Recent changes in pptct guideline, ICTC, ART, PEP, NACP-4, care,support and treatment TB-HIV Coinfection, sentinel survillence

1. Presented by:
Nayan Gupta
Neha Singh
Nikhil Mishra
Nishtha Jain
Nitisha Bilaye
Guided by:
Dr. S.B. Bansal
Dr. Satish Saroshe

2. 1. Introduction
2. PPTCT
3. ICTC
4. ART
5. PEP
6. NACP-IV introduction
7. Care, Support and treatment
8. HIV-TB coinfection
9. Sentinel suviellence

3.  India has the third largest HIV epidemic in the world.
 In India (2016)
 Approx. 2.5 million people living with HIV.
 0.3% adult HIV prevalence.
 86,000 new HIV infections.
 HIV prevention in India- NACO is the body responsible for
prevention and control of the HIV epidemic in INDIA.
 Current programme, NACP-IV (2012-2017) , aims to reduce the
HIV infections by 50%.

5. The rate of HIV transmission during pregnancy, labor or
delivery from mothers infected with HIV is
 25% - 30% with no interventions
 But can be reduced
up to <2% with
appropriate intervention.

7. ANC
Group
education
Offer HIV
test
Pre test
counseling
HIV testPost test
counseling
HIV
positive
HIV
negative
Primary
prevention
Participant

8.  All pregnant women detected positive for HIV should be started
on life long ART irrespective of disease stage and CD4 count.
 Preferred regimen-
Tenofovir 300mg + Lamivudine 300mg+ Efavirenz 600mg
 Alternate regimen
Azathioprine + Lamivudine + Efavirenz,
Azathioprine + Lamivudine + Nevirapine,
Tenofovir + Lamivudine + Nevirapine
 According to NACO guideline- Dec 2013
 Previous it was single dose Nevirapine.

9. Daily Nevirapine
prophylaxis for 6 weeks
If mother
received ART
adequately in the
antenatal period
Daily Nevirapine
prophylaxis for 12 weeks
If mother has not
received ART
Received ART
for less than 24
weeks
OR
 According to NACO guideline- Dec 2013

10. 1) Exclusive breastfeeding is the recommended infant feeding
choice in the first 6 months.
2) In situations where breastfeeding cannot be done (maternal
death, severe maternal illness) or individual mother’s choice (at
her own risk), then exclusive replacement feeding may be
considered only if AFASS Criteria for exclusive replacement
feeding is fulfilled.
3) After 6 months complementary feeding should be introduced
gradually.
4) MIXED FEEDING should NOT be done during the first 6
months. (Feeding a baby with both breast feeds and
replacement feeds in the first 6 months is known as mixed
feeding which leads to mucosal abrasions in the gut of the baby
facilitating HIV virus entry through these abrasions).

11. • Breastfeeding continued until 12 month of
age.
If EID Is negative
• Breastfeeding continue until the baby is 2
year old.
If EID Is positive
 Breast-feeding should NOT be stopped ABRUPTLY

12. A
• AFFORDABLE
F
• FEASIBLE
A
• ACCEPTABLE
S
• SUSTAINABLE
S
• SAFE

15. Integrated Counselling
and Testing Centres

16.  An ICTC is a place where a person is counseled and tested for
HIV, on his/her own will (self- initiated) or as advised by a
medical provider (provider- initiated).
 Functions of ICTC
 Early detection of HIV
 provide basic information on modes of transmission and
prevention of HIV for promoting behavioural changes and
reducing vulnerability.
 Linking PLHIV with other HIV prevention, care and
treatment services.

17. ICTC
Fixed
ICTC
Standalone
ICTC
Facility
ICTC
Mobile
ICTC
In hard to reach areas and remote
areas.
In medical college, district
hospital, sub district hospitals
and CHCs.
Below block level in PHCs and
24×7 PHC

18.  Public private partner (PPP) ICTC- These are established
in private facilities (NGOs, community based organizations,
federation of Self-Help Groups (SHGs), hospitals, nursing
homes, clinics and laboratories)
 Infrastructure
 A counselling room
 Laboratory
 Sample collection room
 Manpower in an ICTC
 ICTC manager
 Counsellor
 Laboratory technician
 Outreach workers

19.  Counselling in ICTC done by GATHER approach
G
A
T
H
E
R
Greet the client
Ask the problem
•Active listener
•Access degree of risk behavior
•Show respect and tolerance
•Enable patient to express freely
•Determine assess to support and help in family and
community
Tell the client about the specific information which
he/she desires
Help them to making decision
Explain the myths or misconceptions
Return for follow up or Referral

22.  CLINICAL GOALS : Prolongation of life and improvement in quality of
life
 VIROLOGICAL GOALS : Greatest possible reduction in viral load for as
long as possible
 IMMUNOLOGICAL GOALS : Immune reconstitution both quantitative
and qualitative
 THERAPEUTIC GOALS : Rational sequencing of drugs that achieves
clinical , virological and immunological goals while maintaining treatment
options limiting drug toxicity and facilitating drug adherence
 REDUCTION OF HIV TRANSMISSION : By suppression of viral load

23.  ART should be initiated in all adults, adolescent , pregnant and breast
feeding living with HIV regardless of WHO clinical stage and at any
CD4 cell count
 As a priority, ART should be initiated in all with severe or advanced
HIV clinical disease{WHO clinical stage 3 and 4}and with CD4 count
<350cells/mm3
 In infant and children younger than 10 years of age:
 Infants diagnosed in the first year of life
 Children living with HIV 1 year old to less than 10 year
 Children <2 years and younger than 5 years of age with WHO clinical
stage 3 & 4 & or CD4 count <750 cells/mm3 and 5 years of age and
older with CD4 count <350 cells/mm3

24. FIRST LINE ART PREFFERED FIRST LINE
REGIMENS
ALTERNATIVE FIRST LINE
REGIMENS
ADULTS TDF+3TC[or FTC]+EFV AZT+3TC+EFV[OR NVP]
TDF+3TC[or FTC]+DTG
TDF+3TC[or FTC]+EFV
TDF+3TC[or FTC]+NVP
PREGNANT OR BREASTFEEDING
MOTHER
TDF+3TC[or FTC]+EFV AZT+3TC+EFV[or NVP]
TDF+3TC[or FTC]+NVP
ADOLESCENTS TDF+3TC[or FTC]+EFV AZT+3TC+EFV[or NVP]
TDF[or ABC]+3TC[or FTC]+DTG
TDF[or ABC]+3TC[or FTC]+EFV
TDF[or ABC]+3TC[or FTC]+NVP
CHILDREN 3 YEARS TO LESS
THAN 10 YEARS
ABC+3TC+EFV ABC+3TC+NVP
AZT+3TC+EFV[or NVP]
TDF+3TC[or FTC]+EFV[or NVP]
CHILDREN LESS THAN 3 YEARS ABC[or AZT]+3TC+LPV/r ABC[or AZT]+3TC+NVP

25. PHASE OF HIV
MANAGEMENT
RECOMMENDED
HIV DIAGNOSIS HIV TESTING
CD4 CELL COUNT
TB SYMPTOMS SCREENING
FOLLOW UP
BEFORE ART
CD4 CELL COUNT[EVERY 6-12 MONTHS IF ART IS DELAYED]
RECEIVING ART HIV VIRAL LOAD[AT 6 MONTHS AND 12 MONTHS THEN EVERY 12
MONTHS THEREAFTER]
SUSPECTED
TREATMENT
FAILURE
SERUM CREATININE
PREGNANCY TEST

26. FAILURE DEFINITION COMMENTS
CLINICAL NEW OR RECURRENT CLINICAL EVENT
[SEVERE IMMUNODEFICIENCY]AFTER 6
MONTHS
CONDITION MUST BE DIFFERENTIATED
FROM IRIS OCCURING AFTER INITIATING
ART
IMMUNOLOGICA
L
ADULTS & ADOLOSCENTS-
CD4 COUNT <250 CELLS/MM3
FOLLOWING CLINICAL FAILURE OR
PERSISTENT CD4 LEVELS BELOW 100
CELLS/MM3
CHILDREN-< 5 YEARS PERSISTENT CD4
LEVEL BELOW 200 CELLS/MM3
> 5 YEARS PERSISTENT CD4 LEVELS
BELOW 100CELLS/MM3
WITHOUT CONCOMITANT OR RECENT
INFECTION TO CAUSE A TRANSIENT
DECLINE IN THE CD4 CELL COUNT
VIROLOGICAL VIRAL LOAD ABOVE 1000 COPIES/ml
BASED ON TWO CONSECUTIVE VIRAL
LOAD MEASUREMENTS IN 3 MONTHS
WITH ADHERENCE SUPPORT FOLLOWING
THE FIRST VIRAL LOAD TEST
AN INDIVIDUAL MUST BE TAKING ART
FOR AT LEAST 6 MONTHS BEFORE IT CAN
BE DETERMINED THAT A REGIMEN HAS
FAILED

27. POPULATION FAILING FIRST –LINE
REGIMEN
PREFERRED SECOND
LINE REGIMEN
ADULTS AND
ADOLESCENTS
2 NRTIs+EFV[ or NVP]
2 NRTIs +DTG
2NRTIs +ATV/r or LPV/r
PREGNANT OR BREAST
FEEDING
2NRTIs+EFV[or NVP] 2NRTIs+ATV/r or LPV/r
CHILDREN
<3 years
>3 years to <10 years
2NRTIs+LPV/r
2NRTIs+NVP
2NRTIs+LPV/r
2NRTIs+EFV[or NVP]
2NRTIs+RAL
2NRTIs+LPV/r
2NRTIs+EFV
2NRTIs +LPV/r
If ABC+3TC orTDF(or FTC) was used in first-failing regimen , AZT +3TC should
be used in second line

28. POPULATION THIRD LINE REGIMEN
ADULTS AND ADOLESCENTS(>10
years)
DRV/r + DTG(or RAL)+1-2 NRTIs
PREGNANT OR BREASTFEEDING
WOMAN
DRV/r + DTG(or RAL)+1-2 NRTIs
CHILDREN(0-10 years) RAL(or DTG)+2 NRTIs
DRV/r+2 NRTIs
DRV/r + RAL(or DTG)+1-2 NRTIs
RAL can be used in children failing PI based treatment when DTG is not available
and when RAL has not been used in a previous regimen
DRV/r should not be used in children younger than 3 years of age.

29. H.I.V.
BY NIKHIL
MISHRA

30.  "Post exposure prophylaxis" (PEP) refers to the
comprehensive management given to minimize the risk
of infection following potential exposure to blood-borne
pathogens (e.g.HIV,HBV,HCV).
 It includes-
1. First aid
2. Counseling
3. Risk assessment Relevant laboratory investigations based on
informed consent of the source and exposed person.
4. Depending on the risk assessment, the provision of short term (4
weeks) of antiretroviral drugs.
6. Follow up and support.

32. Exposure route risk
Blood transfusion 90-95%
perinatal 20-40%
Sexual exposure 0.1-10%
vaginal 0.05-0.1%
anal 0.065-0.5%
oral 0.005-0.1%
Needle stick exposure 0.3 %

33. • Immediately wash the wound with water
and soap.Skin
• Irrigate exposed eye immediately with
water or normal salineEye
• Spit fluid out immediately
• Rinse the mouth thoroughly, using water or
saline and spit again
Mouth

34. Mild exposure
• Mucus membrane
/non intact skin
with small volume
• e.g. superficial
wound with plain
or low calibre
needle
Moderate exposure
• Mucus membrane
/non intact skin
with large volume.
• cut or needle stick
injury penetrating
gloves.
Severe exposure
• Percutaneous with
large vol.
• An accident with
caliber needle
visibly
contaminated with
blood.
Step 2.1-assessing nature of exposure and risk of transmission

35. • PEP is not effective when given more than 72 hours after
exposure. A baseline rapid HIV testing should be done before
starting PEP.
• Initiation of PEP where indicated should not be delayed while
waiting for the results of HIV testing of the source of exposure.
• Informed consent should be obtained before testing of the
source as per national HIV testing guidelines.
PEP must be initiated as soon as possible, preferably within 2 hours

36. Source h.i.v
status
Definition of risk
h.i.v. negative Source is not h.i.v. infected
Low risk h.i.v positive and clinically asymptomatic
Moderate risk h.i.v. positive and clinically symptomatic
unknown Status of patient is unknown (risk assessment will be
based upon h.i.v. prevalence in that locality)

37. • The exposed individual should have confidential counseling and assessment
by an experience physician.
• The exposed individual should be assessed for pre-existing HIV infection
intended for people who are HIV negative at the time of their potential exposure
to HIV.
• Exposed individuals who are known or discovered to be HIV positive should
not receive PEP. They should be offered counseling and information on
prevention of transmission and referred to clinical and laboratory assessment
to determine eligibility for antiretroviral therapy (ART).

38. • Exposed persons should receive appropriate information about PEP and risk
and benefits of PEP in order to get informed consent.
• It should be clear that PEP is not mandatory.
• Psychological support: Many people will feel anxious after exposure. This
will help to relieve part of the anxiety, but some may require further
specialized psychological support.
.

39. • HIV testing of the source patient should not delay the decision about
whether or not to start PEP.
• In the case of a high risk exposure from a source patient who has
been exposed to or is taking antiretroviral medications, consult an
expert to choose the PEP regimen, as the risk of drug resistance is
high.

40. EXPOSURE HIV + AND
ASYMPOMATIC
HIV + AND CLINICALLY
SYMTOMATIC
HIV SATUS
UNKNOWN
MILD
Consider 2-drug PEP Start 2-drug PEP Usually no PEP or
Consider 2-drug PEP
MODERATE
Start 2-drug PEP Start 3-drug PEP Usually no PEP or
Consider 2-drug PEP
SEVERE
Start 3-drug PEP Start 3-drug PEP Usually no PEP or
Consider 2-drug PEP
Step 4.1-Deciding on PEP regimen
There are two types of regimens-
• Basic regimen: 2-drug combination (Zidovudine, Stavudine)
• Expanded regimen: 3-drug combination (Zidovudine, Stavudine, Lamivudine)
• All clients starting on PEP must take 4 weeks (28 days) of medication.

41. Step 4.2 Selection of the PEP regimen when the source patient is
known to be on ART:
The physician should consider the comparative risk represented by the
exposure and information about the exposure source, including-
 history of and response to antiretroviral therapy based on clinical response,
 CD4cell counts,
 viral load measurements(if available)
 current disease stage (WHO clinical staging and history).
When the source person's virus is known or suspected to be resistant to one or
more of the drugs considered for the PEP regimen, the selection of drugs to
which the source person's virus is unlikely to be resistant is recommended.

42. • All clients starting on PEP must take 4 weeks (28 days) of
medication.
• In all cases, the first dose of PEP should be offered as soon as
possible, once the decision to give PEP is made.
• HIV testing or results of the source HIV test can come later.
 Step 4.3 Amount of Medication to dispense for PEP

43. The reason for HIV testing soon after an occupational exposure is to establish a
"baseline“ against which to compare future test results.
• If the person is HIV-negative at the baseline test, it is in principle possible to prove
that subsequent infection identified by follow-up testing is related to the occupational
exposure (Depending on the timing of infection and consideration of other risks or
exposures) .
• When offered HIV testing, the exposed person should receive standard pre-test
counseling according to the national HIV testing and counseling guidelines, and
should give informed consent for testing.
• Confidentiality of the test result must be ensured..
Do not delay PEP if HIV testing is not available.
Step 5 – Laboratory Evaluation

44. • An exposed person should be advised to use precautions (e.g., avoid
blood or tissue donations, breastfeeding, unprotected sexual relations or
pregnancy) to prevent secondary transmission, especially during the first
6-12 weeks following exposure. Condom use is essential.
Whether or not PEP prophylaxis has been started, follow up is indicated
to monitor for possible infections and provide psychological support.
Step 6- FOLLOW UP
LABORATORY FOLLOW UP
• Follow-up HIV testing: exposed persons should have post-PEP
HIV tests at the completion of PEP
• Therefore, testing at 3 months and again at 6 months is
recommended.

45. Adherence and side effect counseling should be provided and
reinforced at every follow-up visit. Psychological support and
mental health counseling is often required.

48.  1986=1st case of HIV detected
 1992= NACP1= to slow down the spread
 1999=NACP 2=focussing on behaviour change
 2007=NACP3
 2012=NACP 4

49.  The epidemic continues to progress with the following
characteristics
 High risk groups to low risk groups
 Urban to rural areas
 High prevalence states to all states
 High vulnerability of young persons and women
 MSM and IDUs not received appropriate attention
 Growing number of people living with HIV/AIDS has
increased the need for care , support and treatment

53.  Providing psychosocial support to the infected and affected
individual esp. to marginalised woman and children affected by
epidemic
 Ensure accessible, affordable and sustainable treatment services.
 Free antiretroviral therapy
 Prevention and treatment of opportunistic infections includingTB
 Facilitating home based care and impact mitigation

54.  Medicine Departments of Medical Colleges and District hospitals.
 Based on prevalence of HIV in the region
 Provide free comprehensive services including ART, CD4
testing & drugs required for treatment of Opportunistic Infections.
 “306 centres providing freeART to more than 4,12,125 patients in
India”.

56.  Main constraints-- Distance, travel time and costs to access ART
services and adherence to treatment.
 Leads to--Poor drug adherence, lost to follow up and missed cases.
 Make -- Accessible and facilitate delivery of ARV drugs, Link ART
Centres are established , located at district level hospitals nearer to the
patient’s residence.
 Located -- Integrated Counseling and Testing Centres (ICTC) which
further helped in linkage between ICTC and ART
 April 2011-- “612 Link ART Centres facilitate delivery of services
nearer to the patients homes”

57.  Patients needed to travel long distance to access the second line
treatment. This issue has resulted in low uptake of second line treatment.
 In View of these, it was decided to expand the number of facilities that
can provide second line ART.Previously till 2009 it was given in 2 COE.
 For this, some good functioning ART Centres were upgraded & labelled
as ‘ART Plus Centres’

59. OBJECTIVES:
 To improve health seeking behaviour of high risk groups
 Reduce their risk of acquiring STI and HIV infections.
HIGH RISK GROUP INCLUDES:
 Female sex workers
 Men who have sex with men
 transgenders
 Injecting drug users
 Bridge population include high risk behaviour migrant and long
distance truckers.

60. SERVICES OFFERED UNDERTHETARGETED
INTERVENTION PROGRAMME
 Detection and treatment for sexually
transmitted infections.
 Condom promotion and distribution
 behaviour change communication
 Creating and enabling environment with
community involvement and participation
 Linkages to integrated counselling and
testing centres
 Linkages with care and support services for
HIV positive HRGs
 Community organization and ownership
building
 Specific interventions for IDUs
1. Distribution of clean needles and syringes
2. Abscess prevention and management

62.  National blood transfusion(NBTA) to be set up as an autonomous body.
 Establishment of Centre of Excellence in Transfusion Medicine in
four metro cities of Delhi, Kolkata, Mumbai and Chennai.
 Approval for setting up of one Plasma Fractionation Centre has
been obtained, for processing of 1.5 lakh litres of plasma
annually. Land for this purpose has been provided at Chennai.
 Achieve 90% of the annual requirement of blood by voluntary
donation.Presently -79.2%
 80% of blood collected to be converted to components for appropiate
use.Presently - 155 BCSU with 52% conversion
 Standardisation of testing protocol & reagents /kits in use.
 Establish blood storage centres in community care centres.
 Provide refrigerated vans in 500 districts for networking with blood storage
centres.

63.  It is a mandate to strengthen all public health facilities at and above
district level as designated STI/RTI clinics, with the aim to have at least
one NACO supported clinic per district.
 Presently - 1,033 designated STI/RTI clinics which are providing STI/RTI
services based on the enhanced syndromic case management. 90 new
clinics to be set up.
 Strengthen 7 regional STI training, reference and research centres.
 Role of these centres is to provide etiologic diagnosis to the STI/RTI
cases, validation of syndromic diagnosis, monitoring of drug résistance to
gonococci and implementation of quality control for Syphilis testing.
 Safdarjung Hospital acts as the Apex Centre in the country.
STI CLINICS

64.  Increase condom use during sex with non-regular partner, which is
the key to limiting HIV spread through sexual route.
 Increase the number of condoms distributed by social marketing
programmes.
 Increase the number of free condoms distributed through STI and
STD clinics, reaching those who are at the highest risk of acquiring or
transmitting HIV.
 Increase access to condoms, especially to men who have sex with
non-regular partners.
 Increase the number of non-traditional outlets for socially marketed
condoms, e.g., paan shops, lodges, etc. in strategically located
hotspots
CONDOMS NACP IV
Condom promotion continues to be an important prevention strategy

66.  P=PRACTICE SAFE SEX
 R=REMOVE MYTHS /MISCONCEPTIONS
 E=ENSURE EARLY DETECTION & t/t OF CASES
 V= VERTICAL TRANSMISSION TO BE PREVENTED
BY APPROPRIATE CONTRACEPTION
 E=ENSURE USE OF STERILISED NEEDLES
 N=NEGOTIATION SKILL TO BE DEVELOPED
 T=TRANSFER ONLY SCREENED BLOOD /BLOOD
PRODUCTS/ORGAN TRANSPLANTS
 I=I.E.C FACILTIY
 O=OPEN/ONGOING DISCUSSION WITH THE YOUTH
 N=NOTIFICATION /TRACING OF PARTNER

67. Programme Title Days
Rural Youth 5 Down MohabbatExpress Monday-Tuesday
Rural women Babli Boli Wednesday-Thursaday
Migrant Youth Kitney Dur Kitney Pass Saturday -Sunday
RADIO PROGRAMMES AIRED BY NACO

69. • Red, like love, as a symbol of passion and tolerance towards those affected.
• Red, like blood, representing the pain caused by the many people that died of
AIDS.
• Red, like the anger about the helplessness by which we are facing a disease for
which there is still no chance for a cure.
• Red as a sign of warning not to carelessly ignore one of the biggest problems
of our time.“ to carelessly ignore one of the biggest problems of our time."

71.  TB and HIV co-infection is when people have
both HIV infection, and also either latent or
activeTB disease. Each disease speeds up the
progress of the other.
 The estimated 10% activation of dormantTB
infection over the lifespan of an infected person,
increases to 10% in one year, if HIV infection is
superimposed.
 TB is one of the most commonly occurring
opportunistic infections in HIV infected patients.

72. HIV and TB interact in several ways:
- Reactivation of latent infection.
- Primary infection.
- Recurring infection.
- In the community.

73. “When a virus (HIV) and a bacteria (TB) can
work so well together, why can't we?”
- UNAIDS

74. 1. Huge dual burden of both HIV andTB.
2. High mortality ofTB-HIV coinfection.
3. Large country with heterogeneous HIV
epidemic. Health system capacity varies
tremendously.
4. Late diagnosis of HIV.
5. Leaky care cascade for HIV: difficult to track LFU.
6. Airborne infection control difficult due to over-
congested health facilities.

77.  Purpose:The overall purpose is to articulate the national
policy forTB/HIV Collaborative Activities between RNTCP and
NACP so as to ensure reduction ofTB and HIV burden in India.
 Objectives:
1. To maintain close coordination between RNTCP and NACP at
National, State and District levels.
2. To decrease morbidity and mortality due toTB among
persons living with HIV/AIDS
3. To decrease impact of HIV inTB patients and provide access
to HIV related care and support to HIV-infectedTB patients.
4. To significantly reduce morbidity and mortality due to HIV/TB
through prevention, early detection and prompt management
of HIV andTB together.

84. CD4 cell count ART recommendation
Timing of ART in
relation to treatment
for MDR-TB
≤ 350 cells/cu mm Recommend ART After 2 wk, as soon as
the t/t for MDR-TB is
tolerated.
> 350 cells/cu mm Defer ART Re-evaluate patient
monthly for
consideration of ART.
CD4 testing is
recommended every 3
months during t/t for
MDR-TB.
Not available Recommend ART After 2 wk, as soon as
the t/t for MDR-TB is
tolerated.

85.  Started from February 1, 2017.
 People who have been tested positive for HIV, and those affected
with tuberculosis, have to collect Fixed Dose Combination (FDC)
from district hospital and ART centre to be taken on a daily basis.
 Daily supply of FDC, instead of thrice a week, has been introduced
under the 99 DOTS (Directly ObservedTreatment, Short-Course)
scheme.
 The scheme is called 99 DOTS because it has 99% chances of cure of
the patients taking the medical course.
 Under this initiative, medicines for 28 days will be given to the
patient and there will be a tab on the consumption of the medicines.
Patient medication is packaged envelopes with dosage instructions,
and a series of hidden numbers behind the pills. Each time a patient
takes a dose of medication, he will have to call on the number and if a
call is not received at the centre, he is called on the registered mobile
number to remind him about the dosage.

90.  To determine the level of HIV infection among general
population as well as HRGs in different states.
 To understand the trends of HIV epidemic among
general population as well as HRGs in different states.
 To understand the geographical spread of HIV
infection and to identify emerging pockets.
 To provide information for prioritisation of
programme resources and evaluation of programme
impact.
 To estimate HIV prevalence and HIV burden in the
country.