National AIDS Control Programme

1. NACP III&IV
Dr Anupkumar T N
Junior Resident
Dept of Community Medicine
Govt Medical College,Thrissur

2. To cover…
• Brief history
• NACP1,2 achievements
• NACP III- formulation, key strategies,
achievements
• NACP IV-origin, goals,objectives,where are we
now

3. • AIDS was first clinically observed in 1981 in
the United States

4. TIMELINE
1986 - First case of HIV detected
- AIDS Task Force set up by the ICMR
- National AIDS Committee (NAC)established under
MOH
1990 - Medium Term Plan in four states and the four metros
1992 - NACP I to slow down the spread of HIV infection
- National AIDS Control Board constituted
- National AIDS Control Organisation set-up

5. • 1999 - NACP II begins, focusing on behaviour change
- State AIDS Control Societies established
• 2002 - National AIDS Control Policy adopted
- National Blood Policy adopted
• 2004 - ART Treatment initiated
• 2006 - National Council on AIDS
- National Policy on Paediatric ART formulated

6. Key achievements under NACP-I
• National AIDS response structures formed
• Partnership with the World Health
Organisation (WHO)
• Established NACO and the State AIDS Control
Cells
• India's management capacity to respond to
the epidemic.

7. • Improved blood safety,public awareness of
HIV.
• Expanded sentinel surveillance(55 TO 180)
• Expanded STI control and services.
• Improved condom promotion activities.
• Created and disseminated a national HIV
testing policy

8. Key achievements under NACP-II
• NGOs implemented 1,033 targeted
interventions and set up 875
• voluntary counselling and testing (VCT)
centres and 679 STI clinics at the district level.
• Behaviour Sentinel Surveillance (BSS) surveys
were conducted.
• Prevention of parent-to-child transmission
(PPTCT) programme was expanded.

9. • computerized management information
system (CMIS)
• computerized project financial management
system (CPFMS).
• HIV prevention ,care and support
organizations and networks were
strengthened.
• Support from bilateral, multilateral, and other
partner agencies

11. WHY NACP III…?
• The nature of HIV epidemic
• Trained staff and programme manager
• Attention to high risk groups as well as others
• Capacity development with technical support
• Social marketing

12. • Participation from different levels
• Convergence with NRHM
• Underreporting
• Financial investment and policy making

13. Then….
• Consultations with working groups,e-
forums,ngo’s,PLHA networks
• Inputs from studies and assessments
• Consolidate gains and address gaps
• So after one year……………………….

14. NACP III (2007-2012)
• Focus on halt/reverse of epidemic
• Bettering the target of HIV related MDG
• Four pronged approach

15. GUIDING PRINCIPLES
• Three ones
• Equity in prevention
• Rights of PLHA
• Social ownership ,community involvement
• Environmental change for affected
• Universal access
• Human resource
• interventions

16. 4 PRONGED STRATERGY
• Preventing new infection-TI, Scaled up
intervention
• Extend care, support and treatment
• Strengthening the infrastructure for
prevention and care
• Strengthen SIMS
• Budget-11585 crores

18. PREVENTION

19. UPSCALING PREVENTION
• Mainstay of NACP III
• To reduce the spread from HRG to general
population
• Behaviour change stratergy based on effective
IEC campaign
• Continuum of care at all levels
• Interlinked services with apt information

20. In high risk groups
• Increase demand of products& services
• Provide counselling,risk reduction training
• Focus on partner referral
• Demand,access and availability of condoms
• Environement for safe behaviour
• Increase programme sustainability
• Integrate prevention to care, support,
treatment

21. By all these…
• Saturate 80% of HRG and decrease spread
• Special focus to IDU & MSM

22. In bridge population
• Peer led interventions
• Promote,provide condoms
• Develop linkage between different groups
• Peer support groups and safe spaces creation

23. In general population
• Women especially wives of HRG& bridge
groups
• Youth
• Marginalized
• Tribals

24. All these will..
• Set up cadre of link workers
• More access to HIV testing
• Red ribbon clubs for youth
• PPTCT access and treatment improvement
• Assured blood and products
• STI treatment in public and private
• Reduce stigma,discrimination

25. Information,education and
communication
• Remove stigma and more access
• Promote value based lifestyle
• Reduce risky behaviour
• Promote condom
• Raises demand

26. ICTC
• Hub of HIV related services
• 4955 ICTC s
• 22 million people will be tested

27. PPTCT
• 1,89000 pregnancies
• Nevirapine prophyalaxis scaled up to 80%

28. Managing STIs
• 4-6% of adult population,more females
• Expand STI services with NRHM
• Also NGOs,private
• Screen high risk for STI –A KEY STRATERGY

29. CONDOM PROMOTION
• Awareness increased but less use
• Promoting use,ensure availability
• Negotiating skills in HRG

30. BLOOD SAFETY
• Provide safe blood within an hour
• Well coordinated network to reduce HIV
transmission
• 0.5% from1.92%
• Voluntary blood donation to 90%

31. STRENGTHENING CARE,SUPPORT
AND TREATMENT

32. COMPREHENSIVE STRATERGY
• Psychosocial support
• Ensure accessible affordable and sustainable
treatment sevices
• Reduce stigma,poverty and discrimination
• CD4 testing facilities
• Capacity building of ART centres
• Procure ART drugs

33. COMMUNITY CARE CENTRES

34. LINKED ART

35. CENTRE OF EXCELLENCE

36. • Increasing quality of drugs
• Necessary training to all
• Linkage to community care centres
• Adherence to monitoring systems and
treatment
• Ext quality assurance
• Smart health card to patients

38. Care and support
• Improve quality of life,social integration and
dignity
• Partnership with not for profit org.
• Expanding access to services
• Social support,counselling and referrals
through 350 community care centres

39. Anteretroviral therapy
• Increase life span and quality
• Free of cost
• Through 250 centers cover 3lakh adults and
40000 children

40. PROGRAMME MANAGEMENT

41. • Decentralization upto district level
• Strengthening CPFMS&SIMS
• Technical support units at state level

42. Augmenting capacity
• All levels
• All persons involved
• Initiating private sector involvement
• Streamline public health delivery
system,function and accountability
• 380000 persons will get trained

44. Strengthening SIM
• Propose change in purpose and effectiveness
of data collection at all levels
• To maximize effectiveness of available
information
• To implement evidence based planning
• Address stratergic planning,monitoring
,evaluation &surveillance

45. • All programme officers trained
• 1119 sent.sites,127 ART centres,2211 bld
banks,4132 ICTC,866 STI clinics&1220 NGO&TI
interventions in May 2007

47. Decentralization
• From state level to district
• District AIDS Prevention&Control Unit(DAPCU)
• Operate within District societies
• NRHM
• Under DMO
• Non health activities through Distrrict
collector

48. MAINSTREAMING
• Beyond the risks and impact
• Involve more sectors and organisations
• Develop ownership in AIDS prevention and
control programmes
• Lead by national council support by NACO
• 31 member ministries 11 priority departments
for mainstreaming

49. • Can use their medical infrastructure
• Mainstreamed to their workplan
• Allocate their internal resources

50. Partnership
• UN,bilateral,multilateral,funding agencies
• Steering committee for donor cordination
• To prevent duplication,maximize effort
• Share information and plan
• Joint review of performance

51. • Enabling environment
• Necessary legislative reforms,policy making
• Legal ,ethical concerns

52. WHAT NACPIII HOPE TO ACHIEVE..?

54. WHAT HAPPENED…??

55. ACHIEVEMENTS
• FSW-81%,MSM-80%,IDU-64%
• Truckers-57%,migrants-40%
• 159 districts link worker scheme
• 537 ICTC,9196-Facility int ICTC,1805-PPP
• 194.94 lakh,85.63 lakh pregnant ladies
• 335 ART centres,725 LINKED art,253CCC
• Red ribbon express

56. Epidemic scenario..
• HIV as an epidemic tends to decline
• Both incidence and prevalance decreased
• Prevalance 0.41%-2001,0.35%-2006,0.27%-
2011
• Overall 57% reduction in new HIV
cases2.74lakhs-2000 to 1.16 lakhs-2011
• In FSW-5.06% to2.67%,MSM- 7.41%to4.43%

57. • 29% reduction in estimated annual IADS
related death
• Free ART saved 1.5 lakhs livestill 2011

58. Concerns and challenges
• Need to consolidate successes gained
• Saturating coverage to quality of services
• Address migration which causes emergence of
epidemics
• Treatment demands should be met without
sacrificing prevention
• Regions with diff maturity levels to be
considered

59. • Financial problems to be addressed
• Integration with large health systems
• Social protection schemes for affected
• Stigma and discrimination still remaining
• Innovation in key strategies

60. NACP-IV preparatory phase
• Elaborate and extensive process
• 15 working groups,30 subgroups covering the
whole area
• 624 representatives including community
• Regional,statelevel and e-consultaions
• Overseen by planning commission steering
committee.

61. • All working group met twice in 2011
• Detailed discussions on NACP3 current
status,gaps,priorities,strategic options etc…..
• Reports by working groups

62. NACP-IV
• Goal:accelerate reversal and integrate
response
• 2012-2017
• Reduce new infections by 50%-2007 baseline
• Provide comprehensive care and support to
PLHA and to all those require

63. KEY STRATEGIES
• Intensify and consolidate prevention services
with focus on HRG and vulnerable
• Increase access and promote comprehensive
care and support
• Expand IEC for HRG and general pop focusing
behavior change and demand generation

64. • Capacity building at all levels
• Strengthening SIMS

65. GUIDING PRINCIPLES
• Continue emphasis on agreed action
framework,coordinating authority,M&E system
• Equity
• Gender
• Rights of PLHA
• Civil society representation,participation
• PPP
• Evidence based result oriented programme
implementation

66. Cross cutting areas of focus
• Quality
• Innovation
• Integration
• Leveraging partnerships
• Stigma and discrimination

67. Key priorities
• Prevent new infections
• Prevent antenatal transmission
• Focus on IEC strategies
• Provide treatment for all PLHA
• Reducing stigna and discrimination,GIPA
• Decentralizing
• Ensure effective use of strategic information in all
levels
• Capacity building of NGO& civil society partners

68. • Integrate HIV services to health system
• Mainstreaming departments

69. BUDGET

70. PACKAGE OF SERVICES

71. 1.Preventive
• Targetted interventions
• NSEP&OST for IDU
• Intervention for migrants
• Link worker scheme
• Prevention and control of STI
• Blood safety
• Counselling and testing services

72. • PPTCT
• Condom promotion
• IEC &BCC
• Social mobilization,youth and adolescent
edubcation
• Mainstreaming HIV/AIDS response
• Work place intervention

73. 2.Care ,support and treatment
services
• Lab service for CD4 tesing and other services
• Free ART 1st and 2nd line
• Paediatric ART
• Early infant diagnosis of HIV exposed infants
and below 18 months
• HIV-TB coordination
• Treating opportunistic infection
• Drop in centres for PLHIV networks

74. New initiatives
• Differential strategies for districts based on
data with due weightage to vulnerabilities
• Scale up programmes to target key
vulnerabilitieseg:IDU,migrants,Transgenders
• Scale up multidrug regimen for PPTCT
• Social protection schemes by earmarking
funds

75. • Establishment of metro blood banks and
plasma fractionation centre
• Launch 3rd line ART
• Demand promotion strategies eg:folk,red
ribbon express

76. Strategic summaries

77. 1.Intensify and consolidate prevention
services
• Prevention-core strategy
• To cover 90% HRG through TI
• More ICTC in high prevalent areas
• Chc and Phc involvement
• Condom promotion
• Blood bank services

78. • Quality prevention services to HRG
• StrengthenNSEP& OST for IDU
• Reaching to MSM,TG
• Address issues in cover ing and managing rural
intervention
• Provide quality STI/RTI services
• Strengthen positive prevention

79. • Strengthen management structure of blood
transfusion services
• Implementing quality assurance

80. 2.Comprehensive care,support and
treatment
• Scale up ART centres,linked ARTs,& COE
• Follow up strengthening,improve quality of
counselling
• Use PLHIV linkages
• Guidelines for training staff

81. 3.Expanding IEC
• Increase awareness in general population
• BCC in HRG &vulnerable group
• Focus on demand generation services
• Reaching vulnerable group in rural

82. 4.Building capacities
• Nation state and district level planning
mangement
• Local priorities,need,community involvement

83. Strategic information management
system
• Integrated bioogical &behavioural
surveillance
• National data analysis plan
• National research plan
• SIMS to advance analytic&geographic
information system
• Institutionalising data quality monitoring
system for routine data collection& decision
making

85. Impact indicators
• Reduction in new HIV cases
• Reduction in HIV related mortality
• Survival after 24 months

86. Outcome indicators
• Behaviour change in FSW,MSM,IDU

87. Where we are…?
• Among ANC prevalance kerala-0.05 india-0.29
nagaland
• Among FSW prevalance kerala-0.73 india-2.67
andhra,maharashtra
• Among MSM prevalance kerala-0.36
india-4.43 nagaland,chathisgarh
• Among IDU prevalance kerala-4.95 india-7.14
punjab,delhi

88. References
• National AIDS Control Programme Phase III:
2006-2011. Strategy and implementation
plan’. NACO, Ministry of Health and Family
Welfare, Government of India. November 30
• ‘National AIDS Control Programme Phase IV:
2012-2017. Strategy and implementation
plan’. NACO, Ministry of Health and Family
Welfare, Government of India.

89. • HIV IBBS REPORT 2014-15
• Park textbook of preventive and social
medicine

90. T
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