National AIDS Control Program

introduction  According to the HIV Estimations 2012,the estimated number of people living with HIV/AIDS in India was lakh in  The adult (15-49 age-group)HIV prevalence at national level has continued its steady decline from estimated level of 0.41% in 2001 to 0.27% in But still, India is estimated to have the third highest number of estimated people living with HIV/AIDS, after South Africa and Nigeria (UNAIDS Report on the Global AIDS epidemic 2010).

Milestone  1986 : first case of HIV detected, AIDS task force set by ICMR.  1990 : medium term plan launched for 4 states & 4 metro  1992 : NACP 1 launched & NACB constituted.  1999 : NACP 2 begins, SACS established  2002 : NACP adopted.  2004 : ARV Treatment started.  2007 : NACP 3 launched for 5 years.  2012 :NACP 4 launched for next 5 year.

Current epidemiology of HIV/AIDS  The PLHIV in India is estimated at around 20.9 lakh in  Children <15 years of age account for 7% (1.45 lakh) of all infections; while 86% are in the age-group of years.  Of all HIV infections, 39% (8.16 lakh) are among women.  declining trend from 23.2 lakh in 2006 to 20.9 lakh in  The four high prevalence States of South India (Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu) account for 53% of all HIV infected population in the country.  India is estimated to have around 1.16 lakh annual new HIV infections among adults and around 14,500 new HIV infections among children in  the previously high HIV prevalence States of Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland account for 31% of new infections, whereas, some low prevalence States (Odisha, Jharkhand, Bihar, Uttar Pradesh, West Bengal, Gujarat, Chhattisgarh, Rajasthan, Punjab & Uttarakhand) together account for around 57% of new infections.

Key Strategies under NACP-IV  Intensifying and consolidating prevention services, with a focus on HRGs and vulnerable population.  Increasing access and promoting comprehensive care, support and treatment  Expanding IEC services for general population and high risk groups with a focus on behaviour change and demand generation.  Building capacities at national, state, district and facility levels  Strengthening Strategic Information Management system

New Initiatives under NACP-IV  Differential strategies for districts based on data triangulation with due weightage to vulnerabilities  Scale up of programmes to target key vulnerabilities  Scale-up of Opioid Substitution Therapy for IDUs  Scale-up and Strengthening of Migrant Interventions at Source, Transit & Destinations  Female Condom Programme  Multi-Drug Regimen for PPTCT in keeping with international protocols  Social protection for marginalised populations through earmarking budgets for HIV among concerned government departments  Establishment of Metro Blood Banks and Plasma Fractionation Centre  Demand promotion strategies specially using midmedia, e.g. National Folk Media Campaign & Red  Ribbon Express and buses (in convergence with NRHM)  Scale up of Second Line ART

Package of services provided under NACP-IV Preventive services  Targeted Interventions for High Risk Groups  Needle-Syringe Exchange Programme and Opioid Substitution Therapy for IDUs  Prevention Interventions for Migrant population at source, transit and destination  Link Worker Scheme for HRGs and vulnerable population in rural areas  Prevention & Control of STI/RTI  Blood Safety  HIV Counseling & Testing Services  Prevention of Parent to Child Transmission  Condom promotion  Information, Education & Communication, and Behaviour Change Communication. Care,support &treatment  Laboratory services for CD4 Testing and other investigations  Free First line & second line Anti- Retroviral Treatment through ART centres and Link ART Centres, ART Plus centres.  Pediatric ART for children  Early Infant Diagnosis for HIV exposed infants and children below 18 months  Nutritional and Psycho-social support through Community Care Centres (CCC)  HIV-TB Coordination (Cross- referral, detection and treatment of co-infections)  Treatment of Opportunistic Infections  Drop-in Centres for PLHIV networks

TARGETED INTERVENTION  Key risk groups covered under the Targeted Intervention programme Core High Risk Groups  Female Sex Workers  Men who have Sex with Men  Transgenders & Hijras  Injecting Drug Users & their spouses Bridge Populations  Long Distance Truckers  High Risk Migrants

Services offered under the Targeted Intervention Programme  Detection and treatment for Sexually Transmitted Infections (STIs)  Condom distribution  Condom promotion through social marketing  Behaviour change communication  Creating an enabling environment with community involvement and participation  Linkage to Integrated Counseling and Testing Centres  Linkage with care and support services for HIV positive HRGs  Community organisation and ownership building  Specific Interventions for IDUs  Specific Interventions for MSM / TGs  Specific Interventions for FSWs

LINK WORKER SCHEME  Convergence with NACO  Convergence with health department  Convergence with non health & social protection department

Management of STD/RTI Provision of RTI/STI in high risk group population includes:  Free consultation and treatment for their symptomatic STI complaints  Quarterly medical check-up  Asymptomatic treatment (presumptive treatment)  Bi-annual syphilis and HIV screening

Condom promotion

Blood Safety  Increasing regular voluntary non-remunerated blood donation to meet the safe blood requirements of safe blood in the country  Promoting component preparation and availability along with rational use of blood in health care facilities and building capacity of health care providers to achieve this objective  Enhancing blood access through a well networked  regionally coordinated blood transfusion services  Establishing Quality Management Systems to ensure Safe and quality Blood  Building implementation structures and referral linkages

BASIC SERVICES Integrated counseling & testing center PPTCT Mother baby pair coverage Counseling & testing of HRGs & STI clinic attendee HIV testing of presumptive cases Intensified TB case finding at ART centre Treatment of TB/HIV cases

ICTC & ITS LINKAGE

Care support & treatment  ART center  link ART center  link ART plus center  center of excellence  ART plus center  community care center  Pediatric center of excellence  pediatric second line ART  Early infant diagnosis

LINKAGE FOR CARE SUPPORT & TREATMENT Home care Tertiary Health Care Integrated Counselling Testing The entry point Secondary Health Care Community Care Centres PLH A District Hospitals HIV Clinics Specialised Care facilities ART Centres Link ART CENTRES Primary Health Care NGO & Peer Groups

IEC & Mainstreaming  Mass media campaign  Long formal radio or TV program  Red ribbon express project  Advertisement through newspaper  Hoarding  Folk media Mainstreaming activities Inter Ministerial conference Training of frontline worker Greater involvement of PLHIV Social protection

capacity building  In order to provide uniform, quality training to different categories of staff working with NGOs/CBOs, like program managers, counsellors, finance accountants, outreach workers, peer educators and link workers, NACO has institutionalized the training and capacity building process with the establishment of the State Training and Resource Centres (STRC).  STRCs function with the objectives of -  1) ensuring need based training of TIs as per NACP III’s technical and operational guidelines;  2) enhancing the capacity of NGOs and civil society organizations in proposal development for NACP funded targeted intervention projects;  3) undertaking operational research and evaluation of TIs.  STRCs have been established in 14 states and 6 more are being established. Training modules for programme managers have been developed and modules for rest of project staff are in process

Monitoring & evaluation HIV sentinel surveillance system: Information gathered through HIV sentinel surveillance, AIDS case surveillance and STD surveillance helps in tracking the epidemic and provides the direction to the programme. A nationwide computerised management information system (CMIS) provides programme monitoring and evaluation.  Strategic Information Management Unit (SIMU) To maximize effective use of all available information and implement evidence based planning, to address strategic planning, monitoring and evaluation, surveillance and research. SIMU assists NACP in tracking the epidemic and the effectiveness of the response and help assess how well NACO, SACS and all partner organizations are fulfilling their commitment to meet agreed objectives. NACP envisages a robust Strategic Information Management System (SIMS) which focuses on programme monitoring, evaluation and surveillance, and knowledge gathering.