SEMINAR ON NATIONAL AIDS CONTROL PROGRAMME

"I will cause deadly disease which is easier to prevent than to cure" HIV.

At the end of 2010, an estimated 34 million people [31.6 million – 35.2 million] were living with HIV worldwide

• Avoidable • Incurable • Disease • Syndrome .

AIDS/HIV In India At the beginning of 1986.000 reported AIDS cases worldwide. despite over 20. India had no reported cases of HIV or AIDS .

and a lack of capacity to test and store blood would severely hinder the ability of the Government to control AIDS if the disease did become widespread. In addition. research facilities.• “Unlike developed countries. India lacks the scientific laboratories. widespread poverty and malnutrition. equipment.” . factors such as cultural taboos against discussion of sexual practices. poor coordination between local health authorities and their communities. and medical personnel to deal with an AIDS epidemic.

• Dr Jacob John and Dr Suniti Solomon identified 10 HIV positive samples out of a group of 102 female sex workers from Chennai.AIDS/HIV In India….. .

Nagaland.AIDS/HIV In India…. Andhra Pradesh. . Manipur.. Maharashtra. Karnataka and Tamil Nadu.

the sex work-driven epidemic of the south of India.. • HIV epidemic has played out in various forms drug use-driven epidemic of the North East seen in Manipur and Nagaland.AIDS/HIV In India…. .

UNAIDS and NACO – 2 million -3. which equates to a prevalence of 0.6 million  In 2007.3% .Current Scenario-India In 2006 UNAIDS -5.1 million people living with HIV In 2008 -2.2.4 million people were living with HIV in India.31 million In 2009 .

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NATIONAL AIDS CONTROL PROGRAMME ( NAPC) • 1987 • AIM  To prevent the further transmission of HIV  To decrease the morbidity and mortality  To minimize the socioeconomic impact resulting from HIV infection .

MILESTONES • 1986 • 1990 • 1992 • 1999 • 2002 • 2004 • 2006 • 2007 .

• Issuing specific guidelines for management of detected cases and their follow-up .THE COMPONENTS OF NATIONAL STRATEGY • Establishment of surveillance centers • Identification of high-risk group and their screening.

THE COMPONENTS OF NATIONAL STRATEGY…… • Formulating guidelines for blood bank. • Condom programme. • Information education and communication activities • Control of sexually transmitted disease. blood donors and dialysis units. blood products manufacturers. .

1999) slow the spread of HIV to reduce future morbidity.National AIDS Control Programme Phase I and II • Phase-I (1992 . mortality.2006) reducing spread of HIV infection in India and strengthen India's capacity to respond to HIV epidemic on long term basis. • Phase-II (1999 . . and the impact of AIDS by initiating a major effort in the prevention of HIV transmission.

(This first phase was extended to 1999 when it was realized in 1997 that barely half of earmarked funds had been utilized.National AIDS Control Programme Phase I • Strategic Plan for Prevention and Control of AIDS in India was developed for the period 1992-97.) . later described as the first phase of the NACP.

2 million from WHO.5 million from the government of India. .2 million. • The National AIDS Control Organization (NACO) was established in June 1992 under the Department of Health for implementation of the programme.National AIDS Control Programme Phase I…… • The final estimated cost of NACP-I was US$27. $2. and IDA credit of $84.

• treatment for sexually transmitted diseases and limited treatment for AIDSrelated conditions. • a system to monitor the prevalence of HIV.Services of NACP-I • education campaigns. • condom promotion. • Two components were added later: targetted interventions and ―intersectoral collaboration‖ . • protection of the blood supply.

UN agencies as well as other international donors provided funding as well as technical assistance.1999-2007 • In November 1999. • The final outlay from all sources was about Rs 2.NACP-II .000 crore (see table). NACP-II was launched with financial credit support from the World Bank of US$ 191 million. .

1999-2007… • While the World Bank and DFID are the major donors.NACP-II . have become increasingly important donors since 2004. . TB and Malaria. the Bill and Melinda Gates Foundation and the Global Fund for AIDS.

81 6.74 487.4 2 3 4 5 6 7 8 GOI World Bank USAID CIDA UNDP AusAID Global Fund DFID 9 .65 122.47 24. 1 Amount (in Rs crore) 196 959 230. Donor/agency N o .Source of funding for NACP-II S .58 37.

blood banks were required to test all donated blood for Hepatitis C and an external quality assurance system for HIV testing was set up .NACP-II…components…. • The targeted intervention • Voluntary counseling and testing centres (VCTCs) • In addition to testing for HIV.

• The Programme for Prevention of Mother (later Parent) to Child Transmission (PPTCT) of HIV • Surveillance of the HIV epidemic was upgraded during NACP-II • Treatment and prophylaxis for opportunistic infections .NACP-II…components….

000 patients were receiving first line antiretroviral drugs from 107 ART centres throughout the country • The NACP II institutionalized the use of the society model for the programme at the state level .NACP-II…components… • The antiretroviral therapy (ART) programme started in April 2004 in the high prevalence states. By December 2006. about 56.

• Recognizing the need of care and support for people living with HIV and AIDS and scaling up of Community Care Centers. .Significant Achievements of NACP-I &II • Scaling up PMTCT and VCCTC services especially in the high prevalence states. • Increasing access to free ARV is one of the major achievements of NACP-II.

• Initiating the process for developing draft legislation on HIV and AIDS.Significant Achievements of NACP-I &II…. chaired by the Prime Minister. • Focus has shifted from raising awareness to behavior change.. • The National AIDS Prevention and Control Policy and the National Council on AIDS (NCA). provide policy guidelines and political leadership to the response. . from a national response to a decentralized response and an increasing engagement of NGOs and networks of people living with HIV/AIDS.

Lesson learnt from Phase I &II • The epidemic continues to progress with the following characteristics – High risk groups to low risk groups – Urban to rural areas – High prevalence states to all states – High vulnerability of young persons and women • MSM and IUDs have not received appropriate attention • Growing number of people living with HIV/AIDS has increased the need for care . support and treatment .

NACP-III: 2007-2012 •GOAL Reverse the epidemic in India over the next 5 years .

NACP-III: 2007-2012 GOAL…. . prevention of new infection in high risk groups and general population through: • Saturation of coverage of high risk group with targeted achievements. 1.Providing greater care . support and treatment to a large number of people living with HIV/AIDS. • Scaled up interventions in the general population. 2.

4.Strengthening the infrastructure . Strengthening a nation-wide Strategic Information Management System . and treatment programmes at the district. system and human resources in prevention. 3.NACP-III: 2007-2012 GOAL…. care . state and national level. support. .

Guiding principles .

. • Equity is to be monitored by relevant indicators in both prevention and impact mitigation strategies • Respect for the rights of people living with HIV/AIDS (PLHA). one National HIV/AIDS Coordinating Authority and one Agreed National Monitoring and Evaluation System. . one Agreed Action Framework.e.Guiding principles… • The unifying credo of Three Ones. i.

• Creation of an enabling environment wherein those infected and affected by HIV can lead a life of dignity.Guiding principles… • Civil society representation and participation in the planning and implementation of NACP-III is essential for promoting social ownership and community involvement. . This is the cornerstone of all interventions.

Guiding principles… • Provide universal access to HIV prevention. commitment and continuity . support and treatment services. the HRD strategy of NACO and SACS is based on qualification. competence. care. • For making the implementation mechanism more responsive. proactive and dynamic.

Providing greater care. Strengthening a nation wide strategic information .support.treatment 3.STRATEGY Of NACP-III: 2007-2012 1. Prevention of new infection in high risk groups 2. Strengthening the infra structure and human resources 4.

1)PreventIion of new infections • Saturation of coverage of high risk group through targeted interventions..STRATEGY Of NACP-III: 20072012. • Scaling up interventions among general population. .

. Care and Treatment • Essential elements of targeted interventions are: – Access to behavior change communication – Prevention services ( condoms. • Targeted Interventions for Prevention.Saturation of coverage of high risk group through targeted interventions. drug substitution for IDU – Creation of enabling environment at project sites. STI services. needles and syringes – Treatment services( STI services.

Scaling up interventions among general population
• i) women • ii)Youth and HIV/AIDS • iii) Adults and STD Control Program

• 2)Care, support and treatment • Improved treatment access for opportunistic infections and continuation of care. • Children affected and infected by HIV • Integration of prevention with care, support and treatment. • Community care and support programs • Collaboration with PLHA network • Impact mitigation and linking it with livelihood support. • Improving access to ART for PLHA, Children, quality of services

Criteria for ART
• CD4 (cell /mm3) Actions
• < 200 Treat irrespective of clinical stage • 200 – 350 Offer ART for symptomatic patients Initiate Rx before CD4 drop below 200 cells/mm3 For Asymptomatic people * • >350 Defer treatment in asymptomatic persons * If CD4 is between 200-250, this should be repeated in 4 weeks and treatment to be considered in asymptomatic patients.

systems and human resources • State AIDS control societies • District AIDS prevention and control units • Strengthening of the National AIDS control organization – Capacity building – Sustained technical training support to public and private agencies – Mainstreaming HIV and partnership development – Convergence with RCH. TB and MoHFW • Coordination and partnership with donors .3)Strengthen the infrastructure.

4)Strengthening strategic information systems (SIMS )… • One nationwide strategic information system – Strengthening the computerised management system (CMIS) and making it more appropriate and userfriendly – Developing community friendly information systems – Developing indicators for the state plans and instiutitonal arrangement for collecting. analyzing and monitoring progress – Hardware and software procurements .

support and treatment Collaborations decentralization Mainstreaming Surveillance Monitoring and evaluation • • • • • • • • .Programme Components Of NACPIII • • • • Targeted interventions Voluntary counseling and testing PPTCT program Universal precautions and Post exposure prophylaxis Blood safety Improved access to quality condoms Care.

Targeted interventions core transmitter bridge populations information promoting condom use and making condoms available and referring to treatment centres for STDs when needed .

needle exchange. abscess management to IDUs. substitution therapy. and lubricants and appropriate condoms to MSM. women account for around one million out of 2.Targeted interventions… TIs are meant to provide detoxification.5 million estimated number of people living with HIV/AIDS . deaddiction and rehabilitation.

VCTCs are merged with treatment facilities such as antenatal services and tuberculosis treatment centres. and renamed Integrated Counselling and Testing Centres (ICTC). .Voluntary counseling and testing • NACP-III aims to provide counseling and testing to 22 million people by 2012. Under NACP-III.

to reduce the chances of HIV transmission from mother to child. .PPTCT Program • The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme was started in the country in the year 2002 • Women who are HIV-positive are offered a dose of the antiretroviral drug Nevirapine during labour and their child is given a dose immediately after birth.

5 % .Blood safety • The specific objective of the blood safety programme is to ensure reduction in the transfusion associated with HIV transmission to 0.

blood components and products .NACO -bridge the gap in the availability and improve quality of blood under NACP-III – Raise voluntary blood donation to 90 percent – Establish blood storage centres in Community Health Centres – Expand external quality assessment services for blood screening – Quality management in blood transfusion services – Sensitise clinicians on optimum use of blood.

– Add 39 blood banks in districts that do not have blood transfusion facility – Establish blood storage centres in 3222 community care centres – Provide refrigerated vans in 500 districts for networking with blood storage centres. – Establish additional model blood banks in 22 states.NACO -bridge the gap…. 10 are functional already .

NACO -bridge the gap…. – Set up additional Blood Component Separation Units (BCSU) in 80 tertiary care hospitals and separate at least 50 percent of the collection at all BCSUs (162) into components – Promote autologous blood donation – Liaise with Indian Red Cross Society and Ministry of Youth Affairs and Sports to promote voluntary blood donation among the youth – Set up 32 model blood banks in various states .

NACO -bridge the gap…. – Establish one additional plasma fractionation facility in the country – Establish four Centres of Excellence in blood transfusion services in the four metros in order to cater to any region of the country in time of a crisis – Introduce accreditation of blood banks . – Liaise with the Indian Medical Council (IMC) to mandate the requirement of a department of transfusion medicine in all medical colleges and appropriate transfusion practices in the syllabus of MD/MS clinical subjects.

. HCV).Post exposure prophylaxis • Post exposure prophylaxis (PEP) refers to comprehensive medical management to minimise the risk of infection among Health Care Personnel (HCP) following potential exposure to blood-borne pathogens (HIV. HBV.

25 million in 2006) by 2010. and in areas where sex is solicited.Condom promotion • NACP III aims to distribute 3. . through social marketing at targeted interventions.5 billion condoms every year (up from 2. distributing them at STI/RTI clinics. and through commercial sales via condom vending machines at unconventional sales outlets such as post offices and rural banks.

reaching those who are at the highest risk of acquiring or transmitting HIV. – Increase the number of free condoms distributed through STI and STD clinics. .Condom promotion… – Increase condom use during sex with non-regular partner. – Increase the number of condoms distributed by social marketing programmes. which is the key to limiting HIV spread through sexual route.

in strategically located hotspots of solicitation.g. .. e. lodges. paan shops.Condom promotion… – Increase the number of nontraditional outlets for socially marketed condoms. etc.

Care. and first-line antiretroviral drugs to those adults and children who qualify according to its medical criteria .support and treatment • treatment for opportunistic infections (such as TB and fungal infections).

networks of people living with HIV/AIDS and government departments to integrate HIV prevention into their activities. youth groups. community care centres providing medical and social support. women’s groups.Collaborations • NGOs that provide nutrition and other welfare services. . private sector. civil society organisations. trade unions.

DECENTRALIZATION • State AIDS Control Societies SACS • District AIDS Prevention and Control Units (DAPCU • Adolescent Education Programme. monitoring • evaluation and mainstreaming . supportive supervision of TIs.

the National Council on AIDS (NCA) headed by the Prime Minister of India has been constituted.Mainstreaming • In order to facilitate a strong multisectoral response to HIV/ AIDS. which held its first meeting in February 2006. .

behavioural sentinel surveillance and STD surveillance helps in tracking the epidemic and provides the direction to the programme. AIDS case surveillance. .Surveillance • Information gathered through HIV sentinel surveillance.

in its third HIV/AIDS programme introduced Strategic information management system(SIMS) .Monitoring and evaluation • NACO.

PROGRAMME PRIORITIES  Considering 99% free from infectionPreventure efforts  HIGHEST PRIORITY.High risk population  All persons who need treatment(ART)  Prevention of parent to child transmission  Care and support  Community care centres  Work with other agencies  Migrants & Populations in Cross-border Areas .

KEY ACHIEVEMENTS UNDER NACP .

the government of India approved the National AIDS prevention and control policy OBJECTIVE • Reduction of the impact of epidemic and bring about a zero transmission by the year 2007.NATIONAL AIDS PREVENTION AND CONTROL POLICY INTRODUCTION • In April 2002 . .

COMPONENTS OF NAC POLICY • a) BLOOD SAFETY PROGRAMME .

b) HIV TESTING AND COUNSELLING .

c)STD CONTROL PROGRAMME Syndromic approach Integrate treatment of RTIs & STDs .

HIV SURVEILLANCE OBJECTIVE • To identify trends of seropositivity in specific high risk groups & low risk groups .

TARGETTED INTERVENTIONS • Behaviour change • Communication • Treatment of STD • Creating an environment that facilitate behaviour changes .

and (f) Integration with surveillance of other diseases like tuberculosis etc . (e) Behavioural Surveillance. • • • • • • (a) HIV Sentinel Surveillance. '(d) STD Surveillance. (c) AIDS Case Surveillance. (b) HIV Sero—Surveillance.HIV SURVEILLANCE….

SCHOOL AIDS EDUCATION PROGRAMME • Learning for life • University talk AIDS project .

To promote desirable practice such as use of condom 3.INFORMATION EDUCATION COMMUNICATION SOCIAL MOBILISATION • OBJECTIVES 1. To raise awareness 2. To create a supportive environment for care of persons with HIV .

To raise awareness • 2.RED RIBBON EXPRESS PROJECT : • 1. To promote desirable practice such as use of condom • 3. To create a supportive environment for care of persons with HIV .

electronic media.TV spots • . field publicity • Massive media campaign• .film cilpings • . press campaign.Awareness campaign through multimedia • Awareness campaign through multimedia • Print media.posters • .cinema slides .

Red Ribbon Clubs (RRCs) .

To raise awareness in rural & slum areas -To facilitate early detection and prompt teratment .FAMILY HEALTH AWARENESS CAMPAIGN (FHAC • Period:15 days • OBJECTIVES .

• LINK WORKER SCHEME • ANTI-RETROVIRAL TREATMENT • HIV and TB • POST-EXPOSURE PROPHYLAXIS FOR HEALTH CARE WORKERS : • NATIONAL AIDS TELEPHONE HELPLINE .

INTEGRATED COUNSELLING& TESTING CENTERS .

PREVENTION OF PARENT TO CHILD TRANSMISSION .

NATIONAL PAEDIATRIC AIDS INITIATIVES .

• 2011-2015 Theme • "getting to zero –zero new HIV Infections" .World AIDS DAY • DEC-1.

The Kerala State AIDS Control Society (KSACS) • Jyothis Centres .

Jyothis Centres… .

Jyothis Centres… .

Prathyasa Centres .

Targeted Intervention (Suraksha) Programme .

Pulari'.Sexually Transmitted Infections (STI) testing and treatment services for everyone .

Pulari… .

USHUS.Free Anti Retroviral Treatment (ART) for HIV Positives .

USHUS… .

Tele-counseling .

community Care Center (CCC) for People living with HIV/AIDS (PLHA)

ROLE OF COMMUNITY HEALTH NURSE IN IMPLEMENTING NACP

conclusion