NACP IV critical analysis , where we have given a brief idea about the burden of HIV/AIDs globally , National and statewise. Evolution of NACO and NACP under different phases. Current achievements and the indicator to monitor the progress

1. Critical analysis National
AIDS control Programme
Presenters: Dr Arundas H
Dr Akshaya Shekhar
Mentor : Dr Ashwini Kumar

2. Contents
• Introduction
• Burden of HIV/ADS
• National AIDS control Programme (NACP)
• Karnataka State AIDS prevention society (KSAPS)
• District AIDS prevention & Control Unit (DAPCU)
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3. Introduction
• HIV continues to be a major global public health issue
• 37 million people living with HIV at the end of 2020
• HIV targets the immune system and weakens people's defense
• Advanced stage of HIV infection is AIDS
• Prevention & lifelong treatment and care make it a manageable
chronic disease
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4. Global burden of HIV/AIDS
Source: UNAIDS/WHO estimates
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Global HIV epidemic summary, 2020
People living with HIV
in 2020 (in million)
People acquiring HIV in
2020
People dying from HIV
related causes in 2020
Total 37.7 1.5 million 6.8 Lakh
Adults 36 1.3 million 5.8 Lakh
Women 19.3 6.6 Lakh 2.4 Lakh
Men 16.7 6.4 Lakh 3.4 Lakh
Children 1.7 1.5 Lakh 99K
Table 1

5. Global
burden:
Region-wise
Dept
of
Community
Medicine
,
KMC
Manipal
9/19/2021 5
Fig.1

6. National
situation
(2019-20)
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HIV prevalence in India 0.2% , 23.29 Lakh
Women living with HIV 9.9Lakh
79K Children living with HIV
69K New HIV infections in 2019
58K AIDS related deaths
37% ↓ in new infection b/w 2010 & 2019
Source: NACO report 2020

7. National
situation
Dept
of
Community
Medicine
,
KMC
Manipal
9/19/2021 7
High prevalence
Medium prevalence
Low prevalence
0.2 % adult prevalence of HIV
Lowest :300 cases
3.9Lakh
3.14 Lakh
2.69Lakh
24K
1 Lakh
1.55 Lakh
Fig.2

8. National Situation: New Infection (2019)
Dept
of
Community
Medicine
,
KMC
Manipal
9/19/2021 8
Fig.3

9. 9/19/2021 Dept of Community Medicine , KMC Manipal 9
Karnataka : HIV Prevalence
Estimated People Living with HIV 2.69 Lakh
Estimated Children Living with HIV 8313
Annual New HIV infections 1570
Annual AIDS related deaths 6386
Decline in annual new HIV infections since 2010 75 %
Decline in annual ARD since 2010 80 %
Table.2

10. Udupi
• PLHIV - 5500
• Children <15 years – 200
• HIV with TB – 60
• Deaths- 126
• PLHIV with STI/RTI -313
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11. National
AIDS control
programme
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1986- 1st case of HIV detected
AIDS task force set up by ICMR
1992- NACP launched
NACO set-up
1999- NACP II launched
Decentralization
State AIDS control society establishment
2007- NACP III launched
2012 NACP IV launched

12. Aims
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Prevent further
transmission of
HIV
1
Decrease
morbidity &
mortality
associated
2
Minimize
socioeconomic
impact
3

13. Goal
• To halt & reverse the epidemic in India over next 5 years by
integrating programmes for preventions & care, support & treatment
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14. Objectives
1.Reduce new infection by 50% (acc. To NACP III base line)
2.Provide care, support & treatment to all living with HIV/AIDS and
treatment service for all who needs it.
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15. Strategies
• Intensifying and consolidating prevention services
• Comprehensive care, support and treatment
• Expanding IEC services
• Strengthening institutional capacity
• Strategic Information Management System
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16. Targets
• Reducing new HIV infections by 80%
• Elimination of mother-to-child transmission of HIV
• Elimination of stigma and discrimination
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17. Targets
• Achieving 95-95-95 goal
• 95% of those who are HIV-positive in the country know their status
• 95% of those who know their status are on treatment
• 95% of those who are on treatment experience effective viral load
suppression
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18. NACO Structure
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Addl Secretary &
DG, NACO
Joint secretary
NACO
Targeted
Intervention &
LWS
Lab services
Care support &
treatment
Blood safety
STI/ RTI
Basic services IEC
Strategic
information
Admin &
Procurement
Finance

19. 9/19/2021 Dept of Community Medicine , KMC Manipal 19
Care support &treatment
Targeted interventions
STI
Basic services
Blood safety
Monitoring & evaluation
IEC
Finance section
Karnataka state
AIDS prevention
society
Project
Director
Additional
Project
director

20. District AIDS prevention & Control unit : Udupi
District AIDS prevention
& control officer
District ICTC supervisor
Monitoring & Evaluation
assistant
Admin assistant
Account assistant
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Best DAPCU award : 3 times in last 10 years

21. Targeted interventions
• Core TI (FSW, MSM, TG & IDU)
• Bridge TI (Migrant & Truckers)
Objectives
1. Improve health seeking behavior of high-risk groups
2. Reduce risk of acquiring STI/HIV
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22. Targeted Interventions: Services
• Detection & treatment of STI
• Condom distribution & promotion
• Behavior change communication
• Community involvement & participation
• Linkages to ICTC and CST
• Specific interventions for IDUs
• Specific interventions for MSM/TGs
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23. Indicator India Karnataka
Targeted
Interventions
1426 76
OST centres 226 2
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MSM
Indicator India Karnataka
Coverage (%) 80 133
Condoms distributed 5.5Cr 68 Lakh
Tested for HIV 1.9Lakh 17702
Linked to ART 450 39
STI/RTI treated 7312 302

24. Basic services : Integrated counselling & testing centre
1. Fixed ICTC
• Standalone
• Facility integrated (Govt)
• Facility Integrated (PPP)
2. Mobile ICTC
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Indicators India Karnataka
ICTC facilities 33220 3310
Standalone 5330 473
FICTC (Govt) 21187 2420
FICTC (PPP) 4209 413

25. Udupi centres for testing, Rx & Counselling
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NAME NUMBER LOCATION ROLE
ICT centers 12 Testing & counselling
ICT PPP centers 10 Private hospitals Testing & counselling
Mother ICT
center
1 DH Confirmatory testing
F-ICT center 60+ All PHCs, Prison Testing with minimum
documentation

26. Basic services: PPTCT
Prevention of parent to child transmission
Access to all pregnant women for HIV diagnostic, prevention,
care & treatment services
Aim
• HIV testing to all pregnant women in the country
• Cover all estimated HIV positive pregnant women
• Eliminate transmission of HIV from mother-to-child
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27. 9/19/2021 Dept of Community Medicine , KMC Manipal 28
Indicator India Karnataka
Estimated pregnant
women
2.9Cr 12 Lakh
HIV Positive PW 15112 1177
Babies tested for HIV
(6 w- 6m)
11460 16

28. Basic services: HIV-TB
Indicators India Karnataka
HIV-TB cross-referral 33.6 Lakh 2.27Lakh
In referral from TB programme 19Lakh 77143
ICTC clients referred to NTEP 14 Lakh 1.5 Lakh
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29. Basic services: HIV-TB
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TB/HIV co-ordination to reduce mortality
Prevention
1. Isoniazid preventive treatment
2. Airborne infection control
3. Awareness generation
Early detection of TB/HIV
1. 100% coverage of PITC in TB patients
2. PITC in presumptive TB cases
3. Rapid diagnostics for TB in PLHIV
4. ICF activities at all HIV settings
Prompt treatment of TB/HIV
1. Early initiation of ART
2. Prompt initiation of TB treatment
Management of special TB/HIV cases
TB/HIV in children
TB/HIV in pregnant women
Drug resistant TB/HIV

30. Care support and treatment
Aims
Provide comprehensive service to PLHIV to improve survival & quality
of life
Services
1. Free universal access to lifelong ART
2. Free lab diagnostic & monitoring services
3. Facilitate long term retention of care
4. Prevention, diagnosis & management of opportunistic infections
5. Linkage to care & support and social protection scheme
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31. Care support and treatment
Indicators India Karnataka
ART Centres 553 65
Centre of Excellence (Adult) 11 1
Centre of Excellence (Paediatric 7 1
Link ART Centres 1270 305
Care Support Centres 310 36
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Selected medical
colleges
MCH & district
level hospitals
Sub district level
hospital & CHC
CoE
&
ART Plus
ART Centres
Link ART centres &
LAC plus centres

32. RTI/STI
• Person with STI/RTI is 2-9 times prone to get HIV
• Upto 40% HIV transmission can be cut down by treating STI
• Management of STDs through syndromic approaches by color coded
kits
• Integration of services for treatment of reproductive tract infections
& STDs at all levels of health care
• NACO has branded the STI/RTI services as “Suraksha Clinic”
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33. Blood transfusion services
• Promoting non- remunerated Voluntary Blood Donation; screening
for HIV and other Transfusion Transmissible Infection;
• Promoting Component separation
• Strengthening Quality management systems and Capacity building
• Around 12 million blood units collected in 2018-19
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34. IEC
• Awareness through media
• Awareness and prevention of HIV
• Available government services & schemes
• Adolescent health education programme
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35. References
• Park K. Park’s textbook of preventive and social medicine. 26th ed. Jabalpur: M/s
Banarsidas Bhanot Publishers; 2018.
• J.Kishore.National health programmes of India. 13th edition. Century Publishers;
2018.
• Dr.D.K.Taneja.Health policies and programmes in India. 13thedition. Doctors
Publications;2015
• National AIDS Control Organisation, Department of AIDS Control, Ministry of
Health and Family Welfare. Annual Report 2019-20.
• NACP IV, National AIDS Control Organisation, M/o H & FW, Govt. of India, N.Delhi.

36. Thank you
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