India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.

2. India HIV Estimations 2015
 National adult HIV prevalence is estimated at 0.26%.
 The total number of PLHIV in India 21.17 lakhs.
 Estimated to have around 86 thousand new HIV infections.
 An estimated 67.6 thousand people died of AIDS related
causes
 India has achieved 6th MDG in regards to HIV/AIDS.
 SDG Target: Reduce the annual number newly infected with
HIV by 90% and annual number of people dying from AIDS
related cause by 80% ( compared with 2010 data)

3.  India has one of the world’s largest and most robust HIV
surveillance systems.
 This system has aided the national govt to better monitor
 the trends,
 levels and burden of HIV among different population
groups and
 facilitated the delivery of an effective response to
control the epidemic in the country.

4. Objectives
 Estimate national/local HIV prevalence
 Describe risk behaviors
 AIDS incidence
 Estimate AIDS mortality

5.  Providing an accurate assessment of the distribution of disease by
person, place and time
 Providing information on changes or trends in disease distribution by
geographic, socio-demographic or exposure parameters
 Identifying groups or geographical areas for targeted intervention
efforts
 Providing information to evaluate effectiveness of intervention efforts
 Providing data for prevention program management (such as for
voluntary counselling and testing, prevention of mother-to-child
transmission and sexually transmitted infection management)
 Providing data for development and implementation of research efforts

6. Types of HIV/AIDS surveillance
 HIV sentinel surveillance
 Sexually transmitted infection (STI)
surveillance
 Integrated Biological & Behavioural
surveillance
 AIDS case reporting

7.  HSS is defined as "a system of monitoring HIV epidemic
among specified population groups by collecting information
on HIV from designated sites ( sentinel sites) over years
through consistent methodology that allow comparison of
findings across place and time to guide programme
response".
 Sentinel site is defined as "designated service point/facility
where blood specimen and information are collected from
a fixed number of eligible individuals from a specified
population group over a fixed period of time, periodically,
for the purpose of monitoring the HIV Epidemic"

8. The 14th round of HSS
was implemented During
2014-15 at 776 Antenatal
Clinic (ANC)Surveillance
Sites covering 572
districts across 35 States
and UTs in the country.

9. Element Summary
 Sentinel Site: Antenatal clinic
 Sample Size: 400
 Duration : 3 months
 Sampling Method: Consecutive
 Eligibility Criteria
Pregnant Women, aged 15-49 years, attending the antenatal clinic for the
first time during HSS period
 Exclusion Criteria
Already visited once at the ANC site during the current round of surveillance
 Testing Protocol: Two Test Protocol

11.  With a view to strengthen the surveillance activities among HRGs, NACO
implemented IBBS Surveillance to generate evidence on risk behaviours.
 The first ever nationwide Integrated Biological and Behavioural
Surveillance conducted among high risk groups in 2014-15.
 It was implemented across six population groups comprising
 Female Sex Workers (FSW),
 Men who have Sex with Men (MSM),
 Injecting Drug Users (IDU),
 Transgender (TG),
 Migrants and Currently Married Women
(CMW) in high outmigration districts.

12. The specific objectives are:
 To analyse and understand HIV related behaviours and HIV
prevalence among key risk groups in different regions, by
linking behaviours with biological findings
 To measure and estimate the change in HIV related risk
behaviours and HIV prevalence among key risk groups.
Phases of the IBBS
a) presurveillance assessment
b) sampling frame development and
c) Behavioural and biological data collection

13. Behavioural indicators:
 Profile of FSW/MSM/IDUs
 Sexual Behaviour
 Pattern types and condom use
 Anal sex and condom use
 Alcohol and other substance use
 Self-reported STI
 Stigma and discrimination
 HIV Prevalence {2.2%, [FSW] 4.3% [MSM], 9.9% [IDU]

14.  STI data are useful for planning, monitoring and
evaluation of both STI and HIV programmes.
 As STIs are markers of HIV risk behaviours, surveillance
for STIs serve as an early warning of the emergence of
HIV.

15. The key components of STI surveillance are:
 (i) STI syndromic and etiological case-reporting;
 (ii) Syphilis screening among pregnant women;
 (iii) Syphilis screening in donated blood;
 (iii) Population-based STI prevalence assessment
and monitoring;
 (iv) Antimicrobial resistance monitoring.

16. Syndromes:
•Urethral Discharge in Males
•Vaginal Discharge in Women
•Genital Ulcers in Males &
Females
•Neonatal Conjunctivitis
Diseases:
•Chancroid
•Bacterial Vaginosis
•Chlamydial& Gonococcal
Infections
•Herpes Simplex Virus Infections
•Syphilis (incl. Congenital
syphilis),
•Donovanosis
•Trichomoniasis

17.  AIDS Case Reporting:
It was initiated in India in 1985 as a means for tracking HIV infection early in
the course of the epidemic.
•Minimum data:
Age, sex, residence, sector of employment, route of transmission, date of
diagnosis, major and minor signs.
Strategy
 Universal AIDS reporting(passive)
 Universal AIDS reporting(active)
 Opportunistic Infection Reporting

18.  To measure burden
 How many persons have AIDS?
 To monitor trends
 Are the number of persons with AIDS decreasing over time?
 To assess access to care
 Did they know they were HIV positive before developing
symptoms?
 Were they offered ART or had access to ART?
 Did they receive care or prophylaxis for O.Is?

19.  AIDS Deaths Reporting:
•Minimum data:
Includes all information on AIDS cases plus cause of death.
SOURCES:
 vital registration systems
 Routine ART programme cohort data analysis
allows the calculation of mortality (case fatality)
among patients who are on treatment.

20.  In developing countries like India with weak vital
registration systems and the widespread HIV-
associated stigma, it is challenging to measure
HIV associated mortality.
 Death registry information not adequate enough
to know who died from an AIDS related illness
 Under reporting

21. Integrated Counselling & Testing Centre

22. A place where a person is counselled
and tested for HIV, on his own free will
or as advised by medical provider.
 More than 15,000 ICTC in India.
 The Challenge before us is to make all HIV Infected People in the Country
aware of their status so that they adopt healthy life styles and prevent
the transmission of HIV to others, and access life-saving care and
treatment.
 Counselling and testing services are important components of prevention
and control of HIV/AIDS in country.

23. The earlier voluntary
counseling and testing
centers(VCTCs) and
facilities providing
prevention of parents 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 as “Integrated
counseling and testing
centers”(ICTCs).

24.  ICTCs should ideally be located such that they provide maximum access
to at-risk/vulnerable populations.
 An ICTC may be located in
Government health sector
Private/not-for-profit sector
Public sector/other government departments
NGO sector
 In the health facility, the ICTC should be well coordinated with the
Department of Medicine, Microbiology, Obstetrics and Gynaecology,
Paediatrics, Psychiatry, Dermatology, Preventive and Social
Medicine,etc.

25. 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 positive people with other HIV prevention, care and treatment
services
 Prevention of Parent to Child Transmission (PPTCT)
 Cross referrals – TB/STI/ART/TI-NGO/DIC/CCC etc

27. 1. Fixed-facility ICTCs
 “Stand-alone” ICTC
 “Facility-integrated” ICTC
2. Mobile ICTCs

28. Human resources for an ICTC
1. ICTC manager
2. Counsellor
3. Laboratory technician
4. Outreach workers

29.  There are Subpopulation who are more vulnerable or practice high risk
behaviour.
These include
o sex workers and their clients,
o Men who have sex with men (MSM),
o transgender, injecting drug users (IDUs),
o Truckers, Migrant workers,
o spouses And children of man who are
prone to risky behaviour.
 Medical Providers also refer patients
who have a h/O risky behaviour or
have signs and symptoms suggestive
of HIV/AIDS.
 Emergency testing .
Who needs to be tested in an ICTC

30. 1. Provider-initiated counselling and testing – “Opt
out”
2. Client-initiated counselling and testing – “Opt in”
or Direct walk-in clients

31. General Principles of HIV
Testing
It should be part of the overall
comprehensive and preventive
program
Testing should be technically
sound and appropriate.
Test Procedure must be
cost effective.
Laboratory Procedure must be
monitored for ensuring
quality.

32. Purpose of HIV Testing
 Information is useful for prophylaxis, medical management and treatment of HIV
 To assure blood safety and donation safety
 To assess the efficacy of targeted intervention in a defined cohort.
 To monitor trends of epidemic (sentinel surveillance etc.)
 Identification of asymptomatic individuals (practicing high risk behavior)
 To plan personal and family’s future if the result is positive.
 To motivate for behavior modification through counseling amongst those who test
negative and who practice high risk behaviors.
 To induce behavior change and prevent transmission by counseling in those who
are test positive
 To diagnose clinically suspected cases
 For peace of mind of individuals practicing high risk behavior

33. A client who has a negative result in one test is declared to be HIV-negative.
A client is declared to be HIV-positive when the same blood sample is tested three
times using kits with different antigens/principles and the result of all three tests is
positive.

34.  The ICTC staff will endeavour to maintain the highest standards of
quality in the services they provide. They will be held personally
accountable for any substandard delivery of services.
 EQAS involves sending of “coded” samples from the reference
laboratories to the ICTCs twice a year for testing.
 In addition, ICTCs should send samples, which will include 20% of
all positive samples and 5% of all negative samples collected in
the first week of every quarter, for cross-checking to the SRL once
every quarter.

35. What is HIV counselling?
A confidential dialogue between a client
and a counsellor aimed at providing
information on HIV/AIDS and bringing
about behaviour change in the client.
 The steps in HIV counselling are:
1) HIV pre-test counselling/information: This involves provision of basic
information on HIV/AIDS and risk assessment.
2) HIV post-test counselling: Here the client is helped to understand and cope
with the HIV test result.
3) Follow-up counselling: In follow-up counselling there is a re-emphasis on
adoption of safe behaviours to prevent transmission of HIV infection to others.

37.  All HIV testing services must include the 5 C’s
recommended by WHO: informed Consent,
Confidentiality, Counselling, Correct test results and
Connection (linkage to care, treatment and other
services).

38. THANK YOU

39.  Epidemiological Surveillance:
 Knowledge, Attitudes, Beliefs and Practices (KABP)
or Behavioural Surveillance Surveys:
 Audit of quality of treatment and care for PLWHA
and patients with Sexually Transmitted Infections: