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Dr. A. K.Gupta Additional Project Director Delhi State AIDS Control Society

HIV/AIDS GLOBAL, INDIAN & STATE SCENARIO

AND ACTIVITIES OF DSACS


TIME LINE Dr. A. K.Gupta

  • 1981- Cases of unusual immune deficiency identified

  • in USA

  • 1982- Acquired Immune Deficiency Syndrome (AIDS)

  • defined for the first time

  • 1983-The Human Immune Deficiency Virus (HIV)

  • identified as the cause of AIDS

  • 1983-In Africa, a heterosexual AIDS epidemic is revealed

  • 1985-The first HIV antibody test becomes available

  • 1987-The WHO launches the Global AIDS Programme


TIME LINE (contd) Dr. A. K.Gupta

  • 1988-The first therapy for AIDS – zidovudine, or AZT

  • approved for use in the USA

  • 1994- Highly Active Antiretroviral Treatment launched

  • 1996- First treatment regimen to reduce mother-to-child

  • transmission of HIV

  • 1997-Brazil becomes the first developing country to

  • provide antiretroviral therapy through its public

  • health system

  • 2001-Global Fund to fight AIDS, Tuberculosis and Malaria

  • launched

  • 2003-Launch of "3 BY 5" initiative -goal of reaching 3

  • mill people in developing world with ART by 2005


Global estimates for adults and children, 2008 Dr. A. K.Gupta

  • People living with HIV33.4 million[31.1 – 35.8 million]

  • New HIV infections in 20082.7 million [ 2.4 – 3.0 million]

  • Deaths due to AIDS in 20082.0 million[1.7 – 2.4 million]


Adults and children estimated to be living with HIV, 2008 Dr. A. K.Gupta

Eastern Europe & Central Asia

1.5 million

[1.4 – 1.7 million]

Western &

Central Europe

850 000

[710 000 – 970 000]

North America

1.4 million

[1.2 – 1.6 million]

East Asia

850 000

[700 000 – 1.0 million]

Middle East&North Africa

310 000

[250 000 – 380 000]

Caribbean

240 000

[220 000 – 260 000]

South & South-East Asia

3.8 million

[3.4 – 4.3 million]

Sub-Saharan Africa

22.4 million

[20.8 – 24.1 million]

Latin America

2.0 million

[1.8 – 2.2 million]

Oceania

59 000

[51 000 – 68 000]

Total: 33.4 million (31.1 – 35.8 million)


Over 7400 new HIV infections a day in 2008 Dr. A. K.Gupta

  • More than 97% are in low- and middle-income countries

  • About 1200 are in children under 15 years of age

  • About 6200 are in adults aged 15 years and older,

  • of whom:

    • almost 48%are among women

    • about 40% are among young people (15–24)


Indian scenario
Indian Scenario Dr. A. K.Gupta

First case: 1986, Estimates 2007: 2.31 million PLHAs,

86.5% -15-49 years age group (27.9 % in 15-29 and 58.6% in 30-49 age groups)

Epidemic concentrated in H.R.Gs; Spreading From : H.R.Gs to the general population & Urban to Rural areas

Feminization (39.3% - women) of epidemic

7,50,500 HIV +VE Regd. In HIV Care At ART Centers

3,50,000 Initiated on ART

2,60,000 alive and on treatment


1998 Dr. A. K.Gupta

2001

2002

1986

1990

1994

HIV Prevalence reaches over 5% amongst high risk group in Maharashtra and Manipur

First case of HIV detected in Chennai

> 1 % antenatal women

> 5 % high risk groups

< 5 % high risk groups


TIME LINE –INDIAN ACTIVITIES Dr. A. K.Gupta

  • 1990-1992-AIDS Task Force (ICMR), National AIDS

  • Committee , Medium Term Plan (1990-1992)

  • 1992- NACP I

  • 1997-VCTC SERVICES

  • 1999-NACP PHASE II

  • 2002- NATIONAL PMTCT PROGRAMME

  • 2004- NATIONAL ART PROGRAMME

  • 2004- COMPREHENSIVE PPTCTC PROGRAMME

  • 2006- REVISED WHO ART GUIDELINES

  • 2007-NACP III LAUNCHED


Characteristics of indian epidemic
Characteristics of Indian Epidemic Dr. A. K.Gupta

  • Heterogeneous epidemic

  • A wide variation in HIV prevalence between districts and intra districts even within the states

  • A concentrated epidemic, focused in HRGs (CSWs,MSMs,IDUs)

  • < 1% Prevalence

HIV & Nephrology 23-08-07


DELHI SCENARIO Dr. A. K.Gupta

  • Total population - 16 million, First case-

  • 1988

  • Estimated PLHAs (2007)- 32,000

  • Low prevalence state (Prevalence in Gen.

  • population- 0.22%)

  • Highly vulnerable state- (Migrant labour-

  • 0.88 million, Truckers stationed/day-35000)

  • Total high risk population ->1.00 Lakh

  • (FSW-61261, MSM- 28999, IDU- 17173)

  • PLHAs detected at ICTCs/VCTCs since 2002- 34,759

  • HIV +VE Regd. In HIV Care At ART Centers : 33,473

  • No. Currently Alive & on ART-9624

  • LFU (7%), DIED (8%) OR TRANSERRED OUT TO ART CENTRES (21%) OF

  • OTHER STATES.


DELHI STATE AIDS CONTROL SOCIETY- Dr. A. K.Gupta1ST NOVEMBER, 1998 HAVING A STAFF OF 56 PROGRAMME OFFICERS & SUPPORT STAFF & HEADED BY PROJECT DIRECTOR.

SERVICE OUTLETS – 93 ICTC CENTRES, 17 STI/RTI CLINICS, 9 ART CENTRES, 4 CCCs, 57DICs, 85 T.I PROJECTS FOR HRGs RUN BY NGOs, 21 BLOOD BANKS & 10 BSC, QA -4 SRLs.

FUNDED BY NACO, GOI

SOCIETY & ECCHAIRED BY CHIEF SECY, GNCT OF DELHI

DELHI STATE AIDS COUNCIL CHAIRED BY HON’BLE C.M. OF DELHI

GENERAL BODY – PRESIDENT HON’BLE HM




HIV & Nephrology 23-08-07


Dynamics of hiv transmission
Dynamics of HIV Transmission Dr. A. K.Gupta

High Risk Population

GENERAL POPULATION

GENERAL POPULATION

0.22%

0.22%

(2.6 -11%)

Bridging Population

Clients, Truckers, migrant population etc.



PERINATAL Dr. A. K.Gupta

OTHERS

I.D.Us

BLOOD TRANSFUSION

SEXUAL


Risk of transmission
RISK OF TRANSMISSION Dr. A. K.Gupta

  • TRANSFUSION OF INFECTED BLOOD / BLOOD PRODUCTS-> 90%

  • PERINATAL TRANSMISSION- 25-30%

  • SEXUAL ROUTE-(ORAL- 0.01%, VAGINAL -0.1%, ANAL-0.5%)

  • PERCUTANEOUS NEEDLE STICK- 3: 1000 (0.3%)


1. Dr. A. K.GuptaPrevention

Of New Infection

2. Care,

Support &

Treatment

3. Institutional

Strengthening

Capacity

building

4. Strategic

Management

Information

system

  • Targeted intervention-85

  • STI Diagnosis & treatment-17

  • Condom promotion

  • Blood Safety-53

  • ICTC-93

  • IEC and social mobilisation

  • AEP- launched

  • PEP- all govt hospitals

  • Mainstreaming-7 departments

  • COE for ART-LNH

  • Model Blood bank -DDUH

  • Regional STD Lab-MAMC

  • TSU for DSACS & Parivar Sewa for PPP STI clinics

  • Training

  • EQAS-4 SRLs

  • Operational Research

  • ART Centres-9

  • CCCs-4

  • DICs-7

  • Holistic Approach-

  • Widow pension & jobs for PLHAs

  • Programme management (CMIS & CPFMS)

  • Surveillance-20 sites

  • M & E

  • Computerization of ICTCs & STI clinics

  • Common National reporting format


Prevelance of hiv positivity
PREVELANCE OF HIV POSITIVITY Dr. A. K.Gupta

  • GENERAL POPULATION- INDIA : 0.36%, DELHI-0.22% ( SENTINEL SURVEILLANCE ANC DATA 2007)

  • HIGH RISK GROUPS- 2.64% to 11.73%

  • STI ATTENDACE: 4.38%

  • VULNERABLE POPULATION ATTENDING ICTC: 3.5%

  • TB PATIENTS HIV POSITIVE: 5%

  • TRUCKERS - 2.5% (TCI)


Natural history of hiv infection
Natural History of HIV Infection Dr. A. K.Gupta

Initial Infection (lasting 4–8 weeks),

Acute HIV Syndrome (lasting 1 week–3 months),

HIV-Specific Immune Response (1–2 weeks),

Clinical Latency (10 years, median),

AIDS-Defining Illnesses (2 years on average),and

Death


Natural history of hiv 1 infection prior to treatment
Natural History of HIV-1 Infection Dr. A. K.GuptaPrior to treatment

Seroconversion

Death

Initial Infection

Asymptomatic

Symptomatic

AIDS

1000

CD4+

Cells/L

500

ARS

0

Up to 12 years

4-8 wks

2-3 years

W.P.


10 Dr. A. K.Gupta%

60%

30%


Characteristic viral load cd4 cd8 changes over time in cases with hiv infection
Characteristic Viral Load ,CD4 & CD8 Changes Over Time In Cases with HIV Infection

CD8 COUNT

P24 Ag

CD4 COUNT

VIRAL LOAD


CD 4 COUNT & OPPORTUNISTIC INFECTIONS Cases with HIV Infection

500

200

50


The changing natural history of hiv aids in the haart era
The Changing Natural History Of HIV/AIDS In The 'HAART' Era Cases with HIV Infection

Dramatic reductions in the incidence of

1. Opportunistic Infections

2. HIV-related Malignancies

3. Kaposi's Sarcoma

4. Deaths in advanced AIDS cases



Who clinical staging hiv infection
WHO Clinical Staging HIV Infection Cases with HIV Infection

Clinical Stage I:

  • Asymptomatic

  • Persistent Generalized lymphadenopathy (PGL)


Who clinical stage ii
WHO CLINICAL STAGE II Cases with HIV Infection

  • Moderate unexplained weight loss (< 10% of body weight).

  • Recurrent bacterial upper respiratory tract infections (current event plus one or more in last six-month period).

  • Herpes zoster

  • Angular cheilitis

  • Recurrent oral ulcerations (two or more episodes in last six mths.

  • Papularpruritic eruption

  • Seborrhoeic dermatitis

  • Fungal nail infections.


Who clinical stage iii
WHO CLINICAL STAGE III Cases with HIV Infection

  • Unexplained severe weight loss (> than 10% of body wt)

  • Unexplained chronic diarrhoea for longer than one month.

  • Unexplained persistent fever > one month

  • Oral candidiasis

  • Oral hairy leukoplakia.

  • Pulmonary tuberculosis (current).

  • Severe bacterial infection for example, pneumonia, meningitis, empyema, pyomyositis, bone or joint infection, bacteraemia or severe pelvic inflammatory disease.

  • Acute necrotizing ulcerative gingivitis or necrotizing

    ulcerative periodontitis.

  • Unexplained anaemia, neutropenia or chronic (more than one month) thrombocytopenia


Who clinical stage iv
WHO CLINICAL STAGE IV Cases with HIV Infection

  • HIV wasting syndromei

  • Pneumocystiscarinii pneumonia

  • Recurrent bacterial pneumonia.

  • Chronic herpes simplex virus (HSV) infection (orolabial, genital or anorectal) of more than one month, or visceral of any duration.

  • Oesophageal candidiasis.

  • Extra Pulmonary tuberculosis

  • Kaposi’s sarcoma.

  • Cytomegalovirus disease (other than liver, spleen or lymph node).

  • Central nervous system toxoplasmosis.

  • HIV encephalopathy.

  • Extrapulmonarycryptococcosis (including meningitis)

  • Disseminated nontuberculousmycobacteria infection.

  • Progressive multi focal leukoencephalopathy (PML).

  • Cryptosporidiosis (with diarrhoea lasting more than one month).

  • Disseminated mycosis (coccidiomycosis, histoplasmosis, penicilliosis)

  • Cerebral or non hodgkins Lymphoma, invasive cervical Carcinoma,

  • Recurrent non salmonella typhoid

  • HIV cardiomyopathy, nephropathy


Socio economic profiling of plhas
SOCIO-ECONOMIC PROFILING OF PLHAs Cases with HIV Infection

A STUDY WAS UNDERATKEN IN COLLABORATION WITH ILO AT TWO ART CENTRTERS (RML & LNH)

SALIENT FEATURES:

SAMPLE SIZE: 1171 PLHAs (816 MALES, 333 FEMALES & 22 TS/TG

LNH: 584 PLHAs, RML:587 PLHAs

90.9% PLHAs BELONG TO 16-45 YRS AGE GROUP

SEX COMPOSITION: MALES 70%, FEMALES-28%, TS/TG-2%

MARITAL STATUS: MARRIED-72%, WIDOW-12%, SINGLE-16%

STATUS OF RESIDENCE: 62% FROM DELHI,

38% ARE MIGRANTS (UP,HARYANA)

EDUCATIONAL STATUS: MAJORITY (61%)- LOW EDUCATION STATUS: 25%-ILLITERATE, 36% PRIMARY SCHOOL. ONLY 29%-SEC SCHOOL & 10% COLLLEGE GRADIATE

EMPLOYMENT STATUS: > 51% -UNEMPLOYED(90% WOMEN, 50% TS/TG & 35% MEN); 12% DAILY WAGE, 37% REGULAR EMPLOYMENT

OCCUPATIONAL BREAKUP OF EMPLOYED : SELF EMPLOYED/BUISENSS-34%, PVT SECTOR-35%, GOVT -8%, LABOUR-14%, FARMER-5%, HAWKERS-4%

MONTHLY HOUSLEHOLD INCOME: 46.9% < RS. 2000/PM; 79.2% < RS. 4000/PM;18.2% BETWEEN 4000-10,000/PM; 2.6% . > RS. 10,000/PM


THANK YOU Cases with HIV Infection


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