The document summarizes the National AIDS Control Programme (NACP) in India. It discusses the four phases of NACP, their objectives and strategies. Key services discussed include integrated counselling and testing centres (ICTC), prevention of parent-to-child transmission (PPTCT), HIV/TB collaboration, care and treatment services, guidelines on infant feeding, and STD control programs. The NACP aims to slow the spread of HIV/AIDS through prevention efforts like targeted interventions and increasing access to treatment.

1. SUBMITTED TO: SUBMITTED BY:
MRS. ASHA MA’AM MANJEET KAUR
CON,SJH

2.  AIDS is defined as the most severe form of a
continuum of illnesses associated with human
immunodeficiency disease(HIV) infection .
 HIV: belongs to a group of viruses known as
RETROVIRUSES ( type of viruses that carry their
genetic material in the form of ribonucleic
acid[RNA] rather than deoxyribonucleic
acid[DNA] ).

3.  The immunodeficiency virus(HIV) principally
attacks CD4 T-cells, a vital part of the human
immune system . As a result , the body’s ability to
resist opportunistic viral, bacterial , bacterial ,
fungal , and other infection is greatly weakened .

4.  HIV is retrovirus.

7.  CLASSIFICATION OF STATES:
1. High prevalence : >5% in HRG & >1% in ANC
Maharashtra , TN , Andhra Pradesh , Karnataka ,
Nagaland.
2. Moderate prevalence : >5% in HRG & 1% in ANC
Gujarat , Pondicherry , Goa .
3. Low prevalence : >5% in HRG & 1% in ANC
all other states and UTs

8.  12,70,678 people are on ART.
 21,16,581 people were living with HIV.
 75,948 people became newly infected with HIV.
 67,612 deaths due to AIDS.
 35,255 pregnant woman needs PPTCT.

9.  INTRODUCTION
 HIV infection s first detected in 1986, when 10
HIV positive samples were found from a group of
102 female sex workers from Chennai.
62 AIDS surveillance centres were gradually
established nationwide .

10.  The milestones of the programme are
summarized as follows
1986- - first case of HIV detected
- AIDS task force setup by the ICMR
- national AIDS committee established
under the ministry of health.
 1990- -mid term plan launched for from states
and the four metros.

11.  1992- - NACP 1 launched to show down the spread of
HIV infection
- national AIDS control board constituted
- NACO setup
 1999- - NACP 2 begins focusing on behaviour change ,
increased decentralization and NGO involvement.
- state AIDS control societies developed .
 2002- - national AIDS control policy adopted.
- national blood policy adopted.

12.  2004- - antiretroviral treatment initiated .
 2006- - national council on AIDS constituted under
chairmanship of prime minister.
- national policy on paediatric ART formulated.
 2007- - NACP 3 launched for years (2007-2012)
 2012- - NACP 4 launched for next 5 years

13. NATIONAL AIDS CONTROL
PROGRAME -1
OBJECTIVES: Slow and prevent the spread of HIV
through a major effort to prevent HIV
transmission.
KEY STRATEGIES:
Focus on raising awareness , blood safety ,
prevention among high risk populations.

14. Improving surveillance
ACHIEVEMENTS:
National AIDS response structures at both
national and state levels and provided critical
financing
Strong partnership with the WHO and later
helped mobilized additional donor resources
Established the state AIDS control cells.

15. NATIONAL AIDS CONTROL
PROGRAMME-2
OBJECTIVE: Reduce the spread of HIV infection in
India through behaviour change and increase
capacity to respond to HIV on a long-term basis.
KAY STRATEGIES:
Targeted interventions for high risk groups.
Preventive interventions for general populations.
Involvement of NGOs.
Institutional strengthening.

16. ACHIEVEMENTS:
At the operational level 1,033 targeted
interventions setup, 875 voluntary counselling and
testing centres (VCTC) and 679 STF clinics at the
district level.
National wide and state level behaviour
surveillance surveys(BSS) were conducted .
PPTCT expanded.
A computerized management information
system(CMIS) created .

17. HIV prevention and care and support organisation
and networks were strengthened
Support from partner agencies increased
substantially.

18. NATIONAL AIDS CONTROL
PROGRAMME-3
OBJECTIVES: Reduce the rate of incidence by 60%
in the first year of the programme.
KEY STRATEGIES:
 Prevention – targeted intervention (TI) , ICTC ,
blood safety.
 Care support and treatment
 Capacity building- establishment , support and
capacity

19.  Strategic information management monitoring
and evaluation.
PROGRAMME PRIORITIES
 Considering that more than 99% of the population
in the country is free fro the infection , NACP-3
has place the highest priority on prevention efforts
while, at the same time seeking to integrate
prevention with care, support and treatment .

20.  Sub population that have the highest risk of
exposure to HIV will receive the highest priority
for intervention .
 Those in general population who have greater
need for accessing prevention services such as
treatment of STIs.
 Ensures who need treatment would have access to
prophylaxis and management of opportunistic
infection.

21.  Provision of services for prevention of parent to
child transmission of disease.
 Impact of HIV will be mitigated through welfare
agencies providing nutritional support.
 Invest in community care centres to provide
psycho-social support.
 Socio-economic determinants that make a person
vulnerable also increase the risk of infection.

22. ACHIEVEMENTS:
 There were 306 fully functional ART centres .
 Nearby 12.5 Lacs PLHIV were registered and
420000 patients were on ART .
 612 link ART centres(LAC) had been established
wherein , 26023 PLHIV were taking services .
 There were 10 centres of excellence.
 7 regional paediatric centres also functional.
 259 community care centres across the country.

23.  6000 condoms and 6000 village information
centres established.
 3000 red ribbon clubs established.
 Link workers training module updated .

24. NATIONAL AIDS CONTROL
PROGRAMME-4
Launched on 12 February 2014.
Total budget outlet Rs. 1429 crores.
Goal: accelerate reversal and integrate response .
OBJECTIVES:
Reduce new infection by 50% (2007 baseline of
NACP-3)
Provide comprehensive care and support to all
persons living with HIV/AIDS.

25. STRATEGIES:
Intensify and consolidate preventive services .
Increase assess and promote comprehensive care,
support & treatment.
Expanding IEC services.
Capacity building .
Strengthening strategic information management
system.

26. KEY PRIORITIES UNDER NACP-4
Preventing new infections by sustaining the reach
of current interventions and effectively addressing
emerging epidemics.
Prevention to parent to child transmission
Focusing on IEC
Providing comprehensive care , support and
treatment to eligible PLHIV.

27.  Reducing stigma
 De-centralizing rollout of services including technical
support.
 Ensuring effective use of strategic information at all
levels of programme.
 Building capacities of NGO and civil society partners
especially in states with emerging epidemics.

28. Integrating HIV services with health system in a
phased manner.
Mainstreaming of HIV/AIDS activities.
PREVENTION SERVICES:
Targeted interventions for high risk group and
bridge population.
Needle-syringe exchange programme(NSEP) and
opioids substitution therapy (OST) for IDUs.

29. Prevention intervention for migrant population at
source , transit and destination.
Link worker scheme (LWS) for HRGs and
vulnerable population in rural areas .
Prevention & control of sexually transmitted
infection/reproductive tract infections.
Blood safety

30.  HIV counselling and testing services .
 Prevention to parent to child transmission.
 Condom promotion.
 Information , education and communication(IEC) &
behaviour change communication(BCC).

31.  Surveillance are being carried out to detect spread
of the disease & to make appropriate strategy for
prevention and control i.e. by area specific target
interventions & best practice approach .
 Types of surveillance:
HIV sentinel surveillance
HIV sero-surveillance
AIDS case surveillance
STD surveillance
Behavioural surveillance

32. Integration with surveillance of other disease like TB
etc.
• Out of above most effective surveillance is HIV
sentinel surveillance .
• The main aim of the surveillance is confined to
monitor the trend of HIV infection.
OBJECTIVES OF THE SURVILLANCE :
To determine the level of HIV infection among general
population as well as HRGs in different states
To uderstand the trend of HIV epidemic .

33.  To understand the geographical spread of infection
and to identify emerging pockets.
 To provide information for prioritization of the
program resources & evaluation of program impact
 To estimate prevalence & HIV burden in the country .
 It is done in same place over few years by anonymous
serological tests i.e. HIV testing is done without
identification for purposes eg. VDRL , STD clinics.
 The demerit of the test is that +ve person is not
identified.

34.  In 1994 it was started with 55 sentinel sites and
become 180 in 1998
 The number of HRG of people increased in HIV
sentinel sites .
 THE KEY FEATURES OF SURVEILLANCE ARE
1. Inclusion of data from high risk population through
targeted intervention sites
2. Adding rural samples through antenatal clinics
 The strategy adopted was whatever be the sentinel
site and amount of sample collected – the duration ,
frequency and age group of people in the surveillance
should be same in all HRG , bridge population and
general population.

35. Counselling and HIV testing services :
1. ICTC
2. Prevention of parent to child transmission
3. HIV/TB collaborative activities
4. Care, support & treatment services.
5. Guidelines for HIV and infant feeding
6. STD control programme

36. 1. Integrated counselling and testing services :-
 This is available to increase access to HIV
diagnosis.
 It includes testing services & community
approaches at various level of health system in
India like state, district, sub-district, &
village/community level.
 Functions:
 Early detection of HIV.

37. Provision of basic information on modes of
transmission, prevention of HIV for promoting
behavioural change and reducing vulnerability and
liking the PLHIV to care , support & treatment .
 Two types of ICTC:
1. Fixed facility ICTC
2. Mobile ICTC

38. All HIV testing services must follow the WHO-
recommended principles known as the “5 Cs”:
 informed Consent
 Confidentiality
 Counseling
 Correct test results
 Connection (linkage to care, treatment and other
services).

39. 2. Prevention of parent to child transmission:-
 The prevention of parent to child transmission of
HIV/AIDS(PPTCT) program was started in 2002.
 Currently there are more then 15000 ICTCs in
country which offer PPTCT services to pregnant
women.
 The aim of the PPTCT program is to offer HIV
testing to every pregnant woman (universal
Coverage ) in the country , so as to cover all
estimated HIV positive pregnant women and
eliminate transmission of HIV from mother o
child.

40.  In India , PPTCT interventions under NACP was
started in 2002 , using SD-NVP prophylaxis for
HIV positive women during labour and also for her
new born child immediately after birth.
 The PPTCT services provide access to all pregnant
women for HIV diagnosis prevention , care and
treatment services.

41. 3. HIV/TB collaborative activities :-
 NACP-4 covers the HIV testing of TB patients.
 It is combined work of NACP & RNTCP.
 State with high prevalence covers about 90% of
TB patients for HIV testing.
 There is expected detection of HIV within 2-4
weeks of TB positivity.
 This service was started in 2002 in Karnataka
followed by Maharashtra , Andhra Pradesh &
Tamil Nadu.

42. 4. Guidelines for HIV and infant feeding :-
 Till 2009, WHO advise HIV positive mothers to
avoid breast feeding if they were able to afford
and store formula milk safely.
 On 30th November 2009 ,WHO released new
recommendations on infant feeding by HIV
positive mothers .
 HIV positive mothers or their infants take anti
retroviral drugs throughout the period of breast

43. Feeding and until the infant is 12 months old.
 Child can benefit from breast feeding with every little
risk of becoming infected with HIV.

44. 5. Care, support & treatment services:-
 Laboratory services for CD4 testing and other
investigations .
 Free first line & second line ART through ART
centers and link ART centers , centers of
excellence & ART plus centers .
 Pediatric ART for children
 Early infant diagnosis for HIV exposed infants

45. And children below 18 months .
 HIV/TB coordination ( cross , referral , detection
and treatment of co-infection).
 Treatment of opportunistic infections .
 Drop-in centers for PLHIV networks.

46. 6. STD control programme :-
 STD control is linked to HIV/AIDS control as
behaviour resulting in the transmission of STD
and HIV are same
 HIV is transmitted more easily in the presence of
another STD
 Hence, early diagnosis and treatment of STD is
now recognized as one of the major strategies to
control spread of HIV infection.

47. we have studied , what is AIDS and HIV ?
Sign and symptoms of AIDS , Indian statistics of
AIDS , National AIDS Control Program ,
milestones of NACP , its four phases , services
under NACP to control the spread of AIDS like
ICTC , Prevention of parent to child transmission
, HIV/TB collaborative activities , Care, support
& treatment services , Guidelines for HIV and
infant feeding ,STD control programme.

48.  http://naco.gov.in/nacp
 http://en.m.wikipedia.org/wiki/national_AIDS_Contr
ol_Organisation
 K. Park, K. Parks text book of Preventive And Social
Medicine, New Delhi , Bhanot Publications, page no.
343-355 ,431-438.