National Aids Control Program

Community medicine

1. NATIONAL AIDS CONTROL PROGRAMME(NACP) MOHAMMED Y O U S UF MOHAMMED S A A D Z A K I 11/8/2019 1

2. NATIONAL AIDS CONTROL PROGRAMME National AIDS control programme was launched in india in 1987. The aim of the programme is To prevent further transmission of HIV To decrease morbidity & mortality associated with HIV infection To minimze the socio-economic impact resulting from HIV infection 11/8/2019 2

3. MILESTONES OF PROGRAMME 1986 - First case of HIV detected - AIDS task force was set up by ICMR - National AIDS committe established under the Ministry of Health 1990 - Medium term plan launched for 4 states & 4 metros. 1992 - NACP-1 launched to slow down the spread of HIV infection. - National AIDS control Board constituted. - National AIDS Control Organization was set-up 11/8/2019 3

4. 1999 - NACP-2 begins, focussing on behaviour change, increased decentralizaton & NGO involvement. - State AIDS Control Societies established. 2002 - National AIDS Control Policy Adopted. - National Blood Policy adopted 2004 - Anti-Retroviral Treatment(ART) initiated 2006 - National Council on AIDS constituted under charmanship of the prime minister. - National Policy on Paediatric ART formulated. 11/8/2019 4

5. 2007 - NACP-3 launched for 5 years (2007-2012) 2012 - NACP-4 launched for 5 years (2012-2017) 2017 - National Strategic plan for HIV/AIDS and STIs 2017-2024 launched 11/8/2019 5

6. The national strategy has following components: Establishment of surveillance centres to cover the whole country. Identification of High-Risk group & their screening. Issuing specific guidelines for management of detected cases & their follow up. Formulating guidelines for blood bank, blood product manufacturers, blood donors & dialysis units. Information, education & communication activities by involving mass media & research for reduction of personel & social impact of the disease. Control of Sexully Trasmitted Diseases(STD) Condom programme. 11/8/2019 6

7. The government of India initiated programmes of prevention & raising awareness under the MEDIUM TERM PLAN (1990-92) NACP-1 (1992 - 99) NACP -2 (1999 - 2006) NACP - 3 (2007 - 2012) Based on the lessons learnt & achievement made in Phase 1,2 & 3 NACP- 4 was launched (2012 - 2017) 11/8/2019 7

8. 11/8/2019 8 Key strategies under NACP-4 Intensify & consolidate preventive services Increase access & promote comprehensive care, support & treatment Exapanding IEC services Capacity building Strengthening strategic Information management system *IEC = Information, Education, Communication

9. SERVICES UNDER NACP-4 11/8/2019 9 Prevention services Care, support & treatment services

10. 1. Prevention services Targeted interventions for high-risk group (female sex workers, transgenders, injecting drug users) & bridge population ( truckers & migrants) Needle-syringe exchange programme & opioid substitution therapy for IUD (Intravenous Drug Users) Prevention intervention for migrant population Link worker scheme for HRG's & vulnerable population Prevention of STI/RTI *STI= sexually transmitted infections, RTI = reproductive tract infection, HRG= high risk groups 11/8/2019 10

11. Blood safety. HIV counselling & testing centre Prevention of Parent To Child Transmission(PPTCT) condom promotion Information, education & communication social mobilization, youth intervention & adolescence education programme mainstreaming HIV/AIDS response work place interventions 11/8/2019 11

12. 2. Care, support & treatment services Laboratory services for CD4 testing & other investigations Free 1st line & 2nd line Anti-Retroviral Therapy (ART) through ART centres & Link ART Centres (LACs), Centre of Excellence (CoE) & ART plus centres Paediatric ART for children Early infant diagnosis for HIV exposed infants & children below 18 months. Nutritional & psycho-social support through Care & Support Centres (CSC) HIV/TB coordination Treatment of opportunistic infection Drop-in centres for PLHIV 11/8/2019 12

13. HIV SURVEILLANCE Different types of surveillance activites are being carried out in the country such as HIV Sentinel Surveillance HIV sero-surveillance AIDS case surveillance STD surveillance Behavioural surveillance Integration with surveillance of other diseases like TB etc 11/8/2019 13

14. HIV SENTINEL SURVEILLIANCE The objectives of the surveillance are To determine the level of HIV infection among general population as well as high risk group in different states To understand the trends of HIV epidemic among general population as well as high risk group in different states To understand the geographical spread of HIV infection & to identify emerging pockets To provide information for prioritization of programme resources & evaluation of programme impact To estimate HIV prevalence & HIV burden in the country. 11/8/2019 14

15. COUNTRY SCENARIO BASED ON SENTINEL SURVEILLANCE GROUPS DESCRIPTION Group 1 High prevalence states: Maharashtra, Tamil Nadu, Karanataka, Andhra pradesh, Manipur & Nagaland where HIV infection has crossed 5% mark in high risk groups & 1% or more in Antenatal women Group 2 Moderate prevalence states: Gujarat, Goa & puducherry where HIV infection has crossed 5% or more among high risk groups but the infection among Antenatal women is below 1% Group 3 Low prevalence states: Includes remaining states where the HIV infection in any of the high risk groups is less than 5% & less than 1% among Antenatal women 11/8/2019 15

16. NATIONAL AIDS CONTROL ORGANIZATION (NACO) The ministry of health & family welfare launched NACO in 1992. It works as a separate wing to implement & closely monitor the various components of the programme. It is headed by the Additional Secretary, Ministry of Health & Director General, NACO Govt. of India 11/8/2019 16

17. ORGANIZATIONAL STRUCTURE OF NACO *LWS = LINE WORKER SCHEME , PPTCT = PREVENTION OF PARENT TO CHILD TRANSMISSION 11/8/2019 17 Addl. Secretary & DG, NACO Joint Secretary NACO Targeted Interventions & LWS Basic services (ICTC,PPTCT & HIV/TB) STI/RTI Management Blood safety Lab services Care, Support & Treatment Information, Education & Communication Strategic information (monitoring, Evaluation, surveillance, research & Data analysis) Admin & procurement Finance

18. COUNSELLING & HIV TESTING SERVICES It includes the following components Integrated Counselling & Testing Centre(ICTC) Prevention of parent-to-child transmission of HIV(PPTCT) HIV/TB collaborative activities 11/8/2019 18

19. ICTC 11/8/2019 19 Fixed facility ICTC Mobile ICTC Standalone ICTC(SA-ICTC) Functional ICTC(F-ICTC) Public Private Patnership ICTC (PPP-ICTC)

20. 11/8/2019 20 Figure: Level of counselling & testing services in India

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22. PREVENTION OF PARENT TO CHILD TRANSMISSION (PPTCT) OF HIV It was started in the country in the year 2002. The main aim of the PPTCT programme is to offer HIV testing to every pregnant women (universal coverage) so as to cover all the estimated HIV positive women to eliminate transmission of HIV from mother to child 11/8/2019 22

23. 11/8/2019 23 In india PPTCT was started with single dose Nevirapine prophylaxis for HIV positive pregnant women during labour & also for her new born child. But in 2010 WHO adopted with the department of AIDS control adopting ''option B'' were it directed for the use of multi-drug ARV prophylaxis instead single dose Nevirapine. In september 2012 India transitioned from single dose Nevirapine to multi-drug ARV prophylaxis. *ARV=Anti-retroviral

24. 11/8/2019 24 Without any intervention risk of transmission of HIV from infected mother to her child is between 20-45%. Single dose Nevirapine is highly effective in reducing risk of transmission from about 45% to less than 10%. Multiple drugs for PPTCT can reduce transmission to less than 5% if started early in pregnancy & continued throughout period of delivery & breast feeding.

25. Essential package of PPTCT services Offer HIV counselling & testing Moving from ANC centric to Family centric ART to all HIV pregnant women regardless of CD4 count & clinical stages of HIV progression. Preferred regimen is TDF+3TC+EFV. Promoting institutional delivery Provision of care for associated conditions Counselling for exclusive breastfeeding upto 6 months Provision of ART prophylaxis to infants upto 6 months Ensuring initiation of Co-trimoxazole prophylactic Therapy(CPT) & Early Infant Diagnosis (EID) using HIV-DNA PCR at 6 weeks of age onwards, as per the EID guidelines 11/8/2019 25 *TDF=TENOFOVIR, 3TC=LAMIVUDINE, EFV=EFAVIRENZ

26. HIV TESTING OF TB PATIENTS Detection of HIV by offering HIV test to diagnosed TB patient is being implemented by NACP & RNTCP jointly since 2007-08. States with high HIV prevalence cover about 90% TB patients for HIV testing, but case fatality rate among HIV infected cases remain 13-14%,as compared to less than 4% in HIV negative cases, indicating delayed detection of HIV/TB inspite of good coverage. HIV testing in presumptive cases of TB rolled out in india in OCT 2012 in karnataka followed by maharashtra, Andhra Pradesh & Tamil Nadu. 11/8/2019 26

27. Figure: Pronged strategy for HIV/TB coordination 11/8/2019 27

28. CARE, SUPPORT & TREATMENT(CST) The CST component of NACP aims to provide comprehensive services to people living with HIV(PLHIV) to improve the quality of life. The policy package include the following Free universal access to life long standardized ART Free laboratory diagnostic & monitoring services Facilitating long term retention in care Prevention, diagnosis & management of opportunistic infection Linkage to care & support services & linkage to social protection scheme 11/8/2019 28

29. The country has adopted fast track target of 90-90-90 which aims at ending AIDS as public health treat by 2030 by achieving fast track targets by 2020. They are as follows 90 per cent of PLHIV know their status of which 90 per cent of PLHIV are on ART, of which 90 per cent of PLHIV have viral suppression A significant step of rolling out ''test & treat'' policy has been taken towards achieving this target. 11/8/2019 29 *PLHIV=PEOPLE LIVING WITH HIV

30. Figure: Model of HIV treatment services 11/8/2019 30 *CoE=centre of exellence LAC= link ART centre ART=anti-retroviral therapy

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34. Condom promotion It is a strategy that will be strengthened through free distribution & social marketing channels, non-traditional outlets, females condoms etc It is aided by an effective communication strategy. The programme will continue to link prevention with care, support & treatment. This will promote positive prevention. 11/8/2019 34

35. SURAKSHA CLINIC It is branded by NACO It has been developed for the better health services & prevention of HIV/AIDS & other STI/RTI diseases These clinics are associated with dermatology department so the patient do not feel hesitated in explaining their problems 11/8/2019 35

36. NATIONAL STRATEGIC PLAN(NSP) FOR HIV/AIDS & STI 2017-2024 It is developed with a vision of an AIDS free India. The mission is to attain universal coverage of HIV prevention, testing, treatment to care continuum that is effective, inclusive, equitable & adapted to population & local needs. 11/8/2019 36

37. GOAL The goal is to achieve zero new infection, zero AIDS-related deaths & zero AIDS related stigma & discrimination. 11/8/2019 37

38. STRATEGIC FRAMEWORK NSP is designed around a result-based framework that reflects the fast-track targets and the ''ending of AIDS'' commitment. Based on this strategic framework, a specific planning approach is required which helps differentiate States and Union Territories (UT) according to 3 predominant epidemiological contexts. States / Union Territories with a “ mature ” epidemic where HIV incidence and prevalence are high in key,bridge and other at risk population and in some cases other segments of the general populations . 11/8/2019 38

39. Those States/ UT where there are emerging epidemics with relatively new and rising rates of infection among key bridge and other at risk population . States /UT with low or stable epidemics where there is still a need to focus on potential risks among key bridge and other at risk populations to maintain the low infection rates and eliminate HIV transmission. 11/8/2019 39

40. OBJECTIVES NSP proposes six objectives towards fulfilling its vision of an AIDS free INDIA, these are; Reduce 80% new infections by 2024 (baseline 2010) Ensure 95% of estimated PLHIV (people living with HIV / AIDS) know there status by 2020 Ensure 95% PLHIV have ART( Anti retroviral treatment) initiation and retention by 2024, for sustained viral suppression Eliminate mother to child transmission of HIV and syphilis by 2020 Eliminate HIV/AIDS related stigma and discrimination by 2020 Facilitate systainable NACP ( National AIDS control programme ) service delivery by 2024 11/8/2019 40

41. Achievement of these objectives by 2024 would result in Estimated new infections will reduce from 102,226 (2010) to < 21,000 per year 2.14 million PLHIV of the total estimated PLHIV (2.25 million) would know their status 2.03 million PLHIV would be put on ART 1.93 million PLHIV would be retained on treatment and have HIV VL <1000 copies/ml Attainment of < 50 cases of new pediaetric HIV infections per 1,00,000 live births with a mother to child transmission rate < 5% by 2020 and maintainence of same thereof 11/8/2019 41

42. Attainment of < 50 cases of congenital syphilis per 1,00,000 live births and maintainance of same thereof HIV /AIDS will be percieved as chronic manageable disease with no stigma and discrimination attached to it Key components of NACP such as prevention outreach , testing , treatment , prevention of mother to child transmission ,viral load separation , care and support , as well as social protection scheme will continue through 100% domestic funding 11/8/2019 42

43. INFORMATION, EDUCATION & COMMUNICATION Communication in NACP-4 is directed at: To increase knowledge among general population ( especially youth and women) on save sexual behaviour To sustain behaviour change in high risk groups and bridge populations To generate demand for care , support,and treatment services To make appropriate changes in social norms that reinforce positive attitude , beliefs and practices to reduce stigma and discrimination 11/8/2019 43

44. Adolescence Education Programme This programme runs in secondary and senior secondary schools to built up life skills of adolescents to cope with the physical and physiological changes associated with growing up. Under the programme 16 hour sessions are scheduled during the academic terms of class 9th and 11th. State AIDS control society have further adapted the modules after state level consultations with NGOs , academicians , psychologists and parent teacher bodies. 11/8/2019 44

45. The purpose to establish red ribbon clu b in college is to encourage peer-to-peer messaging on HIV prevention and to provide a safe space for young people to seek clearifications of their doubts and myths surrounding HIV /AIDS . This also promotes blood donation among youths. 11/8/2019 45 RED RIBBON CLUB

46. RED RIBBON EXPRESS Its an HIV/AIDS, other sexually transmitted infection awareness campaign train by Indian railway. The motto of the red ribbon express is ''Embarking on the journey of life'' Partners involved NACO, UNICEF, State AIDS control Societies(SACS), National Rural Health Mission & Indian railways 11/8/2019 46

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48. SWOT ANALYSIS 11/8/2019 48

49. STRENGTHS Political commitment. Programme decentralized through state & district societies in order to effective implementation & ensure local planning. Budget allocation is high. Surveillance component both sentinel & behavior. 11/8/2019 49

50. WEAKNESS Stigma Conflicting roles of national & international agency Under utilization of funds in many states More expenditure on ART. 11/8/2019 50

51. OPPORTUNITIES WHO & UNICEF should provide central leadership & uniform guidelines worldwide. Indian pharmaceuticals are strong & prompted to produce drugs in India. That will reduce cost. Social & religious groups involved in raising awareness. Awareness in rural areas can be increased. Strategy for rehablitation should aslo be made. 11/8/2019 51

52. THREATS Reduced budget can hamper the progress. Withdrawal of international agencies could hamper progress. Some states such has gujarat, Chhatisgarh, Goa, Rajasthan have banned sex education due to religious & cultural sentiments which is a serious setback to the programme. 11/8/2019 52

53. REFERENCES Textbook of Park 25th EDITION National AIDS control organization http://www.naco.gov.in/ Textbook of suryakanth 4th edition WHO guidelines for ART 11/8/2019 53

54. QUESTIONS LONG ESSAY National AIDS control programme explain in detail. SHORT ESSAY Describe the strategies adopted by National AIDS control programme . Clinical manifestation of HIV infection. SHORT ANSWER Sentinel surveilance for HIV in India. HAART ( Human AIDS Anti Retroviral Therapy) . Window period. Case definition used for diagnosis of AIDS. 11/8/2019 54

55. THANK YOU 11/8/2019 55