Published on March 6, 2014
AIDS CONTROL PROGRAMME IN INDIA DR.MAHESWARI JAIKUMAR
AIDS • AIDS (Acquired Immuno-deficiency Syndrome) is also called as “SLIM DISEASE”. • It is a fatal disease caused by a retro virus called as the HUMAN IMMUNO DEFICIENCY VIRUS (HIV).
HUMAN IMMUNO VIRUS
STRUCTURE OF HIV VIRUS
A PERSON WITH AIDS (Appearance of body)
• A person suffering from this disease is vulnerable to life threatening opportunistic infections due to breakdown of his immune system. • Once infected by HIV infection a person remains infected for the remaining life time.
• Strictly the term AIDS refers to the last stage of the HIV infection. • AIDS can be called as a modern pandemic affecting both industrialized and developing countries.
PROBLEM STATEMENT (WORLD) INDICATOR 2007 2008 2009 2010 2011 NUMBER OF PEOPLE LIVING WITH HIV (in millions) 31.8 32.3 32.9 34 34.2 NEWLY INFECTED (in millions) 2.7 2.7 2.7 2.7 2.5
PROBLEM STATEMENT (WORLD) INDICATOR 2007 2008 2009 2010 2011 PEOPLE DYING FROM 2.1 AIDS (in millions) 2.0 1.9 1.8 1.7 % OF PREGNANT 15% WOMEN TESTED FOR HIV (Middle Income Countries) (in millions) 21% 26% 35% -
HIV ESTIMATES FOR INDIA (2007) Category Estimation Total population 1.027 billion HIV prevalence (15-49 years) 0.34% HIV prevalence among men (15-49 years) HIV prevalence among women (15-49 years) Number of people living with HIV (adults and children) Number of Children living with HIV (>15 years) Dr. KANUPRIYA CHATURVEDI 0.40% 0.27% 2.31 million 3.8% of total
The overall HIV prevalence among different population groups in 2007 continues to portray the concentrated epidemic in India. With a very high prevalence among High Risk Groups - IDU (7.2%), MSM (7.4%), FSW (5.1%) & STD (3.6%) and low prevalence among ANC clinic attendees (Age adjusted - 0.48%).
CURRENT SCENARIO • HIV situation in the country is assessed and monitored through regular annual sentinel surveillance established since 1992. • There are 1.8 - 2.9 million (2.31 million) people living with HIV/AIDS at the end of 2007. The estimated adult prevalence in the country is 0.34% (0.25% - 0.43%) and it is greater among males (0.44%) than among females (0.23%). Dr. KANUPRIYA CHATURVEDI
The overall HIV prevalence among different population groups in 2007 continues to portray the concentrated epidemic in India, with a very High prevalence among High Risk Groups - IDU (7.2%), MSM (7.4%), FSW (5.1%) & STD (3.6%) and low prevalence among ANC clinic attendees (Age adjusted 0.48%).
NATIONAL AIDS CONTROL PROGRAMME • The National AIDS Control Programme was launched in the year 1987. • The Ministry of Health & Family Welfare has set up National AIDS Control Organization (NACO) as a separate wing to implement & closely monitor the components of the programme.
MILE STONES OF NACP • 1986 – First Case detected & National Aids Committee Established. • 1990 – Medium Term Plan launched for four states & four metros.
• 1992 - NACP-I launched. • 1999 - NACP-II launched. • 2002 - National Aids Control Policy adopted. • 2004 - Anti retroviral treatment initiated. • 2006 - National Council on AIDS constituted. • 2007 – NACP III launched.
NACO VISION AND VALUES NACO envisions an India where every person living with HIV has access to quality care and is treated with dignity. Effective prevention, care and support for HIV/AIDS is possible in an environment where human rights are respected and where those infected or affected by HIV/AIDS live a life without stigma and discrimination.
NACO envisions: • Building an integrated response by reaching out to diverse populations • A National AIDS Control Programme that is firmly rooted in evidence-based planning. • Achievement of development objective • Regular dissemination of transparent estimates on the spread and prevalence of HIV/AIDS
• Building an India where every person is safe from HIV/AIDS • Building partnerships • An India where every person has accurate knowledge about HIV and contributes towards eradicating stigma and discrimination
• An India where every pregnant woman living with HIV has the choice to bring an HIV free baby into the world • An India where every person has access to Integrated Counselling & Testing Centers (ICTCs) • An India where every person living with HIV is treated with dignity and has access to quality care
• An India where every person will eventually live a healthy and safe life, supported by technological advances • An India where every person who is highly vulnerable to HIV is heard and reached out to
NACP The aim of the programme is to prevent further transmission of HIV infection & to minimize the socio economic impact resulting from HIV infection.
THE NATIONAL STRATEGY To achieve the programme objectives the following components are enlisted. • Establishment of Surveillance centers in the country. • Identification of high risk groups & their screening. • Issuing specific guidelines for the management of detected cases
• Formulation of guidelines for blood bank, blood product manufacturers, blood donors & dialysis units. • IEC activities involving mass media. • Research for reduction of personal & social impact of the disease.
• Control of sexually transmitted diseases. • Condom programme.
INITIATIVES OF GOVT OF INDIA • The Govt of India has initiated programmes of prevention & raising awareness under the Medium Term Plan . (1990 -92) NACP-I (1992-2000) NACP -II (2007-2012) NACP-III
NACP-I (1992-1999) The objective of was to control the spread of HIV infection. During this period a major expansion of infrastructure of blood banks was undertaken with the establishment of 685 blood banks and 40 blood component separation. Infrastructure for treatment of sexually transmitted diseases in district hospitals and medical colleges was created with the establishment of 504 STD clinics.
• HIV sentinel surveillance system was also initiated. NGOs were involved in the prevention interventions with the focus on awareness generation. • The programme led to capacity development at the state level with the creation of State AIDS Cells in the Directorate of Health Services in states and union territories.
NACP-II (1999-2006) • During a number of new initiatives were undertaken and the programme expanded in new areas. Targeted Interventions were started through NGOs, with a focus on High Risk Groups (HRGs) viz. • commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs), and bridge populations (truckers and migrants).
• The package of services in these interventions includes Behaviour Change Communication, management of STDs and condom promotion.
The School AIDS Education Programme was conceptualized to build up life skills of adolescents and address issues relating to growing up. All channels of communication were engaged to spread awareness about HIV/AIDS, promote safe behaviors and increase condom usage.
GOALS OF NACP-III • The primary goal of NACP III is to halt & reverse the epidemic in India over the next 5 years by : • 1.Prevention of new infection in high risk groups & general population through saturation of coverage of high risk group with targeted interventions & scaled up interventions in general population.
• Providing greater care, support & treatment to a large number of people with HIV infection. • Strengthening the infrastructure, system & human resources in prevention, care, support & treatment programmes at dist, state & national levels.
• Strengthening a nation wide Strategic Information Management System.
PROGRAMME PRIORITIES • General population who have greater need for accessing prevention services, treatment, voluntary counseling & testing & condom will be in the next line of priority.
• Ensure that all persons who need treatment would have access to prophylaxis & management of opportunistic infections & persons needing anti retro viral treatment (ART) will get first line of ARV drugs.
• Provision of services for prevention of parent to child transmission of disease & assured access to pediatric ARV for children having HIV. • Impact if HIV will be mitigated through welfare agencies providing nutritional support, opportunities for income generation.
• NACP will invest in community care centers to provide psycho social support, outreach services, referrals & palliative care. • Socio economic determinants that make a person vulnerable also increases the risk of exposure to HIV, NACP will work with agencies such as women’s group & trade unions to integrate HIV prevention into their activities.
PROGRAMME COMPONENTS OF NACP III PREVENTION CARE, SUPPORT & TREATMENT CAPACITY BUILDING STRATEGIC INFORMATION MANAGEMEN T Targeted ART interventions among HRG, CSW. Establishment, Monitoring & support & Evaluation capacity strengthening Other Pediatric ART interventions (Truckers, Prison inmates) Training Surveillance
PREVENTION CARE, SUPPORT & TREATMENT CAPACITY BUILDING STRATEGIC INFORMATION MANAGEMENT Integrated Counseling & testing Centers Center of Excellence Managing Research programme implementa tion & contracts Blood Safety Care & Support ( Community care centers & impact mitigation) Mainstreami ng / private sector partnerships
PREVENTION Communication, Advocacy & social mobilization CARE, CAPACITY SUPPORT & BUILDING TREATMENT Nil Nil STRATEGIC INFORMATION MANAGEMENT Nil
NATIONAL AIDS PREVENTION & CONTROL POLICY
PREVENTION OF NEW INFECTIONS IS ACHIEVED THROUGH
1.Saturation of coverage of high risk group through targeted interventions.
2.Scaling up interventions among general population
SATURATION OF COVERAGE OF HIGH RISK GROUP THROUGH TARGETED INTERVENTIONS • Essential elements of targeted interventions are: Access to behavior change communication Treatment services( STI services, drug substitution for IDU Creation of enabling environment at project sites.
SCALING UP INTERVENTIONS AMONG GENERAL POPULATION • STD control program • Voluntary counseling and testing • PPTCT program.
• Blood safety. • Improved access to quality condoms. • Universal precautions and Post exposure prophylaxis
• Focused efforts on women, children and Young people. • Expanding HIV/AIDS response at workplace. • Focused efforts on migrants, mobile populations and in cross border areas.
STD CONTROL PROGRAM • An estimated five percent adult population affected by STDs, also has HIV infection.. Limited diagnostic facilities to : • manage complicated STDs and drug resistance to major STDs are the other issues of concern that NACP-III addresses
• Under NACP-III, a demand for STD services is generated through its awareness on one hand and on the other STD services are expanded ......... • Through its integration with the Reproductive and Child Health Programme..
VOLUNTARY COUNSELING AND TESTING • HIV counselling and testing services were started in India in 1997. There are now more than 4000 Counselling and Testing Centres, mainly located in government hospitals.
• Under NACP-III, Voluntary Counselling and Testing Centres (VCTC) and facilities providing Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) services are remodelled as a hub or ‘Integrated Counselling and Testing Centre’ (ICTC) to provide services to all clients under one roof. • An ICTC is a place where a person is counselled and tested for HIV, of his own free will or as advised by a medical provider. The main functions of an ICTC are:
PPTCT PROGRAM • The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme was started in the country in the year 2002 following a feasibility study in 11 major hospitals in the five high HIV prevalence states.
• Presently, there are more than 4000 Integrated Counselling and Testing Centres (ICTCs) in the country, most of these in government hospitals, which offer PPTCT services to pregnant women. • 502 are located in Obstetrics and Gynaecology Departments and in Maternity Homes where the client load is predominantly comprised of pregnant women
BLOOD SAFETY NACO is committed to bridge the gap in the availability and improve quality of blood under NACP-III. To achieve these objectives NACO plans to: 1. Raise voluntary blood donation to 90%
2. Establish blood storage centres in Community Health Centres. 3. Expand external quality assessment services for blood screening . 4. Quality management in blood transfusion services. 5. Sensitise clinicians on optimum use of blood, blood components and products.
6. Add 39 blood banks in districts that do not have blood transfusion facility. 7. Establish blood storage centres in 3222 community care centres . 8. Provide refrigerated vans in 500 districts for networking with blood storage centres.
9. Establish additional model blood banks in 22 states; 10 are functional already. 10. Set up additional Blood Component Separation Units (BCSU) in 80 tertiary care hospitals and separate at least 50 percent of the collection at all BCSUs (162) into components . 11. Promote autologous blood donation
12. Establish one additional plasma fractionation facility in the country. 13. Establish four Centres of Excellence in blood transfusion services in the four metros in order to cater to any region of the country in time of a crisis. 14. Introduce accreditation of blood banks
13. Liaise with Indian Red Cross Society and Ministry of Youth Affairs and Sports to promote voluntary blood donation among the youth. 14. Set up 32 model blood banks in various states . 15. Co-ordinate with the Indian Medical Council (IMC) to mandate the requirement of a department of transfusion medicine in all medical colleges & appropriate transfusion practices in the MD/MS Curriculum
POST EXPOSURE PROPHYLAXIS • Post exposure prophylaxis (PEP) refers to comprehensive medical management to minimise the risk of infection among Health Care Personnel (HCP) following potential exposure to blood-borne pathogens (STDs).
• Prophylactic measures include, counselling, risk assessment, relevant laboratory investigations based on informed consent of the source. • follow up and support of exposed person, first aid and depending on the risk assessment, the provision of short term (four weeks) of antiretroviral drugs
PROMOTION OF CONDOM • Under NACP-III condom promotion continues to be an important prevention strategy. The programme AIMS : 1. Increase condom use during sex with non-regular partner, which is the key to limiting HIV spread through sexual route.
2. Promote condoms distributed by social marketing programmes. 3. Increase the distribution of free condoms distributed through STI and STD clinics, reaching those who are at the highest risk of acquiring or transmitting HIV. 4.Increase access to condoms, especially to men who have sex with non-regular partners.
5. Increase the number of commercial condoms sold. 6. Increase the number of nontraditional outlets for socially marketed condoms, e.g., paan shops, lodges, etc. in strategically located hotspots of solicitation
CARE, SUPPORT & TREATMENT • Integration of prevention with care, support . • Community care and support programs.
COMMUNITY SUPPORT PROG
• Improved treatment access for opportunistic infections and continuation of care. • Special focus on children affected and infected by HIV. • Impact mitigation and linking it with livelihood support.
COMMON ANTIVIRALS DRUG DOSE ABACAVIR 300 mg /twice daily DIDANOSINE 600 mg /once daily ZIDOVUDINE 250-300 mg /twice daily
COMMON ANTIVIRALS DRUG DOSE STAVUDINE 30 mg /twice daily NEVIRAPINE 200 mg/once daily for 14 days followed by 200 mg/twice daily
COMMON ANTIVIRALS DRUG DOSE TENOFOVIR 300 mg /once daily ETRAVIRINE 200 mg / twice daily LAMIVUDINE 300 mg/once daily
STRENGTHEN THE INFRASTRUCTURE, SYSTEMS AND HUMAN RESOURCES 1. Capacity building. 2. Sustained technical training support to public and private agencies. 3. Convergence with RCH, TB and MoHFW. 4. Coordination and partnership with donors.
NATIONAL AIDS TELEPHONE HELPLINE • Toll free number has been set up to provide access to information & counselling on HIV/AIDS related issues. • This is a computerized four digit number : 1097
ACHIEVEMENTS UNDER NACP • Promotion of voluntary blood donation has enabled reducing transmission of HIV infection through contaminated blood from about 6.07% (1999), 4.61% (2003), 2.07% (2005), 1.96% (2006) to 1.87% (2007).
• The number of integrated counseling and testing centres increased from 982 in 2004, 1476 in 2005, 4027 in 2006, 4567 in 2007 and 4817 in 2008. • The number of persons tested in these centres has increased from 17.5 lakh in 2004 to 37.9 lakhs in 2008-09 (August, 2008).
• The number of STI clinics being supported by NACO has increased from 815 in 2005 to 895 in 2008. • The reported number of patients treated for STI in 2005 was 16.7 lakh, in 2006, 20.2 lakh and 25.9 lakh in 2007
• A total of 3.2 million pregnant women accessed PPTCT services at ICTCs across the country of which 18449 pregnant women were diagnosed to be HIV +ve. • Of these 11460 (62%) pregnant women and the infants born to them received prophylactic single dose Nevirapine.
• As of September 2008, 5,61,981 patients have been registered at ART centers and 1,77,808 clinically eligible patients are receiving free ART in Govt. & intersectoral health facilities.
• The Targeted Intervention (TI) projects aiming to interrupt HIV transmission is implemented among highly vulnerable populations. • They include - commercial sex workers, injecting drug users, homosexuals, truckers and migrant workers.
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