Nacp iii&iv.pptx

National AIDS Control Programme

1. NACP III&IV Dr Anupkumar T N Junior Resident Dept of Community Medicine Govt Medical College,Thrissur

2. To cover… Brief history NACP1,2 achievements NACP III- formulation, key strategies, achievements NACP IV-origin, goals,objectives,where are we now

3. AIDS was first clinically observed in 1981 in the United States

4. TIMELINE 1986 - First case of HIV detected - AIDS Task Force set up by the ICMR - National AIDS Committee (NAC)established under MOH 1990 - Medium Term Plan in four states and the four metros 1992 - NACP I to slow down the spread of HIV infection - National AIDS Control Board constituted - National AIDS Control Organisation set-up

5. 1999 - NACP II begins, focusing on behaviour change - State AIDS Control Societies established 2002 - National AIDS Control Policy adopted - National Blood Policy adopted 2004 - ART Treatment initiated 2006 - National Council on AIDS - National Policy on Paediatric ART formulated

6. Key achievements under NACP-I N ational AIDS response structures formed P artnership with the World Health Organisation (WHO) Established NACO and the State AIDS Control Cells India's management capacity to respond to the epidemic .

7. Improved blood safety,public awareness of HIV. Expanded sentinel surveillance(55 TO 180) Expanded STI control and services. Improved condom promotion activities. Created and disseminated a national HIV testing policy

8. Key achievements under NACP-II • NGOs implemented 1,033 targeted interventions and set up 875 voluntary counselling and testing (VCT) centres and 679 STI clinics at the district level. Behaviour Sentinel Surveillance (BSS) surveys were conducted. Prevention of parent-to-child transmission (PPTCT) programme was expanded .

9. computerized management information system (CMIS) computerized project financial management system (CPFMS). HIV prevention ,care and support organizations and networks were strengthened. Support from bilateral, multilateral, and other partner agencies

10. WHY NACP III…? The nature of HIV epidemic Trained staff and programme manager Attention to high risk groups as well as others Capacity development with technical support Social marketing

11. Participation from different levels Convergence with NRHM Underreporting Financial investment and policy making

12. Then…. Consultations with working groups,e-forums,ngo’s,PLHA networks Inputs from studies and assessments Consolidate gains and address gaps So after one year……………………….

13. NACP III (2007-2012) Focus on halt/reverse of epidemic Bettering the target of HIV related MDG Four pronged approach

14. GUIDING PRINCIPLES Three ones Equity in prevention Rights of PLHA Social ownership ,community involvement Environmental change for affected Universal access Human resource interventions

15. 4 PRONGED STRATERGY Preventing new infection-TI, Scaled up intervention Extend care, support and treatment Strengthening the infrastructure for prevention and care Strengthen SIMS Budget-11585 crores

16. PREVENTION

17. UPSCALING PREVENTION Mainstay of NACP III To reduce the spread from HRG to general population Behaviour change stratergy based on effective IEC campaign Continuum of care at all levels Interlinked services with apt information

18. In high risk groups Increase demand of products& services Provide counselling,risk reduction training Focus on partner referral Demand,access and availability of condoms Environement for safe behaviour Increase programme sustainability Integrate prevention to care, support, treatment

19. By all these… Saturate 80% of HRG and decrease spread Special focus to IDU & MSM

20. In bridge population Peer led interventions Promote,provide condoms Develop linkage between different groups Peer support groups and safe spaces creation

21. In general population Women especially wives of HRG& bridge groups Youth Marginalized Tribals

22. All these will.. Set up cadre of link workers More access to HIV testing Red ribbon clubs for youth PPTCT access and treatment improvement Assured blood and products STI treatment in public and private Reduce stigma,discrimination

23. Information,education and communication Remove stigma and more access Promote value based lifestyle Reduce risky behaviour Promote condom Raises demand

24. ICTC Hub of HIV related services 4955 ICTC s 22 million people will be tested

25. PPTCT 1,89000 pregnancies Nevirapine prophyalaxis scaled up to 80%

26. Managing STIs 4-6% of adult population,more females Expand STI services with NRHM Also NGOs,private Screen high risk for STI –A KEY STRATERGY

27. CONDOM PROMOTION Awareness increased but less use Promoting use,ensure availability Negotiating skills in HRG

28. BLOOD SAFETY Provide safe blood within an hour Well coordinated network to reduce HIV transmission 0.5% from1.92% Voluntary blood donation to 90%

29. STRENGTHENING CARE,SUPPORT AND TREATMENT

30. COMPREHENSIVE STRATERGY Psychosocial support Ensure accessible affordable and sustainable treatment sevices Reduce stigma,poverty and discrimination CD4 testing facilities Capacity building of ART centres Procure ART drugs

31. COMMUNITY CARE CENTRES

32. LINKED ART

33. CENTRE OF EXCELLENCE

34. Increasing quality of drugs Necessary training to all Linkage to community care centres Adherence to monitoring systems and treatment Ext quality assurance Smart health card to patients

35. Care and support Improve quality of life,social integration and dignity Partnership with not for profit org. Expanding access to services Social support,counselling and referrals through 350 community care centres

36. Anteretroviral therapy Increase life span and quality Free of cost Through 250 centers cover 3lakh adults and 40000 children

37. PROGRAMME MANAGEMENT

38. Decentralization upto district level Strengthening CPFMS&SIMS Technical support units at state level

39. Augmenting capacity All levels All persons involved Initiating private sector involvement Streamline public health delivery system,function and accountability 380000 persons will get trained

40. Strengthening SIM Propose change in purpose and effectiveness of data collection at all levels To maximize effectiveness of available information To implement evidence based planning Address stratergic planning,monitoring ,evaluation &surveillance

41. All programme officers trained 1119 sent.sites,127 ART centres,2211 bld banks,4132 ICTC,866 STI clinics&1220 NGO&TI interventions in May 2007

42. Decentralization From state level to district District AIDS Prevention&Control Unit(DAPCU) Operate within District societies NRHM Under DMO Non health activities through Distrrict collector

43. MAINSTREAMING Beyond the risks and impact Involve more sectors and organisations Develop ownership in AIDS prevention and control programmes Lead by national council support by NACO 31 member ministries 11 priority departments for mainstreaming

44. Can use their medical infrastructure Mainstreamed to their workplan Allocate their internal resources

45. Partnership UN,bilateral,multilateral,funding agencies Steering committee for donor cordination To prevent duplication,maximize effort Share information and plan Joint review of performance

46. Enabling environment Necessary legislative reforms,policy making Legal ,ethical concerns

47. WHAT NACPIII HOPE TO ACHIEVE..?

48. WHAT HAPPENED…??

49. ACHIEVEMENTS FSW-81%,MSM-80%,IDU-64% Truckers-57%,migrants-40% 159 districts link worker scheme 537 ICTC,9196-Facility int ICTC,1805-PPP 194.94 lakh,85.63 lakh pregnant ladies 335 ART centres,725 LINKED art,253CCC Red ribbon express

50. Epidemic scenario.. HIV as an epidemic tends to decline Both incidence and prevalance decreased Prevalance 0.41%-2001,0.35%-2006,0.27%-2011 Overall 57% reduction in new HIV cases2.74lakhs-2000 to 1.16 lakhs-2011 In FSW-5.06% to2.67%,MSM- 7.41%to4.43%

51. 29% reduction in estimated annual IADS related death Free ART saved 1.5 lakhs livestill 2011

52. Concerns and challenges Need to consolidate successes gained Saturating coverage to quality of services Address migration which causes emergence of epidemics Treatment demands should be met without sacrificing prevention Regions with diff maturity levels to be considered

53. Financial problems to be addressed Integration with large health systems Social protection schemes for affected Stigma and discrimination still remaining Innovation in key strategies

54. NACP-IV preparatory phase Elaborate and extensive process 15 working groups,30 subgroups covering the whole area 624 representatives including community Regional,statelevel and e- consultaions Overseen by planning commission steering committee.

55. All working group met twice in 2011 Detailed discussions on NACP3 current status,gaps,priorities,strategic options etc….. Reports by working groups

56. NACP-IV Goal:accelerate reversal and integrate response 2012-2017 Reduce new infections by 50%-2007 baseline Provide comprehensive care and support to PLHA and to all those require

57. KEY STRATEGIES Intensify and consolidate prevention services with focus on HRG and vulnerable Increase access and promote comprehensive care and support Expand IEC for HRG and general pop focusing behavior change and demand generation

58. Capacity building at all levels Strengthening SIMS

59. GUIDING PRINCIPLES Continue emphasis on agreed action framework,coordinating authority,M&E system Equity Gender Rights of PLHA Civil society representation,participation PPP Evidence based result oriented programme implementation

60. Cross cutting areas of focus Quality Innovation Integration Leveraging partnerships Stigma and discrimination

61. Key priorities Prevent new infections Prevent antenatal transmission Focus on IEC strategies Provide treatment for all PLHA Reducing stigna and discrimination,GIPA Decentralizing Ensure effective use of strategic information in all levels Capacity building of NGO& civil society partners

62. Integrate HIV services to health system Mainstreaming departments

63. BUDGET

64. PACKAGE OF SERVICES

65. 1.Preventive Targetted interventions NSEP&OST for IDU Intervention for migrants Link worker scheme Prevention and control of STI Blood safety Counselling and testing services

66. PPTCT Condom promotion IEC &BCC Social mobilization,youth and adolescent edubcation Mainstreaming HIV/AIDS response Work place intervention

67. 2.Care ,support and treatment services Lab service for CD4 tesing and other services Free ART 1 st and 2 nd line Paediatric ART Early infant diagnosis of HIV exposed infants and below 18 months HIV-TB coordination Treating opportunistic infection Drop in centres for PLHIV networks

68. New initiatives Differential strategies for districts based on data with due weightage to vulnerabilities Scale up programmes to target key vulnerabilitieseg:IDU,migrants,Transgenders Scale up multidrug regimen for PPTCT Social protection schemes by earmarking funds

69. Establishment of metro blood banks and plasma fractionation centre Launch 3 rd line ART Demand promotion strategies eg:folk,red ribbon express

70. Strategic summaries

71. 1.Intensify and consolidate prevention services Prevention-core strategy To cover 90% HRG through TI More ICTC in high prevalent areas Chc and Phc involvement Condom promotion Blood bank services

72. Quality prevention services to HRG StrengthenNSEP & OST for IDU Reaching to MSM,TG Address issues in cover ing and managing rural intervention Provide quality STI/RTI services Strengthen positive prevention

73. Strengthen management structure of blood transfusion services Implementing quality assurance

74. 2.Comprehensive care,support and treatment Scale up ART centres,linked ARTs,& COE Follow up strengthening,improve quality of counselling Use PLHIV linkages Guidelines for training staff

75. 3.Expanding IEC Increase awareness in general population BCC in HRG &vulnerable group Focus on demand generation services Reaching vulnerable group in rural

76. 4.Building capacities Nation state and district level planning mangement Local priorities,need,community involvement

77. Strategic information management system Integrated bioogical & behavioural surveillance National data analysis plan National research plan SIMS to advance analytic&geographic information system Institutionalising data quality monitoring system for routine data collection& decision making

78. Impact indicators Reduction in new HIV cases Reduction in HIV related mortality Survival after 24 months

79. Outcome indicators Behaviour change in FSW,MSM,IDU

80. Where we are…? Among ANC prevalance kerala-0.05 india-0.29 nagaland Among FSW prevalance kerala-0.73 india-2.67 andhra,maharashtra Among MSM prevalance kerala-0.36 india-4.43 nagaland,chathisgarh Among IDU prevalance kerala-4.95 india-7.14 punjab,delhi

81. References National AIDS Control Programme Phase III: 2006-2011. Strategy and implementation plan’. NACO, Ministry of Health and Family Welfare, Government of India. November 30 ‘National AIDS Control Programme Phase IV: 2012-2017. Strategy and implementation plan’. NACO, Ministry of Health and Family Welfare, Government of India.

82. HIV IBBS REPORT 2014-15 Park textbook of preventive and social medicine

83. THANK YOU