NACP IV Critical analysis

NACP IV critical analysis , where we have given a brief idea about the burden of HIV/AIDs globally , National and statewise. Evolution of NACO and NACP under different phases. Current achievements and the indicator to monitor the progress

1. Critical analysis National AIDS control Programme Presenters: Dr Arundas H Dr Akshaya Shekhar Mentor : Dr Ashwini Kumar

2. Contents Introduction Burden of HIV/ADS National AIDS control Programme (NACP) Karnataka State AIDS prevention society (KSAPS) District AIDS prevention & Control Unit (DAPCU) 8/11/2021 Dept of Community Medicine , KMC Manipal 2

3. Introduction HIV continues to be a major global public health issue 37 million people living with HIV at the end of 2020 HIV targets the immune system and weakens people's defense Advanced stage of HIV infection is AIDS Prevention & lifelong treatment and care make it a manageable chronic disease 8/11/2021 Dept of Community Medicine , KMC Manipal 3

4. Global burden of HIV/AIDS Source: UNAIDS/WHO estimates 8/11/2021 Dept of Community Medicine , KMC Manipal 4 Global HIV epidemic summary, 2020 People living with HIV in 2020 (in million) People acquiring HIV in 2020 People dying from HIV related causes in 2020 Total 37.7 1.5 million 6.8 Lakh Adults 36 1.3 million 5.8 Lakh Women 19.3 6.6 Lakh 2.4 Lakh Men 16.7 6.4 Lakh 3.4 Lakh Children 1.7 1.5 Lakh 99K Table 1

5. Global burden: Region-wise Dept of Community Medicine , KMC Manipal 8/11/2021 5 Fig.1

6. National situation (2019-20) 8/11/2021 Dept of Community Medicine , KMC Manipal 6

7. National situation Dept of Community Medicine , KMC Manipal 8/11/2021 7 High prevalence Medium prevalence Low prevalence 0.2 % adult prevalence of HIV Lowest :300 cases 3.9Lakh 3.14 Lakh 2.69Lakh 24K 1 Lakh 1.55 Lakh Fig.2

8. National Situation: New Infection (2019) Dept of Community Medicine , KMC Manipal 8/11/2021 8 Fig.3

9. 8/11/2021 Dept of Community Medicine , KMC Manipal 9 Karnataka : HIV Prevalence Estimated People Living with HIV 2.69 Lakh Estimated Children Living with HIV 8313 Annual New HIV infections 1570 Annual AIDS related deaths 6386 Decline in annual new HIV infections since 2010 75 % Decline in annual ARD since 2010 80 % Table.2

10. Udupi PLHIV - 5500 Children <15 years – 200 HIV with TB – 60 Deaths- 126 PLHIV with STI/RTI -313 8/11/2021 Dept of Community Medicine , KMC Manipal 10

11. National AIDS control programme 8/11/2021 Dept of Community Medicine , KMC Manipal 11

12. Aims 8/11/2021 Dept of Community Medicine , KMC Manipal 12

13. Goal To halt & reverse the epidemic in India over next 5 years by integrating programmes for preventions & care, support & treatment 8/11/2021 Dept of Community Medicine , KMC Manipal 13

14. Objectives 1.Reduce new infection by 50% (acc. To NACP III base line) 2.Provide care, support & treatment to all living with HIV/AIDS and treatment service for all who needs it. 8/11/2021 Dept of Community Medicine , KMC Manipal 14

15. Strategies Intensifying and consolidating prevention services Comprehensive care, support and treatment Expanding IEC services Strengthening institutional capacity Strategic Information Management System 8/11/2021 Dept of Community Medicine , KMC Manipal 15

16. Targets Reducing new HIV infections by 80% Elimination of mother-to-child transmission of HIV Elimination of stigma and discrimination 8/11/2021 Dept of Community Medicine , KMC Manipal 16

17. Targets Achieving 95-95-95 goal 95% of those who are HIV-positive in the country know their status 95% of those who know their status are on treatment 95% of those who are on treatment experience effective viral load suppression 8/11/2021 Dept of Community Medicine , KMC Manipal 17

18. NACO Structure 8/11/2021 Dept of Community Medicine , KMC Manipal 18 Addl Secretary & DG, NACO Joint secretary NACO Targeted Intervention & LWS Lab services Care support & treatment Blood safety STI/ RTI Basic services IEC Strategic information Admin & Procuremen t Finance

19. 8/11/2021 Dept of Community Medicine , KMC Manipal 19 Care support &treatment Targeted interventions STI Basic services Blood safety Monitoring & evaluation IEC Finance section Karnataka state AIDS prevention society Project Director Additional Project director

20. District AIDS prevention & Control unit : Udupi District AIDS prevention & control officer District ICTC supervisor Monitoring & Evaluation assistant Admin assistant Account assistant 8/11/2021 Dept of Community Medicine , KMC Manipal 20 Best DAPCU award : 3 times in last 10 years

21. Targeted interventions Core TI (FSW, MSM, TG & IDU) Bridge TI (Migrant & Truckers) Objectives Improve health seeking behavior of high-risk groups Reduce risk of acquiring STI/HIV 8/11/2021 Dept of Community Medicine , KMC Manipal 21

22. Targeted Interventions: Services Detection & treatment of STI Condom distribution & promotion Behavior change communication Community involvement & participation Linkages to ICTC and CST Specific interventions for IDUs Specific interventions for MSM/TGs 8/11/2021 Dept of Community Medicine , KMC Manipal 22

23. Indicator India Karnataka Targeted Interventions 1426 76 OST centres 226 2 8/11/2021 Dept of Community Medicine , KMC Manipal 23 MSM Indicator India Karnataka Coverage (%) 80 133 Condoms distributed 5.5Cr 68 Lakh Tested for HIV 1.9Lakh 17702 Linked to ART 450 39 STI/RTI treated 7312 302

24. Migrants Migrants Indicator India Karnataka Coverage (%) 82 135 Tested for HIV 8 Lakh 43131 Linked to ART 1112 40 8/11/2021 Dept of Community Medicine , KMC Manipal 24 Female sex workers Female sex workers Indicator India Karnataka Coverage (%) 91 97 Condoms distributed 18.8 Cr 2 Cr Tested for HIV 5.4 Lakh 56543 Linked to ART 569 46 STI/RTI treated 34K 2321

25. Basic services : Integrated counselling & testing centre Fixed ICTC Standalone Facility integrated (Govt) Facility Integrated (PPP) Mobile ICTC 8/11/2021 Dept of Community Medicine , KMC Manipal 25 Indicators India Karnataka ICTC facilities 33220 3310 Standalone 5330 473 FICTC (Govt) 21187 2420 FICTC (PPP) 4209 413

26. Udupi centres for testing, Rx & Counselling 8/11/2021 Dept of Community Medicine , KMC Manipal 26 NAME NUMBER LOCATION ROLE ICT centers 12 Testing & counselling ICT PPP centers 10 Private hospitals Testing & counselling Mother ICT center 1 DH Confirmatory testing F-ICT center 60+ All PHCs, Prison Testing with minimum documentation

27. Basic services: PPTCT Prevention of parent to child transmission Access to all pregnant women for HIV diagnostic, prevention, care & treatment services Aim HIV testing to all pregnant women in the country Cover all estimated HIV positive pregnant women Eliminate transmission of HIV from mother-to-child 8/11/2021 Dept of Community Medicine , KMC Manipal 27

28. 8/11/2021 Dept of Community Medicine , KMC Manipal 28 Indicator India Karnataka Estimated pregnant women 2.9Cr 12 Lakh HIV Positive PW 15112 1177 Babies tested for HIV (6 w- 6m) 11460 16

29. Basic services: HIV-TB Indicators India Karnataka HIV-TB cross-referral 33.6 Lakh 2.27Lakh In referral from TB programme 19Lakh 77143 ICTC clients referred to NTEP 14 Lakh 1.5 Lakh 8/11/2021 Dept of Community Medicine , KMC Manipal 29

30. Basic services: HIV-TB 8/11/2021 Dept of Community Medicine , KMC Manipal 30 TB/HIV co-ordination to reduce mortality Prevention Isoniazid preventive treatment Airborne infection control Awareness generation Early detection of TB/HIV 100% coverage of PITC in TB patients PITC in presumptive TB cases Rapid diagnostics for TB in PLHIV ICF activities at all HIV settings Prompt treatment of TB/HIV Early initiation of ART Prompt initiation of TB treatment Management of special TB/HIV cases TB/HIV in children TB/HIV in pregnant women Drug resistant TB/HIV

31. Care support and treatment Aims Provide comprehensive service to PLHIV to improve survival & quality of life Services Free universal access to lifelong ART Free lab diagnostic & monitoring services Facilitate long term retention of care Prevention, diagnosis & management of opportunistic infections Linkage to care & support and social protection scheme 8/11/2021 Dept of Community Medicine , KMC Manipal 31

32. Care support and treatment Indicators India Karnataka ART Centres 553 65 Centre of Excellence (Adult) 11 1 Centre of Excellence ( Paediatric 7 1 Link ART Centres 1270 305 Care Support Centres 310 36 8/11/2021 Dept of Community Medicine , KMC Manipal 32 Selected medical colleges MCH & district level hospitals Sub district level hospital & CHC CoE & ART Plus ART Centres Link ART centres & LAC plus centres

33. RTI/STI Person with STI/RTI is 2-9 times prone to get HIV Upto 40% HIV transmission can be cut down by treating STI Management of STDs through syndromic approaches by color coded kits Integration of services for treatment of reproductive tract infections & STDs at all levels of health care NACO has branded the STI/RTI services as “Suraksha Clinic” 8/11/2021 Dept of Community Medicine , KMC Manipal 33

34. Blood transfusion services Promoting non- remunerated Voluntary Blood Donation; screening for HIV and other Transfusion Transmissible Infection; Promoting Component separation Strengthening Quality management systems and Capacity building Around 12 million blood units collected in 2018-19 8/11/2021 Dept of Community Medicine , KMC Manipal 34

35. IEC Awareness through media Awareness and prevention of HIV Available government services & schemes Adolescent health education programme 8/11/2021 Dept of Community Medicine , KMC Manipal 35

36. References Park K. Park’s textbook of preventive and social medicine. 26th ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 2018. J.Kishore.National health programmes of India. 13th edition. Century Publishers; 2018. Dr.D.K.Taneja.Health policies and programmes in India. 13thedition. Doctors Publications;2015 National AIDS Control Organisation , Department of AIDS Control, Ministry of Health and Family Welfare. Annual Report 2019-20. NACP IV, National AIDS Control Organisation , M/o H & FW, Govt. of India, N.Delhi .