National AIDS Control Programme NACP

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.
The National AIDS Control Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for prevention and control of HIV/AIDS in India. Over time, the focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and networks of PLHIV.

1. National Aids Control Programme (NACP) Presented by: Harsh Rastogi , Nursing Tutor, M.S. Institute of Nursing, Lucknow .

2. Introduction HIV infection first detected in India in 1986, when 10 HIV positive samples were found from a group of 102 female sex workers from Chennai . 62 AIDS surveillance centers were gradually established nationwide.

3. Milestones 1986: First case of HIV detected, AIDS task force set by ICMR. 1990: Medium term plan launched for 4 states & 4 metro 1992: NACP 1 launched & NACB constituted. 1999: NACP 2 begins, SACS established 2002: NACP adopted. 2004: ART started. 2007: NACP 3 launched for 5 years. 2012: NACP 4 launched for next 5 year .

4. Global statistics 2015 17 million people were accessing antiretroviral therapy 36.7 million [34.0 million–39.8 million] people globally were living with HIV 2.1 million [1.8 million–2.4 million] people became newly infected with HIV 1.1 million [940 000–1.3 million] people died from AIDS-related illnesses

5. Cont… 78 million [69.5 million–87.6 million] people have become infected with HIV since the start of the epidemic 35 million [29.6 million–40.8 million] people have died from AIDS-related illnesses since the start of the epidemic

6. Indian statistics 2015 12,70,678 People on ART 2116581 people were living with HIV 75948 people became newly infected with HIV 67612 deaths due to AIDS 35255 pregnant woman needs PPTCT

7. Key terms High risk group: Female Sex Worker (FSW) Men who have sex with Men (MSM) Transgender Injecting drug users (IDU)

8. Cont… Bridge population: Migrant Truckers Clients of sex worker

9. Cont… Vulnerable population: Women having casual partners Spouses of high risk groups

10. Classification of states High prevalence >5% in HRG & >1% in ANC MR, TN, Andhra, Manipur, Karnataka, Nagaland

11. Cont… Moderate prevalence >5% in HRG & <1% in ANC Gujarat, Puducherry , Goa

12. Cont… Low prevalence <5% in HRG & <1% in ANC All other states/UTs

13. Classification of districts Districts are classified into four categories A to D: Category A: More than 1% ANC prevalence in district in any of the sites in the last 3 years. Category B: Less than 1% ANC prevalence in all the sites during last 3 years with more than 5% prevalence in any HRG site (STD/FSW/MSM/IDU)

14. Cont… Category C: Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites, with known hot spots (Migrants, truckers, large aggregation of factory workers, tourist etc.) Category D: Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites with no known hot spots OR no or poor HIV data .

15. Case Definition of AIDS ADULTS : Positive test for HIV antibody by 2 separate test using 2 different Antigens plus Any one or more of the following: Weight loss >10% of bw Chronic diarrhea >1 month

16. Cont… Chronic cough >1 month Disseminated ,military or extra-pulmonary TB Neurological impairment Esophageal candidiasis Kaposi sarcoma

17. Cont… CHILDREN: At least 2 major signs + 2 minor signs Major: Weight loss, failure to thrive, chronic diarrhea, prolonged fever, candidiasis , Tuberculosis, Herpes zoster. Minor: Generalized lymphadynopathy , Oropharyngeal candidiasis , persistent cough for >I month, generalized dermatitis, Confirmed maternal HIV infection.

18. WHO HIV Clinical Stages Short, flu-like illness occurs 1-6 weeks after infection Infected person can infect other people Average- 10 years Mild symptoms HIV in blood drops to very low levels Antibodies are detectable in the blood The immune system deteriorates Opportunistic infections (OI)start to appear Rap i d the d e c l i n e in nu m ber of CD4 + T cells Opportunistic infections become severe and cancer may develop

19. AIDS control programme in India HIV infection first detected in India in 1986, when 10 HIV positive samples were found from a group of 102 female sex workers from Chennai. In 1986 Government set up an AIDS Task Force under ICMR and established a National AIDS Committee (NAC) chaired by Secretary, Department of Health and Family Welfare. In 1987, National AIDS Control Programme was initiated, with help from the World Bank .

20. Cont… In 1989, a Medium Term Plan for AIDS Control was developed with the support of the WHO. First National AIDS Control Programme (NACP - I) was launched in 1992. NACP - II launched in 1999: decentralization of programme implementation to State level and greater involvement of NGOs. NACP - III implemented during 2007-2012. NACP - IV has been developed for the period 2012-2017 .

21. NACP I Objective 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, Improving surveillance

22. Cont… Achievements National AIDS response structures at both the national and state levels and provided critical financing. Strong partnership with the World Health Organization (WHO) and later helped mobilize additional donor resources. Established the State AIDS Control Cells

23. NACP II Objective Reduce the spread of HIV infection in India through behavior change and increase capacity to respond to HIV on a long-term basis. Key strategies Targeted Interventions for high-risk groups Preventive interventions for general populations Involvement of NGOs Institutional strengthening

24. Cont… Achievement At the operational level 1,033 targeted interventions set up, 875 Voluntary counseling and testing centers (VCTC) and 679 STI clinics at the district level. Nation-wide and state level Behaviors Sentinel Surveillance (BSS) surveys were conducted. PPTCT Expanded. A computerized management information system (CMIS) created. HIV prevention and care and support organizations and networks were strengthened. Support from partner agencies increased substantially.

25. NACP III Objective Reduce the rate of incidence by 60 per cent in the first year of the programme . Strategies Prevention – Targeted intervention (TI), ICTC, blood safety Care, support and treatment- Capacity building – establishment, support and capacity strengthening, training, managing programme implementation and contracts, mainstreaming/private sector partnerships. Strategic information management–monitoring and evaluation .

26. Cont… Achievements There were 306 fully functional ART Centers. Nearly 12.5 lakh PLHIV were registered and 420000 patients were on ART. 612 Link ART centre (LAC) had been established wherein, 26023 PLHIV were taking Services There were 10 Centers of Excellence, 7 Regional Pediatric centers also functional. 259 Community Care Centers across the Country 6000 condoms & 6000 village information centers established 3000 Red ribbon clubs established Link Workers training module updated

27. NACP IV Launched on 12 February 2014. Total budget outlay Rs 14295 crores . Goal: Accelerate Reversal and Integrate Response. Objective 1: Reduce new infections by 50% (2007 Baseline of NACP III) Objective 2: Provide comprehensive care and support to all persons living with HIV/AIDS.

28. Key priorities under NACP-IV Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics. Prevention of Parent to Child transmission Focusing on IEC. Providing comprehensive care, support and treatment to eligible PLHIV Reducing stigma .

29. Cont… 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. Integrating HIV services with health systems in a phased manner. Mainstreaming of HIV/ AIDS activities.

30. Prevention services Targeted Interventions for High Risk Groups and Bridge Population. Needle-Syringe Exchange Programme (NSEP) and Opioid Substitution Therapy (OST) for IDUs. Prevention Interventions for Migrant population at source, transit and destination. Link Worker Scheme (LWS) for HRGs and vulnerable population in rural areas.

31. Cont… Prevention & Control of Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) Blood Safety HIV Counseling & Testing Services Prevention of Parent to Child Transmission Condom promotion Information, Education & Communication (IEC) & Behavior Change Communication (BCC ).

32. Care, Support & Treatment Services Laboratory services for CD4 Testing and other investigations. Free First line & second line Anti-Retroviral Treatment (ART) through ART centers and Link ART Centers (LACs), Centers of Excellence (COE) & ART Plus Centers. Pediatric ART for children.

33. Cont… Early Infant Diagnosis for HIV exposed infants and children below 18 months. HIV-TB Coordination (Cross referral, detection and treatment of co-infections) Treatment of Opportunistic Infections Drop-in Centers for PLHIV networks

34. NEW INITIATIVES UNDER NACP-IV Scale up of Multi-Drug Regimen for Prevention of Parent to Child Transmission (PPTCT). Social protection for marginalized populations through mainstreaming and earmarking budgets for HIV among concerned government departments. Establishment of Metro Blood Banks and Plasma Fractionation Centre .

35. Cont… Launch of Third Line ART and scale up of first and second Line ART. Demand promotion strategies specially using media, e.g., National Folk Media Campaign & Red Ribbon Express and buses.

36. References National AIDS Control Organization. About NACO; NACO 2013. Available from: http://www.nacoonline.org/About_NACO/ . MSACS–Maharashtra state AIDS control society. Mahasacs.org.in India HIV estimations 2015 Technical Report , NACO AND National Institute of Medical statistics , ICMR, Ministry of Health and Family Welfare, New Delhi Textbook of Park, 23 rd Edition, page no. 343-354 , 431-438 Textbook of Suryakanta , 4th Edition , 498-519, 924- 930, page no. 387- 391 WHO Guidelines for ART 2013 Factsheet Statistics 2015- UNAIDS Textbook of national health programmes of India , national policies and legislations related to health, J. KISHORE, 11th Edition.

37. Thank you!