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24 Chapter 496AN2018-19 PDF
24 Chapter 496AN2018-19 PDF
CHAPTER
National AIDS Control
Organization (NACO)
24.1 INTRODUCTION B. Information, Education and
Communication (IEC): Awareness
NACO is the nodal organization for National AIDS
generation services were rolled out 25 years
response in the Ministry of Health and Family
ago with a focus on awareness generation
Welfare. National AIDS Control Programme is a
on the modes of transmission of HIV/
fully funded Central Sector Scheme implemented
AIDS and the services available for testing
through State/ UT AIDS Control Societies (SACS)
and treatment, and continues to be the
in States/Union Territories (UTs) and closely
monitored through District AIDS prevention and mainstay of NACP through vibrant multi-
control unit (DAPCU) in 188 high priority districts. media approach comprising Mass media,
Currently, National AIDS Control programme mid-media and on-ground mobilization &
(NACP)-IV (extension) is under implementation Inter Personal Communications across the
for the period 2017-20. country.
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CHAPTER-24
the annual number of AIDS related deaths has screening, treatment, care and support services to
declined by almost 71%. In 2017, an estimated various HRGs. People from high risk communities
69.11 (29.94 –140.84) thousand people died of are engaged to deliver services and act as catalysts
AIDS-related causes nationally. AIDS-related linking them for services and commodities.
deaths have dropped in all of India’s States/UT TI projects provide a package of prevention, support
with the exception of Assam, Bihar, Jharkhand, and linkage services to HRGs through drop-in-
Haryana, Delhi, and Uttarakhand. centre (DIC) and outreach-based service delivery
India is estimated to have had 22.67(10.92-40.60) model which includes screening for and treatment
thousand HIV positive women who gave birth in of STI, free condom and lubricant, among core
2017. State wise Prevention to Mother to child groups, Behaviour Change Communication (BCC),
transmission (PMTCT) number were highest in creating an enabling environment with community
Maharashtra (2.41 thousand) followed by Uttar involvement and participation, linkages to
Pradesh (2.29 thousands), Bihar, Andhra Pradesh, integrated counselling and testing centers for HIV
Karnataka, Telangana, West Bengal, Gujarat and testing, linkages with care and support services
TamilNadu, least being in Sikkim. for HIV positive HRGs, community mobilization,
ownership building and specifically for IDUs, free
Figure 24.2.1: HIV Prevalence (%) among ANC distribution of sterile needles and syringes, abscess
Client, FSW, MSM, IDU & other risk groups, India prevention and management, Opioid Substitution
(HSS 2016-17) Therapy (OST) and linkages with detoxification/
rehabilitation services.
The entire programme is built on the peer led
approach in partnership with NGOs/CBOs
along with SACS and Technical Support Units
(TSU). They extend mentoring, handholding and
technically supporting the TIs for quality service
delivery and enhancing the overall program
performance.
24.3.1 Performance of TI Programme
Coverage of core HRG group: As far as
24.3 TARGETED INTERVENTIONS the coverage of Hijra (H)/ Transgender (TG)
population is concerned, NACO has been making
NACO through its NACP aims at halting and consistent efforts to scale up the programme and
reversing HIV epidemic in India. India’s HIV improve the coverage in high priority States.
epidemic is considered to be concentrated in Based on the recommendations of Mid Term
nature. Appraisal, option paper developed for TIs, States
NACO has targeted its preventive efforts towards were guided to re-structure the TIs keeping in
sub-groups of population identified to be at high parameters such as positivity, number of years of
risk of acquiring HIV infection. These High Risk HRG’s association with TI programme, changing
Groups (HRGs) include FSW, MSM, Hijra(H)/ dynamics in sex work and injecting practices, etc.
Transgenders (TG), IDU and Bridge Populations These strategies will help to enrol new and young
such as Migrants and Long Distance Truckers. HRGs across typology. TSUs have been directed
They are provided with a number of preventive to provide on-site assistance and handholding to
services through around 1,443 NGO/CBO led revise the outreach plan so as to cover hard-to-
TIs at present, including; HIV prevention and reach and hidden population.
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Coverage of Core HRGs (FSW, MSM, IDU and H/TG) (April 2018 to March 2019)
9.00
8.00
7.00
6.00
In Lakhs
1.51 (85 %)
2.63 (74%)
0.43 (61%)
5.00
4.00
3.00
2.00
8.68
3.57
1.77
0.70
1.00
0.00
FSW MSM IDU HTG
Estimated Coverage
STI Diagnosed & Treated against Clinic Visit): STI/RTI cases diagnosed and treated was high
As per NACO guidelines every HRGs should visit among FSWs as 2.06% while MSM population has
STI clinics every quarter, especially for regular recorded more than 1.16 %. Out of total migrant
medical check-up and for treatment of STI / provided STI clinical services, 3.5% are having
Reproductive Tract Infections (RTI). The clinic STI infections; similarly out of total foot fall of
footfall for STI screening was approximately truckers 3.7% found STI infections.
more than 68% among all core groups, however
STI Diagnosed & Treated against Clinic Visit in Percentage (April, 2018 to March, 2019)
80 73 4
68 69 70 3.7
70 3.5 64 3.5
60 3
50 44 2.5
Percent
Percent
40 2.06 2
30 1.6 1.5
1.16
20 1
10 0.5
0.35
0 0
FSW MSM IDU TG Migrant Truckers
HIV testing and positivity rate among HRGs: performed among HRGs through referrals from
As per the NACO guidelines, all core HRGs should TI programmes. The positive detection amongst
be tested for HIV once every six months. The HRGs has been less than 1.12% and the positivity
below figure depicts the percentage of HIV tests recorded 0.22 % and 0.48 % among migrant and
trucker respectively. The programme statistics positivity has remained a matter of concern among
reveals that HRGs who have been associated with IDUs and HTG population. Testing among the
TIs for more than five years have been regular to Bridge Population remains a challenge because
testing and keeping consistent efforts to remain of their mobility. Positivity among migrants and
negative across majority of the States. However, truckers is the same as in last year (0.2%).
HRGs tested for HIV and positivity rate (April, 2018 to September, 2018)
90 85 2.2
80 73 71 70
66 67 1.7
70
60
1.2
Percent
Percent
50 1.12
40 0.7
30 0.59 0.48
20 0.21 0.22 0.2
0.13
10
0 -0.3
FSW MSM IDU TG Migrant Trucker
Axis Title
Alive PLHIV (in numbers) HRG currently be on ART. However, 100% achievement is still
registered at ART Centre (Table 24.3.1): Under not being achieved.
the test and treat strategy, all positive HRG should
Table 24.3.1: Alive PLHIV (in numbers) HRG currently registered at ART Centre
(April, 2018 to March, 2019)
HRG/Bridge Population PLHIV identified & Currently on ART Achievement (in %)
registered to ART
FSW 10433 9563 92%
MSM 5451 4888 90%
IDU 6722 5678 84%
HTG 1297 1197 92%
Migrant 3025 2602 86%
Trucker 582 478 82%
Source: Monthly Indicator of TI Reporting (MITR) 2019
Condom distribution among HRGs: Condoms and correct usage of condoms in all sexual
are distributed to HRGs as per their requirement encounters through one-to-one and one-to-group
through NGOs/CBOs implementing TI interpersonal communication. Fig 24.3.4 shows
programme. Peer Educators and Outreach workers the typology-wise number of condoms (free and
engaged in TI programme emphasize on consistent social marketing) distributed to the HRGs.
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CHAPTER-24
2200
2077
1700
1630 (79%)
1200
In Lakhs
550 (89%)
700
462(79%)
97 (90 %)
619
588
117
200
Demand Distribution
Source: Monthly Reporting of TI Indicators March 2019
Needle & Syringe distribution patterns among of sterile syringes and needles and reduces the
IDUs: As part of the overall Harm Reduction possibility of sharing injecting equipment, thus
strategy, to prevent HIV amongst IDUs, free clean decreasing risk of HIV transmission and other
needles and syringes are distributed to IDUs as per blood borne diseases. Programme data shows
their requirement through NGOs implementing TI that the distribution of needles and syringes to
programme. Peer educators at the field as well as at be consistently high (more than 87%), while the
the DICs and IDUs are encouraged to return the used return rate observed is more than 79%.
syringes and needles, which ensures availability
Fig 24.3.5: Distribution and Return of Needles & Syringes (April, 2018 to March, 2019)
400.0 87%
85%
350.0
300.0 88% 79% 348.0
250.0 302.0
In Lekhs
267.0 258.0
200.0 233.0
150.0 185.0
100.0
50.0
0.0
Syringe Needle
Table 24.3.2: State-wise and Typology-wise distribution of Targeted Interventions (TIs) supported
by NACO during the FY 2018-19 (April, 2018 to March, 2019)
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Table 24.3.3: State Wise Typology wise coverage of High Risk Groups under the programme
2018-19 (April to March, 2019)
24.3.2 Opioid Substitution Therapy (OST) followed under OST programme for IDUs. The
Programme for IDUs operational guideline on OST for clinical staff has
been revised incorporating new development in the
OST was included as a part of the Harm Reduction
area. A training manual on special needs of Female
package in 2008. India has adopted two model
Injecting Drug Users (FIDU) has been developed
of OST service delivery: - NGO Model and
which aims to address the issues of FIDU. Quality
Collaborative Model. In collaborative model,
Assurance Protocol (QAP-Medical) of OST in
the OST services are being delivered at the
India (A reference guide for mentors) has been
Government Health Facilities in coordination with
developed. The QAP serves as a resource material
the link IDU-TI. There has been massive OST
for mentors, entrusted with the task of carrying out
scale up in India from 56 centres in 2007 covering
periodic ‘Quality Assurance (QA) visits’ to OST
5,500 IDUs (approx.) to 212 Stand-alone centres
centres.
and 13 Satellite centres currently covering 29,543
active IDUs (approx.) while the overall IDU ever With the successful implementation of OST, it is
on OST are more than 70,000. now being recognized as an effective treatment
option under the Narcotic Drug and Psychotropic
For providing and assuring quality services, a
Substances (NDPS Amendment Act, 2014). NDPS
continuous process of capacity building is being
allows “management” of drug dependents.
Table 24.3.4: Number of OST Centers FY2018-19 (April, 2018 to Dec, 2019)
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TB Screening & Treatment Cascade: In India, and its control efforts fifteen years back in early
there are 20.2 Lakh new TB cases annually, with 2001. Considering the above, TB screening has
the highest TB burden in the world. Also, there been initiated by TIs in July, 2018; total 24,465
is a concentrated HIV epidemic in India which is core HRGs and bridge population have been
focussed only due to its risky behaviour within a screened out of which 42,178 were referred for
limited population. NACP of India and Revised TB testing, 24,465 were tested for TB and 793
National Tuberculosis Programme (RNTCP) HRGs diagnosed for TB. Total 589 were put on
recognized the importance of HIV/TB co-infection TB treatment out of 793 diagnosed for TB.
Table 24.3.6: TB Screening and Treatment Cascade (April, 2018 to Mar, 2019)
24.3.3 HIV and TB intervention in Prisons & and Haryana, Phase-III was observed extensively
other Closed Settings across the country during this reporting period.
Based on the direction of AS & DG (NACO), the
NACO is implementing HIV/TB intervention in a
intervention has been expanded to Women, living
phased manner in prisons and other closed settings
in Swadhar, Ujjawala and other State-run Homes
in India. While Phases I&II were being stabilised
in India in close collaboration with Ministry of
in North-Eastern (NE) States, Punjab, Chandigarh
Women and Child Development, Govt. of India.
459
CHAPTER-24
Following were some of the key activities carried by AS & DG (NACO), at a function held
out during this reporting period: in Bhubaneshwar, in the presence of
Commissioner-cum-Secretary, Department
¾¾ S & DG, NACO launched HIV/AIDS
A of Health and Family Welfare, Government
intervention programme for women living of Odisha, DIG Prisons, Director, Family
in correctional Homes at a function held in Welfare, Deputy Secretary, State Legal Aid
State Home for Women, Guwahati in the Services.
presence of Principal Secretary, Health and
Family Welfare, Govt. of Assam and other ¾¾ n inter-divisional meeting was organized
A
senior officials from line departments. under the chairmanship of AS & DG
(NACO) to enhance synergies between
¾¾ IV Prevention, Treatment and Care
H HIV & TB intervention in prisons and other
Programme in prisons and other closed closed settings.
settings for Haryana was launched by Shri
K.L. Panwar, Hon’ble Jail Minister, Govt. ¾¾ consultation meeting with NCB, MSJE,
A
of Haryana at a high level meeting held in BPR&D and UNODC in the context of
Chandigarh. drug use & HIV in prisons and other closed
settings was chaired by JS-NACO and JS-
¾¾ IV prevention in prisons and other closed
H Social Defence Division at NACO. During
settings was launched by AS &DG, NACO the meeting, MSJE informed that the
in Jaipur in the presence of Additional proposals submitted by State Governments
Chief Secretary, Health Services, Govt. would be given priority to start the drug de-
of Rajasthan and other senior officials addiction centres in prisons.
from State prisons and women and child
development departments. ¾¾ hree consultation meetings were held
T
under the chairmanship of AS&DG (NACO)
¾¾ IV & TB intervention in prisons & other
H with key stakeholders in New Delhi. Inputs
closed settings in Madhya Pradesh was received from technical experts have helped
launched by Additional DG, NACO and Shri NACO submit to the final draft operational
G S Meena, Addl. Director General of Prisons guidelines on HIV/TB intervention in prisons
& Correctional Services, Government of and other closed settings which was approved
Madhya Pradesh. by AS&DG (NACO) during this reporting
period- the printing and dissemination of the
¾¾ IV and TB Intervention in prisons and other
H guidelines is currently in process.
closed settings in Telangana was launched by
AS & DG (NACO), at a high-level function The National Consultation on HIV Intervention
held in Hyderabad, in the presence of Deputy in Prisons and Other Correctional Institutions was
Inspector General of Prisons, Govt. of held under the Chairmanship of AS & DG, NACO
Telangana, Director, Department of Women in New Delhi.
Development & Child Welfare, Govt. of The commitment to the issue was evident in the
Telangana, Project Director, TSACS, Zonal participation of senior officials from: MHA,
Director, NCB, Member, Secretary State MSJE, MoWCD, NCB, Office of Delhi Police
Legal Service Authority. Commissioner, Customs, BPR&D, WHO,
UNODC, USAID, CDC, NICED, NARI, State
¾¾ IV and TB intervention in prisons and
H
Prisons Departments, Social Welfare Dept. and
other closed settings in Odisha was launched
Dept. of Women and Child Development from
different States, civil society organizations including Table 24.3.7: Progress of Prison and Swadhar
FHI360, Emmanuel Hospital Associations (EHA),
Solidarity and Action Against HIV Intervention Settings Prisons Swadhar/
Ujjawala
in India as well as representatives from Swadhar Homes
and Ujjawala Homes and TI-NGOs. The inputs
received from the experts have helped in finalising No. of sites covered 709 45
the Operational Guidelines for implementing HIV Total Inmates 3,99,338 1,478
interventions in Prisons and other Closed Settings Inmates Tested for HIV 2,27,536 906
and setting up Surveillance sites in prison settings.
Inmates found HIV Positive 3,121 23
Inmates linked to ART 2,651 23
Inmates diagnosed with Hep-C 5,252 1
Inmates on Hep-C Treatment 365 1
Inmates screened for TB 18,712 67
Inmates diagnosed with TB 1,969 3
Inmates on TB -DOTS Treatment 351 3
STI Treated 820 1
461
CHAPTER-24
was to advocate with police training academies to ¾¾ 8 5% of the HIV positive inmates have been
include topics related to drug use and HIV/AIDS registered for ART while only 18% of the TB
into their police training curricula. cases have been linked for treatment
In his inaugural address, Shri Sanjeeva Kumar, ¾¾ nly 7% of the Hep-C cases were linked for
O
Additional Secretary & Director General (NACO, treatment
RNTCP & CGHS), Ministry of Health and Family
Welfare, said that the unifying theme for this ¾¾ 1 0% -21% of total prison inmates were
initiative is to create awareness about HIV/AIDS identified as drug addicts (% vary across
among police personnel. He said NACO is taking States –Punjab and NE States reported high
concerted efforts to engage with other agencies in numbers)
terms of providing technical support on training ¾¾ ignificant number of STI cases were treated
S
and capacity building to enhance access to various across 7 States (3 UTs & 4 States)
HIV prevention and treatment services. He had
advised NACO officers to fast-track signing formal ¾¾ ACS have been requested to liaise with
S
MoUs with key Ministries and Departments to concerned State TB Officer to make TB
move forward on this important initiative. He had prevention and treatment services available
reiterated the need to incorporate the experiences for prison inmates
of CBOs and NGOs while finalising the topics on ¾¾ I t was proposed to establish F-ICTC, ART
drug use and HIV for police training academies. and OST in all 139 central prisons. As of
Key achievements (Prisons): now, only 145 testing facilities (28 ICTC
+ 117 FICTC); 16 Link ART centres;
¾¾ 2 3 States and 7 UTs have commenced the and 12 satellite OST centres have been
implementation of HIV/TB intervention in established.
prisons
Key achievements (Swadhar, Ujjawala & State- Enhancing Partnerships between Law
run Homes): Enforcement Agencies & Civil Society
Organizations in the Context of Drug Use and
¾¾ IV/TB intervention launched by AS
H HIV:
& DG, NACO in Assam has paved way
for expanding the intervention to women The legal and structural barriers continue to
living in other closed settings across other pose huge challenges in reaching out to the most
States. CBS, mobile ICTC and health camp vulnerable population with HIV prevention and
approaches are being deployed for carrying treatment services. In order to sensitize and forge
out HIV testing facilities amongst women. partnerships between officials enforcing law;
¾¾ 1 00% ART and TB treatment linkages have NGOs implementing TI interventions and senior
been achieved by the team implementing officials working with State Health System, a
programmes in homes. State-level sensitization workshop was organized
under the chairmanship of AS & DG, NACO in
¾¾
N ine States have commenced the
Guwahati, Assam. There were 7 national-level
implementation of HIV/TB prevention
consultations held and 36 State/district-level
and treatment services in homes and other
sensitization workshops were organized through
States are in the process of rolling out the
intervention. which more than 1,400 officials were sensitized
on various aspects of drug use and HIV; and
Based on the guidance of AS & DG (NACO), NDPS Act. These workshops provided a stage for
majority of the Sates where intervention formally discussion and experience sharing in promoting
inaugurated have signed MoU between SACS, State partnerships between key functionaries of law
Prisons department and Dept. of Women and Child enforcement Agencies (LEA), TI-NGOs and the
Development to ensure effective implementation State Health Department.
of proposed HIV/TB intervention.
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in Chhattisgarh, Madhya Pradesh and who are linked to the industries directly or
Odisha primarily focusing on building the indirectly. Under this model, efforts are made
local capacity initiatives of TI NGOs and to involve major industries and associations
SACS. The project has built the capacity to integrate comprehensive HIV/AIDS
of more than 128 TIs through a mentorship prevention to care programme within their
programme; enabled KPs to avail social existing structure. MoUs are signed by the
protection schemes; sensitized healthcare SACS with the respective employers. SACS/
providers across facilities at district level; TSU build the capcity of the employers and
and obtained community feedback by support them to conduct different activities
deploying community score card approaches for the informal laboureres. Around 527
to ensure quality service delivery. MoUs are signed with the industries. The
achivements for MoU signing is 72%. Out
f) Multi-country South Asia HIV program of total MoUs signed, about 444 number
for MSM & HTG: The regional HIV of industries have started implementing
programme is to reduce the impact of HIV activities for the informal labourers and
on MSM and H/TG in South Asia funded by around 1.60 lakh informal workers are
Global Fund to Fights AIDS, TB and Malaria covered through the outreach activities.
(GFATM) under Round 9. Under the VHS-
MSA DIVA Project during the year 2018 – District AIDS Prevention and Control Units
2019, the project has capacitated more than (DAPCU)
250 TI staff on various components of NACO
TI operational guidelines on HTG people, In NACP-III, as a major structural reform, the
sensitised around 100 Government and management of HIV prevention and control
key stakeholders on issues affecting HTG programme was decentralized to district level.
people, advocated with around 600 people at Using the HIV Sentinel Surveillance data (2004-
State and local levels on HIV related issues 2006), all the districts in the country were divided
affecting HTG people. into four categories (Category A, B, C and D) based
on the disease burden. As per this, there were 156
g) Community System Strengthening: Category A and 39 Category B districts (total 195
NACO is leading a focused initiative on districts) across the country that required priority
vulnerability reduction and Community attention. NACO established DAPCUs in 188
System Strengthening (CSS) focussing such districts to provide programmatic oversight
on CBOs of Andhra Pradesh, Telangana, through decentralized facilitation, monitoring and
Karnataka, Maharashtra and Tamil Nadu for coordination of HIV/AIDS programme activities
FSWs program (BMGF through SWASTI). in the district.
During the reporting period (January, 2018 to
September, 2018), the project has continued The major responsibility of DAPCU is facilitation,
to provide technical support on vulnerability monitoring and coordinating NACP activities at the
reduction services for 64 COs across 5 States district and sub- district level by integrating with
(Andhra Pradesh, Telangana, Tamil Nadu, the health system to the extent possible for better
Maharashtra & Karnataka). synergy and optimal results. DAPCUs, through
active engagement of the district administration
h) Employer Led Model (ELM): The ELM engages allied line departments and private sector
has been designed to provide HIV/AIDS in mainstreaming the programme and advocates
prevention to care services to informal district-specific initiatives even by leveraging
laboueres including migrants and truckers, local resources. This helps in linking vulnerable
465
CHAPTER-24
population with various social entitlements and The scheme envisages creation of demand for
welfare schemes. DAPCU staff builds the capacity various HIV/AIDS related services, linking of
of the facility staff, monitor the referrals and the target population to existing services (as
linkages through regular supervisory visits to HIV the scheme itself does not create any service
facilities and monthly review meetings, addresses delivery points), creating an enabling and stigma
supply chain management issues through inter free environment, ensuring the target population
and intra-district transfers and make troubleshoot continue to access information, services in a
visits, wherever necessary. sustained manner, creating linkages with services
of other departments through ASHA volunteers,
A team of experts under DAPCU National Resource anganwadi workers, panchayat heads etc.
Team (DNRT), have been able to continuously
mentor these district level units, at the same time, The scheme involves highly motivated and trained
have been providing technical assistance at the state community members – 20 Cluster Link Workers
and national level to improve the functioning of in each district for clusters of villages (usually
DAPCUs. To promote wider sharing of knowledge 5 villages each) – responsible for establishing
within the districts, different platforms have been linkages between the community on one hand
created. One of them is identification of successful and information, commodities and services on the
approaches and models, documenting them as other. These Cluster Link Workers are supervised
case studies and sharing them widely with all the by 2 Zonal Supervisors in each district.
DAPCU staff in the form of “DAPCU Series”.
This practice has encouraged many DAPCUs
to document and present their achievements to
SACS and NACO through DAPCU series. While
it is difficult to include all the experiences through
this mode, the need for a larger space was felt.
“DAPCU SPEAK” (http://dapcuspeak.blogspot.
in/), is another initiative that emerged from this
experience. This helps in peer learning and gradual
building of knowledge in the field staff, if used
properly.
Link Worker Scheme (LWS) - Reaching-out to The specific objective of the scheme includes:
Rural Populations Reach out to HRGs and vulnerable men and women
In fourth phase of NACP, the LWS has been in rural areas with information, knowledge, skills
designed to intensify and consolidate the prevention on STI/HIV prevention and risk reduction. This
services focusing on risk population in the rural entails: (a). Increasing the availability and use
areas with a mandate to work in 128 districts across of condoms among HRGs and other vulnerable
16 States of India in the FY 2018-19. Two districts men and women. (b). Establishing referral and
are withdrawn since last year. The LWS aims to follow-up linkages for various services including
address complex needs of rural HIV prevention, treatment for STIs, testing and treatment for TB,
care and support through identification and training ICTC/PPTCT services, HIV care and support
of village level workforce of Zonal Supervisors, services including ART, (c). Creating an enabling
Cluster Link Workers and other stakeholders on environment for PLHA and their families, reducing
issues of HIV/AIDS, gender, sexuality and Sexual stigma and discrimination against them through
Tract Infections. interactions with existing community structures/
groups, e.g. Village Health Committees (VHC),
Self Help Groups (SHG) and Panchayat Raj has consistently focussed on prevention from
Institutions (PRI). HIV/AIDS through safe sex practices. Given the
significant role of condoms in the prevention of
LWS Progress in FY 2018-19 STI/HIV infections, the NACO promotes condom
In FY 2018-19, LWS was proposed to be use for controlling the epidemic.
implemented in 128 districts across 16 States. As In view of the prevailing status regarding condom
on March, 2019, LWS was implemented in 121 usage in the country, a well-focussed national
districts. Under the scheme, over 50,311 FSW, level condom programme has been implemented
4,121 IDUs, 5,100 MSMs and 226 TGs were that includes distribution of free condoms among
reached in rural areas nationally. In addition to this, the most vulnerable ones. The desired behavioural
the scheme also covered nearly 5.0 lakh migrants, outcomes of the condom programme are to increase
0.78 lakh truckers and 6.4 lakh other vulnerable consistent use of condoms among men with the
populations. The programme also reached out to non-regular sexual partners or in commercial
21,637 PLHIV; 1.4 Lakh ANC and around 12,559 sex encounters and among married couples for
TB cases. Around 8.8 Lakh population were tested preventing unwanted pregnancies.
for HIV; and 41,907 cases have sought treatment
for STI. The above services were provided by Condom Demand Generation
establishing linkages with existing services.
60,04,025 free condoms and approximately NACO continued to follow its communication
6,75,112 socially marketed condoms were framework devised under the current strategy
distributed during the period. adopted for long term that is based on promoting
condom use by enhancing self-risk perceptions.
The primary objective is to motivate the behaviour
change among the key target population like HRGs,
bridge population as well as general population
especially the youth as a category. Under this
strategy, all condom promotion communication
activities were developed to focus on bringing
positive behaviour change towards consistent
condom use. These promotions are designed
to promote condoms for its benefits of triple
protection from the risks of HIV/AIDS, STI and
unwanted pregnancy.
Condom Promotion Programme
NACO promotes safe sex and regular condom
Condom promotion by the MoHFW, Government use through its campaigns on mass media.
of India (GoI) has a long history. In the initial period, These condom promotion campaigns on mass
condom was promoted under National Family media are aired on national networks of Door-
Planning Program. With the emergence of HIV as darshan, leading Cable & Satellite Channels, All
a serious health threat, promotion of condom for India Radio and private FM channels to ensure
preventing HIV/AIDS was taken under the NACP. countrywide footprints. This year, a new mass
With the knowledge that maximum percent of media campaign was developed in Hindi and other
HIV infection is transmitted through unsafe sex, regional languages.
significant efforts have been made by NACO to
increase the awareness and usage of condoms to The new campaign is based on theme of ‘making
prevent the transmission of HIV/AIDS. NACP regular condom use a habit’ to ensure its consistent
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CHAPTER-24
use. The basic premise of this communication is to Table 24.3.8: Free Condom Estimation under
encourage audience to adopt safe sex practice by NACO for 2018-19
using condom every time. This campaign has been
developed in two parts depicting various common States Estimated Total Supply
incidents and events occurring in daily life of a Annual Demand
of Free Condoms
lay man. The essence of each of these episodes
is to highlight benefits of good habits and thus Ahmedabad 2,412,000 2,050,000
appealing for making condom use a habit in order A&N Islands -
to play safe while having sex. This campaign was
Andhra Pradesh 47,046,960 43,412,900
conceived to be an integrated one encompassing
compatibility across various media platforms Arunachal 444,000 450,000
including television, radio, outdoor, social media Pradesh
sites on the internet, mid-media activities, leaflets Assam 5,412,000 5,500,000
and merchandise as promotion material for display
Bihar 5,304,528 3,000,000
at the points of purchase. Digital cinema screening
was also included in condom campaign; media Chandigarh 2,418,000 2,000,000
plan to reach out to the target population through Chhattisgarh 9,000,000 8,200,000
cinema halls of smaller towns. Only those cinema Dadar& Nagar 14,400 100,000
halls located in priority districts are shortlisted. Haveli
Free Supply of Condoms Daman & Diu 390,000 400,000
24.4 SEXUALLY TRANSMITTED INFECTIONS The details of number of individual availed STI
(STI) AND REPRODUCTIVE TRACT service and diagnosed STI and pregnant women
INFECTION (RTI) CONTROL & tested for Syphilis and diagnosed syphilis during
PREVENTION PROGRAM FY 2017-18 and FY 2018-19 (from January, 2018
till March, 2019 along with North –East data), are
The prevention and control of STIs is a well- provided in the following table.
recognised, cost effective strategy for controlling
2017-18 40,21,460 16,863 36,77,932 15,840 44,98,740 36, 80,696 3946 1882
(0.4%) (0.43%) (82%) (0.11%) (48%)
469
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drugs used to treat common STI/RTI are included During the period May-August, 2017, Apex
in the National/State List of Essential Drugs. Regional center, (Safdarjung Hospital) has
The division also procured Injection Benzathine conducted STI Surveillance and community
Penicillin 2.4 million units for all health facilities based study in HRGs to find out the Susceptibility
including NHM facilities. &Sensitivity Pattern of Gonococci (GASP), first
Regional STI/RTI Training, Research and line drug used for the Gonorrhoea.
Reference Laboratories Training and Capacity building and regular onsite
There are 10 functional Regional STI Training, mentoring of STI/RTI service providers.
Reference and Research Laboratories supported & Standardized training curriculum for doctors, staff
strengthened by NACO. These are located at : nurse, laboratory technician and counsellor is in
1) Osmania Medical College, Hyderabad place. The training to these staff is provided in a
cascade form through a cadre of national, State and
2) Medical College Kolkata and Institute of regional resource faculties across all States. All
Serology, Kolkata faculty members have been trained using the same
3) Government Medical College, Nagpur training material, following adult learning methods.
The State and regional resource faculties in turn
4) Government Medical College, Baroda have conducted training of STI/RTI clinic staff in
5) Institute of Venereology, Chennai the designated clinic and TI NGO. Additionally,
each district has district resource facilities for
6) Maulana Azad Medical College, New Delhi training doctors, nurses and laboratory technicians
7) BYL Nair Hospital, Topiwala National on STI/RTI management for sub district health
Medical College, Mumbai facilities (PHC, CHC, and Sub –district hospital),
and doctors in private sector also.
8) Government Medical College, Guwahati,
Assam Basics of STI programme activities were included
in the curriculum developed for trainings of
9) Post Graduate Institution of Medical ANM at FICTC and laboratory technicians of
Education and Research, Chandigarh ICTC, wherein the related curriculum has been
10) Safdarjung Hospital, New Delhi which acts incorporated into their existing curriculum so as to
as the Apex Centre as well as Regional make service delivery comprehensive. To enable
screening of pregnant women accessing labour
Laboratory for the country. room directly, a training module was designed to
The key functions of these laboratories are to orient labour room nurses for screening of direct
provide etiologic diagnosis of common STI/RTI walk in pregnant women both for HIV and Syphilis.
syndromes, validation of syndromic diagnosis, Convergence with NHM
monitoring of drug sensitivity of gonococci and
implementation of Syphilis External Quality STI/RTI services are also an integral part of
Assessment Service (EQAS). services provided at all Government health
facilities including PHC/CHC. At each of these
NACO and CDC with SHARE India have health facilities a standardized service delivery
conducted assessment of all the Regional STI protocol is followed. Medical and paramedical
Centre last year, during assessment of Quality staffs are trained, free STI treatment is provided to
management system and programme component. patients and monthly reports on STI/RTI indicators
are reported by these facilities through existing component of the TI projects. All the core group
HMIS. population receives packages of services which
include:
In addition of earlier indicators, the following
indicators of Syphilis have been incorporated in the 1. Free consultation and treatment for
Health Management Information system (HMIS). their symptomatic STI complaints
1. Number of PW tested using POC test for 2. Quarterly medical check-up
Syphilis
3. Asymptomatic treatment (presumptive
2. Out of above, number of PW found sero- treatment)
positive for syphilis
4. Bi-annual syphilis and HIV screening
3. Number of pregnant women tested for
Syphilis Preferred Private Provider approach has been
4. Number of pregnant women tested found rolled out to scale up STI/RTI services to HRG
sero-positive for Syphilis population under TI Projects. These providers
5. Number of syphilis positive pregnant women are selected by the community members through
treated for Syphilis group consultation. This approach has enhanced
access to services for the HRG. Under this
6. Number of babies diagnosed with Congenital approach, all the HRG receives free STI/RTI
Syphilis treatment and the providers receive a token fee of
7. Number of babies treated for congenital Rs.75 per consultation. A total of 3400 preferred
Syphilis providers are providing STI/RTI services to the
National operational guidelines and training HRG. All these preferred providers are trained
modules for medical officers and para-medical staff using a standardized curriculum on syndromic
for STI/RTI services have been developed jointly case management. Colour coded STI/RTI drug kits
by NACO & NHM and disseminated. A joint have also been made available to these providers
convergence meeting between NACO and NHM for free treatment of sex workers, MSM and
is conducted once every quarter. STI curriculum is IDU, and data collection tools are also provided
integrated in the training module for nurses and an to them.
integrated package of STI/HIV training is imparted Partnering with PSU and Professional
by Indian Nursing Council for nursing staff as per Organization
the standardized curriculum.
The major proportion of patients with STI/RTI seek
NACO has revised national STI/RTI technical services from the vast network of private health
guidelines, 2014 in consultation with NHM. STI care delivery systems ranging from freelance
Division and NHM are jointly implementing private practitioners to large public hospitals. Also,
Elimination of Parent to Child Transmission many populations are accessing services from
(EPTCT) of Syphilis and has done joint public health care systems under other sectors like
procurement of Inj. Benzathine Penicillin for railways, ESI, Armed Forces, CGHS, Railways,
NHM. Port hospitals as well as health facilities of public
Provision of STI/RTI Services in HRG sector undertakings like Coal India Ltd, SAIL
Population etc. It has been felt that reaching out to maximum
number of people suffering from STI/RTI is not
The provision of a standardized package of STI/ possible without partnership with private sector
RTI services to HRG population is an important and organized public sector. NACO has initiated
471
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partnership with organized public sector and 24.5 BLOOD TRANSFUSION SERVICES
private sector through professional associations to
The annual requirement of blood for the country
support the delivery of STI/RTI services with the
is estimated at 1.5 crore units of blood and the
objective to reach the populations presently not
endeavour is to meet the blood needs of the country
covered by the public health care delivery system.
through voluntary non-remunerated donation
STI/RTI services have been rolled out in major
through a well-coordinated and networked blood
port hospitals, ESIC, private medical colleges.
transfusion service.
National Strategic Plan 2017-2024 (NSP)
Blood Transfusion Services (BTS)
The vision of STI/RTI control and prevention
The BTS comprise of 3,108 licensed blood banks
program is to provide standardized STI/RTI
across all states and sectors, of which a network of
services and Sexual and Reproductive Health
1,131 blood banks are supported by NACO in the
services (SRH) at all levels of health system
way of equipment, manpower and consumables.
through convergence with NHM and private
Overall 75.05% of blood was subjected to
sector; especially focusing on women, adolescent
componentization in NACO supported Blood
and marginalized population.
Component Separation units in 2018-19.
The strategies propose to provide comprehensive
NACO has been primarily responsible for ensuring
STI/RTI services not only to vulnerable populations
provision of safe blood for the country since 1992.
and HRGs but also to the general population and
During NACP, the availability of safe blood
communities at large. In doing so, NACO will
increased from 44 lakh units in 2007 to 1.22 crore
ensure greater convergence and ownership of STI/
units by 2018-19. During this phase, incidence of
RTI management in the general health system and
donor HIV sero-reactivity has declined from 1.2%
partnership with private sector.
to 0.14% in NACO supported blood banks.
Table 24.5.1: Blood Donation statistics for Blood Transfusion Services, India
During the FY 2018-19, 70.2 lakh blood units BTS and encourage the appropriate use of
were collected across the country in NACO blood and blood product and encourage the
supported blood banks. 76.30% of the collection research and development of field transfusion
was through voluntary blood donation (VBD). medicine and related technology
The VBD percentage is comparatively lower than
the previous years due to a change in definition • Take adequate regulatory and legislative
of voluntary blood donor, so as to exclude family steps in blood transfusion process and
donors. provide adequate resource policy framework
of blood bank services in the country.
Key Strategies:
NBTC and State Blood Transfusion Council
Government has adopted a comprehensive (SBTC) are the apex bodies responsible for BTS at
approach towards strengthening BTS, key national and state level.
strategies for which include:
Activities of NBTC in 2018-19 include:
• Increasing regular voluntary non-
remunerated blood donation to meet the 1. EQAS through two Proficiency Testing
safe blood requirements of safe blood in the providers @ Rs. 4,000 per blood bank per
country; year for
• Promoting component preparation and a) 179 blood banks through CMC, Vellore
availability along with rational use of blood completed
in health care facilities and building capacity b) 189 blood banks through SDMH,
of health care providers to achieve this Jaipur Completed
objective;
2. Review meeting of SACS/SBTC and RTC
• Enhancing blood access through a well held in March, 2018
networked regionally coordinated BTS;
3. Dissemination of report of National Study
• Establishing Quality Management Systems on Blood Requirement in India
to ensure safe and quality blood and
4. TRG meeting held in May, 2018
• Building implementation structures and
referral linkages. 5. Draft document of BB and BTS Standards
submitted to TRG for review
National Blood Transfusion Council (NBTC)
6. Observance of World Blood Donor Day
The functions of NBTC as the policy formulating through a month long campaign
apex body in relation to all matters pertaining to
operation of blood centers are as follows: 7. Nation-wide VBD drives in partnership with
Akhil Bharatiya Terapanth Yuvak Samiti,
• Commitment to provide safe and adequate TCIF, NTR trust, Rotary Club
quantity of blood, blood components and
blood products through an organized blood 8. First meeting of Standing Committee of
transfusion service in the country; NBTC under the chairpersonship of JS
Policy, MOHFW on 27th June, 2018
• Formulate and implement National Blood
Policy and implement National Blood 9. First meeting of Expert Working Group for
Programme in the country; Make latest VBD Guidelines held on 28th June, 2018
technology available for operating the
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10. Dissemination of revised Manpower Norms 15. Review and revision of specifications of
for blood banks with recommendation to testing kits to include IVth generation kits for
DCG(I) for regulatory amendments HIV ELISA, HIV Rapid and HCV ELISA.
11. MoU with AATM for conduction of trainings 16. Recruitment against vacancy of Programme
for private sector blood banks Officer QC
12. National Review Meeting for Regional 17. Training of the Technical Officers for lab
Training Centres and curriculum review in services and blood bank conducted in NACO
September, 2018 HQ in March, 2019
13. Expansion of pool of master trainers for
counselling blood donors in September, 18. Joining of Medical Officer with Pathology
2018 qualification through detailment from CGHS
14. Review and revision of specifications of 19. Development of Mobile app for NBTC,
blood bags to include triple blood bags with security audit and upgradation of NBTC
SAGM and diversion pouch in triple and website.
quadruple blood bags.
475
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35000
Stand Alone ICTC F-ICTC PPP-ICTC CBS
30000 2,054
4,283
25000 3,780
Number
20000 2,465
3,434
2,377
15000 1,977 16,168 18,228
3780 12,067 13,243
10000 964 8,811
10,645
5,018 16168
1,270 2,302
5000
4,567 5,027 5,210 5,239 4,533 4,508 4,818 5,347 5,521 5,545 5,546 5,412
0
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19
Year
(data (provisional) source is Strategic Information Management System (SIMS) as on March, 2019
and the cumulative data since April, 2018 –March, 2019 has been taken)
HIV Counselling and Testing Services of HIV positive. While, during Jan, 2018 to March,
General Individuals 2019, around 308 lakhs general individuals have
been tested for HIV, out of which 2,21,428 were
During the FY 2017-18, around 209.9 lakhs
diagnosed HIV Positive. The below Figure shows
general individuals were tested for HIV out of
year wise general individuals tested for HIV and
against the annual target of 180.7 lakhs and out of
the positivity.
which 182,397 general individuals were diagnosed
350 6.0
General Individual Tested (In Lakhs) Positivity (in %) 309
5.0
300 5.0
Number Tested (in Lakhs)
3.2
200 165
186
2.5 150 3.0
150 130
109 104
1.4 2.0
100 83 90
2.2 1.2
1.0
1.8 0.9
0.7
50
56 1.0
0 0.0
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 Jan.2018
to Mar
19
Years
(data (Provisional) source is SIMS as on 22nd April, 2019 and the cumulative data for Jan, 2018 to March,
2019 has been taken)
477
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B. Prevention of Parent to Child Transmission were found HIV positive. There were 4,792* known
of HIV (PPTCT) HIV positive Pregnant women were also reported
in FY 2017-18. Out of total (new +known) 14,342
The PPTCT programme was started in the country
HIV positive pregnant women, 93% (13,276) were
in the year 2002. As on 2019 March, 29,977 ICTCs
registered at ART and 91% (13,027) were initiated
in the country offer PPTCT services. The aim of
lifelong ART. Further HIV exposed live birth
the PPTCT programme is to offer HIV testing to
reported in 2017-18 is 11,409 out of which, 87%
every pregnant woman (universal coverage) in the
babies were initiated ARV prophylaxis.
country, so as to cover all estimated HIV positive
pregnant women and eliminate transmission of During the period of January, 2018 to March,
HIV from mother-to-child. During the FY 2015- 2019, around 274 Lakhs of pregnant women were
16, NACO has decided to implement Early Infant tested** for HIV, and total 18,240 (11,839 new
Diagnosis(EID) service through all SA-ICTCs cases & 6,401 known cases*) HIV positive cases
(fixed) across the country. Currently this service is were reported, out of which, 91% (16,604) were
available through all (5,412) SA-ICTCs. initiated lifelong ART*. During Jan, 2018 to Mar,
2019, around 13,768 HIV exposed live birth were
In the FY 2017-18, against the target of 180.7 lakhs
reported, out of which 11,870 (86.2%) babies were
pregnant women, 207.7 lakhs were tested for HIV.
received ARV prophylaxis.
Out of which, 9,550(new cases) pregnant women
30 0.80
0.72 27.4
Tested (in Million) % HIV positivity
0.65 0.70
No. of women tested in millions
25
20.7 0.60
20 0.47
16.8 0.50
15 0.33 0.40
12.5
11.7
0.25 9.7 0.30
10 8.4 8.3
6.1 0.20
4.6 0.12
5 6.9
0.18
0.15
0.09 0.08
2 2.3 0.05 0.05 0.04 0.10
0 0.00
2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 Jan.2018
to Mar
2019
(**data (provisional) source is SIMS as on 22nd Apr., 2019 and the cumulative data since Jan, 2018 to March,
2019 has been taken)
*(CST-MPR Report)
1. Early Infant Diagnosis (EID) January, 2018 to March, 2019, about 7,491 babies
(6 weeks to 6 months) were tested under the EID
HIV exposed infants born to infected pregnant Programme using DBS DNA PCR, out which
women have to undergo DNA-PCR tests using 137(1.8%) babies were confirmed HIV positive
Dried Blood Spot (DBS) test (DNA-PCR). During
under DBS DNA PCR confirmatory test, and 100 V. Community Based Screening approach:
(73%) babies were put on ART. Under this period, CBS is an important approach for improving
5,216 HIV exposed babies (6 weeks to 6 months) early diagnosis, reaching first-time testers
were initiated on CPT. and people who seldom use clinical services,
including men and adolescents in high-
Total no. of HIV exposed babies who underwent prevalence settings and HRG populations.
18-month antibody test was 9,234, among these To improve HCTS access and coverage,
babies 399 (4.3%) were diagnosed/confirmed HIV community-based HIV screening is carried
positive and 356 (89.2%) initiated on Paediatric out through various approaches such as:-
ART.
a) Mobile HCTS;
2. Quality Improvement Initiatives under
Basic Services b) Screening by ancillary health-care
providers (ANC);
I. Supervision and Monitoring Mechanism:
Supportive Supervisory visit conducted c) Screening for HIV by TI (TI-ICTC);
by BSD Official to NACP facilities in
Haryana, Punjab and Chandigarh from 7th d) HCTS for prison inmates and
& 10th-12th July, 2018 to review on ground e) HCTS at the workplace.
implementation of the NACP services. This
visit was aligned with PLHIV-ART Linkage Currently the bulk of CBS efforts are through
System (PALS) Training programme targeting HRGs via TIs and Other Development
organized by Chandigarh and Haryana Partners and CSO.
SACS. • In this regards regional ToT were conducted
II. Quality assurance and EQAS: The in different regions to create master pool for
diagnostic services provided through ICTCs conducting the field level training. NACO
across the country are strictly monitored has completed the TOTs and around 2,015
by a strong Internal and External Quality master trainer are trained from all 36 States/
Assurance Scheme (EQAS). UTs.
III. Supply Chain Management: A strong • Standard Operating Procedures for CBS
monitoring mechanism for inventory and training manual “Testing through TI”
management is in place. The inventory status for Community Based HIV testing under
for all commodities at the State, District and National HIV Counselling & Testing
Facility level is monitored on monthly basis Services Guidelines, 2016 has been shared
at the National level. with all the States.
IV. PLHIV-ART Linkage System (PALS): • As on 2018 December, 1,821 CBS sites
NACO has implemented PALS in India for were established under different settings as
tracking & monitoring of cascade of services mentioned above and reporting to NACP
provided to HIV Positive general individuals, through SIMS.
pregnant women and their children. PALS • In current financial year approximately 8
allow the tracking services provided by lakh Pregnant Women were screened for
different health facilities at different time HIV through VHND level testing.
points & geo-locations. All States/UTs
implemented PALS and are reporting data in • As per the current SIMS Report, 25 States
it. are implementing CBS. Out of 1,427 TIs,
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786 TIs are reporting in SIMS with 4.1lakh transmission is defined as a reduction of
individuals screened since April, 2018, and transmission to such a low level that it no
there are multiple civil society organizations longer constitutes a public health problem.
having conducted a cumulative of 100,000+
screenings. India is signatory for achieving the EMTCT of HIV
and Syphilis by 2020. A road-map for achieving
VI. Achieving Elimination of Mother to Child EMTCT was prepared and has been steadily rolled-
Transmission of HIV (EMTCT):- Every out under the current NACP.
year, globally, an estimated 10.4 lakh
women living with HIV become pregnant. Looking at elimination of MTCT goals, NACO
Untreated, they have a 15-45% chance of has conducted the data verification for EMTCT of
transmitting the virus to their children during HIV & Syphilis in the 6 identified States(phase-1);
pregnancy, labour, delivery or breastfeeding. Andhra Pradesh, Telangana, Maharashtra,
However, the risk drops to just over 1% if Tamil Nadu, Karnataka, Mizoram and data
ARV medicines are given to both mothers validation in the State of Maharashtra, which
and children at the stages when chances of have demonstrated successful implementation &
transmission can occur. As treatment for achievements of EMTCT in our country, based on
prevention of mother-to-child-transmission certain programme indicators which are outlined
is not 100% effective, elimination of in the global guidelines on criteria and process of
EMTCT verification.
To accelerate the activities towards EMTCT data Bengal, Punjab and Chandigarh) and (phase-1)
verification exercise in the States, NACO has viz. Andhra Pradesh, Telangana, Maharashtra,
initiated the process of data verification in the Tamil Nadu, Karnataka and Mizoram). EMTCT
identified EMTCT Phase-2 States of the country assessment activities is going on 19 States (phase-1
(viz. Assam, Bihar, Delhi, Gujarat, Odisha, & phase-2).
Jharkhand, MP, Manipur, Rajasthan, UP, West
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rolled out with 25 States and UTs through register in all HCTS centers and the
“WebEx session” at UNAIDS Office. NACO preparatory work has begun since August
is organising regular webinars to facilitate 2017. E-fountain, an IT firm has been
counsellors and lab technicians in SACS, appointed for developing the e-registers
DAPCU and ICTC levels to adopt the (software format of Counselling registers
digitised trainings. uses in SA-ICTC and F-ICTC) in software
format. Finally, the software for registers
• More than 800 counsellors joined WebEx has been developed and piloted in 10 HCTS
session till December, 2018. facilities (both SA-ICTC &F-ICTC) in Delhi
• Around 130 counsellors completed the State.
course from the State Madhya Pradesh and Way forward:
received their certificate.
1. Scaling up of CBS of HIV by 100%
• NACO is continuously requesting State/ saturation of TI Projects and VHND level
UTs to motivate their counsellor to access HIV Screening of Pregnant women across
the eLearning platform (http://elearninghcts. the country.
org/) and complete certification.
2. All the State will be oriented on the
Newer Initiatives: eLearning Module by end of March, 2019,
1. Implementation of E-Learning Module on following which all SACS will ensure that
HCTS guideline to digitalize the training of all the counsellors go through the E-learning
HCTS staff with aim to introduce innovation module package.
in technology and ease of comfort for 3. Implementation of risk assessment tool in
counsellors, lab technicians and other ICTC for assessing the risk and vulnerability
critical partners in this journey, NACO, in of self-initiated client to reach first 90.
collaboration with UNAIDS has captured the
National HCTS guidelines in an engaging, 4. F–ICTC has to start in different OPD of all
simplistic, and retainable eLearning module the medical colleges, in coordination with
in Hindi and English languages, to facilitate MCI.
smooth scale up, efficient implementation
and uptake of HCTS. 5. Implementation of Digitalized ICTC/PPTCT
register with minimum typing content for
2. EMTCT Phase –II, State assessment has counsellor with the support of PATH.
been conducted in 19 States (phase II states
via; Assam Bihar Delhi, Gujarat, Odisha d) HIV/TB Collaborative Activities
Jharkhand, Madhya Pradesh, Manipur, TB disease is the commonest opportunistic
Rajasthan, Uttar Pradesh West Bengal, infection among HIV-infected individuals. Further
Punjab, Chandigarh and phase I Andhra it is also known that, TB being a major public
Pradesh, Telangana, Maharashtra Tamil health problem in India accounts for 25% of deaths
Nadu, Karnataka and Mizoram). among PLHIV. It is known that nationally about 3%
3. CBS of HIV has been scaled up through TI TB patients registered under the Revised National
project, VHND level screening of PW and Tuberculosis Control Programme (RNTCP) also
though CSO. have HIV infection. In Manipur and Mizoram
States, HIV positivity among TB patients is more
4. BSD-NACO has decided to make paperless than 10%. Thus, while the country is dealing
effectively with HIV burden, TB associated HIV TB Screening through outreach, (b) Screening of
epidemic is posing a great challenge. Presumptive TB cases through RMC&C, (c) TB
Screening at OST centre.
Broadly the national HIV/TB response includes
activities to reduce burden of HIV among TB Annual trend of TB-HIV burden for India
patients and TB among HIV infected individuals. (2001-2017)
These activities are closely guided through duly
constituted National HIV-TB Coordination
Committee, National Technical Working Group
and State and District level Coordination
Committees. The NACO and RNTCP have been
successful in increasing access and uptake of HIV
testing and counselling for all TB and presumptive
TB patients.
The objectives of the collaboration are to have
close coordination between RNTCP and NACP at
National, State and District levels & to decrease The co-location of Designated Microscopy Centres
morbidity and mortality due to TB among persons (DMCs) and HIV testing facilities was 85% as on
living with HIV/AIDS. The framework adopted a April 2018. The trend in the Linkage of TB HIV co-
four-pronged strategy infected patients to CPT and ART is also showing
healthy trend in India. 93% & 89% of co-infected
a. Preventive activities focusing on IPT and patients received CPT and ART respectively during
infection control measures 2018-19 (till Dec, 2018) whereas 92% & 88% of
b. Early detection of TB/HIV with the use of TB HIV co-infected patients were linked to CPT
molecular diagnostics and ART during FY 2017-18.
483
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(8,83,456 out of 9,48,551) PLHIV attending ART • Assessing feasibility of other innovative
centre were screened for ICF for 4 TB symptoms TB prevention therapies like 3 months of
at ART centres and subsequently 6% (50,053 out Isoniazid and Rifapentine, 4 months of
of 8,83,456) were identified as Presumptive TB Rifampicin as an alternative to 6 months
cases & 69% (34,732 out of 50,053) presumptive Isoniazid preventive therapy with INH.
TB cases were referred to RNTCP, among whom
85% (29,620 out of 34,732) were tested for TB and • Strengthening linkages of TB and HIV
3,444 PLHIVs were diagnosed with TB i.e., 12% patients for nutritional support.
as per monthly ART centre report (MPR-Mar., 24.7 CARE, SUPPORT AND TREATMENT
2019).
The Care, Support and Treatment (CST) component
Isoniazid (INH) Preventive Therapy (IPT): of the NACP aims to improve the survival and
IPT is one of the strategies globally recommended quality of life of Person Living with HIV (PLHIV)
for prevention of incident TB among HIV infected with Universal access to Comprehensive HIV care.
individuals. IPT is a key public health intervention CST services are provided through a spectrum
for the prevention of TB among people living with of service delivery models including ART
HIV. IPT Coverage among eligible PLHIV is 43% Centers (ARTCs), Center of Excellence (CoE),
as on March, 2019. PaediatricCenters of Excellence (P-CoE), Facility
Newer Initiatives: Integrated ART Centers (FI-ART), Link ART
Centers (LAC), Link ART Plus Centre (LAC Plus)
• Launch of E-Nishchit implementation and Care & Support Centers (CSCs) established
of initiative on capacity building of ART by NACO in health facilities across the country
centres using ECHO Platform for HIV TB with aim to provide universal access to free and
on 2nd April, 2018 at National Institute of comprehensive CST Services. There are active
Tuberculosis and Respiratory Diseases linkages and referral mechanism for monitoring,
(NITRD), New Delhi. mentoring, decentralization and specialized care.
• Country-wide coverage of policy for HIV The CST services includes free universal access to
testing among all presumptive TB cases. lifelong standardized ART, free lab diagnostic and
• Expansion of TB HIV collaborative activities monitoring services (baseline tests, CD4 testing,
in private sector health facilities. targeted VL), facilitating long term retention in
• Nationwide implementation of TB infection care, prevention, diagnosis and management of
control activities at all ART centers. opportunistic Infections and linkages to care and
support services and linkage to social protection
• TB active case finding campaign among scheme.
HRGs of HIV across various districts of the
country. Facilities March-2019
ARTCenter 544
Way forward
Link ART Centers 1108
• Scaling up Provider Initiated HIV testing Care and Support Centers 310
and Counselling (PITC) across the country Center of Excellence (CoE) 11
among Presumptive TB cases and Private
PediatricCoE 07
sector TB patients.
ART Plus Center 93
• Strengthening IPT implementation PPP-ART 26
Beneficiaries March-2019 Model and Test & Treat policy. Other interventions
such as, quarterly feedback and score card have
PLHIV on ART 1292938 also facilitated in improving retention rate.
PLHIV in Preparedness Phase 31579
The major stages in retention cascade are as
PLHIV on Second Line 52192 following:
PLHIV on Third Line 2295 • Diagnosis to Registration at Treatment
CLHIV 75521 site: ICTC to ART linkage has increased
from 80% in 2013-14 to 91% in 2017-18.
24.7.1 Accomplishments and Learning There are approx. 1,52,000 HIV positive
cases diagnosed at ICTC.
A. National Technical Guidelines
• ART Initiation: The program has achieved
Standardized and uniform national technical a remarkable improvement in ART initiation
guidelines are necessary for standardizing rate from 61% in 2013-14 to 91% in 2018-19.
treatment practices and hence improving the quality There are around 1,74,667 new registrations
of HIV care across all sectors of health care in our at ART centre across the country and
country context especially when many guidelines 1,59,208 new initiations in ART at the end of
with spectrum of recommendations already exist. the reporting year.
Based on recent developments, the guidelines for
ART initiation
ART were revised. Major focus and inclusions in
the revised guidelines are as follows: 200 191 184 178 170 172
87%
91%
174 100%
180 159 90%
61% 72% 150
• Focus on National recommendations
160 66% 80%
65%
In Thousands
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Based on the recommendations, following MoU with Plan India (a civil society organization)
differentiated care strategies have been initiated: for the last mile solution for supply chain
management of all ARV drugs and testing kits.
¾¾ ulti-Month Prescription (MMP): 2
M
months dispensation was already approved The last mile solution for Supply chain mechanism
in guidelines, however due to various issues for ARVs and testing kits engages third party
the access to it was very limited. Country logistics to ensure physical delivery of the
has started 3-month dispensation for stable commodities till last facility (ICTC/ARTC). The
PLHIV since Sep-2018 in phased manner. In project envisions efficient transformation and
first phase it is limited to people who are on coordination of NACO/SACS commodity supply
TLE. App 6 lakh PLHIV are on this regimen. chain, with good data visibility, in order to ensure
consistent supply and continuous availability of
¾¾ I ntensified Adherence Counselling: As ARV drugs and Testing Kits at ART and ICTC.
more than 30% become MIS within first
3 months, it is important to counsel and
follow-up the newly initiated patients during
the first three months specially to help the
PLHIV who might have developed side-
effects due to initiation of ART. Under this
approach, now all newly initiated clients are
being actively followed up by ORW for first
three months to ensure their retention and
adherence during this critical period.
¾¾ ommunity Led ART Dispensation: The
C
ART dispensation for stable clients is now 24.7.2 Feedback Mechanism
also available at selected Care & Support
centers managed by PLHIV network as well The ART services have grown many folds since
as NGOs running TIs for KPs. Currently app its launch, through 8 ART centers in 2004 to 544.
1200 PLHIV are availing these service. These ART centers are providing free treatment to
approx. 12.73 lakh People Living with HIV/AIDS
E. End Mile Supply Chain Solution (PLHA) till date.
In order to strengthen national response to AIDS, Along with quantitative scale up, the division has
NACO with the support of Global Fund has signed been working consistently towards maintaining the
487
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quality of services provided under the programme. decided critical indicators in an individual state
To ensure this, CST division has designed a set of at a single glance to the programme managers
monitoring and evaluation (M&E) tools namely 1) at SACS. The performance under the indictors
Score Card and 2) Quarterly feedback report. are denoted by colour coding wherein green
color denotes good performance, yellow as in
a. Score Card average and red denotes the performance deficit.
The tool is developed with an intention to provide These scorecards are being sent quarterly to all
performance status of each ART center on pre- the SACS.
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prompts for timely actions, etc. In this regard, EXTERNAL QUALITY ASSURANCE (EQA):
NACO is also planning a pilot on Lo::(SVA: The EQA was set up to ensure high reliability
Self Verified Adherence) under 99 DOTS for and validity to the HIV and CD4 tests under the
PLHIV on Antiretroviral Therapy (ART) at the programme and higher levels of proficiency in the
ART centers. participating laboratories.
24.8 LABORATORY SERVICES NEQAS categorized the laboratories into four
Laboratory Services Division functions at the tiers, as follows:
cross-cutting interface of all other divisions. • Apex Laboratory (first tier) - National AIDS
It is recognised that work related to laboratory Research Institute, Pune.
services are not just confined to HIV testing,
but are overarching and have an impact on other • National level: 13 (NRLs) (second tier).
interventions including those under prevention,
care, support and treatment, STI management, blood • State level: 117 State Reference Laboratories
safety, procurement and supply chain management. (SRLs) (third tier).
Emphasis on quality assured laboratory service • Districts-level: all standalone ICTC.
delivery is important to the success of the NACP.
Universal availability and routine access to quality Thus, a complete network of laboratories has been
assured HIV related laboratory services is ensured established throughout the country. Each NRL has
in all service delivery points through this division. attached SRLs for which it has the responsibility
In NACP IV, laboratory services have been of supervision. Each SRL, in turn, has ICTC which
positioned as an independent division at the state it monitors. One Technical Officer at each SRL
level as well. is supported by funds from NACO to facilitate
supervision, training and continual quality
improvement in all SRLs and linked ICTCs.
EQA for HIV is done in two ways:
1) Panel Testing:
• The participation and performance of NRL
in FY’ 18-19 is 100%,
• The % participation and % discordance
of SRL in FY’ 18-19 is 98.7% and 0.85%
respectively,
• The % participation and % discordance of
The assurance of quality in HIV testing services ICTCs in FY’ 18-19 is 89.2% and 0.33%
through the implementation of External Quality respectively,
Assessment Scheme (EQAS) for HIV and CD4
testing has been addressed in NACP with special 2) Re-testing/ Reverse Testing:
focus. NACO launched “National External Quality In the four quarters of FY’ 18-19, the average
Assessment Scheme” (NEQAS) in the year 2000 to percentage of participation of ICTCs is 85.7 %,
assure the standard quality of the HIV tests being and average percentage of concordance is 99.9%.
performed in the programme.
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were 1157 EID centres where DBS of infants prevalence districts of Maharashtra (Mumbai,
are collected. This is being upscaled to 5266 Pune and Thane), Andhra Pradesh (East Godavari,
standalone ICTCs. From April, 2018 to March, Guntur and Krishna), Nagaland (Dimapur,
2019, total of 15,230 babies were tested and 499 Kohima, Wokha, Tuensang and Mokokchung),
babies were found confirmed positive on PCR. Mizoram (Aizwal, Champai, Lunglei) and
Manipur (Churachandpur, Thoubal, Imphal East
24.8.1 New Initiatives in Lab Services Division
and Imphal West). Out of 265 ICTCs in cluster, a
Improvement and Implementation of Quality total of 71 (AP= 18, Mumbai= 12 and Manipur= 20
Management System (QMS) at Standalone and Maharashtra = 21) ICTCs have been awarded
ICTCs in cluster districts Certificate of Excellence.
To extend the scope of QMS to ICTCs, NACO has Viral load testing
laid Quality standards and implemented a checklist
Shri J P Nadda, Union Minister of Health and
for implementation of quality in ICTCs in the
Family Welfare launched the ‘‘Viral Load testing
cluster districts of Andhra Pradesh, Maharashtra,
for all People Living with HIV/AIDS on February
Manipur, Mizoram and Nagaland.
26, 2018.
A total of 871 participants were trained from high
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The initiative will provide free of cost VL testing The document defines processes
for more than 12 lakh PLHIV on treatment in the and procedures for monitoring of
country at least once a year”. “Viral Load test is of VL testing in outsourced labs and
immense importance to monitor the effectiveness of provides list of quality indicators and
treatment of patients taking lifelong Antiretroviral monitoring checklist for assuring
Therapy”. quality of services.
NACO has introduced routine VL monitoring of • Testing has started from 8th Feb, 2018.
all patients on ART in a phased manner. Broadly
there are 2 strategies as below: • It has been planned to conduct 2,
10,000 tests in 1st year, 4, 25,000 tests
1) PPP model by engaging Metropolis started in 2nd year & 6, 80,000 tests in 3rd year.
in phased manner: since 8/2/2018
2) Scale up of in-house VL laboratories:
• The PPP (Public Private Partnership)
model engages Metropolis to test for • To strengthen country’s capacity,
VL on a turnkey basis. Metropolis NACO has procured VL machines to
is responsible for sample collection meet the demand of VL tests for more
from 525 ART Centers, VL testing and than 10 lakhs per year.
delivery of reports.
VL testing for monitoring of PLHIV on ART,
• To monitor the VL tests done NACO has developed two guidelines:
by Metropolis under PPP model
“Guidelines on NACO’s Quality (1) National Operational Guidelines for VL
Monitoring System for outsourced Testing and
VL tests’ has been developed. (2) National Guidelines for HIV-1 VL Testing.
Labs for Life Project (L4L): waste management, and air-borne infection.
The 3rd phase of the L4L project, a partnership 24.9 INFORMATION, EDUCATION
initiative between NACO, MoHFW, CDC-India & COMMUNICATION & MAIN-
and BD, started in September, 2018. The project STREAMING
focuses on the 22 ART co-located public health
laboratories in Andhra Pradesh and Maharashtra Strategic Communication plays a vital role
cluster districts which were identified in the 2nd in addressing the whole spectrum of the HIV
phase. programme from prevention, treatment to care
and support. Building on the lessons learnt, IEC
Under the 3rd phase of the project, the specific is integrated with all programme components with
objectives are the following: the objective of HIV prevention and increasing
• Training and Lab Mentorship. utilization of services communication in NACP.
• Specimen referral system/Innovative, cost- The major activities undertaken during 2018-
effective sample transportation systems. 19 under IEC, Youth & Mainstreaming are:
• Improve the access to TB diagnosis, Mass Media Campaigns: An annual media
drug resistance detection, and treatment
calendar was prepared to strategize, streamline
monitoring.
and synergise mass media campaigns with other
• Utilize multiple communication platforms to outreach activities and mid-media activities.
deliver HIV and TB information. NACO conducted 360-degree multimedia
• Develop a Centre of Excellence (CoE) form campaigns on youth & HIV &promotion of HIV
Phlebotomy, Injection safety bio-medical counselling and testing on Door-darshan, cable
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and satellite channels, All India Radio (AIR), and & Family Welfare Minister Sh. J.P Nadda on
FM radio networks. To amplify the reach of mass the occasion of World AIDS Day. The helpline
media campaigns, innovative technologies were currently operates in 12 regional languages
also utilised viz. dissemination of advertisements from 04 hubs (Hyderabad, Guwahati, Jaipur &
through cinema theatres and internet also. In Solan) in the country. 49 trained and experienced
Outdoor Advertising Awards (OAA, 2018) held counsellors keep the helpline functional 24/7.
in Mumbai on 27th -28th July, 2018, NACO has Toll Free Helpline number 1097 can be reached
bagged awards for the Youth & HIV campaign in from any mobile/landline across the country.
public &social service category. In Exchange for Information, Counselling, Referral & Feedback
Media Awards (EFM) 2019 held in February 2019 services regarding HIV/AIDS are provided to the
in Delhi, NACO bagged award for the innovation callers. Total received call volume recorded on the
in outdoor media under Youth & HIV campaign. helpline server till 31st March, 2019 is 27,12,034.
Long Format Radio and TV programmes:
NACO and SACS have been conducting various
long format programmes like phone-in and panel
discussions on HIV related issues on regional
networks of All India Radio and Door-darshan.
These live phone-in programmes are interactive
programmes that help in dissemination of
information and also address the doubts of
audience/ listeners. On 2nd December, 2018 the
Total Health Show programme on DD News was
dedicated to the theme of HIV/AIDS. During
the programme, NACO has showcased the
achievements of NACP and detailed about the
Key Milestones:
various facilities and services related to HIV/
AIDS. • “Pradhan Mantri Rashtriya Swasthya
Suraksha Mission” initiative was integrated
Outdoor Activity: Outdoor activities like
with 1097 helpline during May & June,
hoardings, bus panels, pole kiosks, information
2018.
panels, and panels in railways and metro trains
were implemented by the SACS to disseminate • An “Online Grievance Management
information on HIV prevention and related services. Redressal System” was developed and is
NACO has developed a well-coordinated plan made operational from Jan, 2019 to address
involving different agencies to avoid duplication the complaints received through the helpline.
of activities. Wall writings have been emphasised Folk-Media and IEC Vans: NACP has
in many States to maximise the reach of HIV extensively used folk media as an innovative
awareness to rural population. The National Toll tool for developing an effective communication
Free Helpline no. 1097 has also been promoted in package to reach the unreached in the remote and
all the outdoor activities. media dark areas. Folk Media has been recognized
Helpline: National Toll Free AIDS Helpline – as a powerful communication tool to reach out to
1097 is consistently operational since its launch people with social messages particularly in rural
on 01st December, 2014 by Hon’ble Union Health areas.
In order to ensure effective and efficient utilization people, help adolescents, cope with negative
of folk media to disseminate HIV/AIDS messages, peer pressure and develop positive behaviour
standardize scripts are developed by SACS in improving awareness on sexual health preventing
the regional languages. Folk troupes have been HIV infections. Program is implemented in
selected and trained on SACS/NACO vetted collaboration with NCERT. 16-hour curriculum
scripts by SACS. Folk performances are completed is taught in the schools to adolescent students of
by folk troupes in remote villages as per planned class VIII, IX and XI. Currently, the programme
route plan as decided by SACS. is functional in more than 55,000 schools in the
country.
Budgets are earmarked to 32 SACS for the State
level folk workshop and folk performances in FY
2018-19. The folk campaign is being implemented
in two phases focusing on women and youth
covering 32 States and UTs. In year 2018-19
through 7348 performance SACS have reached
more than 1.41 crore people.
Youth Interventions
Adolescence Education Programme (AEP) is
a key intervention to build life skills of young
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Red Ribbon Club (RRC) programme is a Orphan and vulnerable children (OVC) of
comprehensive promotional and preventive KP:This project is being implemented in 10
intervention to harness the potential of youth in districts of 5 States i.e. (i) Maharashtra (Mumbai,
educational institutions, specifically to mainstream Thane, Pune) (ii) Andhra Pradesh (Guntur,
HIV and AIDS prevention, care & support and Krishna, East Godavari) (iii) Manipur (Imphal
treatment, impact mitigation, stigma reduction and East &Imphal West), (iv) Nagaland (Dimapur) and
enhance VBD. (v) Mizoram (Aizawl). This project aims to follow
the case management approach for children of key
It also prepares and promotes youth peer educators population (CKP) to address the health and non-
within and outside the campuses. Currently there health needs (nutrition, education, psychosocial
are 12616 Red Ribbon clubs constituted/functional and social safety).
in colleges under the program.
Goals:
Activities undertaken by the members of RRCs
are: • To reduce vulnerability of children of KPs
by improving their access to health, social
• Observance of important events (International services and social protection schemes.
Youth Day, Rally and awareness of VBDD,
RRC competition, World AIDS Day, • To improve parental capacity to meet
National Youth Day, College fest). children’s needs.
• Community outreach and mobilisation of 24.9.1 Events
youth.
World AIDS Day: # KnowYourStatus
• Training of Peer Educators.
World AIDS Day (WAD) is observed on 1st
• Constitution of Joint Working Group December every year across the World. The
Committee (JWG) at state. observance of WAD is the commitment of the
Government in order to strengthen HIV/AIDS
response and providing care & treatment to those
infected and affected by HIV and AIDS.
Film Festival:
Epidemics like HIV/AIDS know no geographical
boundaries and as such they have to be fought
collectively by everyone. Realizing the potential
power of collaborations, NACO, MoHFW,
Govt. of India, in partnership with PEPFAR, the
American Centre and the UNAIDS hosted “Live
Life Positively:
Out of school youth (OSY) intervention aims
to sensitise school dropouts who are not covered
under AEP. It is implemented through NIOS
(learners’ engagement activities) and NYKS (state
level engagements). The program is functional in 7
states Bihar, Chhattisgarh, Meghalaya, Nagaland,
Rajasthan, Sikkim and West Bengal.
Like every year, this year also, NACO, MoHFW, Govt. of India organized a mega event in BHIM
Auditorium, Dr. Ambedkar International Centre (DAIC), Janpath, New Delhi.
The event was attended by more than 1000 people from civil society organizations, Central Govt. Hospitals,
community members, students from schools and colleges, volunteers from NYKS, HRGs & PLHIVs
representatives from NGOs, Bilateral and Multilateral Development Partners, officials from different
Government departments.
499
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A Film Festival” from December 1st – 8th, 2018, States in the late 1970s and early 80s and soon
featuring a list of films produced in India & engulfed in the entire World. The Film Festival
America, portraying humanity’s fight with an was inaugurated by Smt. Preeti Sudan, Secretary
unknown virus that showed up in the United (HFW), Govt. of India.
The objective to conduct the film festival was to The workshop had sketch, strategize, develop and
use the absolute power of cinema in spreading implement the National Communication Strategy
awareness about the HIV/AIDS epidemic by on HIV/AIDS with prototypes visualized for
bringing back some of the empowering cinematic the national program which will further lead to
portrayals which were so ahead of their times that development, pre-testing, iteration and finalization
they still fit best in the periphery of the issues faced of prototypes. The four-day co-creation workshop
by PLHIV on day to day basis such as stigma & was attended by NACO, SACS, Community
Members, Creative Experts, and Development
discrimination.
Partners to flesh out the new communication
North-East Multimedia Campaign 2018 material designing & strategies through a
consultative process.
First North-East Multi Media Campaign was
organized by NACO & hosted by Nagaland SACS The National Consultation on Dissemination of
on 18th Feb 2019, at Khuochiezie, Local Ground, Orphan and Vulnerable Children (OVC) Project
Phase-I was held under the Chairpersonship of
Kohima, Nagaland. The event indeed marked a big
Shri. Sanjeeva Kumar, AS & DG (NACO), NACO
success as the total number of audience was more
on 29th May, 2018 in Delhi.
than 10,000.
Co-creation Workshop for the development of
new communication prototypes for KP
NACO has planned to craft innovative
communication materials for this new era of
multi modal communication for better awareness,
reach adherence, societal acceptability and better
prevention on HIV/AIDS. On this noble innovative
initiative of NACO, FHI360 supported for further
development and Co-creation workshop is being
done for ideating and creating some of the best
communication prototypes. National Dissemination Meet on HIV/AIDS OVC
Social Protection Project
The workshop was successfully organized at
OVC project is dedicated to provide comprehensive
“Hotel ITC Rajputana”, Jaipur from 16th - 19th
care, support & treatment, linkages & uptake of
January, 2019. social protection to OVC.
Objectives of the workshop are:
1. To disseminate key learning’s of OVC
Project Phase I,
2. To replicate different Models of OVC project
in other States.
Representatives from various sectors like SACS,
Development Partners, Project Directors etc were
present at the workshop.
501
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The entire workshop was bifurcated in the five redressal mechanism at establishments (terms of
sessions. The major focus areas were strategies reference, manner of inquiry and disposal of cases,
to enhance identification, assessment and service confidentiality etc of Complaints Officer) (Section
delivery for all vulnerable CABA and need for 21) were notified on 17th September, 2018 by the
OVC/CABA interventions. Central Government.
24.9.2 The HIV and AIDS (Prevention and 24.9.3 Mainstreaming and Partnership
Control) Act, 2017
The Human Immunodeficiency Virus and Acquired A. Partnership with Ministries and Roll out
Immune Deficiency Syndrome Bill, 2014 was of MoUs:
passed by the Rajya Sabha on 21st March, 2017 and
NACO is collaborating with various key Ministries/
by Lok Sabha on 11th April, 2017. The bill received
Departments of Govt. of India with objective of
the Presidential assent on 20th April, 2017.
multi-pronged, multi-sectoral response which will
The Human Immunodeficiency Virus and Acquired ensure better use of available resources for risk
Immune Deficiency Syndrome (Prevention and reduction and impact mitigation of HIV. NACO
Control) Act, 2017 was notified on e-gazette on has formalized partnership with key Ministries/
21st April, 2017. Departments of Govt. of India.
The MoU was signed by Shri Ram Muivah, C. World of Work Response to HIV:
Secretary on behalf of North Eastern Council
Regional Workshop on ‘Strengthening
(NEC), Ministry of Development of North Eastern
Public and Private Sector Response in NACP
Region and Shri Sanjeeva Kumar Additional
IV’ in Chandigarh: A regional workshop
Secretary & Director General, NACO & RNTCP,
on ‘Strengthening Public and Private Sector
MoH&FW in the august presence of Dr. Jitendra
Response in NACP IV’ was organized by NACO
Singh, Hon’ble Minister, MOS (IC) M/o DoNER
in collaboration with International Labour
and Dr. InderJit Singh, Secretary, M/o DoNER,
Organization (ILO) in Chandigarh on 24th & 25th
Govt. of India.
May, 2018.
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The workshop was attended by officials from Consultation on ‘Fast Track VCT @ Work’ in
Labour Department, Construction Workers Gujarat
Welfare Board, Dattopant Thengadi Board for
World of work response to HIV is one of the
Worker Education and Development (Formerly
strategic priorities of NACP in India. NACO
known as CBWE)., Employer Organization,
through SACS in collaboration with ILO has
Confederation of Indian Industry, Enterprises
made several efforts to strengthen engagement of
like Ambuja Cement Foundation, GMR-Toll
industries of public and private sector, employer
Plaza, GMR Foundation, Helpage India, Anand
organizations and other key stakeholder to
Automotive, WIPRO, CIPLA, Morepen Labs, Sun
strengthen national response to HIV and AIDS in
Pharma, KCCI, SAFL, SACS official from eight
the world of work and to promote voluntary testing
states Punjab, Haryana Chandigarh, Himachal
among workers through campaign ‘VCT@Work’.
Pradesh, Jammu & Kashmir, Uttaranchal, Delhi
and Karnataka. To move ahead with an agenda to strengthen
‘VCT@Work’ campaign, NACO in collaboration
State specific presentations on ICTC data analysis
with ILO and Gujarat SACS were successfully
for eight States were presented by ILO and NACO.
organized consultations on ‘Fast Track VCT@
Experiences and good practice were presented
Work’ in the three priority districts of Gujarat
by selected industries like Ambuja Cement
namely Ahmedabad, Surat and Jamnagar on 11th,
Foundation, WIPRO, GMR, HelpAge India and
13th and 18th March, 2019 respectively.
state experience on industry mobilization by
SACS’ representatives.
Sessions were planned on to share experience and
strategy to reaching workers engaged in formal
and informal sector, importance of communication
in strengthening programme, briefing by network
of positive people in special reference to reduce
stigma & discrimination at the workplace.
Regional Workshop on ‘Strengthening Public
and Private Sector Response in NACP IV’ in Engagement of Industries (Public and Private
Gangtok, Sikkim Sector) in various States:
A regional workshop on ‘Strengthening Public and Regional Workshops were organized by NACO
Private Sector Response in NACP IV’ organized by in collaboration with ILO. States have taken lead
NACO in collaboration with International Labour to follow up with identified industries for their
Organization and Sikkim SACS in Gangtok, engagement in HIV/AIDS prevention activities.
Sikkim from 26th to 27th September, 2018. The The progress made in different States is listed as
two-day workshop was inaugurated by Sh. Arjun
follows:
Kumar Ghatani, Hon’ble Minister, Health & Family
Welfare, Government of Sikkim. The inaugural ¾¾ West Bengal: HIV/AIDS awareness
function was also graced by presence of Dr.Naresh programme strengthened in various
Goel, Deputy Director General, NACO; Ms. Zug industries. FICTC started in companies like
Castillo Brigitte, Senior Technical Specialist, Coal India, Damodar Valley Corporation,
International Labour Organization Geneva; Dr. Kolkata Port Trust, Haldia Dock Complex.
Pempa Tshering Bhutia, Health Principal Director, FICTC started in Coal India, DVC, KPOT
Government of Sikkim. and Haldia. Advocacy meeting is done in
private sector like L&T, Asian Leather etc. ¾¾ umbai & Maharashtra: HPCL and IOCL
M
have displayed banner at their petrol pump
¾¾ Jharkhand: Coordination established
on occasion of World AIDS Day. IOCL
with public and private sectors. CCL
sponsored ANAND Mela, a carnival for
started two ICTC centre in project hospital
CLHIV, 1074 police officials were sensitized
in mining areas (Khlari and Rajrappa).
at 22 Police Station in Mumbai. Meeting
Awareness programme started for workers
conducted with Railway Officials.
in coal mining areas. Blood donation camps
started. USHA Martin and TICF organized ¾¾ Chhattisgarh: Major industries are
awareness programme for truckers. CMPDI mobilized like JK Lakshmi Cement, Censuri
started awareness programme for daily Cement, Nalwa Steel, Kalptaru Power
wages workers. Transmission Limited, Shri Bajrang Power
& Ispat Ltd, HPCL and Transport Workers
¾¾ Bihar: 13 training sessions have been
association. Sensitization, awareness
conducted and 750 officials were
programme and HIV testing programme
participated. Advocacy and sensitization
were carried out in these industries. More
programme conducted in industries namely
than 1400 workers were tested for HIV in
COMFED-Sudha Dairy, Tirupati Transport-
industries (JK Lakshmi, Censuri Cement
Hazipur, Hasanpur Sugar Mill- Samastipur,
Nalwa Steel and KPTL). Maruti Clean
Bihar State Road Development Corporation
Coal & Power Ltd conducted HIV/AIDS
Ltd- Patna, NTPC Ltd. Barh Project- Patna,
awareness programme on WAD, voluntary
NTPC Ltd. Barh Project- Patna.
counselling and testing at dispensary. 2
¾¾ Odisha: - Follow up done with Odisha SACS. Blood donation camp were organized.
No major activity has been conducted.
¾¾ Madhya Pradesh: 5 advocacy and
¾¾ Gujarat Ahmedabad: 15 major industries sensitization programme were conducted in
are mobilized. 198 training sessions are Pithampur, Dewas, Mandideep and Gwalior
conducted by SACS as well as Industries. industrial areas. Approx. 100 industries
13000 workers are trained. 30 banners, 45 representative attended.
wall paining and 4 hoardings erected by
¾¾ Rajasthan: Sensitization and training
industries. Gujarat State Road Transport
programme was conducted. Agenda HIV/
Corporation (GSRTC) prepared flex banner,
AIDS is integrated in training module.
training programmed for drivers, conductor
Regular training programme is conducted for
Helpers were organized. Express Freight
workers engaged in metro rail project. HIV/
Consortium (TATA-Baroda) and Gayatri
AIDS sensitization programme for Transport
Consortium have adopted workplace policy,
workers, drivers and their family member
trainings were conducted. Kandla Port
were organized by Reliance Industries Ltd.,
Trust started ICTC, HIV/AIDS prevention
Jaipur.
programme conducted on the regular
basis with the support of local NGO. Wall ¾¾ Goa: HIV/AIDS sensitization programme
Painting and folk programme conducted. for Hotel Industries (Goa Tourism
Sensitization and training programme are Development Corporation) were organized
conducted for industries association and at GTDC Complex. 53 people participated
railways by Ahmedabad SACS. in the training.
505
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250 people sensitized and 27 employees tested for collaboration and partnership through sharing
HIV in the awareness drive for HPCL, MPT, GSL of data on activities carried out on HIV/AIDS
and Konkan railways. Two training programme was prevention, testing and treatment was held on 12th
conducted by Siemens. 70 workers participated and September, 2018 in New Delhi.
40 were voluntarily tested for HIV. Sensitization
programme Kadamba Transport Corporation Ltd The purpose of the meeting was to strengthen
(KTCL) was mobilized and announce 100% travel collaboration and partnership to garner support
concession to PLHIV. in reaching out to large number of people with
information on HIV/AIDS, prevention activities
¾¾ Telangana: 15 Industries are mobilized for
and services on voluntary counselling & HIV
HIV/AIDS programme. Meeting conducted
testing and Anti-Retroviral (ARV) treatment
with Dept. of Labour. Sensitization
programme was conducted for Factory and sharing of report on activities undertaken on
Inspector. 280 workers were sensitized. HIV/AIDS prevention & control by respective
Linkages developed with HIV facilities Ministries of Government of India. The meeting
and TI Migrant NGOs. IEC activities were was attended by senior officials from six ministries
carried out by industries for workers. of Govt. of India viz. Department of Internal
Security MHA, Department of Defence, Ministry
¾¾ Puducherry: Meeting was carried out for
of Labour & Employment, Ministry of Petroleum
Industries association in Karaikal region.
& Natural Gas, Ministry of Railways and Ministry
Training programme conducted for peer
of Coal.
educators in ONGC and Port Pvt. Ltd.
Sensitization programme conducted for Meeting with Department of Defence (AFMS)
20 labour contractors who are engaged in and NACO
various activities.
A meeting of NACO officials with those of the
¾¾ Tamil Nadu: HIV/AIDS awareness
AFMS was held at Office of the DG-AFMS, ‘M’
programme were conducted for industries.
Block, New Delhi on 12th Nov, 2018.The meeting
212 people sensitized in Sterlite Industries
Tuticorin, HIV/AIDS awareness drive was attended by various stake holders from the
started and 500 people reached in Tollgate AFMS and NACO departments. The objectives
(Tuticorin to Madurai) Vahikulum, Tuticorin. of the meeting were overview of partnership
Awareness programme and HIV testing were between NACO and AFMS, sharing of activities
carried out in Port Trust, Tuticorin. IEC carried out on HIV/AIDS prevention by AFMS,
activities are carried out for local van and understanding the existing facilities and services
auto drivers in Vilathikulum. 70 people were offered on counselling, testing and ART, system of
participated in the programme. capturing data and its confidentiality in the Armed
Forces and to discuss mechanisms to share data
Besides the above, efforts have been made to
with NACO/ SACS.
mobilize various industries, corporations in the
North-Eastern region. Meeting with Northern Railways Central
D. Meeting with Key Ministries on HIV/ Hospital and NACO
AIDS prevention and roll out of MoU A meeting between Northern Railways Central
Meeting with key Ministries held in NACO Hospital and NACO was held on 16 November,
2018 to understand the existing mechanism
A meeting between NACO and key Ministries/ of services offers by M/o Railways primarily
Departments of Government of India to strengthen
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The M&E officers at the state levels are managed Release of India HIV Estimation 2017
by this unit and they have been trained in two
NACO undertakes HIV estimations biennially
batched: first batch from 8th to 11th May, 2018 and
in collaboration with the Indian Council of
second batch from 4th June to 7th June, 2018 on the
Medical Research (ICMR) - National Institute of
monitoring and evaluation component of NACP Medical Statistics (NIMS). The objective of HIV
and also provided hands on training of various estimations is to provide updated information
tools for developing of state specific monitoring on the status of the HIV epidemic in India at the
and evaluation report. national and State/UT level.
Shri Sanjeeva Kumar, AS&DG (NACO & G & Chair NWG, ICMR-NIMS) and Dr. Shobini
RNTCP), MoHFW Released the ‘‘India HIV Rajan (ADG, SI, NACO) also graced the occasion.
Estimation 2017” on 14th September, 2018. The meeting was attended by representatives from
development partners, civil societies, national
Shri Alok Saxena (JS-NACO), Dr. Bilali Camara and regional institutes of surveillance as well as
(Country Director, UNAIDS India), Dr. Swaroop various SACS.
Sarkar (Director, Department of Communicable
Diseases, WHO, SEARO), Dr. DCS Reddy (Former Initiation of 16th round of HIV Sentinel
HOD, Dept. of PSM, Institute of Medical Sciences, surveillance at Central Prison site across 35
BHU), Dr Raman R. Gangakhedkar (Scientist G & States/UT in India
Head, Epidemiology and Communicable Diseases,
ICMR), Dr. Payden (Deputy WHO Representative The National HIV Sentinel Surveillance (HSS) is
to India), Dr. Ryan D. McGee (Deputy Country mainstay of second generation HIV surveillance
Director, CDC India), Dr. D K Shukla (Scientist in India. This is one of the largest HIV survey
system across the globe providing evidences on
509
CHAPTER-24
the magnitude and directions of HIV epidemic during concomitant ritonavir administration in
in various population groups and geographical HIV infected TB patients.
areas and, thus, provides inputs to programme for
strengthening prevention and control activities. • The Division started a new initiative in the form
of Brown Bag Seminar Series with the aim to
Globally, HIV interventions at correctional inform as well as build capacities and knowledge
institutions is strongly recommended with of programme managers at NACO and SACS,
‘prisoners’ identified as one of the groups at higher civil society and community, academicians and
risk of HIV infection. In this view NACO has scientists, development partners and other key
initiated HIV intervention among prison setting. stakeholders. The seminar series serves as a
In December 2017, NACO organized a national gateway for knowledge sharing, open dialogue
consultation to improve the ongoing prison HIV of information, resulting into cross-learning on
interventions. The consultation was attended by all new developments, programme management
the key stakeholders including those from Ministry and strengthening NACO’s research agenda.
of Home Affairs, Narcotics Control Bureau, World The ‘Brown Bag Seminar Series’ has been
Health Organization and United Nations Office on playing a vital role, in creating a new culture of
Drug and Crime. ‘learning something new’ and ‘broadening our
perspective’ through sharing of knowledge and
24.12 RESEARCH AND EVALUATION experiences over informal gatherings. Eight
Research & Evaluation is a vital component of SI talks were organized during the FY 2018-19.
Management. • Aligned with the mandate to build capacities
• During the FY 2018-19, 12 research studies in evidence generation, the Research &
initiated in 2017-18 are ongoing to generate Evaluation Division organised a ‘Capacity
evidence through operational research on Building Workshop on Operational Research
critical gaps in programme implementation. for Strengthening HIV/AIDS Programmatic’ in
These areas vary from survival analysis among collaboration with USAID and FHI 360 from 18
adult and paediatric, EID, HIV-HCV burden – 21 September, 2018 at Pune. The workshop
among transgenders, vulnerability assessment focused on priority research areas identified
study among select female migrant populations, for evidence generation under the national
hard to reach MSM, changing trends in sex programme. Participants from TISS, NARI,
work dynamics and use of new technology, NICED, PGIMER NIE, Population Council,
understanding sero-discordant settings etc. programme managers from NACO and SACS
attended the Workshop. The participants
• There are eight studies completed projects on worked under the guidance of mentors, experts
priority areas identified by the programme in the field of public health and HIV/AIDS
viz., functional convergence of services among research. During the workshop, six protocols
RCH and NACP for KP and for attendees at were developed on key gaps in programme
public health care facilities, biomarkers to implementation – strategies to address stigma
identify immunological and virologic failure, & discrimination, treatment literacy, risks and
service linkages between HIV and family vulnerabilities among adolescents and the
planning to improve use of dual protection youth, understanding emerging epidemics. A
among HIV positive people, prevalence of follow-up workshop on Operational Research
WHO recommended TB Symptom Screening in HIV/AIDS was organised in October, 2018
complex among patients attending ART centres, to review the status of the studies.
dose related pharmacokinetics of Rifabutin
• One Expert Committee meeting was intra-mural research projects under Project
organised this year – 18th meeting of the Review Committee on STI & HIV, Indian
TRG on Research. The TRG reviewed 18 Council of Medical Research.
agenda items including research protocols
and progress reports for technical review. ¾¾ echnical collaboration on DBT-ICMR
T
programme for integrating the treatment
• Promoting Operational Research at local cohorts through NACO and initiating
levels - This year, there was a consolidated activities for integrating with the proposed
effort to promote Operational Research at national bio-repository in this programme
SACS and involving the States in programme and enabling storage of treatment samples;
formulation, data generation, evidence, and towards the same initiating policy and
planning processes. Programme Managers funding integration; and exploration of joint
from SACS were involved in identifying studies towards common goals in socio-
priority areas, conducting operational behavioural and epidemiological research
research studies for finding localised through the platform.
solutions to programmatic gaps at state and
district levels. ¾¾ I ndo-Dutch collaborative programme
under which NACO is a scientific partner;
Synergies with other Key Stakeholders – capacity building through the PhD and
training initiatives and stakeholder from the
¾¾
Technical coordination with National perspective of implementing policies based
Surveys e.g. National Family Health Survey on programme output.
(NFHS) and National Sample Survey (NSS).
¾¾ I ndia-Africa (India-SA MRC) platform
¾¾ echnical collaboration on Indo-foreign
T through partnership in scientific areas
collaborative research proposals referred by of common interest, initiating policy
Health Ministry’s Screening Committee, and integration; and research knowledge
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NACO has initiated the Internship Programme on varied priority areas such as secondary data
in 2018 for young students who wish to engage analysis of ICTC and PPTCT programme, MSM
with the Government. The internship programme interventions, EID programme, primary research
envisages an opportunity for young students and data analysis on community perceptions on
to get familiar with and understand the various HIV/AIDS Act, 2017 and Transgender Persons
dimensions of policy making & implementation (Protection of Rights) Bill, 2018.
of the (NACP). It serves as an exposure for the
interns regarding functioning of GoI. It is mutually 24.13 DATA ANALYSIS & DISSEMINATION
beneficial for the organization as well as students UNIT (DADU)
to have a structured internship programme under Data Analysis & Dissemination Unit (DADU), a
the aegis of NACO, MoHFW. key component of Strategic Information, NACO
Till date 11 interns have successfully completed focuses on strengthening data quality, use and
their internship and have submitted project reports management, systematic analysis, synthesis,
developing standardized approaches, methods and are conducted annually. Procurement Division
tools for quality monitoring, validation and analysis does the procurement of ARV Drugs, HIV testing
of different datasets etc. It is mandated to support Kits, Blood Bags & equipment etc. Procurements
and supervise SACS to strengthen the capacity are done though procurement Agent i.e. M/s RITES
of staff at various levels particularly in analysing Limited & Central Medical Services Society
data and making better use of it in decision (CMSS) and direct contract management by
making, performing on-site data validations and NACO. M/s RITES Limited is providing services
data verification for informing policy making and to NACO as procurement agent in terms of the
programme management at all levels including contract signed between NACO and M/s RITES
field units to SACS upto Central level. Limited on 08th Oct, 2015 and further renewal from
08th Oct, 2017 to 07th Oct, 2019. Central Medical
DADU also lays emphasis on knowledge translation Services Society (CMSS) has been associated with
as an important element of policy making and NACO as a Procurement Agent since 2016.
programme management at all levels. With this
in view, DADU has initiated Round 2 of National The details of expenditure (year wise) from 2014-
Data Analysis Plan (NDAP) to analyze the huge 15 to 2018-19 are given below:
amount of data generated under the programme,
to develop analytic documents, scientific papers, Year-wise Expenditure (Exp.) during 2014-15
journal articles, etc. for publication and wider to 2018-19 (Rs. In crore)
dissemination and to provide scientific evidence Financial Year Revised Expenditure
for programme management by strengthening and Estimates
scaling up appropriate strategies. 2014-15 1,397.00 1,287.39
2015-16 1,615.00 1,605.72
24.14 PROCUREMENT
2016-17 1,753.00 1,749.12
Under the NACP, NACO provides free 2017-18 2,163.06 2,009.76
Antiretroviral (ARV) drugs to approx. 1.27 Million 2018-19 1,925.00 1,803.19
PLHIV. In addition, approx. 45 Million HIV tests
513