National aids control programme

This presentation explains graphically , statistically and in detail the National AIDS Control Programme (Indian scenario)

1. National AIDS Control Programme Dr. IMMANUEL JOSHUA Junior Resident-1, Community Medicine , IMS, BHU, Email: [email protected] (NACP)

2. COUNTRY SCENARIO States with >5% prevalence in High Risk Group and 1% or more in antenatal women. ( Maharashtra, Karnataka, Tamil Nadu, Andra Pradesh, Manipur ) States with >5% prevalence in High Risk Group but <1 % in antenatal women. ( Gujarat, Goa, Puducherry ) States with <5 % prevalence in High Risk Group and <1% in antenatal women. ( Remaining states ) Based on sentinel surveillance data, the HIV prevalence in adult population can be broadly classified into three states/ Uts in the country: GROUP-1 GROUP-3 GROUP-2 HIGH PREVALENCE LOW PREVALENCE MODERATE PREVALENCE

3. State wise adult HIV prevalence ( 2019 ) State/UT-wise PLHIV size ( 2019 )

4. State/UT-wise percent contribution in total new Infections (2019)

5. State/UT-wise AIDS death in 2019 (in thousands)

6. A B C D CATEGORIES OF DISTRICTS More than 1%ANC/Parent to C hild transmission prevalence in district at any time in any of the sites in the last 3 years Less than 1%ANC/PTCT prevalence in all the sites in the last 3 years associated with >5% prevalence in any High Risk Group < 1%ANC prevalence in all the sites in the last 3 years with <5 % prevalence in all STD clinic attendees or any HRG with known hotspots < 1%ANC prevalence in all the sites in the last 3 years with <5% prevalence in all STD clinic attendees or any HRG or poor data with no known hotspots

7. 1986 1999 1992 2002 2004 2007 2014 2017 National AIDS committee established NACP-1 launched NACP-II begins NAC policy adopted ART initiated NACP-III launched NACP-IV launched National strategic plan for HIV/AIDS and STIs MILESTONES Aim is to prevent further transmission of HIV, to decrease morbidity and mortality associated with HIV infection and to minimize socio-economic impact resulting from HIV infection.

8. NACO STRUCTURE Additional Secretary & Director General (NACO) Strategic information Finance Joint Secretary (NACO) Blood safety Lab services Care, Support and Treatment Administration & Procurement Targeted intervention STI management Basic services IEC activities

9. HIV Surveillance TYPES OF SURVEILLANCE

10. OBJECTIVES OF HIV SENTINEL SURVEILLANCE 1 5 4 3 2 To determine the level of HIV infection among general population as well as high risk groups in different states To estimate Human Immunodeficiency Virus prevalence and HIV burden in the country To provide information for prioritization of programme resources and evaluation of programme impact To understand the geographical spread of HIV infection and to identify emerging pockets To understand the trends of HIV epidemic among general population as well as high risk groups in different states

11. Level of HIV Counselling & Testing S ervices

12. Integrated Counselling and Testing Centres (ICTC) “A person is counselled and tested for HIV at ICTC, either of hos own free will ( CLIENT INITIATED ) or as advised by a medical provider ( PROVIDER INITIATED )” ICTC Mobile ICTC Facility integrated Standalone ICTC Fixed facility ICTC Located in medical colleges, district hospitals, sub-district hospitals, CHCs Full time counsellor and Lab technician High client load For rapid scale-up & sustainability Set up below the block levels at 24x7 PHCs Staffs of existing health facilities are trained Receives logistic support from DAC Temporary clinics in hard-to-reach areas (Van with a room)

13. Prevention of Parent-to-Child transmission of HIV The PPTCT programme was started in the country in the year 2002 Currently there are >15000 ICTC s in the country which offer PPTCT services to pregnant women The aim of the PPTCT programme is to offer HIV Testing to every pregnant woman ( UNIVERSAL COVERAGE ) in the country Covers all estimated HIV positive pregnant women and Eliminate transmission of HIV from Mother-to-Child The Nationa l Strategic Plan for PPTCT services using Multi-drug ARVs in India was developed in May-June 2013 for nationwide implementation in phased manner

14. 6 4 2 The essential package of PPTCT services in India are as follows: Move from ANC-centric to a “Family-centric approach” Promotion of institutional deliveries of all HIV infected pregnant women Provision of nutrition, counselling and psychological support for HIV women 1 5 3 Routine offer of HIV counselling to all Antenatal mother with an ‘Opt out’ option Provision of life-long ART (TDF + 3TC + EFV) to all pregnant and lactating HIV women Provision of care for associated conditions (STI/RTI/TB,.. etc )

15. 10 8 Provision of ARV prophylaxis to infants from birth upto 6 months Initiation of Co- trimoxazole Prohy . Therapy and Early infant diagnosis 7 11 9 Provision of counselling for timely initiation and continuation of breast feeding Integrating follow-up of HIV exposed infants into routine healthcare services Strengthening community followup and outreach through local community networks Contd …

16. Activities to reduce TB-HIV mortality PREVENTION Isoniazid preventive treatment Air borne infection control Awareness generation MANAGEMENT OF SPECIAL CASES TB/HIV patients on PI based ARV TB/HIV in children TB/HIV pregnant women Drug resistant TB/HIV PROMPT TREATMENT Early initiation of ART Prompt initiation of TB treatment EARLY DETECTION 100% coverage of PITC in TB patients PITC in presumptive TB cases Rapid diagnostics Intensified case finding activities TB/HIV coordination to reduce mortality

17. Care, Support, Treatment I hope and I believe that this Template will your Time, Money and Reputation. Get a modern PowerPoint Presentation that is beautifully designed. I hope and I believe that this Template will your Time, Money and Reputation. Get a modern PowerPoint Presentation that is beautifully designed. I hope and I believe that this Template will your Time, Money and Reputation. Get a modern PowerPoint Presentation that is beautifully designed. Free universal access to life long standardized Anti Retroviral Therapy Free laboratory diagnostic and monitoring services Facilitating long term retention in care Prevention, Diagnosis and Management of opportunistic infection Linkage to care and support services and to social protection scheme 01 02 03 04 05 This component of NACP aims to provide comprehensive services to PLHIV to improve the Survival and Quality of Life

18. 90-90-90 TARGET “ 1 . 90% of PLHIV know their status , of which 2. 90% of PLHIV are on ART , of which 3. 90% of PLHIV have Viral Suppression” The country has adopted fast track target of 90-90-90 which aims at ending AIDS as public health threat by 2030 by achieving the targets by 2020 A significant step of rolling out “ Test and Treat ” policy has been taken towards achieving these targets

19. TARGET vs ACHIEVEMENT

20. Model of HIV treatment services Centres of Excellence and ART Plus centres in Select Medical Colleges Sub-district level hospitals and CHCs Medical college and District level hospital

21. Centres functioning in India (2017) 530 350 52 7 17 1108 ART Centres Link ART Centres Centres of Excellence Pediatric Centres of Excellence ART Plus Centres Care and support Centres

22. SERVICES First line ART Alternative First line ART Third line ART Second line ART Provide free of cost to eligible PLHIV Assessment to eligibility is done through clinical examination & CD4 Counselling provided Followup done Treatment of opportunistic infections are also provided Started and expanded in CoEs Decentralization was done through capacitating and upgrading some ART centres as “ART Plus centres ” For evaluation for initiation, a State AIDS Clinical Expert Panel has been constituted by DAC Rolled out in 2015 Raltegravir & Darunavir Done through CoEs and ART Plus for those having toxicity/intolerance to 1 st line ART

23. Centre of excellence in HIV care, Varanasi , Uttar Pradesh

24. ART Center, IMS, BHU, Varanasi, Uttar Pradesh w here facility for second and third line drugs is available Only 1 Uttar Pradesh Bihar Monitors the activity of 11 ART centres in Bihar , Uttar Pradesh and Madhya Pradesh Link ART centers Ballia Ghazipur Jaunpur Mau Sonebhadra Bhadohi Chandauli Azamgarh A pproximately 27000 patients are registered with this ART Centre

25. High Risk Groups & HIV Prevalence TARGETED INTERVENTIONS The main objective is to improve health seeking behavior of High Risk groups and reduce their risk of acquiring Sexually transmitted infections and HIV infections

26. The services offered through Targeted Interventions include: Detection and Treatment for Sexually transmitted infections Condom promotion & distribution Behaviour change communication Linkages to Integrated Counselling & Testing Centres Linkages with care & support services for HIV+ HRGs Community organization & Ownership building Specific interventions for IDUs and MSM/TGs Linkages with detoxification/rehabilitation services Substitution Therapy

27. Pre-Packed STI/RTI colour coded kits These are procured centrally and supplied to all State AIDS Control Societies for free supply to all designated STI/RTI clinics Vaginal discharge , Burning micturition, increased frequency Genital complaints by sexual partners Low backache Genital ulcer, single/multiple , painful/painless Burning sensation in the genital area Enlarged lymph nodes If allergic to Inj. Penicillin: Doxycycline 100 MG (Bid for 15 days) Azithromycin 1GM (Single dose) Urethral discharge Ano -rectal discharge Cervicitis

28. Lower Abdominal Pain Fever Vaginal Discharge Menstrual symptoms, dyspareunia , dysuria, tenesmus Swelling in inguinal region (bubo) Preceding genital ulcer or discharge Systemic symptoms Genital ulcer (herpetic) or vesicles, single or multiple, painful, recurrent Burning sensation in the genital area Contd … NACO has branded the STI/RTI services as “ SURAKSHA CLINIC ”

29. National Strategic Plan for HIV/AIDS and STI (2017-2024) The GOAL is to achieve zero new infection , zero AIDS related deaths and zero AIDS related stigma & discrimination . The NSP is designed around a results-based framework based on a causal relationship between the Vision , Mission , Goal and Outcomes Based on this strategic framework, a specific planning approach is required which helps differentiate State & UTs according to 3 EPIDEMIOLOGICAL CONTEXTS States/UTs with; Mature Epidemic Low/Stable Epidemic Emerging Epidemic

30. OBJECTIVES of NSP 1 2 3 4 5 6

31. Achievement of the above objectives by 2024 would result in the following: Estimated new infections will reduce from 102226 (2010) to <21000 per year 2.14 million 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 <10000 copies/ml <50 cases of new pediatric HIV infections per 100000 live births with MTCT rate <5% by 2020 <50 cases of congenital syphilis per 100000 live births HIV/AIDS will be perceived as chronic manageable disease with no stigma and discrimination Key components of NACP will continue through 100% domestic funding

32. 2 2 T H E M E “Ending the HIV/AIDS Epidemic: Resilience and Impact” T H A N K Y O U … ! ! ! Stay Home…! Stay Safe…!!