NACP

National AIDS Control Programme

1. Demonstrated by : Megha Devgan & Mehak Khanna

2. Burden of HIV in india Among the States/UTs, in 2017, Maharashtra has the highest estimated number of PLHIV (3.30 Lakhs , 2.53-4.35) followed by Andhra Pradesh (2.70 Lakh , 2.00-3.58), Karnataka (2.47 Lakh , 1.91-3.23), Telangana (2.04 Lakh , 1.49-2.77), West Bengal (1.44 Lakh , 1.03-1.91), Tamil Nadu (1.42 Lakh , 0.93-1.97), Uttar Pradesh (1.34 Lakh , 1.01-1.77) and Bihar (1.15 Lakh , 0.83-1.58). These Eight States together account for almost three fourth (75.00 %) of total estimated PLHIV. Other all states have less than 1 lakh people living with HIV.

3. History • 1981 , cases of Pneumocystis carinii pneumonia (PCP) in 5 gay men in Los Angeles • New York and California reported with Kaposi’s Sarcoma (KS). • 1981, December- PCP were reported in people who inject drugs. • 270 reported cases of severe immune deficiency among gay men - 121 of them had died • 1982- initially called gay-related immune deficiency (GRID )

4. Suniti Solomon Diagnosed the first I ndian cases in Chennai in 1986. In 2009, she was awarded , “National Women Bio-scientist Award” by the Indian ministry of Science and Technology. On 25th January 2017, Govt. of India announced “ Padma shri ” award for her contribution towards Medicine “what is killing people with AIDS more is the stigma and discrimination”

5. INTRODUCTION HIV is the Human Immunodeficiency Virus- lentivirus -retrovirus Leads to Acquired Immune Deficiency Syndrome, or AIDS. Destroy specific blood cells, called CD4+ T cells, which are crucial for fighting diseases. No cure for HIV infection. Currently, people can live much longer - even decades - with HIV before they develop AIDS. “Highly active” combinations of medications that were introduced in the mid 1990s.

6. Modes of transmission

7. 2012-2017

8. AIDS Control Programme in India HIV infection first detected in India in 1986, when 10 HIV positive samples were found from a group of 102 female sex workers from Chennai. In 1986 Government set up an AIDS Task Force under ICMR and established a National AIDS Committee (NAC) chaired by Secretary, Department of Health and Family Welfare. In 1987, National AIDS Control Programme was initiated, with help from the World Bank. In 1989, a Medium Term Plan for AIDS Control was developed with the support of the WHO.

9. AIDS Control Programme in India First National AIDS Control Programme ( NACP-I) was launched in 1992. NACP-II launched in 1999: decentralization of programme implementation to State level and greater involvement of NGOs. NACP- III implemented during 2007-2012: scaling up HIV prevention interventions for HRG and general population, and integrate them with Care , Support & Treatment services. NACP-IV has been developed for the period 2012-2017

10. NACP-I 1992, IDA (International Development Association) Credit of USD 84 million, commitment to combat the disease. OBJECTIVE: slowing down the spread of HIV infections so as to reduce morbidity, mortality and impact of AIDS in the country. KEY STRATEGIES: • NACB was constituted and an autonomous NACO was set up to implement the project • awareness generation • setting up surveillance system • access to safe blood and preventive services for high risk group populations

11. NACP-II 1999 November, World Bank credit support of USD 191 million OBJECTIVE Reduce the spread of HIV infection in India through behavior change and increase capacity to respond to HIV on a long-term basis. KEY STRATEGIES • National AIDS Prevention and Control Policy (2002); • Scale up of Targeted Interventions for High risk groups in high prevalence states • National Blood Policy • Greater Involvement of People with HIV/AIDS (GIPA) • National Adolescent Education Programme (NAEP) • Introduction of counselling , testing and PPTCT • National Anti-Retroviral Treatment (ART) programme • Inter-ministerial group for mainstreaming • National Council on AIDS • Setting up of State AIDS Control Societies in all states

12. NACP-III Formed in 2007, July GOAL: Halting and Reversing the Epidemic by the end of project period KEY PILLARS: • Prevention among HRG and general population • Care, support and treatment KEY STRATEGIES: Prevention – Targeted intervention (TI), ICTC, blood safety, communication, advocacy and mobilisation , condom promotion. The capacities of SACS and DAPCUs have been strengthened Technical Support Units (TSUs) established Dedicated North-East regional Office established State Training Resource Centres (STRC) set up Strategic Information Management System (SIMS) established

13. NACP-IV Launched on 12 February 2014. Total budget outlay Rs 14295 crores . OBJECTIVES: Objective 1: Reduce new infections by 50% . Objective 2: Comprehensive care, support and treatment to all persons living with HIV/AIDS.

14. Key strategies under NACP-iv

15. implementation structure District AIDS Prevention and Control Units(DAPCUs) 188 District AIDS Prevention and Control Units (DAPCUs ) with a team of field. functionaries in A and B category districts for decentralized programme implementation. States AIDS Control Societies(SACS) The NACP is implemented through 35 SACS in the states and UTs A governing body headed by the minister in charge of health/ the chief secretary It approves new policy initiatives, annual plan and budget, appoints statutory auditors and accepts the annual audit report FUNCTIONS: • Medical and public health services; • Communication and social sector services; and • Administration, planning, coordination, monitoring and evaluation, finance

16. organogram Centres of Excellence- alternate First line & Second line ART ART Centres + Tertiary level care Medical Colleges Districts with low seropositivity may have LAC only

17. Organogram

18. The package of services provided under NACP-IV includes: A) PREVENTION SERVICES: ● Targeted Interventions (TI) for High Risk Groups and Bridge Population, Female Sex Workers (FSW), Men who have Sex with Men (MSM), Transgenders / Hijras , Injecting Drug Users (IDU), Truckers & Migrants; ● Needle-Syringe Exchange Programme (NSEP ) and Opioid Substitution Therapy (OST ) for IDUs( Opioid substitution therapy supplies illicit drug users with a replacement drug, a prescribed medicine such as methadone or buprenorphine , which is usually administered orally in a supervised clinical setting .) ; ● Link Worker Scheme (LWS) for High Risk Groups and vulnerable population in rural areas ; ● Prevention & Control of Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI ); ● Blood Transfusion Services; ● HIV Counselling & Testing Services eg . Transmission Integrated Counselling and Testing Centre (ICTC), Prevention of Parent-to-Child Transmission(PPCT) of HIV and HIV/Tuberculosis collaborative activities; ● Condom promotion; ● Information, Education & Communication (IEC) and Behaviour Change Communication (BCC)–Mass Media Campaigns through Radio & TV, Mid-media campaigns through Folk Media, display panels, banners, wall writings etc., special campaigns through music and sports, flagship programmes , such as Red Ribbon Express; ● Social Mobilization, Youth Interventions and Adolescence Education Programme ;

19. TARGETED INTERVENTIONS(TI)

20. B) CARE, SUPPORT & TREATMENT SERVICES: ● Laboratory services for CD4 Testing, Viral Load testing, Early Infant Diagnosis of HIV in infants and children up to 18 months age and confirmatory diagnosis of HIV-2; ● Free first line & second line Anti-Retroviral Treatment (ART) through ART Centres and link ART Centres , Centres of Excellence & ART plus centres ; ● Pediatric ART for children; ● Nutritional and psycho-social support through community and support centres ; ● HIV-TB coordination ( Cross-referral, detection and treatment of co-infections) ● Treatment of Opportunistic Infections.

21. Combination prevention Combination prevention advocates for a holistic approach whereby HIV prevention is not a single intervention (such as condom distribution) but the simultaneous use of complementary behavioural , biomedical and structural prevention strategies.

22. SEXUALLY TRANSMITTED INFECTIONS (STI) AND REPRODUCTIVE TRACT INFECTION (RTI) CONTROL & PREVENTION PROGRAMME

23. World AIDS Day, 1st December Every year 1st December is observed as World AIDS Day (WAD). The day is an opportunity for people worldwide to unite in the fight against HIV , show their support for people living with HIV . On World AIDS Day, awareness activities are implemented at grass root levels by States involving communities, NGOs, Youth etc. opportunity

24. acronyms NACP: National AIDS Control Programme NACB: National AIDS Control Board NACO: National AIDS Control Organization ANC: Antenatal Clinic AIDS: Acquired Immuno Deficiency Syndrome ART: Anti Retroviral Therapy BCC: Behaviour Change Communication DAPCUs: District AIDS Prevention & Control Units GRID: Gay Related Immuno Deficiency GIPA: Greater Involvement of People with HIV/AIDS HRG: High Risk Groups HIV: Human Immunodeficiency Virus ICMR: Indian Council of Medical Research IDU: Injecting Drug Users IEC: Information, Education and Communication ICTC: Integrated Counseling and Testing Centre KS: Kaposi’s Sarcoma LAC: Link ART Centre LWS: Link Worker Scheme NSEP: Needle-Syringe Exchange Programme NAEP: National Adolescent Education Programme PCP: Pneumocystis carinii pneumonia PLHIV: People Living with HIV PPTCT: Prevention of Parent-to-Child Transmission SACS: State AIDS Control Society SIMS: Strategic Information Management System STRC: State Training & Resource Centre STI/RTI: Sexually Transmitted/ Reproductive Tract Infection TI: Targeted Intervention TSUs: Technical Support Units

25. Thank you!