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National AIDS Control Programme – An Overview

National AIDS Control Programme – An Overview. National AIDS Control Programme. Session Objectives. By the end of the session the participant will understand: Epidemiology of HIV in the world and in India National AIDS Control Programme (NACP) and the National response to HIV in India

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National AIDS Control Programme – An Overview

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  1. National AIDS Control Programme – An Overview National AIDS Control Programme

  2. Session Objectives By the end of the session the participant will understand: • Epidemiology of HIV in the world and in India • National AIDS Control Programme (NACP) and the National response to HIV in India • Details on NACP phase III • Goal, Objectives & Key Components • Care, Support and Treatment services • Linkages between different services 2

  3. Global estimates for Adults and Children 2011 3

  4. Adults and children estimated to be living with HIV, 2011 Eastern Europe & Central Asia 1.5 million [1.3 million – 1.8 million] Western & Central Europe 860 000 [780 000 – 960 000] North America 1.4 million [1.1 million –2 million] East Asia 830 000 [590 000 – 1.2 million] Middle East & North Africa 330 000 [250 000 – 450 000] Caribbean 230 000 [200 000 – 250 000] South & South-East Asia 4.2 million [3.1 million – 4.7 million] Sub-Saharan Africa 23.5 million [22.2 million – 24.7 million] Latin America 1.4 million [1.1 million – 1.7 million] Oceania 53 000 [43 000 – 60 000] Total: 34.2 million (31.8 million – 35.9 million) 4 National AIDS Control Programme

  5. Declining Trend of HIV Epidemic in India Female: 38.7% of PLHIV; Children: 4.4% of PLHIV 5 Source: HIV Estimations, 2008-09 National AIDS Control Programme

  6. Estimated Annual New infectionsTrend in India 6 Source: HIV Estimations, 2008-09

  7. Decline in Estimated Annual DeathsTrend in India 7 Source: HIV Estimations, 2008-09

  8. Disease Burden of HIV in India Provisional estimates place the number of people living with HIV in India in 2009 at 23.95 lakhs with an estimated adult HIV prevalence of 0.31 percent Available evidence on HIV epidemic in India shows a declining trend at national level The epidemic is concentrated among high risk group populations and is heterogenous in its spread Heterosexual route of transmission accounts for 87% of HIV cases detected 8 Source: HIV Estimations, 2008-09

  9. District-wise Scenario of HIV/AIDS 9

  10. Routes of Transmission of HIV NACO Annual Report 2009-2010 10

  11. HIV among various population groups in India, 2008-09 Source: HIV Estimations, 2008-09 11

  12. National Response 12

  13. National AIDS Control Programme Phase III (2007-2012) Goal : Halt and reverse the epidemic in India over the next five years Objectives: • Prevention of new infections (Saturation of HRG coverage and scale up of interventions for General population) • Increased proportion of PLHIV receiving care, support and treatment • Strengthening capacities at district, state and national levels • Building Strategic information management systems 13

  14. NACP Phase III: Strategies in detail Prevention Care, Support and Treatment High risk populations Low risk populations People living with HIV/AIDS • Targeted Interventions for High Risk Groups (FSW, MSM, IDU, Truckers & Migrants) • Link Worker Scheme for rural population • Prevention & Control of Sexually Transmitted Infections • IEC, Social Mobilisation & Mainstreaming • Condom promotion • Blood safety • Counselling & Testing Services (ICTC, PPTCT, HIV/TB) • First line & second line ART • Community Care Centres • HIV-TB Coordination • Treatment of Opportunistic Infections 14

  15. Targeted Interventions (TI) • Implemented by NGOs and focuses on saturating the High Risk Groups (FSW, IDUs & MSM) and bridge population (migrants and truckers) • Services offered under TI include: • Condom promotion • Management of Sexually transmitted infections • Needle Exchange Programme / oral substitution therapy (for injecting drug users) • Creating an enabling Environment • Behaviour Change Communication (BCC) • Referral services for counselling and HIV testing and treatment 15

  16. Revised Migrant HIV Strategy • Ten times higher prevalence rates in migrants than General Population; Highest prevalence after the HRG – 3.6 % • Low prevalence districts with high migration to and from high prevalent destinations are rapidly increasing HIV epidemic • Example: from high to low (Ganjam to Surat) • 230 destination site interventions among migrants in 21 States cover 117 districts with high in-migration across country, covering 19.11 lakh high risk migrants • 122 districts identified with high out-migration – source districts across 11 States 16

  17. Link Workers Scheme • Reaches out to HRGs and vulnerable men & women in rural areas • Range of vulnerable population has expanded to widows, out of school youth, people who have multiple sexual partners and spouses / partners of HRGs • NACP–NRHM Convergence covers pregnant women • Information provided on risk reduction, knowledge, skills & services on STIs / HIV prevention • Addresses the potential, outgoing and returnee migrants • Implemented in 127 districts in partnership with partner agencies • GFATM (60 districts), UNICEF (26), UNDP (25) & USAID (16) 17

  18. Sexually Transmitted Infections (STI Clinics) • Provision of STI / RTI case services is an important strategy to prevent HIV transmission and promote sexual and reproductive health under NACP-III and RCH-II. These include: • Training of preferred private practitioners for syndromic management • Diagnosis and treatment of sexually transmitted infections through syndromic cases management by providing colour coded packs • Linkages with HRGs • Referral services from STI clinics to Integrated Counselling and Testing Centres 18

  19. Information Education and Communication (IEC) • IEC campaigns for behaviour change, demand generation linked to services • Theme-wise campaign to promote HIV counselling & testing, ART, treatment for STIs, condoms, voluntary blood donation & address stigma and discrimination • Multimedia approach (use of mass media, mid-media, out door and inter-personal communication) • Special episodes on HIV on Doordarshan • IEC toolkits prepared for High Risk Groups, Integrated Counselling & Testing Centres, ART & STI centres 19

  20. Condom Promotion Free Condoms - Procured by MoHFW • Distributed by NACO through TI NGOs/ICTC/ART centre for HIV/AIDS Prevention • Distributed by MoHFW through PHC, CHC, health workers for Family Planning Socially Marketed Condoms - 8 SMOs • Distributed by Social Marketing Organisations, provided by MoHFW on subsidised rates Commercial Condoms • Distributed by Commercial Organisations like JK Ansell, Men pharma, TTK LIG, etc. 20

  21. Blood Safety • Adequate supply of safe and quality blood • Screening of donated blood for HIV, syphilis, hepatitis B & C and malaria before transfusion • Promoting voluntary blood donations: • Target: 80%; Achievement in 2010: 77.8% • Blood Components Separation Units (BCSU): • Facilities made functional in 60 Blood Banks (Target: 80) • 41.1% whole blood converted into components in BCSU by December 2010 (Target: 80%) • Increasing access to blood in rural areas through blood storage units 21

  22. Blood Safety: New initiatives • Setting up of Metro Blood Banks as Centre of Excellence in Transfusion Medicine • 4 Metro Blood Banks as Centres of Excellence, in New Delhi, Mumbai, Kolkata & Chennai (budget of Rs. 468 crores) • Blood Banks will have State of the Art facilities with 100% Voluntary Blood Donation • 100% blood components preparation and capacity to process more than 100,000 units of blood annually • Plasma Fractionation Centre (PFC) • To set up PFC with a processing capacity of more than 150,000 litres of plasma in Chennai with budget of Rs. 250 crores over 5 years 22

  23. STI and TB Clients, Pregnant Women, Key Populations, and General Populations Referred STI Services TB Services Targeted Interventions Prevention Services Antenatal Care Walk-in Clients Integrated Counselling and Testing Centres (ICTC): HIV Counselling and Testing PLHIV linked to care, support and treatment services through referrals to Onsite Services: PPTCT, TB/HIV, Basic OI Management, TB and STI Care, Reproductive and Child Health, Routine and Emergency Medical Care ART Centres CD4 testing, Care, support & treatment Referral to home and community based care Linkages of ICTC: Gateway to HIV Care

  24. Integrated Counselling & Testing Centres Single window service for: • Pre-test counselling before HIV testing • HIV testing and providing results of the test • Post-test counselling to both positive and negative persons • Condom promotion and distribution • Identification for HIV+ pregnant women • Providing prophylaxis (Nevirapine tablet and syrup and mother and new born) for prevention of transmission from mother to child • Prophylactic (Co-trimoxozole) to exposed children • Education regarding infant feeding • Referral to ART Centre for investigation and treatment • Cross referral between RNTCP and ICTCs 24

  25. District Hospitals HIV Clinics Social/legal Support Hospice -Health posts -Dispensaries -Traditional -Orphan care Specialists and Specialised Care facilities Continuum of Care for PLHIV Primary Health Care Secondary Health Care Voluntary Counselling Testing NGOs Youth Groups Volunteers Peer support ICTC is the entry point Community Care Palliative emotional & spiritual support self care Tertiary Health Care Home care PLHIV 25

  26. Care Support & Treatment • Comprehensive HIV Care: • The overall goal is to improve the survival and quality of life of PLHIV with Comprehensive HIV care package of services including condoms and prevention education • ART Policy Package: • Free Universal Access to ART • Free Diagnostic services • Standardised combination ARV therapy • Regular and secure supply of ARV drugs • Robust Monitoring & Evaluation system 26

  27. Care Support & Treatment Programme Three tier Structure Public Health Infrastructure Model of HIV Treatment Service Selected Medical colleges Medical college and District Level Hospital Sub-District level hospitals & CHC 27

  28. CST Services: Referrals & Linkages RNTCP Care & Support ( CCC & DLN) 28 National AIDS Control Programme

  29. Centres of Excellence • Capacity building of good quality, skilled and knowledgeable healthcare providers in chronic patient management, including treatment failures • Training HIV Care personnel (Training centre) • Operational Research and scientific publications • Fellowship Programmes for doctors • Mentoring ART centres in the region / state • Distance Education / consultation: Telemedicine • Repository of information related to HIV/AIDS 29 National AIDS Control Programme

  30. ART Plus Centres: Rationale • Patients experiencing treatment failure with First Line ART are referred to the Centres of Excellence for further evaluation and Second Line treatment. • Many patients are reportedly facing problems due to long distance, travel, time and costs. • Based on the existing number of patients on Second Line ART & distance from CoE, it has been decided to expand the network of ART centres that would be capacitated to start Second Line treatment following the same referral procedure as adopted for the Centres of Excellence. 30 National AIDS Control Programme

  31. Link ART Centre: Objectives Integrate ART services with the Primary / Secondary Health Care system Build capacity of the health care staff at the Primary Health Care Level in ART treatment Increase access to ART services Improvement in the adherence of patients to ART Improve quality of services at ART Centres by decongestion and decentralisation Reduce the travel cost and travel time of PLHIV to access services 31 National AIDS Control Programme

  32. LAC Plus Scheme • LAC Plus scheme is being implemented in the existing LACs, as and when the patient load (PLHIV on ART) crosses 70 • Manpower: • Currently, the LACs are utilising the existing human resources of the ICTC and the institution • However, for LAC Plus, a contractual nurse is being recruited to handle the additional functions and work load 32 National AIDS Control Programme

  33. Functions of LAC & LAC Plus 33 National AIDS Control Programme

  34. Community Care Centres A Community Care Centre is a community based facility for Accessible, Affordable and Sustainable counselling, support and treatment of PLHIV • Psycho-social support to PLHIV • Drug Adherence and nutritional counselling • Support to new patients on ART • Follow-up of PLHIV including tracing missed cases and those lost to follow-up • Home-based care and services • Treatment of minor OIs (Out-patient / Inpatient Care) • Palliative treatment to terminal cases 34 National AIDS Control Programme

  35. Care Support & Treatment Programme • National ART programme was started on April 1, 2004 at 8 institutions in India • Target under NACP-III: • 250 ART Centres • ART Target NACP-III: • 3 lakh adult PLHIV • 40,000 children (CLHIV) 35

  36. Scale up of CST Facilities 36 National AIDS Control Programme

  37. ICTC–ART Linkages 17,70,750 15,48,557 13,09,906 83% 10,10,393 72.5% 68.2% 60.5% 50.4 % 37

  38. ART Scale up in India 38

  39. ART Scale up in India 60% of Ever started on ART 56% of Registered In HIV Care January 2012 data 39

  40. Issues and Challenges • Low referrals from ICTC to ART centres • Early Infant Diagnosis • Enrollment of children under ART care • Pre-ART care and Follow up • Timely and Early initiation of ART • Ensuring optimal (>95%) adherence to ART • Tracking patients Lost to follow up (LFU) • Second line ART initiation • Linkages with RNTCP and other local networks • Irrational ART Prescriptions outside National Programme 40

  41. Key Points • The estimated number of people living with HIV in India in 2009 is placed at 23.95 lakhs • NACP phase III aims to halt and reverse the epidemic in India, to scale up care and support services and to strengthen capacity at all levels • ICTC is the entry point for providing comprehensive care and support to the HIV-infected persons • ART services are being expanded to provide treatment nearer to patients' homes • Process of decentralisation and appropriate referral and linkage services ensure PLHIV of comprehensive care in the existing health delivery system 41

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