hiv epidemiology in nepal

1. National Centre for AIDS
and STD Control
HIV AND AIDS BACKGROUND AND
EPIDEMIOLOGY

2. National Centre for AIDS
and STD Control
Global Scenario of HIV-2017
Global
Asia and
pacific Region
Nepal
People living
with HIV 36.7 million
5.1 million 31,020
New HIV
Infections (total) 1.8 million
300,000
835
AIDS-related
deaths 1. million 180,000 1,306

3. National Centre for AIDS
and STD Control
About 5,700 new HIV infections (adults and children) a day
in 2015
 About 66% are in Sub Saharan Africa
 About 400 are among children under 15 years of age
 About 5,300 are among adults aged 15 years and older,
of whom:
-almost 47% are among women
-about 35% are among young people (15-24)
Source UNAIDS 2016
Global Statistics

4. National Centre for AIDS
and STD Control
Regional Situation

5. National Centre for AIDS
and STD Control
Global estimation for HIV (UNAIDS, 2017)
Adults and children
living with HIV
Adults and children
newly infected with HIV
Adult & child
deaths due to AIDS
Eastern and southern
Africa
19.4 million
[17.8 million–21.1 million]
790 000
[710 000–870 000]
420 000
[350 000–510 000]
Western and central Africa 6.1 million
[4.9 million–7.6 million
370 000
[270 000–490 000]
310 000
[220 00–400 000]
Middle East and North
Africa
230 000
[160 000–380 000]
18 000
[11 000–39 000]
11 000
[7700–19 000]
Asia and the Pacific 5.1 million
[3.9 million–7.2 million]
270 000
[190 000–370 000]
170 000
[130 000–220 000]
Latin America 1.8 million
[1.4 million–2.1 million]
97 000
[79 000–120 000]
36 000
[28 000–45 000]
Caribbean 310 000
[280 000–350 000]
18 000
[15 000–22 000]
9400
[7300–12 000]
Eastern Europe and central
Asia
1.6 million
[1.4 million–1.7 million]
190 000
[160 000–220 000]
40 000
[32 000–49 000]
Western and central
Europe and
North America
2.1 million
[2.0 million–2.3 million]
73 000
[68 000–78 000]
18 000
[15 000–20 000]
TOTAL 36.7 million
[30.8 million–42.9 million]
1.8 million
[1.6 million–2.1 million]
1.0 million
[830 000–1.2 million]

6. National Centre for AIDS
and STD Control
Country Situation

7. National Centre for AIDS
and STD Control
Current Situation of HIV and AIDS in
Nepal (NCASC, 2016)
• The first HIV infection was detected in 1988 in Nepal.
• Since then HIV epidemic has evolve from low- to
concentrated among Key affected populations
– People with Injecting drugs (PWID)
– Female sex workers (FSW)
– Clients of female sex workers
– Men who have sex with men (MSM)
– Labor migrants
• Heterosexual transmission is dominant
• HIV prevalence in general population is <1%.

8. National Centre for AIDS
and STD Control
State of HIV Epidemics
1) Low Level Epidemics
• HIV <5% in all sub population with high risk behaviour
2) Concentrated Epidemics
• HIV >5% among in any subpopulation with high risk
behaviour and < 1% among women attending antenatal
clinic
3) Generalized Epidemics
• HIV > 1% among women attending antenatal clinic (in
general population)

9. National Centre for AIDS
and STD Control
Concentrated Epidemic
• HIV prevalence >5% among in any sub population
with high risk behaviour & <1% among women
attending antenatal clinic
Current HIV Situation in Nepal

10. National Centre for AIDS
and STD Control
Situation of HIV Epidemic in Nepal 2017
Total Estimated PLHIV 31,020
HIV Prevalence (15-49) 0.15
Male living with HIV 19,020 (61.3%)
Female living with HIV 12,000 (38.7%)
Children living with HIV (out of total infections) 1,192 (3.8%)
HIV Prevalence (15-24) 0.02
New HIV infections 835
Mother Needing eVT services 304
AIDS-related Deaths 1,306

11. National Centre for AIDS
and STD Control
HIV prevalence among adult aged 15-49
years
0.18
0.12
0.15
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Percent
Male Female Total

12. National Centre for AIDS
and STD Control
Trends of Estimated Prevalence, New
Infection and Deaths (1985 – 2020)
1,306
835
0
1000
2000
3000
4000
5000
6000
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Number
of
new
infection
and
deaths
Estimated deaths Estimated new infections

13. National Centre for AIDS
and STD Control
ARV Services in all districts
15,260
on ARV
By Dec, 2017)

14. National Centre for AIDS
and STD Control
PMTCT(eVT) services in all districts
382,827
pregnant women
testedfor
HIV
(July 15, 2016 to
July 15, 2017)

15. National Centre for AIDS
and STD Control
Provincial Situation
Province HIV Testing and Counseling PMTCT On ART
Tested Positive Tested Positive
Province 1 31780 207 53646 27 1197
Province 2 14245 273 32724 17 1428
Province 3 39043 630 100340 45 4082
Province 4 4530 108 45189 20 1807
Province 5 45104 346 81521 13 2772
Province 6 682 9 16899 0 434
Province 7 40844 208 52568 6 2824
Nepal 176228 1781 382,827 128 14544
Source: NCASC,
2017

16. National Centre for AIDS
and STD Control
31020
19720
15260 15260
7998
7184
0
5000
10000
15000
20000
25000
30000
35000
Estimated Number
of PLHIV
Number of alive
PLHIV and know
their status
PLHIV Received
ART
Retension on ART
(12 months)
Viral Load Test Viral Load
Suppression
#
of
PLHIVs
Treatment Cascade of HIV in Nepal 2017
Source: National Center for AIDS and STD
Control (NCASC), 2017
Expansion of viral
load services/access
36%
Need for
expanding ART
enrollment
Retention on ART
program for 12
month and more
51%
PLHIVs are
yet to initiate
ART
Need for
expanding HIV
Testing Coverage
PLHIVs are yet
to have viral
load test and
suppressed
90% 90%
HIVision
2020
64% 49%
23%
PLHIVs are yet
to be
identified to
reach 90
percent
77 %
90%

17. National Centre for AIDS
and STD Control
Services Package Target Populations
Comprehensive HIV prevention package for key
populations at higher risk and general population:
 Targeted interventions: IEC, BCC, Condom
programming, Harm reduction (NSE, OST)
 HIV testing and counseling
 STI diagnosis and treatment
 PWIDs
 SWs and their clients
 MSM/TG
 Labour migrants and spouses
 TB patients (high risk)
 General population
PMTCT ANC attendees
ART , management of OIs, including TB-HIV co-
infection, and infection control
PLHIV
Care and Support (CHBC, CCC, social protection) Infected and affected by HIV
Stigma and discrimination reduction All
Capacity development Health care providers (public &
private)
Social protection, human rights, impact mitigation All (specifically among key
populations at higher risk and
PLHIV)

18. National Centre for AIDS
and STD Control
26 DBS sample
collecting sites for EID
Services
30 CD4 Machines in 28
sites
15 OST sites in 10
Districts
3 Viral Load
testing sites in 3
sites (NPHL, Seti
Zonal Hospital and Bir
Hospital)
TB/HIV service
through 68 ART
sites in 59
districts
Other Services
25 ART
Dispensing
Centers to support
in treatment
adherence

19. National Centre for AIDS
and STD Control
Incidence Meter:
Towards End of HIV Epidemic
Source UNAIDS 2016

20. National Centre for AIDS
and STD Control
National HIV Strategic Plan 2016-2021
• Ending the AIDS epidemic, as a public health threat in
Nepal, by 2030
Vision
• Identify, recommend and test 90% of estimated
population
• Treat 90% of those diagnosed as HIV positive
• Retain 90% of those on ART
• Eliminate vertical transmission of HIV and keep mothers
alive and well
• Eliminate congenital syphilis
• Reduce 75% of new HIV infections
Targets

21. National Centre for AIDS
and STD Control
Key Priority Actions for Ending AIDS
in Nepal
• Strengthen IRRTTR (Identify, Reach, Recommend, Test,
Treat and Retain)
• Scale up HIV testing and treatment for key populations
(TTR and TaSP)
– Community Based Testing approach
• Focus on major sources of new infection
• Scale up evidence-based prevention interventions for
key affected populations
• Integrate and decentralise HIV service delivery systems
• 90-90-90 by 2020

22. National Centre for AIDS
and STD Control
Key Priority Actions for Ending AIDS
in Nepal
• Massive scale up of HIV testing among pregnant
women (reached at least up to birthing center)
• Early DNA-PCR test among exposed baby for early
detection of HIV among infant
• Early enrollment in treatment both mother and
born baby
• Scale up treatment centers and
• Easy access for the EID test
• Elimination of vertical transmission of HIV by 2021

23. National Centre for AIDS
and STD Control
Thank You