NATIONAL AIDS

CONTROL PROGRAMME
PRESENTED TO – MRS. SUMATHI MA’AM [ NURSING TUTOR ]
PRESENTED BY- MS. IQRA ANSAR [ BSC. HONS. 4TH YEAR
NURSING]
 INTRODUCTION
• National Aids Control Programme was launched in1987
• The ministry of heath and Family Welfare has setup
NATIONAL AIDS CONTROL ORGANIZATION
[NACO].
• The aim of the programme is to prevent further transmission
of HIV infection and to minimise the socio economic impact
resulting from HIV infection.
 The milestones of the programme
 1986 - First case of HIV detected ,
 NATIONAL AIDS COMMITTEE established under Ministry of health.
 1990- Medium term plan launched for 4 states and four metros .
 1992- NACP 1 launched to slow down the spread of HIV infection

NATIONAL AIDS CONTROL BOARD constituted , NACO setup.

 1999 – NACP 2 begins , focussing on behaviour change increased decentralization and
NGO involvement ,
And State AIDS control socities established .
2002 – National AIDS control policy.
• National Blood policy adopted adopted.

2004 – Antiretroviral treatment initiated

2006 – National council on AIDS constituted under
chairmanship of Prime Minister .
• National policy on paediatric ART formulated .
2007- NACP 3 launched for 5 years [ 2007- 2012]
2014 – NACP 4 launched for 5 years [ 2012 – 2017 ]
2017 – National strategic Plan for HIV / AIDS and STI [ 2017
-2024]
ORGANIZATIONAL
STRUCTURE
 NATIONAL RESPONSE
• Immediately, after the reporting of first case of HIV in 1986 ,
• The govt of India constituted a High power committee in 1986 only.
• Subsequently , THE NATIONAL AIDS CONTROL PROGRAMME
Was launched in 1987.
• 1986 – 1992 – DENIAL OF THE THREAT OF HIV .
• 1992 – 1999- FIRST ACCELARATION OF PROGRAMME .
• Backed by the WORLD BANK FUNDING and strong WHO
[GPA]
• i.e [GLOBAL PROGRAM ON AIDS ] support this phase the
creation of NATIONAL AIDS CONTROL ORGANIZATION
[ NACO]
THE KEY OBJECTIVES ;
1. Strengthen the management capacity of
HIV control.
2. Build the surveillance and clinical
management capacity.
3. Promote public awareness of HIV/AIDS
community support.
4. Safe and easy blood supply.
5. Control spread of sexually transmitted
disease.
 1999 - 2006 : NACP PHASE 2
• Focus on TARGETED INTERVENTIONS
• Focus on coverage amongst high risk groups like' Sex workers, truck drivers, injectable drug
users and to make program multisectoral.
• Strategies ;
A) PREVENTION ;
• 1. High risk population
 STD treatment
 Condom programming
 Multisectoral collaboration
 Public private partnership
• 2 ) Low risk population
1. Holistic IEC and social mobilization
2. Safe blood
3. Voluntary counseling and HIV testing\
4. AIDS vaccine initiative
5. Sensitizing youth
6. Workplace interventions
• B) CARE
1. Low cost care and support
2. Prevent o parent to child transmission
3. Management of HIV - TB co infection
4. Treatment of opportunistic infections
5. Piloting ART 6. Post exposure prophylaxis
• C) SURVEILLANCE

1. Evidence Based Planning

2. Annual sentinal surveillance
3.AIDS care detection
4. Mapping of high risk
5. Behavioral surveillance
 NATIONAL AIDS PREVENTION and
CONTROL POLICY, 2002
• NACP 2002, was announced with the aim of bringing aids transmission at zero level by 2007.
Strategies ;
1. Prevention of further spread;
• control of STDs.
• promotion of condom use.
2. Providing a socio economical environment to people affevted with HIV.
3. Providing improved services to people living with Aids in ( hospital setting, homes and in
community health care)
Components ;
A - Program management
B - Advocacy and social mobilization
C - surveillance, monitoring and research
D - Target interventions
E - Sexually transmitted disease control program.
F - condom promotion program
G - policy for blood safety
 NACP PHASE - 3 ( 2007- 2012)
• India 's epidemic is still at an early state and this represent a
good opportunity to prevent infection rate from rising!
• Goals ;
1. Prevention of new infection in high risk groups.
a.. Saturation of coverage of high risk groups with targeted
interventions..
b.. Scaled up interventions in general population
• 2. Increasing the proportion of people living with
HIV /AIDs who received care, support and treatment.
• 3. Strengthening the infrastructure, system and
human resources in prevention and treatment prog at
district state and national level.
• 4. Strengthening a nationwide strategic information
management system.
 Program framework ;
1. Creation of an enabling environment.
• Emphasis on enabling environment as critical to achieve its program
objectives.
• This would necessitate the review and reform of restructural constraints,
legal procedures and policies that impede interventions aimed at
marginalized population like - sex workers, IDU and MSM.
2. STRATEGIC COMMUNICATION
• The IEC strategy adopted so far would be developed towards
holistic and strategic communication.
• The scope is to foster behavior change to social mobilization.
• 3. GIPA ( Greater involvement of people living with HIV / AIDs)
Forms a strategy for all stages of program from policy formulation,
implementation and monitoring. Accessing prevention, care, support and
treatment! Stigma against HIV /AIDs.
4. Gender Inequality between men and women Boys and girls and other
identities, compounded by other forms of vulnerability such as socio economic
status, occupation, ethnicity and age.
Objectives

1. To prevent new infection

2. Care, support & treatment
3. Strengthening and capacities at district state, national level,
infrastructure system and human resources
4. Strategic information management system.
 NATIONAL AIDS CONTROL PROG - PHASE
4
• Targeted intervention for Migrants.
Migration - The census of India defines migrants as a person who has moved
from one politically defined area to another similar area.
• Guidelines ; -
People ( both male and female) who move from their place of origin in rural
areas to a town or city for work purpose irrespective of any district / state /
country.
• Return to their origin atleast once in 6 - 12 months while in work at
destination areas.
• move alone or with partners
• Returned to places of origin (at source areas) either temporarily or
permanently.
• Female spouses of returned and active migrants are at risk of HIV.
• Goal - To reduce HIV infection ratio of migrants to non migrants from 4:1 in
2010 to 1:1 in 2017.
• Objective - 1. Increase coverage of high risk migrants. ( both males and
females)
• . Increase consistent condom use.
• 3. Reduce curable STI incidence among migrant and sexual partners.
• 4. Increase HIV testing.
• 5. Enhance integration of HIV and advocacy with work place.
• Interventions priority –
• Source- strengthen response in link worker scheme district. Strengthen
integrated response Scale up in non LWS district.
• Transit –
• Scale up interventions in destination states
• Strengthen quality system in STI
• Possession of condoms at clinic and counseling session
• Strengthening of services for TB migrant settings
 Targeted interventions among Men having
sex with men (MSM)
• Among MSM, HIV prevalence is estimated at 73% more than
twenty times in general population rate.
• (Acc to NACO, 2010) Prevalence of sexually transmitted
infection too is reported high among MSM eg.. Syphilis 5.8% to
14%
• Goal - Towards zero new infection among MSM the end of
2017, and universal access to HIV prevention, care, support and
tx service for MSM.
Strategy ;
• 👉Provide support, behavior changes communication ( to promote
safer sex and access to service.)
• 👉To provide comprehensive package of service ( prevention, care,
support and tx)
• 👉To create and sustain enabling environment that promotes human
rights and access to services for MSM.
• 👉To mobilise and strengthen MSM communities to effectively
contribute to National response to HIV epidemics.
 Targeted interventions among transgenders and Hijras.
• Objective - Improve human rights situation for transgender - strengthen and promote
evidence based on transgender people.
• Services- Minimum basic /essential services package for TG - hijras are;
📎HIV counselling, testing and tx
📎STI screening and tx
📎Screening and tx for genital and anorectal problems
📎services for community based care
📎Treatment for HIV including tx for opportunistic infection ( OIS)
📎preventive services. 📎Psychosexual counseling
 Targeted interventions among Female sex
workers.
• Average HIV prevalence among FSW in India is 5% which is much higher
than in general population .
• Strategies ;
Vision - Empower female sex worker communities who respond to their need
& challenge through a comprehensive programme which builds community
institutions and achieve prevention of STI and HIV leading to an improved
sexual health..
• Specific intervention priorities. ;
👉Improving quality intervention across All TIs.
👉Active participation and sharing of responsibility by community in all levels
of decision making in TI including governance and representations.
👉Building ownership, leadership & accountability of SACS( state Aids control
society)
👉strategy to reach out hard to reach, young and trafficked women. 👉
Addressing trafficking and violence through self regulatory board with
necessary advocacy.
 Targeted Interventions for Truckers
Goal - To reduce HIV infection 2% to less than 1% among truck drivers by
2017.
Objectives-
• 👉Operationalize National network of trucker Target interventions.
• 👉 Ensure universal access to service through use of technology in line with
NACP.
• 👉 strengthen quality and info sharing among national and state level
management structure.
📎SPECIFIC INTERVENTION for IDUs;
👉Distribution of clean needle and syringes.
👉 Abscess prevention and management
👉Opioid substitution therapy
👉Linkage with detoxification / rehabilitation services
 LINK WORKER SCHEME
• It is a community based outreach strategy to address prevention & care needs of high risk group.
Objective - Reaching out to the group with
👉Information and knowledge on prevention + reduction of HIV and STI
👉 Condom promotion and distribution
👉providing referral and follow up services
👉includes counseling, testing, tx of STI.
👉 In partnership with various development partners the link worker scheme has been expanded
and being implemented in 17 states. vulnerable population.
 PACKAGES OF SERVICES
1. Prevention services –
• Targeted interventions for high risk groups..
• Needle syringe exchange program and opiod substitution therapy for IDU.
• prevention intervention for migrant pop at source, transit and destination.
• prevention and control of STI and RTI - HIV testing and counseling
• info education and communication and behavioral change communication
• social mobilization, youth intervention and adolescent education program.
• 2. Care, support and treatment
• LAb Service for CD4 testing

• First line and second line ART ( Anti retroviral therapy)

• pediatric ART for children - early infant diagnosis for HIV exposed children.
Below 18 months.
• Nutritional and psychological support through care and support centre ( csc)
• HIV/ TB coordination.
• Country scenario Classified into 3 groups;
• Group 1. : High prevalence states includes state of Maharashtra, Tamil Nadu, Karnataka,
Andhra Pradesh, Manipur and Nagaland Where HIV infection has crossed 5% mark in
high risk group and 1 % or more in antenatal women.
• Group 2 ; Moderate prevalence state includes state of Gujarat, goa and Puducherry.
Where HIV infection has crossed 5% or more among high risk grp but infection is below
1% in antenatal women.
• Group 3 ; Low prevalence states are the remaining where HIV infection in any case of
high risk group is still less than 5% and is less than 1% among antenatal women.
• Categories of districts ;
A) More than 1% ANC prevalence in district at ay time in any of sites in last 3 years..
B) less than 1% ANC prevalence in all sites during last 3 years associated with more than 5 %
prevalence in any of High risk grp ( STD/ CSW /MSM/IDU)
C) less than 1% in ANC prevalence in alk sites during last 3 years with less than 5% in all STD
clinic attendees or any high risk grp with known hotspot(migrants and truckers)
D) less than 1% in ANC prevalence in all site during last 3 years with less tahn 5% in all STD
clinic attendees or any high risk grp or poor HIV data with no known hotspot.
ANC - Antenatal clinic PTCT- Parent to child transmission
 HIV SURVEILLANCE
• Are carried out to detect the spread of disease and to make appropriate strategy for prevention and
control. i. e by area specific targeted interventions and by best practical approaches.
• Aim - is confined to monitor the trend of HIV infection
 Types –
• HIV sentinel surveillance
• HIV sero surveillance
• AIDs care surveillance STD surveillance
• Behavioral surveillance
• Integrated with other surveillance of other disease like TB
 HIV sentinel Surveillance
Objectives –
• To determine the level of HIV infection among high risk grp
• To understand the trend of HIV epidemic among general pop.
• To understand and geographical spread of HIV infection
• To provide info for prioritization of program resources and evaluating the impact To
estimate prevalence and HIV burden in country.
• It is done in same place over several years by anonymous serological testing. i. e HIV
testing is done without identification of name of samples collected for further purpose
eg.. VDRL, STD clinics.
 COUNSELING and HIV TESTING
SERVICES
• These services were started in India since 1997.
• Components –
1.) ICTC - Integrated counseling and testing centre.
2.) PPTCT - Prevention of parent to child transmission of HIV
1. ICTC Was available to increase the access to HIV diagnosis.
Includes testing services & community approaches like
( state /district/ sub district & village community level).
• Functions
1. Early detection of HIV
2. Provision of basic information on modes of transmission.
• Types of ICTC - 1.) Fixed in hospital. 2.) Mobile ICTC
• Fixed facility ICTC -Are those that are located within an existing health
care facility / hospital / centre.
Types-
1) stand alone Have a full time counsellor and laboratory who undertake
HIV counseling and testing Such facility exist in medical college and district
college.
2.) Facility integrated ICTC Which does not have full time staff and
provides HIV counseling and testing as a service along with other services
Existing staff as auxiliary nurse midwife (ANM) Laboratory technician (LT).
• 2.) Mobile ICTC A mobile ICTC can be one way of taking a package of heath services into
community.
• A mobile ICTC consisting of a team of paramedical health care providers ( a health
educator /ANM / counsellor /LT) can setup a temporary clinic with flexible working hours
in hard to reach areas where services are provided ranging from regular health checkup,
syndromic treatment of STI /RTI. And other minor ailments, antenatal care,
immunization as well as HIV counseling and testing services.
• Community based HIV screening is done by ANM at subcentre level to provide HIV testing
to all pregnant women, done to prevent transmission of HIV from parents to child.
 The essential package of PPTCT
1. Routine offer of HIV counseling & testing a pregnant women
enrolled into antenatal care.
2. Ensuring involvement of spouse & other family members,
moving from an ANC centre as " Family centric approach.
3. Provision of life long ART to pregnant and breast feeding HIV
infected women.
4. Provision of institutional deliveries of all HIV pregnant women.
5. Provision of nutrition, counseling and psychological support of
HIV infected pregnant women
6. Provision of counseling and support for initiative exclusive breastfeeds within
an hour of delivery for 6 months.
7. Provision of ARV prophylaxis to infants from birth to minimum of 6 months.
8. Integrated follow up of HIV exposed infants into health care services including
immunization.
9. Ensuring initiation of co- trimoxazole Prophylaxis therapy ( CPT)
early infant diagnosis (EID) with HIV - DNA PCR at 6 weeks of age onwards.
10. Strengthening community follow up and outcome through local community
networks to support positive pregnant women and their families.
 HIV / TB collaborative activities ;
• NACP covers HIV testing of TB patients. Combined work of
NACP and RNTCP.
• This activity is expected to detect HIV within 2-4 weeks of TB
positive. Leads to early linkage of HIV treatment and
reduction in mortality.
• HIV testing in presumptive TB cases are rolled out in India in
October 2012, in karnataka followed by Maharashtra, Andhra
Pradesh and Tamil Nadu.
Care, support and treatment(CST)
• Comprehensive service to people with HIV.
• Free universal access to life long standardized anti retroviral therapy.
• Free laboratory diagnostic and monitoring services.
• Facilitating long term retention in care.
• prevention, diagnosis and manage o infection
• linkage to care and support service and linkage to social protection
scheme.
• The country has adopted fast track target of 90 - 90 - 90 which aims at ending Aids as public
health threat by 2023 by achieving fast track target by 2020 are ;
1. 90% of PL HIV know their status.
2. 90% of PLHIV are on ART
3. 90% of PLHIV have viral suppression.
Care support and treatment are linked through Co E ( Centre of excellence) and ART Plus centres
at selected institution. While some are decentralised through Link ART centres ( LAC),
• ART centre are linked to ICTS
• STI clinics, PPTCT services and Revised National Tuberculosis Program (RNTCP) in order to
ensure management of TB- HIV co infected patients .
 MODEL OF HIV TREATMENT SERVICES
• A) Prevention.
1. Isoniazid prevention treatment
2. Air born infection control
3. Awareness generation

• B) Early detection of TB / HIV

1.100% coverage of PITC in TB patient
2. PITC in presumptive TB cases.
3. Rapid diagnostics for detection of TB in PL HIV
4. ICF activities at all HIV settings - ICTC, ART, LAC and TI settings.
• C) Prompt treatment of TB / HIV
1. Rarely initiation of ART.
2. Prompt initiation of TB tx

• D) Management of special TB/HIV cases.

1. Tb/HIV patients on PL on ARV
2. TB/HIV in children
3.TB/HIV in children, pregnant women
4.Drug resistant TB/HIV.
 SERVICES PROVIDED ;
• 1. First line ART - Free of cost to all eligible PLHIV through ART centre. Positive
cases are referred by ICTC are registered in ART centre for pre - ART and ART services.
Assessment done through clinical examination and CD 4 count. Patients are provided
counseling on treatment, nutrition and prevention.

• 2. Alternative first line ART It has been observed that small no. Of patients om First
line ART experienced Acute chronic toxicity / intolerance to first line ART drug. Presently
provision of alternative first line ART is done through Centre of excellence and ART plus
centres across country.
3. Second line ART - Began in jan 2008 at two sites - GHTM, Tambaram, Chennai and JJ
hospital.
• Patient were receiving second line drug at Co E / ART plus centre for evaluation of pt for
initiation on second line and alternative first line ART..
• A state Aids clinical Expert Panel ( SACEP) has been Constituted by DAC at all Co E and
ART plus centres.
• The panel meets once in a week for taking decisions on patients reference to them with
treatment failure or major side effect.
4. Third line ART- Some patients in second line ART also experience treatment failure.
National program rolled out third line regimen for them in 2015. Currently Raltegravir and
Darunavir are used for third line regimen.
 BLOOD SERVICES
• 👉 Only licensed blood banks are permitted to operate in country and voluntary
Blood donation is encouraged since 1st jan 1998
• Strategy
📎Ensure safe collection, processing, storage and distribution of blood and blood
products.
📎Zonal blood testing centres have been established to provide linkage with
blood banks.
📎 As per National blood safety policy, testing of every unit of blood is
mandatory for detecting infections like HIV, hepatitis etc.
 CONDOM PROMOTION
• 👉Strengthened through free distribution and social marketing channels
• Aided by an effective communication strategy.
• On the basis of HIV prevalence and family planning needs. The districts have been mapped
and classified into 4 categories.
1.High prevalence of HIV and high Fertility.
2.High prevalence of HIV and low fertility
3. low prevalence of HIV and low fertility.
4.low prevalence of HIV and high fertility.
 STD CONTROL PROGRAM
• HIV is transmitted in the presence of another STD more Easily.
• Hence early diagnosis is mandatory.
👉 Management of STD through syndromic approach by color coded KITS.
👉 Integration of services for txt of RTI and STDs at all level if halth care STD
clinics at district / first referral unit ( FRU). Provided with good quality
condoms and counseling.
• Objective ;
📎Increase demand for condoms among high risk population.
📎Maximize access of free condom.
📎Prevents the risk of STD ( NIRODH) are produced by Ministry of Healthy an
family welfare are distributed by NACO to High risk grps. through NGOs.
📎Making it available with 15 minutes of walking distance for all.
• NACO has branded the STI / RTI services as " Suraksha Clinics"!!
• Pre packed color coded kits are provided free in all states and Aids control societies..
The color codes are as follows ;
👉KIT 1 - Grey for urethral discharge and anorectal discharge.
👉 KIT 2 - Green for genital ulcers.
👉KIT 3 - white genital ulcers
👉KIT 4 - Blue genital Ulcers.
👉KIT 5 - Red genital ulcers.
👉 KIT 6- Yellow for lower abdominal pain
👉KIT 7- Black for inguinal Bubo
 INFORMATION EDUCATION &
COMMUNICATION
• Key generating awareness on prevention and motivating
access to testing.
📎Increasing knowledge among general population ( specially
youth and women) about safe sexual behavior.
📎To sustain behavior change in high risk grps.
📎To generate demand for Care, support and treatment
services.
📎To make appropriate change in social norm that ll promote
positive attitude and belief.
 ADOLESCENCE EDUCATION PROGRAM
• This is for secondary and senior secondary school,
• It educates children how to cope up with different physical and psychological
changes during growing age.
• A 16 hours session was conducted for 9 th and 11 th standard.. Implemented
in march 2014.
[A RED RIBBON CLUB]The purpose is to ensure the peer to peer messaging
HIV prevention and provide safe place for the young people to clear their
doubts regarding HIV/ AIDS. It also promote safe blood donation.
 Objectives;

📎To determine the level of HIV infection among general pop.

📎To understand the geographical spread of HIV.
📎 To provide info for prioritizing prog resources and evaluation.
📎 To estimate prevalence of HIV burden in country.
 ROLE OF NURSE ;
• 👉 PATIENT ON ANTI RETROVIRAL
THERAPY
Discuss common Treatment options.
Discuss common side effects
Discuss treatment outcomes
Administration of medicine and assess the belief about ARV therapy.
 👉 ROLE OF NURSE in STIGMA

Appropriate Universal precautions

Encourage patient to get involved in service planning.
support the patient
Peer counselling
Addressing misconception
 ROLE OF NURSE In Sexual
Health of PLHIV ;

Promote access to Routine STI screening.

Promote safe sex.
Family Planning
SUMMARY
 CONCLUSION
👉 Ist case of HIV was detected in 1986.
👉National Aids Control Program was launched in 1987.
👉National Aids control program was initiated in 1992, then it has four
phases.
👉 The aim was to reduce Aids / HIV disease.
👉 The whole program was fully funded by the central government.
• Books;
BIBLIOGRAPHY
👉Gulani kk community Health Nursing, edition 3, New Delhi Kumar Publication House
page no. (622-632).
👉J kishor 's National health programs of India, edition 10, century publications, (page no.
272 - 324).
👉 Park 's textbook of preventive and social medicine, edition 25, Bhanot publications page
no.. (465 - 472).
• Internet;
National aids control program https;//vikapedia.in/health /nrhm/national-health-programmes-
1/communicable –diseases /national –aids-control-programme.