This presentation explains graphically , statistically and in detail the National AIDS Control Programme (Indian scenario)

1. National AIDS
Control Programme
Dr. IMMANUEL JOSHUA
Junior Resident-1,
Community Medicine, IMS, BHU,
Email: immanuel2346@gmail.com
(NACP)

2. COUNTRY SCENARIO
States with >5% prevalence in High Risk Group and 1% or more in antenatal
women. (Maharashtra, Karnataka, Tamil Nadu, Andra Pradesh, Manipur)
States with >5% prevalence in High Risk Group but <1% in antenatal women.
(Gujarat, Goa, Puducherry)
States with <5% prevalence in High Risk Group and <1% in antenatal women.
(Remaining states)
Based on sentinel surveillance data, the HIV prevalence in adult population can be
broadly classified into three states/Uts in the country:
GROUP-1
GROUP-3
GROUP-2
HIGH
PREVALENCE
LOW
PREVALENCE
MODERATE
PREVALENCE

3. State wise adult
HIV prevalence
(2019)
State/UT-wise
PLHIV size
(2019)

4. State/UT-wise percent contribution in total new Infections (2019)

5. State/UT-wise AIDS death in 2019
(in thousands)

6. A
B
C
D
CATEGORIES OF DISTRICTS
More than 1%ANC/Parent to Child transmission prevalence in district at any
time in any of the sites in the last 3 years
Less than 1%ANC/PTCT prevalence in all the sites in the last 3 years
associated with >5% prevalence in any High Risk Group
<1%ANC prevalence in all the sites in the last 3 years with <5% prevalence in
all STD clinic attendees or any HRG with known hotspots
<1%ANC prevalence in all the sites in the last 3 years with <5% prevalence in
all STD clinic attendees or any HRG or poor data with no known hotspots

7. 1986
1999
1992
2002
2004
2007
2014
2017
National AIDS committee established
NACP-1 launched
NACP-II begins
NAC policy adopted
ART initiated
NACP-III launched
NACP-IV launched
National strategic plan
for HIV/AIDS and STIs
MILESTONES
Aim is to prevent further transmission of
HIV, to decrease morbidity and mortality
associated with HIV infection and to
minimize socio-economic impact
resulting from HIV infection.

8. NACO STRUCTURE
Additional Secretary & Director General (NACO)
Strategic information
Finance
Joint Secretary (NACO) Blood safety
Lab services
Care, Support and Treatment
Administration & Procurement
Targeted intervention
STI management
Basic services
IEC activities

9. HIV Surveillance
TYPES OF SURVEILLANCE

10. OBJECTIVES OF HIV SENTINEL SURVEILLANCE
1 5
4
3
2
To determine the level of HIV
infection among general
population as well as high risk
groups in different states
To estimate Human
Immunodeficiency Virus
prevalence and HIV burden in
the country
To provide information for
prioritization of programme
resources and evaluation of
programme impact
To understand the geographical
spread of HIV infection and to
identify emerging pockets
To understand the trends of
HIV epidemic among general
population as well as high risk
groups in different states

11. • Standalone ICTCs
• Standalone ICTCs &
Facility ICTCs
• Standalone ICTCs &
Facility ICTCs
• HIV screening using
whole blood finger prick
test / mobile ICTCs
COMMUNITY
LEVEL
VILLAGE
LEVEL
STATE &
DISTRICT
LEVEL
SUB
DISTRICT
LEVEL
Level of HIV Counselling & Testing Services

12. Integrated Counselling and Testing Centres (ICTC)
“A person is counselled and tested for HIV at ICTC, either of hos own free will (CLIENT
INITIATED) or as advised by a medical provider (PROVIDER INITIATED)”
ICTC
Mobile ICTC
Facility integrated
Standalone ICTC
Fixed facility ICTC
 Located in medical colleges, district
hospitals, sub-district hospitals, CHCs
 Full time counsellor and Lab technician
 High client load
 For rapid scale-up & sustainability
 Set up below the block levels at 24x7 PHCs
 Staffs of existing health facilities are trained
 Receives logistic support from DAC
 Temporary clinics in hard-to-reach
areas (Van with a room)

13. Prevention of Parent-to-Child transmission of HIV
The PPTCT programme was started in the country in the year 2002
Currently there are >15000 ICTCs in the country which offer PPTCT services to pregnant women
The aim of the PPTCT programme is to offer HIV Testing to every pregnant
woman (UNIVERSAL COVERAGE) in the country
Covers all estimated HIV positive pregnant women and Eliminate transmission of HIV from Mother-to-Child
The National Strategic Plan for PPTCT services using Multi-drug ARVs in India
was developed in May-June 2013 for nationwide implementation in phased manner

14. 6
4
2
The essential package of PPTCT services in India are as follows:
Move from ANC-centric to a “Family-centric approach”
Promotion of institutional deliveries of all HIV infected pregnant women
Provision of nutrition, counselling and psychological support for HIV women
1
5
3
Routine offer of HIV counselling to all Antenatal mother with an ‘Opt out’ option
Provision of life-long ART (TDF + 3TC + EFV) to all pregnant and lactating HIV women
Provision of care for associated conditions (STI/RTI/TB,..etc)

15. 10
8
Provision of ARV prophylaxis to infants from birth upto 6 months
Initiation of Co-trimoxazole Prohy. Therapy and Early infant diagnosis
7
11
9
Provision of counselling for timely initiation and continuation of breast feeding
Integrating follow-up of HIV exposed infants into routine healthcare services
Strengthening community followup and outreach through local community networks
Contd…

16. Activities to reduce TB-HIV mortality
PREVENTION
1. Isoniazid preventive treatment
2. Air borne infection control
3. Awareness generation
MANAGEMENT OF SPECIAL CASES
1. TB/HIV patients on PI based ARV
2. TB/HIV in children
3. TB/HIV pregnant women
4. Drug resistant TB/HIV
PROMPT TREATMENT
1. Early initiation of ART
2. Prompt initiation of TB treatment
EARLY DETECTION
1. 100% coverage of PITC in TB patients
2. PITC in presumptive TB cases
3. Rapid diagnostics
4. Intensified case finding activities
TB/HIV coordination to reduce mortality

17. Care, Support, Treatment
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Free universal access to life long standardized Anti Retroviral Therapy
Free laboratory diagnostic and monitoring services
Facilitating long term retention in care
Prevention, Diagnosis and Management of opportunistic infection
Linkage to care and support services and to social protection scheme
This component of NACP aims to provide comprehensive services to
PLHIV to improve the Survival and Quality of Life

18. 90-90-90 TARGET
PLHIV
90% Know
their status
90% on
ART
90% have
viral
suppression
“1. 90% of PLHIV know their status,
of which 2. 90% of PLHIV are on ART,
of which 3. 90% of PLHIV have Viral
Suppression”
The country has adopted fast track target of 90-90-90
which aims at ending AIDS as public health threat
by 2030 by achieving the targets by 2020
A significant step of rolling out “Test and Treat”
policy has been taken towards achieving these targets

19. TARGET vs ACHIEVEMENT

20. Model of HIV treatment services
CoE &
ART Plus
ART Centres
Link ART Centres and
LAC Plus Centres
Centres of Excellence and ART Plus centres in Select Medical Colleges
Sub-district level hospitals and CHCs
Medical college and District level hospital

21. Centres functioning in India (2017)
530
350
52
7
17
1108
ART Centres Link ART Centres Centres of Excellence
Pediatric
Centres of Excellence
ART Plus Centres Care and support
Centres

22. SERVICES
First line ART
Alternative First line ART
Third line ART
Second line ART
 Provide free of cost to eligible PLHIV
 Assessment to eligibility is done
through clinical examination & CD4
 Counselling provided
 Followup done
 Treatment of opportunistic infections
are also provided
 Started and expanded in CoEs
 Decentralization was done through
capacitating and upgrading some ART
centres as “ART Plus centres”
 For evaluation for initiation, a State
AIDS Clinical Expert Panel has been
constituted by DAC
 Rolled out in 2015
 Raltegravir & Darunavir
 Done through CoEs and ART Plus for those having toxicity/intolerance to 1st line ART

23. Centre of excellence in HIV care, Varanasi, Uttar Pradesh

24. ART Center, IMS, BHU, Varanasi, Uttar Pradesh
where facility for second and third line drugs is available
Only 1 Uttar Pradesh Bihar
Monitors the activity of 11 ART centres in Bihar, Uttar Pradesh and Madhya Pradesh
Link ART centers
Ballia
Ghazipur
Jaunpur
Mau
Sonebhadra
Bhadohi
Chandauli
Azamgarh
Approximately 27000 patients are registered with this ART Centre

25. High Risk Groups & HIV Prevalence
TARGETED INTERVENTIONS
The main objective is to improve health
seeking behavior of High Risk groups
and reduce their risk of acquiring
Sexually transmitted infections and
HIV infections

26. The services offered through Targeted Interventions include:
Detection and Treatment for Sexually transmitted infections
Condom promotion & distribution Behaviour change communication
Linkages to Integrated Counselling & Testing Centres
Linkages with care & support services for HIV+ HRGs
Community organization & Ownership building
Specific interventions for IDUs and MSM/TGs
Linkages with detoxification/rehabilitation services
Substitution Therapy

27. Pre-Packed STI/RTI colour coded kits
These are procured centrally and supplied to all State AIDS Control Societies for
free supply to all designated STI/RTI clinics
Vaginal discharge ,
Burning micturition,
increased frequency
Genital complaints by
sexual partners
Low backache
Genital ulcer, single/multiple, painful/painless
Burning sensation in the genital area
Enlarged lymph nodes
If allergic to Inj. Penicillin: Doxycycline 100 MG (Bid for
15 days) Azithromycin 1GM (Single dose)
Urethral discharge
Ano-rectal discharge
Cervicitis

28. Lower Abdominal Pain
Fever
Vaginal Discharge
Menstrual symptoms,
dyspareunia, dysuria,
tenesmus
Swelling in inguinal
region (bubo)
Preceding genital ulcer
or discharge
Systemic symptoms
Genital ulcer (herpetic)
or vesicles, single or
multiple, painful,
recurrent
Burning sensation in
the genital area
Contd…
NACO has branded the
STI/RTI services as
“SURAKSHA CLINIC”

29. National Strategic Plan for HIV/AIDS and STI (2017-2024)
The GOAL is to achieve zero new infection, zero AIDS related
deaths and zero AIDS related stigma & discrimination.
The NSP is designed around a results-based framework based on a causal relationship
between the Vision, Mission, Goal and Outcomes
Based on this strategic framework, a specific planning approach is required which helps
differentiate State & UTs according to 3 EPIDEMIOLOGICAL CONTEXTS
States/UTs with;
Mature Epidemic Low/Stable Epidemic
Emerging Epidemic

30. Reduce 80% new infections by 2024 (Baseline 2010)
Ensure 95% of estimated PLHIV know their status by 2024
Ensure 95% PLHIV have ART initiation and retention by 2024, for
sustained viral suppression
Eliminate mother-to-child transmission of HIV and syphilis by 2020
Eliminate HIV/AIDS related stigma and discrimination by 2020
Facilitate sustainable NACP service delivery by 2024
OBJECTIVES of NSP
1
2
3
4
5
6

31. Achievement of the above objectives by 2024 would result in the following:
 Estimated new infections will reduce from 102226 (2010) to <21000 per year
 2.14 million of the total estimated PLHIV(2.25 million) would know their status
 2.03 million PLHIV would be put on ART
 1.93 million PLHIV would be retained on treatment and have HIV VL <10000 copies/ml
 <50 cases of new pediatric HIV infections per 100000 live births with MTCT rate <5% by 2020
 <50 cases of congenital syphilis per 100000 live births
 HIV/AIDS will be perceived as chronic manageable disease with no stigma and discrimination
 Key components of NACP will continue through 100% domestic funding

32. 2020 THEME
“Ending the HIV/AIDS Epidemic:
Resilience and Impact”
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