AIDS

1. AIDS CONTROL
PROGRAMME
IN INDIA
DR.MAHESWARI JAIKUMAR
maheswarijaikumar2103@gmail.com

3. 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).

4. HUMAN IMMUNO VIRUS

5. STRUCTURE OF HIV VIRUS

6. SYMPTAMATOLOGY

7. A PERSON WITH AIDS
(Appearance of body)

8. • 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.

9. • 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.

10. 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

11. PROBLEM STATEMENT
(WORLD)
INDICATOR 2007 2008 2009 2010 2011
PEOPLE DYING FROM
AIDS (in millions)
2.1 2.0 1.9 1.8 1.7
% OF PREGNANT
WOMEN TESTED FOR
HIV (Middle Income
Countries) (in
millions)
15% 21% 26% 35% -

12. Dr. KANUPRIYA CHATURVEDI
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)
0.40%
HIV prevalence among women (15-49
years)
0.27%
Number of people living with HIV (adults
and children)
2.31 million
Number of Children living with HIV (>15
years)
3.8% of total

13. 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%).

14. Dr. KANUPRIYA CHATURVEDI
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%).

15. 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%).

16. 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.

17. MILE STONES OF NACP
• 1986 – First Case detected &
National Aids Committee
Established.
• 1990 – Medium Term Plan launched
for four states & four metros.

18. • 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.

19. NACOVISION 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.

20. 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

21. • 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

22. • 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

23. • 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

24. NACP
The aim of the programme is to
prevent further transmission of
HIV infection & to minimize the
socio economic impact resulting
from HIV infection.

25. 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

26. • 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.

27. • Control of sexually transmitted
diseases.
• Condom programme.

28. 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

29. 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.

30. • 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.

31. 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).

32. • The package of services in these
interventions includes Behaviour
Change Communication,
management of STDs and condom
promotion.

33. 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.

34. 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.

35. • 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.

36. • Strengthening a nation wide
Strategic Information
Management System.

37. 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.

38. • 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.

39. • 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.

40. • 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.

41. PROGRAMME COMPONENTS
OF NACP III
PREVENTION CARE,
SUPPORT &
TREATMENT
CAPACITY
BUILDING
STRATEGIC
INFORMATION
MANAGEMEN
T
Targeted
interventions
among HRG,
CSW.
ART Establishment,
support &
capacity
strengthening
Monitoring &
Evaluation
Other
interventions
(Truckers,
Prison
inmates)
Pediatric ART Training Surveillance

42. PREVENTION CARE,
SUPPORT &
TREATMENT
CAPACITY
BUILDING
STRATEGIC
INFORMATION
MANAGEMENT
Integrated
Counseling
& testing
Centers
Center of
Excellence
Managing
programme
implementa
tion &
contracts
Research
Blood
Safety
Care &
Support (
Community
care centers
& impact
mitigation)
Mainstreami
ng / private
sector
partnerships

43. PREVENTION CARE,
SUPPORT &
TREATMENT
CAPACITY
BUILDING
STRATEGIC
INFORMATION
MANAGEMENT
Communicati-
on, Advocacy
& social
mobilization
Nil Nil Nil

44. NATIONAL AIDS
PREVENTION &
CONTROL POLICY

45. IS ACHIEVED THROUGH
PREVENTION OF
NEW
INFECTIONS

46. 1.Saturation of coverage of
high risk group through
targeted interventions.

47. 2.Scaling up interventions
among general population

48. 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.

49. SCALING UP INTERVENTIONS
AMONG GENERAL
POPULATION
• STD control program
• Voluntary counseling and testing
• PPTCT program.

50. • Blood safety.
• Improved access to quality
condoms.
• Universal precautions and Post
exposure prophylaxis

51. • 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.

52. 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

53. • 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..

54. OTHER STRATEGIES

55. 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.

56. • 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:

57. 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.

58. • 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

59. 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%

60. 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.

61. 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.

62. 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

63. 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

64. 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

65. 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).

66. • 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

67. 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.

68. 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.

69. 5. Increase the number of commercial
condoms sold.
6. Increase the number of non-
traditional outlets for socially
marketed condoms, e.g., paan shops,
lodges, etc. in strategically located
hotspots of solicitation

70. CARE, SUPPORT & TREATMENT
• Integration of prevention with care,
support .
• Community care and support
programs.

71. COMMUNITY SUPPORT PROG

72. • 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.

74. COMMON ANTIVIRALS
DRUG DOSE
ABACAVIR 300 mg /twice daily
DIDANOSINE 600 mg /once daily
ZIDOVUDINE 250-300 mg /twice
daily

75. COMMON ANTIVIRALS
DRUG DOSE
STAVUDINE 30 mg /twice daily
NEVIRAPINE 200 mg/once daily
for 14 days followed
by 200 mg/twice
daily

76. COMMON ANTIVIRALS
DRUG DOSE
TENOFOVIR 300 mg /once daily
ETRAVIRINE 200 mg / twice daily
LAMIVUDINE 300 mg/once daily

77. 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.

78. 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

79. 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).

80. • 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).

81. • 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

82. • 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.

83. • 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. & inter-
sectoral health facilities.

84. • 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.