sites in
The last 3 years
B
<1%ANC prevalence in all the sites during
Last 3 years with >5% prevalence in any HRG
site(STD/FSW/MSM/IDU)
C
<1%ANC prevalence in all sites during last 3
Years with <5%in all STD clinic attendees or
Any HRG,with known hots pots
D
<1%ANC prevalence in all sites during last 3
Years with <5% in all STD clinic attendees or
Any HRG or poor HIV data with no
Known hot spots
Category NACP-III
A 156
B 39
C 296
D 118
NewDistricts 30
Total 609
National AIDS Control Programme
District-wise Scenario of HIV/AIDS
8. Routes of Transmission of HIV
NACO Annual Report 2009-2010
National AIDS Control Programme 7
9. National AIDS Control Programme
Goal :
Halt and reverse the epidemic in India
Objectives:
Prevention of new infections: Saturate High Risk Group
coverage and scale up of interventions for General
population
Increased proportion of PLHIV receiving care, support
and treatment
Strengthening capacities at district, state and national
levels
National AIDS Control Programme 8
10. •Targeted Interventions for High Risk Groups (FSW, MSM,
IDU, Truckers & Migrants)
•Link Worker Scheme for rural population
•Prevention & Control of Sexually Transmitted Infections
•IEC, Social Mobilization & Mainstreaming
•Condom promotion
•Blood safety
•Counselling & Testing Services (ICTC, PPTCT, HIV/TB)
• First line & second line
ART
• Care &Support Centres
• HIV-TB Coordination
• Focus on PPTCT
• Treatment of
Opportunistic Infections
Prevention is the mainstay
High risk
populations
Low risk
populations
People living with
HIV/AIDS
Care, Support and Treatment
Institutional StrengtheningStrategic Information Management
NACP Strategies
National AIDS Control Programme 9
11. Prevention Strategies
Targeted Interventions for High Risk Groups
(FSW, MSM, IDU, Truckers & Migrants)
Link Worker Scheme for rural population
Prevention & Control of Sexually Transmitted Infections
IEC, Social Mobilisation & Mainstreaming
Condom promotion
Blood safety
Counselling & Testing Services (ICTC, PPTCT, HIV/TB)
National AIDS Control Programme 10
12. Linkages of ICTC: Gateway to HIV Care
STI
Services
Walk-in
Clients
Prevention
Services
Targeted
Interventions
TB
Services
ART Centres
CD4 testing,
Care, support & treatment
Antenatal
Care
Onsite Services: PPTCT, TB/HIV, Basic OI
Management, TB and STI Care, Reproductive
and Child Health, Routine and Emergency
Medical Care
STI and TB Clients,
Pregnant Women, Key
Populations, and
General Populations
Referred
Integrated Counselling and Testing Centres (ICTC):
HIV Counselling and Testing
PLHIV linked to care, support
and treatment services
through referrals to
Referral to home and community based
care
National AIDS Control Programme
13. Integrated Counselling & Testing Centres
Single window service for:
Pre-test counselling before HIV testing
HIV testing and providing results of the test
Post-test counselling to both positive and negative persons
Condom promotion and distribution
Identification for HIV+ pregnant women
Providing prophylaxis for prevention of transmission from mother to
child
Prophylactic (Cotrimoxazole) to HIV exposed children
Education regarding infant feeding
Referral to ART Centre for investigation and treatment
Cross referral between RNTCP and ICTCs
National AIDS Control Programme 12
14. Tests for Diagnosing HIV
Screening Tests: Antibody Tests
Rapid tests
Enzyme linked immunosorbent
assays (ELISA)
Confirmatory/Supplemental Tests
2nd/3 rd Rapid /ELISA tests to
confirm 1st HIV test
Same blood sample is utilised for
performing the tests for identifying
HIV antibodies (Strategy III)
13National AIDS Control Programme
16. Birth
6 weeks 14 weeks
10 weeks 6 months
9 months
12 months
18 months
DNA PCR
DNA PCR for all
HIV exposed
infants
HIV Antibody test followed by
DNA PCR if HIV+
Final confirmatory
Antibody Test for all
HIV exposed infants at
18 months, irrespective
of earlier testing results /
treatment status
All HIV infected and / or symptomatic infants / children
are to be referred to ART centre
Early HIV detection in Infants & Children
Schedule of visits at ICTC
National AIDS Control Programme 15
17. National AIDS Control Programme
Comprehensive HIV Care
The overall goal is to improve the survival and
quality of life of PLHIV with Comprehensive HIV care
To ensure Free Diagnostic services
To provide appropriate pre ART care and Treatment of
Opportunistic Infections
To widen Access to ART:
Standardised combination of ARV therapy
Regular and secured supply of ARV drugs
Emphasis on Treatment adherence
To enhance capacity building and strengthen linkages
and monitoring of care, support & treatment services
Robust Monitoring & Evaluation system
16National AIDS Control Programme
18. Bacterial Viral Fungal Parasites
Tuberculosis Varicella Zoster Candida Toxoplasma
Respiratory
Pathogens:
Streptococcus
H.influenza
Herpes simplex
Pneumocystis
jiroveci(PCP)
Intestinal:
Cryptosporidium
Isospora
Microspora
Intestinal:
Salmonella,
Shigella
Cytomegalovirus Cryptococcus
Giardia
Entamoeba
Human papiloma PenicilliumM. Leishmania
Ebstein BarrVirus
(OralHairyLeukoplakia;
Lymphoma)
Histoplasma
capsulatum
JC Virus(PML)
Common OIs seen in India
National AIDS Control Programme 17
19. CD4cellcountAssociation between OIs & CD4 Count
PCP; Oesophageal Candidiasis;
Mucocutaneous Herpes
Toxoplasmosis; Cryptococcosis;
Cryptosporidiosis;
PML; CMV; MAC
Herpes Zoster
Tuberculosis
Oral Candidiasis
Time
National AIDS Control Programme 18
20. Eligible for ART
ART preparedness counselling, Address verification,
Identification of care giver (family / community
support), CPT (if eligible), Treatment of active OIs,
ART initiation in TB co-infected
Enrolled in ART Enrolment Register
Enrolment in HIV care (New patients)
Detected HIV Positive at ICTC
• Enrolment in HIV Care at ART Centre / LAC plus Filling up of HIV Care Register,
White card, Green book
• Counselling, Screening for OIs (including TB), STIs and other co-infections
• WHO staging, initial work up (Baseline investigations)
Patient revisits when reports of investigations (including CD4) are available
Not eligible as per ART Guidelines
Continued in Pre-ART Care
National AIDS Control Programme
21. Based on WHO Clinical Staging and CD4 Count
WHO
Clinical Staging
CD4 (cells/cu.mm)
I and II Treat if CD4 Count <350
III and IV Treat irrespective of CD4 Count
Initiation of ART
in Adults and Adolescents
National Guidelines, 2011
National AIDS Control Programme 20
22. Type of
Tuberculosis
Eligible
Clinical Staging
And CD4 Counts
Timing of ART
In relation to start of
TB treatment
Pulmonary TB
(StageIII)
Start ART
Irrespective of
Any clinical
stage
or
Irrespective of
CD4 counts
Start ATT first;
Start ART as soon as
TB treatment is
tolerated
(after 2 weeks &
Before 2 months)
Extrapulmonary TB
(StageIV)
Initiation of ART
in PLHIV with TB Co-infection
21National AIDS Control Programme
23. Co-infection
WHO
Clinical
Staging
CD4(cells/cu.mm)
HIV-HBV or HIV-HCV
co-infection without any
Evidence of chronic active
Hepatitis
I and II
Start ART at CD4 Count
<350
III & IV
Start ART irrespective
Of CD4 Count
HIV-HBVorHIV-HCV
co-infection with documented
Evidence of chronic active
Hepatitis
All Clinical
stages
Start ART Irrespective
Of any CD4 count
Preferred regimen for PLHIV with HBVorHCVco-infection:
Tenofovir+Lamivudine+Efavirenz
Initiation of ART in PLHIV with
Hepatitis B or Hepatitis C Co-infection
22National AIDS Control Programme
25. Regimen NationalARTRegimen Preference
RegimenI
Zidovudine+
Lamivudine+Nevirapine
First line regimen for patients with
Hb>9gm/dl and not on
Concomitant ATT
RegimenI(a)
Tenofovir+
Lamivudine+Nevirapine
First line regimen for patients with
Hb<9gm/dl and not on
Concomitant ATT
RegimenII
Zidovudine+
Lamivudine+Efavirenz
First line regimen for patients with
Hb>9gm/dl and on concomitant
ATT
RegimenII(a)
Tenofovir+
Lamivudine+Efavirenz
•First line regimen for patients
With Hb <9gm/dl and on
Concomitant ATT
•First line regimen for all patients
With HepatitisB & HepatitisC
co-infection
•First line regimen for pregnant
women, with no exposure to
sd-NVP in the past
NACO First line ART Regimens for HIV-1 infection
National AIDS Control Programme 24
26. Clinical and Immunological Criteria
for starting ART in Children
All infants and young children under 24 months of age
with confirmed HIV infection should be started on ART,
irrespective of clinical or immunological stage
Children >24 Months-upto 5 years of age:
Initiate ART for all clinical stage 3 and 4, irrespective of CD4
count or percentage
CD4 less than 25 % for CLHIV with Clinical stages 1 & 2
Children >5 years of age:
Follow CD4 count as in Adult ART Guidelines
National AIDS Control Programme 25
27. Paediatric
Regimen
Regimen Remarks
RegimenPI
Zidovudine+Lamivudine+
Nevirapine
Preferred paediatric regimen
For children with Hb >9g/dl
RegimenPI(a)
Stavudine+Lamivudine+
Nevirapine
For children with Hb < 9g/dl
RegimenPII
Zidovudine+Lamivudine+
Efavirenz
Preferred for children on anti-TB
treatment;
Hb>9g/dl and
age>3 yr and weight >10kg
RegimenPII(a)
Stavudine+Lamivudine+
Efavirenz
For children on anti-TB treatment
Tuberculosis treatment;
Hb<9g/dl and
age>3 yr and weight>10kg
1.Efavirenz is the preferred drug over Nevirapine, whenever children are being
Treated with Rifampicin containing drug regimen for TB coinfection
2.In Children aged <3 years and in children weighing <10Kg, Efavirenz is
contraindicated.
Paediatric First line ART Regimens
National AIDS Control Programme 26
28. MonitoringTool WhentoMonitor?
Body weight Every Visit
Treatment Adherence Every Visit
Clinical Monitoring&
T-Staging
Every Visit
Hb*, TLC,DLC,ALT(SGPT)** Every6-months
CD4 Count
Every 6-months,
Or earlier, if required
Routine Monitoring & Follow up of ART
National AIDS Control Programme
*Hb checked on 15th day after initiation on Zidovudine
** ALT checked on 15th day , when patients on Nevirapine
27
29. Modifying / Changing Therapy
Due to adverse drug effects / intolerance /
Drug Interaction
Due to occurrence of tuberculosis
Due to treatment failure
National AIDS Control Programme 28
30. Substitution vs. Switch
Substitution:
Single drug replacement of individual ARV (usually
within the same class) refers to SUBSTITUTION of
individual drugs for toxicity, drug-drug interactions,
or intolerance; which does not indicate a second line
regimen being used.
Switch:
Failure refers to the loss of antiviral efficacy and
triggers the SWITCH of the entire regimen from
first to second line. It is identified by clinical and/or
immunological and/or virological monitoring.
National AIDS Control Programme 29
31. Terms of Reference to
State AIDS Control Expert Panel
Review referred cases for alternative first line ART
Review and decide all cases referred by the referring ART
centre for second-line ART provision
for finding the eligibility for viral load testing
for starting second line ART, if found eligible
Mentoring referring ART centres and ensuring high
quality case management of PLHIV
Documentation and follow up of all patients registered for
SACEP review
30National AIDS Control Programme
32. Public Health
Infrastructure
Selected Medical
colleges
Medical college
and District Level
Hospital
Sub-District level
hospitals &
CHC
Three-Tier Model of HIV Treatment
Service
CoE
& ART
Plus
Centres
(43)
ART Centres
(400)
Link ART Centres and LAC Plus Centres
( 850)
31
33. LAC LAC
LAC
plus
LAC
plus
Care &
Support
Centres
CoE (10)
pCoE (7)
ART plus (26)
(SACEP)
ART
Centres
(400)
840
Updated
April, 2013
CST Services: Referral and Linkages
Functions
Out Reach working and
Tracing of LFU
National AIDS Control Programme
Functions
1. ART: Monthly Distribution
2. Monitoring and Drug Adherence
3. Treating Minor OIs
32
34. ICTC
LAC
LAC plus
ART
Centres
Centres of
Excellence,
pCoE &
ART plus
centres
Network of PLHIV / District level Network of Positive People (DLN+)
CST Services: Referral and Linkages
HIV-TB linkages: RNTCP
33National AIDS Control Programme
37. Evidence of Programme Impact
57% Reduction in New Infections
(2000-11) with Scale-up of Prevention
Strategies
29% Reduction in AIDS-related Deaths
(2007-11) with Scale-up of Anti-Retroviral
Treatment
National AIDS Control Programme
Source: Technical Report India HIV Estimates 2012, NACO & NIMS
38. Issues and Challenges
Low referrals from ICTC to ART centres
Early Infant Diagnosis
Enrollment of children under ART care
Pre-ART care and Follow up
Timely and Early initiation of ART
Ensuring optimal (>95%) adherence to ART
Tracking patients Lost to follow up (LFU)
Second line ART initiation
Linkages with RNTCP and other local networks
Irrational ART Prescriptions outside National Programme
National AIDS Control Programme 37
39. National AIDS Control Programme
Key Points
The estimated number of people living with HIV in India
in 2011 is placed at 20.9 lakhs
NACP phase III aims to halt and reverse the epidemic
in India, to scale up care and support services and to
strengthen capacity at all levels
ICTC is the entry point for providing comprehensive
care and support to the HIV-infected persons
ART services are being expanded to provide treatment
nearer to patients' residence
Process of decentralisation and appropriate referral
and linkage services ensure PLHIV of comprehensive
care in the existing health delivery system
38