1. Research based Innovative achievements outside normal duties include:
(i) Planning and Implementation of Country’s first State Govt Funded Large Scale
Social Protection Scheme for Children Affected By AIDS including AIDS
Orphans/destitute children on Principle of Household Economic Strengthening of
People Living with HIV:
 Delhi being a low HIV prevalence state of India, the issue of Children Affected by AIDS
(CABA)/AIDS Orphan/destitute children did not received attention of Policy Makers as
the National AIDS Policy was silent on the subject. Further, due to the lack of required
documentation it was difficult to link this most marginalized section of society to the
existing Government Social Welfare Schemes.
 In 2010, National Commission for Protection of Child Rights (NCPCR) referred 5
Children Affected by AIDS (CABA) including 2 AIDS Orphan to Delhi State AIDS
Control Society to support them for nutrition, free blood transfusion, antiretroviral
treatment, free education and free medical treatment etc. Taking this as tip of iceberg
phenomenon, I took the initiative and analyzed the situation of Orphan Children Infected
/ or Affected by AIDS in Delhi for the first time in India in 2010.
 The data gathered was examined for a possible intervention in Delhi for which a State
Technical Working Group was constituted and a financial package was worked out.
State Government approved the proposal and included financial assistance to people
living with HIV/AIDS, CABA, AIDS orphans/Destitute children in the Plan Scheme of
Health & FW Department. The scheme is based on principle of household economic
strengthening of people living with HIV/AIDS and was rolled out w.e.f. 1st April, 2012.
 The salient features of scheme were published in Vulnerable Children & Youth Studies
(U.K.), an international Journal. The study has implications for the National &
International Policy Makers working for the cause Children affected by AIDS/Orphan
Vulnerable Children Infected or Affected by AIDS.
 Under the scheme the care givers, the guardians, & the institutions are required to ensure
that the Orphan Vulnerable Child (OVC) infected or affected by HIV/AIDS aged 0-5
year is taken for immunization and growth monitoring in nearby government health
facility, OVC aged 6-18 regularly attend basic education in government school; care
givers ensures that the amount given is spent on the care of the child and that the HIV
positive OVC regularly visit ART center for adherence to treatment.
 As present about 2296 beneficiaries including 617 CABA and 68 AIDS
Orphans/destitute children of Delhi are availing the benefit of the scheme.
 In follow up, the scheme has ensured 100% adherence to Anti-Retroviral treatment in
the beneficiaries.
(ii) Identified major challenges and bottlenecks in Early Diagnosis of HIV and Early
Initiation of ART in HIV positive infants in Delhi:
 Early Infant Diagnosis of HIV at 6 weeks of age confers significant survival benefits
for HIV infected infants started early ART, preferably by 3 months of age. The facility
of Early Infant Diagnosis (EID) of HIV by DNA PCR test was not available in the
country till December 2010. Eventually many infants born to HIV positive women may
have died undiagnosed/untreated.
 Operational research was undertaken by me to evaluate the performance of EID
programme in relation to Early Initiation of ART in infant detected HIV positive in
Delhi.

2.  This is the first study on the subject from India and was published in Journal of Tropical
Pediatrics (U.K.)
 Important observations and recommendations that emerged from the study are as under:
- Despite national guidance for DNA-PCR test in HIV-exposed infants at 6 weeks of age,
early diagnosis of HIV is still not happening by the desired 3-months age, attributable
to first; lack of specimen collection facility in many public hospitals, second; lack of
robust inter-hospital networking, third; national policy that PCR lab will receive
specimens only once every fortnight, fourth; non-involvement of private hospitals,
where about 50% women deliver, fifth; un-booked deliveries reporting directly to labor
room, sixth; poor postnatal counselling, and seventh; long Turn Around Time of PCR
tests. Hence Point of Care testing may be introduced under National AIDS Control
Programme to ensure early diagnosis of HIV in infants.
- Similarly, initiation of Antiretroviral Treatment (ART) in HIV-1 DNA-PCR positive
infants was also delayed due to, first; delay in performing repeat PCR test when first
test was positive, eventually many infants developed opportunistic infections and died
before the repeat test. It is suggested that when first test shows positive result, the infant
may be initiated ART immediately, and simultaneously a second specimen should be
taken to determine whether ART should be continued, second; few caregiver did not
like to initiate ART in their symptomatic and other wise well infants solely on basis of
DNA PCRtest results. This may be attributed to poor pretest counselling. It is suggested
to inform care giver on role of PCR test and importance of timely initiation of ART in
the pretest counseling.
 The study has implications for Policy Makers to improve overall survival of HIV
infected infants and children of the country.
(iii) Operational research conducted indicated poor efficacy of Single Dose Nevirapine
for prevention of mother to child HIV transmission. Advocated with National AIDS
Control Organization to substitute single dose Nevirapine with highly efficacious
WHO’s Triple ARV regimen (Option B+) which has potential to eliminate pediatric
HIV transmission from the country. NACO eventually rolled out Option B+ PMTCT
regimen in January 2014.
(iv) Operational Research undertaken to improve outcome of HIV-TB co-infected
patients-
 During the third phase of National AIDS Control Programme (April 2007-April 2012),
24% TB/HIV cross-referrals were lost to follow up and there was missed opportunity
for 50% HIV-TB co-infected patients for initiation of ART during TB treatment. This
existing national cross-referral strategy was amended under my leadership.
 The new strategy was launched in May 2012, wherein HIV-TB co-infected and HIV-
positive "TB-suspects" were referred to nearest ART center for HIV care for
investigations of TB at Chest Clinic/Designated Microscopy Centre located within the
same hospital instead of referral to area RNTCP facility.
 Outcome of the strategy was evaluated in March 2013. The results were published in
AIDS care (U.K.), an international Journal in June 2013.
 The new HIV-TB cross-referral strategy in Delhi has shown advantage over national
strategy: first, improved retention of co-infected clients in HIV care; second, ensured
timely initiation of TB-treatment and ART; and third, significantly improved survival of
HIV-TB co-infected patients.

3. (v) Analyzed data of decade of ART program of Delhi that has implications for Policy
makers
 The study indicated that the desired 90% retention at various steps of the retention
cascade could not be achieved despite various measures undertaken during third phase
of National AIDS Control Programme (2007-2014).
 National Policy of delivering ART services through limited number of standalone ART
centers in India, despite its significant success, has limitation of leaky treatment cascade.
 This study has implications for Policy Makers to decentralize the ART programme by
its appropriate integration with general health services and task shifting to improve
continuum of care.
(vi) Planned and rolled out country’s first post exposure prophylaxis telephone
helpline to guide health care workers 24X7 to prevent occupational exposure to
blood born viruses- This helpline has been very useful in implementation of National
PEP Guidelines in Delhi and is probably the first helpline in any developing country
and third globally.
To conclude, the Operational Research activities undertaken during 7 years (2007-2014)
tenure at Delhi State AIDS Control Society was of great help for rolling out country’s
first social protection financial assistance scheme for Children Affected by AIDS in
Delhi, first PEP helpline of the country to prevent occupational transmission of HIV and
Hepatitis B & C, improving outcome of HIV-TB co-infected patients besides
identifying challenges and bottlenecks to improve the implementation of Prevention of
Mother to Child HIV Transmission, Early Infant Diagnosis, and Antiretroviral
Treatment programme in Delhi.