NATIONAL AIDS CONTROL PROGRAMME (NACP)

NATIONAL AIDS CONTROL PROGRAM

1992- - NACP 1 launched to show down the spread of HIV infection
- national AIDS control board constituted
- NACO setup
1999- - NACP 2 begins focusing on behaviour change , increased decentralization and NGO involvement.
- state AIDS control societies developed .
2002- - national AIDS control policy adopted.
- national blood policy adopted.

2004- - antiretroviral treatment initiated .
2006- - national council on AIDS constituted under chairmanship of prime minister.
- national policy on paediatric ART formulated.
2007- - NACP 3 launched for years (2007-2012)
2012- - NACP 4 launched for next 5 years

1. SUBMITTED TO: SUBMITTED BY: MRS. ASHA MA’AM MANJEET KAUR CON,SJH NATIONAL AIDS CONTROL PROGRAMME

2. AIDS is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency disease(HIV) infection . HIV: belongs to a group of viruses known as RETROVIRUSES ( type of viruses that carry their genetic material in the form of ribonucleic acid[RNA] rather than deoxyribonucleic acid[DNA] ). AQUIRED IMMUNODEFICIENCY SNYDROME(AIDS)

3. The immunodeficiency virus(HIV) principally attacks CD4 T-cells, a vital part of the human immune system . As a result , the body’s ability to resist opportunistic viral, bacterial , bacterial , fungal , and other infection is greatly weakened . HUMAN IMMUNODEFICIENCY VIRUS(HIV)

4. HIV is retrovirus. STRUCTURE OF HIV VIRUS

5. WHO HIV CLINICAL STAGES

6. CLASSIFICATION OF STATES: High prevalence : >5% in HRG & >1% in ANC Maharashtra , TN , Andhra Pradesh , Karnataka , Nagaland. Moderate prevalence : >5% in HRG & 1% in ANC Gujarat , Pondicherry , Goa . Low prevalence : >5% in HRG & 1% in ANC all other states and UTs COUNTRY SCENARIO

7. 12,70,678 people are on ART. 21,16,581 people were living with HIV. 75,948 people became newly infected with HIV. 67,612 deaths due to AIDS. 35,255 pregnant woman needs PPTCT. INDIAN STATISTICS 2017

8. INTRODUCTION HIV infection s first detected in 1986, when 10 HIV positive samples were found from a group of 102 female sex workers from Chennai. 62 AIDS surveillance centres were gradually established nationwide . NATIONAL AIDS CONTROL PROGRAMME (NACP)

9. The milestones of the programme are summarized as follows 1986- - first case of HIV detected - AIDS task force setup by the ICMR - national AIDS committee established under the ministry of health. 1990- -mid term plan launched for from states and the four metros. MILESTONES OF NACP:

10. 1992- - NACP 1 launched to show down the spread of HIV infection - national AIDS control board constituted - NACO setup 1999- - NACP 2 begins focusing on behaviour change , increased decentralization and NGO involvement. - state AIDS control societies developed . 2002- - national AIDS control policy adopted. - national blood policy adopted.

11. 2004- - antiretroviral treatment initiated . 2006- - national council on AIDS constituted under chairmanship of prime minister. - national policy on paediatric ART formulated. 2007- - NACP 3 launched for years (2007-2012) 2012- - NACP 4 launched for next 5 years

12. NATIONAL AIDS CONTROL PROGRAME -1 OBJECTIVES: Slow and prevent the spread of HIV through a major effort to prevent HIV transmission. KEY STRATEGIES: Focus on raising awareness , blood safety , prevention among high risk populations.

13. Improving surveillance ACHIEVEMENTS: National AIDS response structures at both national and state levels and provided critical financing Strong partnership with the WHO and later helped mobilized additional donor resources Established the state AIDS control cells.

14. NATIONAL AIDS CONTROL PROGRAMME-2 OBJECTIVE: Reduce the spread of HIV infection in India through behaviour change and increase capacity to respond to HIV on a long-term basis. KAY STRATEGIES: Targeted interventions for high risk groups. Preventive interventions for general populations. Involvement of NGOs. Institutional strengthening.

15. ACHIEVEMENTS: At the operational level 1,033 targeted interventions setup, 875 voluntary counselling and testing centres (VCTC) and 679 STF clinics at the district level. National wide and state level behaviour surveillance surveys(BSS) were conducted . PPTCT expanded. A computerized management information system(CMIS) created .

16. HIV prevention and care and support organisation and networks were strengthened Support from partner agencies increased substantially.

17. NATIONAL AIDS CONTROL PROGRAMME-3 OBJECTIVES: Reduce the rate of incidence by 60% in the first year of the programme. KEY STRATEGIES: Prevention – targeted intervention (TI) , ICTC , blood safety. Care support and treatment Capacity building- establishment , support and capacity

18. Strategic information management monitoring and evaluation. PROGRAMME PRIORITIES Considering that more than 99% of the population in the country is free fro the infection , NACP-3 has place the highest priority on prevention efforts while, at the same time seeking to integrate prevention with care, support and treatment .

19. Sub population that have the highest risk of exposure to HIV will receive the highest priority for intervention . Those in general population who have greater need for accessing prevention services such as treatment of STIs. Ensures who need treatment would have access to prophylaxis and management of opportunistic infection.

20. Provision of services for prevention of parent to child transmission of disease. Impact of HIV will be mitigated through welfare agencies providing nutritional support. Invest in community care centres to provide psycho-social support. Socio-economic determinants that make a person vulnerable also increase the risk of infection.

21. ACHIEVEMENTS: There were 306 fully functional ART centres . Nearby 12.5 Lacs PLHIV were registered and 420000 patients were on ART . 612 link ART centres(LAC) had been established wherein , 26023 PLHIV were taking services . There were 10 centres of excellence. 7 regional paediatric centres also functional. 259 community care centres across the country.

22. 6000 condoms and 6000 village information centres established. 3000 red ribbon clubs established. Link workers training module updated .

23. NATIONAL AIDS CONTROL PROGRAMME-4 Launched on 12 February 2014. Total budget outlet Rs. 1429 crores . Goal: accelerate reversal and integrate response . OBJECTIVES: Reduce new infection by 50% (2007 baseline of NACP-3) Provide comprehensive care and support to all persons living with HIV/AIDS.

24. STRATEGIES: Intensify and consolidate preventive services . Increase assess and promote comprehensive care, support & treatment. Expanding IEC services. Capacity building . Strengthening strategic information management system.

25. KEY PRIORITIES UNDER NACP-4 Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics. Prevention to parent to child transmission Focusing on IEC Providing comprehensive care , support and treatment to eligible PLHIV.

26. Reducing stigma De-centralizing rollout of services including technical support. Ensuring effective use of strategic information at all levels of programme. Building capacities of NGO and civil society partners especially in states with emerging epidemics.

27. Integrating HIV services with health system in a phased manner. Mainstreaming of HIV/AIDS activities. PREVENTION SERVICES : Targeted interventions for high risk group and bridge population. Needle-syringe exchange programme(NSEP) and opioids substitution therapy (OST) for IDUs.

28. Prevention intervention for migrant population at source , transit and destination. Link worker scheme (LWS) for HRGs and vulnerable population in rural areas . Prevention & control of sexually transmitted infection/reproductive tract infections. Blood safety

29. HIV counselling and testing services . Prevention to parent to child transmission. Condom promotion. Information , education and communication(IEC) & behaviour change communication(BCC).

30. Surveillance are being carried out to detect spread of the disease & to make appropriate strategy for prevention and control i.e. by area specific target interventions & best practice approach . Types of surveillance: HIV sentinel surveillance HIV sero -surveillance AIDS case surveillance STD surveillance Behavioural surveillance HIV SURVEILLANCE

31. Integration with surveillance of other disease like TB etc. Out of above most effective surveillance is HIV sentinel surveillance . The main aim of the surveillance is confined to monitor the trend of HIV infection. OBJECTIVES OF THE SURVILLANCE : To determine the level of HIV infection among general population as well as HRGs in different states To uderstand the trend of HIV epidemic .

32. To understand the geographical spread of infection and to identify emerging pockets. To provide information for prioritization of the program resources & evaluation of program impact To estimate prevalence & HIV burden in the country . It is done in same place over few years by anonymous serological tests i.e. HIV testing is done without identification for purposes eg . VDRL , STD clinics. The demerit of the test is that + ve person is not identified.

33. In 1994 it was started with 55 sentinel sites and become 180 in 1998 The number of HRG of people increased in HIV sentinel sites . THE KEY FEATURES OF SURVEILLANCE ARE Inclusion of data from high risk population through targeted intervention sites Adding rural samples through antenatal clinics The strategy adopted was whatever be the sentinel site and amount of sample collected – the duration , frequency and age group of people in the surveillance should be same in all HRG , bridge population and general population.

34. Counselling and HIV testing services : ICTC Prevention of parent to child transmission HIV/TB collaborative activities Care, support & treatment services. Guidelines for HIV and infant feeding STD control programme

35. Integrated counselling and testing services :- This is available to increase access to HIV diagnosis. It includes testing services & community approaches at various level of health system in India like state, district, sub-district, & village/community level. Functions: Early detection of HIV.

36. Provision of basic information on modes of transmission, prevention of HIV for promoting behavioural change and reducing vulnerability and liking the PLHIV to care , support & treatment . Two types of ICTC: Fixed facility ICTC Mobile ICTC

37. All HIV testing services must follow the WHO-recommended principles known as the “5 Cs”: informed Consent Confidentiality Counseling Correct test results Connection (linkage to care, treatment and other services).

38. Prevention of parent to child transmission:- The prevention of parent to child transmission of HIV/AIDS(PPTCT) program was started in 2002. Currently there are more then 15000 ICTCs in country which offer PPTCT services to pregnant women. The aim of the PPTCT program is to offer HIV testing to every pregnant woman (universal Coverage ) in the country , so as to cover all estimated HIV positive pregnant women and eliminate transmission of HIV from mother o child.

39. In India , PPTCT interventions under NACP was started in 2002 , using SD-NVP prophylaxis for HIV positive women during labour and also for her new born child immediately after birth. The PPTCT services provide access to all pregnant women for HIV diagnosis prevention , care and treatment services. Contd..

40. HIV/TB collaborative activities :- NACP-4 covers the HIV testing of TB patients. It is combined work of NACP & RNTCP. State with high prevalence covers about 90% of TB patients for HIV testing. There is expected detection of HIV within 2-4 weeks of TB positivity. This service was started in 2002 in Karnataka followed by Maharashtra , Andhra Pradesh & Tamil Nadu.

41. Guidelines for HIV and infant feeding :- Till 2009, WHO advise HIV positive mothers to avoid breast feeding if they were able to afford and store formula milk safely. On 30 th November 2009 ,WHO released new recommendations on infant feeding by HIV positive mothers . HIV positive mothers or their infants take anti retroviral drugs throughout the period of breast

42. Feeding and until the infant is 12 months old. Child can benefit from breast feeding with every little risk of becoming infected with HIV. Contd …

43. Care, support & treatment services:- Laboratory services for CD4 testing and other investigations . Free first line & second line ART through ART centers and link ART centers , centers of excellence & ART plus centers . Pediatric ART for children Early infant diagnosis for HIV exposed infants

44. And children below 18 months . HIV/TB coordination ( cross , referral , detection and treatment of co-infection). Treatment of opportunistic infections . Drop-in centers for PLHIV networks .

45. STD control programme :- STD control is linked to HIV/AIDS control as behaviour resulting in the transmission of STD and HIV are same HIV is transmitted more easily in the presence of another STD Hence, early diagnosis and treatment of STD is now recognized as one of the major strategies to control spread of HIV infection.

46. we have studied , what is AIDS and HIV ? Sign and symptoms of AIDS , Indian statistics of AIDS , National AIDS Control Program , milestones of NACP , its four phases , services under NACP to control the spread of AIDS like ICTC , Prevention of parent to child transmission , HIV/TB collaborative activities , Care, support & treatment services , Guidelines for HIV and infant feeding ,STD control programme. SUMMARY

47. http://naco.gov.in/nacp http://en.m.wikipedia.org/wiki/national_AIDS_Control_Organisation K. Park, K. Parks text book of Preventive And Social Medicine, New Delhi , Bhanot Publications, page no. 343-355 ,431-438. REFERENCES