National aids control program 4

The slides contain a brief review of NACP 1 through 4.
Key achievements and challenges of NACP Phase 4 have been mentioned. Further, Key strategies of national strategic plan for elimination of HIV/AIDS 2017-2024 has been discussed.

1. BEYOND, CURRENT POLICIES AND STRATEGIES
Presenter: Dr RahulGupta
9/1/2018 1
NATIONAL AIDS CONTROL PROGRAM IV

2. LAYOUT
9/1/2018 2
•HIV PROBLEM STATEMENT
•BRIEF OVERVIEW OF NACP I,II AND III
•NACP IV
–OBJECTIVES
–STRATEGIES
–MTA OF NACP IV
•NATIONAL STRATEGIC PLAN 2017-2024
•QUESTIONS

3. INTRODUCTION
9/1/2018 3
•India has a ‘concentrated’ epidemic (Prevalence , KP>GP).
•FSW is 2.2%,
•MSM is 4.2%,
•H/TG is 7.5%,
•IDU is 9.9%( National IBBS* 2014-2015).
*IBBS-INTEGRATED BIO-BEHAVIOURAL SURVEILLANCE

4. EPIDEMIOLOGY OF HIV IN INDIA
9/1/2018 4
•2015 : Adult {15-49 years, 0.26% (0.22% -0.32%)}
•Males (0.30%)
•Females (0.22%)
•Manipur, Highest Prevalence (1.15%)
•Himachal Pradesh (<0.20%)
•Total number of People Living with HIV = 21.17 Lakhs (17.11 Lakhs-26.49 Lakhs)
v/s 22.26 Lakhs (18 Lakhs –27.85 Lakhs) [2007]
•Highest : Andhra Pradesh and Telangana

5. 9/1/2018 5
•TOTAL HIV INFECTIONS
–Children : 6.5%
–Females : 40.5%
•Estimated number of New HIV infections
•(86 Thousand)
–32% decline from 2007.
–Children account for 12% (10.4 Thousand)
–Remaining among adults.

6. Classification of states
9/1/2018 6
•High prevalence
–>5% in HRG & >1% in ANC
–Manipur, Maharashtra, TN,
Andhra,Karnataka, Nagaland
•Moderate prevalence
–>5% in HRG & <1% in ANC
–Gujarat, Puducherry, Goa
•Low prevalence
–<5% in HRG & <1% in ANC
–All other states/UTs

7. ASIAN EPIDEMIC MODEL-TRANSMISSION DYNAMICS
OF HIV/AIDS
9/1/2018 7
This model helps in understanding the patterns and trends of the epidemic and can help shape policy and
programmatic changes.

8. 9/1/2018 8

9. AIDS Control Programme in India
EVOLUTION-KEY MILESTONES
9/1/2018 9
•1992.
•National AIDS Control Board and
autonomous NACO set up
•Awareness-generation on
HIV/AIDS and STIs rolled out
•HIV Surveillance systems set up
•Safe blood transfusion services set
up
•Focussedpreventive services for
KP initiated
•Voluntary Counselling and Testing
(VCTC) Services launched
(NACP I)
•1999
•State AIDS Control Societies set up
•PPTCT Services launched
•Free Anti-Retroviral Therapy launched
•Targeted Interventions expanded
•VCTC services expanded
NACP-II
•2007
•1821 TIs set up
•159 blood component separation
units
•15,538 ICTCs including F-ICTC
•355 ART centres
•516,412 PLHIV on ART
NACP-III

10. NACP IV
9/1/2018 10
Launched in 2012 with two main objectives
Objective 1:
Reduce new infections by 50% (Baseline 2007)
Objective 2:
Comprehensive CST to PLHIV.

11. KEY STRATEGIES
9/1/2018 11

12. 9/1/2018 12
Mid Term Assessment
2016 ON NACP IV

13. HIV PREVALENCE OVER THE YEARS
9/1/2018 13
•TheestimatednumberofnewHIVinfectionsperannumisalsodecreasing,thoughnotuniformly,acrossthe
nation.
•Somestatesanddistrictscontinuetorecordanincreaseinnewinfections,confirmingtheheterogeneityofthe
epidemic

14. 9/1/2018 14
•TheHIVepidemicinIndiaispredominantlysexually-driven.
•However,injectingdrugusecontinuestocontributetoinfectionsinan
increasingnumberofgeographicalareas,includingtheNorth-East,Punjab,Uttar
Pradesh,Bihar,DelhiandUttarakhand.
•Riskbehaviourssuchasunprotectedsexualencountersandinjectingdruguse
areincreasinglyoverlapping.

15. 9/1/2018 15
•ArisingtrendinannualnewHIVinfectionsamongadultsisnoticedinotherwise
lowprevalenceState/UTs,includingAssam,Chandigarh,Chhattisgarh,Gujarat,
Sikkim,Tripura,andUttarPradesh.
•TheprevalenceintheseState/UTs,barringGujarat,isstilllowerthanthe
nationalaverage.

16. 9/1/2018 16

17. DISTRICTWISE HIV PREVALENCE,HSS 2014-2015
9/1/2018 17
FACTORS CONTRIBUTING TO HIV
EPIDEMIC
•Increase in mobility and migration.
•Advent of information technology.
•Rise in median income levels.
•Persistent economic and gender
inequalities.

18. ESTIMATED NEW HIV INFECTIONS AND DEATHS
AMONG PLHIV, 2007-2015
9/1/2018 18
•Estimatednewinfectionshavefallenby
over66%
between2000and2015.
•EstimatedARDin2015fellby54%as
compared
to2007.
•Thetwolinescrosseachotherin2014
suggestingthatANHIwillcontributetoa
slowdowninthepaceofthe‘declining
HIVprevalence’.

19. RECOMMENDATIONS
9/1/2018 19
•AdaptTIstrategiestomatchchangingdynamicsofbridgeandkeypopulations.
•ImprovingcommunitybasedScreeningandgeo-prioritisation.
•Introduce‘TestandTreat’forkeypopulationandsero-discordantcoupleswhere
thesystemisrobusttodeliverthem.

20. 9/1/2018 20
•StrengthenSIMSasaneffectiveintegratedtoolforprogrammemanagement.
•Ensurelinkagesacrossallprogrammecomponentsforeffectiveindividual-level
casetrackingandretention.
•RevitaliseIECstrategiesbyshiftingtointeractiveformats,harnessingchannels
forspecificaudiencesegments.

21. 9/1/2018 21
•Focusoninstitutionalstrengthening–fillingvacancies,capacitybuildingand
strengtheningsupervision.
•StreamlinefinancialmanagementatSACSforeffectivetransferandutilisationof
financialresources.
•Undertakeacomprehensiveupliftmentofprocurementandsupplychain
functionsunderNACP.

22. 9/1/2018 22
What is next?

23. 2015-2030
9/1/2018 23

24. 9/1/2018 24

25. 9/1/2018 25
NATIONALSTRATEGICPLAN
2017-2024

26. 9/1/2018 26
•Target3.3whichincludes‘EndingoftheAIDSepidemicasapublichealththreat’
by2030.
•Toachievethistarget,countriesneedtofasttracktheirHIV-responseby2020.
•Indiaaimstoachieve90-90-90aswellasotherFast-Tracktargetsby2020.

27. GUIDING PRINCIPLES OF NSP
9/1/2018 27
•Evidence–informedandresult-oriented.
•CoverageandQuality.
•Rights-basedapproach.
•Investment.
•Flexibleandadaptive.
•Multi-sectoraldesignandimplementation.

28. OVERVIEW OF HIV NSP INDIA 2017-2024
9/1/2018 28
Vision:AnAIDSFreeIndia
Goal:Achievingzeronewinfections,zeroAIDS-relateddeathsandzero
AIDSrelatedstigma&discrimination.
Objective1:Reduce80%newinfectionsby2024(Baseline2010)
Objective2:Ensure95%ofestimatedPLHIVknowtheirstatusby2024
Objective3:Ensure95%PLHIVhaveARTinitiationandretentionby
2024,forsustainedviralsuppression
Objective4:Eliminatemother-to-childtransmissionofHIVandSyphilis
by2020
Objective5:EliminateHIV/AIDSrelatedstigmaanddiscriminationby
2020
Objective6:FacilitatesustainableNACPservicedeliveryby2024

29. PRIORITIES
9/1/2018 29
1.AcceleratingHIVpreventionin‘atriskgroup’andkeypopulation.
2.ExpandingqualityassuredHIVtestingwithuniversal
accesstocomprehensiveHIVcare.
3.EliminationofmothertochildtransmissionofHIVandsyphilis.
4.AddressingthecriticalenablersinHIVprogramming.
5.Restructuringthestrategicinformationsystemtobeefficientandpatient-
centric.

30. STRATEGIC FRAMEWORK
9/1/2018 30

31. EXPECTED ACHIEVEMENTS
9/1/2018 31
1.Estimatednewinfectionswillreducefrom102,226(2010)to<21,000peryear.
2.2.14millionPLHIVofthetotalestimatedPLHIV(2.25million)wouldknowtheir
status.
3.2.03millionPLHIVwouldbeputonART.
4.1.93millionPLHIVwouldberetainedontreatmentandhaveHIVVL<1000
copies/Ml.

32. 9/1/2018 32
5.Fulfillmentof<50casesofnewpediatricHIVinfectionsper100,000livebirths.
6.Attainmentof<50casesofcongenitalsyphilisper100,000livebirths.
7.HIV/AIDSwillbeperceivedaschronicmanageablediseasewithnostigmaand
discriminationattachedtoit.
8.100%domesticfunding.

33. CHALLENGES
9/1/2018 33
•WithinaTI,individualsmayhavedifferentriskandvulnerabilityprofilesand
needs.
•Interventionintensitygenerallyfollowsprevalencedata,thoughgreaterfocus
needstobeonmonitoringannualnewHIVinfectionsacrossvarious
populations.
•AvailableevidencereflectsarisingepidemicofnewHIVinfectionsincertain
hithertolowprevalenceStatesanddistricts.Thesegeographiesneedtobegiven
priority.
•ARTadherenceamongKPsisamajorchallenge.Additionally,theHIVandTBco-
infectionratesarehigherwithlowuptakeofservices.

34. POSSIBLE SOLUTIONS
9/1/2018 35
•ThequickestwaytoincreasecoverageistorapidlyincreaseTIsites,andensure
efficientoutreachandservicequality.
•Efficientlinkagetocareandtreatmentservicesarecriticalunderthenew‘test
andtreat’approachtoensurenoleakintheHIVcarecontinuumcascade.
•AdaptTIstrategyforinterventionsamongnewerstaticgroups,including
prisonerpopulationsandadolescentPWIDs.

35. 9/1/2018 36
•Theeffectivecoverageofthis‘atrisk’groupmaynotbepossiblebefore2020,
whichistheenddatefor‘fasttrack’targets.
•Useofmassmedia,midmedia,socialmediaandIEC.
•ExpandsexualandreproductivehealtheducationwithafocusonHIV
preventionacrossallpublicandprivatehighschoolsandamongyouth,inand
outofschool.

36. 9/1/2018 37
•Indiaiscommittedtoachievingthe90-90-90targetsacrossthecountryand
populationgroupsby2020.Toreachthesecondandthird90,itisnecessaryto
achievethefirsttargetof90%.
•Satisfactoryservicetoclientsmustbeensured.
•Highconcordanceamongspouses:Thereisscopetoreinforcecouple
counsellingandHIVtestingforearlydetection.
–Geoprioritisingthedistrictswherehigherpositivityisnotedbuthavealow
coverageoftesting;
–Communitybasedtesting.
–ActiveuseofIECtoincreasedemandforHIVtesting.

37. 9/1/2018 38
•IncreasingthepaceofexpansionofARTcoverageandimprovingARTadherence
aretheprimaryobjectivesofthisNSPtoreachingthesecondandthird90.
a.PluggingthelossofclientsfromICTCstoART.UseofCareSupportCentres
(CSCs),PLHIVnetworks,NGOsandprivatesectors
b.ImprovingaccesstoART.
c.Addressingcrosscuttingissuesofpaucityofhumanresourcesandmonitoring
andevaluation.

38. 9/1/2018 39
•ARTretentionisachallenge.
•Currentretentionrates(12months)arecloseto70%.
a.MobilisePLHIVsforbetteradherenceandretentionofPLHIVsonART.
b.Addressqualityassuranceandqualityimprovementactivities.
c.Engagingtheprivatesector.
d.StrengthenmonitoringofchronicHIVcareandtreatmentincludingscale-up
ofviralloadmonitoringandsurveillancefordrugresistance.
e.Strengthentreatmentmonitoringandevaluationofclinicalcomplicationsand
effectsoflong-termuseofantiretroviraldrugs.

39. 9/1/2018 40
•Indiaaccountsforabout29.7millionpregnanciesannually.
•BridgethetestinggapforHIVandSyphilisamongpregnantwomen.
•UniversalaccesstoARTandSyphilistreatmentforHIVpositivepregnantwomen
andmothers.
•Strengthenfollowupofcohortsofpositivepregnantmothersanduptakeof
EarlyInfantDiagnosis.
•ImprovedlinkagewiththeNHMforpreventingHIVinfectioninyoung
reproductivegroupthroughpreventionmessagingandtoaddressunmetneeds
offamilyplanninginHIVpositives.

40. 9/1/2018 41
•Strategicinformationmanagementsystemandevidencebaseddecisionmaking
throughastrongmonitoring,evaluationandsurveillance(MES)frameworkhas
beenfundamental.
•ImplementationofoneintegratedMESsystemencompassingallinformation
systemsused.
•Sustainedgenerationanalysisanddisseminationofhighqualitystrategic
informationusingcontemporarymethodsandtechnologies.
•Systematicengagementwithpolicymakersandprogrammemanagersatthe
national,State/UTsanddistrictlevel.
•Designandimplementrobustconcurrentevaluationsystemstomeasure
progressandassessimpactwithregardtostatedtargetsandgoalsoftheNSP.

41. CONCLUSION
9/1/2018 42
•Overthepastfifteenyears,IndiahasexperiencedagradualdeclineinestimatednewHIV
infections,prevalenceandmortalityduetoAIDS-relatedcauses.
•However,acomprehensiveandsustainedprogressisnowrequiredtowalk‘thelastmile’.
•IndiahasalreadymetthegoalsetonAIDS-relatedMDGsfrom2000to2015,andithasallthe
pre-requisitesinplacetoreachsub-objective3.3includingtheendingofAIDSby2030as
definedundertheSDG3.
•Tothiseffect,theNACO,intheMinistryofHealthandFamilyWelfarehasdevelopedaseven-
yearNationalStrategicPlanonHIV/AIDSandSTIforIndia.
•ThiswouldresultinreductionofnewHIVinfectionsandwilleliminatemother-to-child
transmissionofHIVandSyphilis,ensuringastigmaanddiscriminationfreeenvironmentatthe
sametime.

42. References
•K.Park24
th
Edition.
•NationalStrategicPlan2017-2024,MOHFW,GOI.
•WorldHealthOrganisation.
•ReportofMTA2016.

43. THANK YOU