NATIONAL AIDS CONTROL

PROGRAMME
• HIV is the Human Immunodeficiency Virus
• Leads to Acquired Immune Deficiency
Syndrome, or AIDS.
• Destroy specific blood cells, called CD4+ T
cells, which are crucial for fighting diseases.
• No cure for HIV infection.
• Currently, people can live much longer - even
decades -with HIV before they develop AIDS.
• “Highly active” combinations of medications
that were introduced in the mid 1990s.
Modes of transmission
Heterosexual 87.4

Parent to Child
5.4

others 3.3

Injecting Drug
Use
1.6

Homosexual/
Bisexual
1.3
Blood and Blood
Products
1
 Risk of transmission
ROUTE EFFICIENCY (%)
Sexual 0.01 to 1
Transfusion of blood products >90
Sharing needles/syringes 3-5
Percutaneous exposure 0.4
Mucocutaneous exposure 0.05
Mother to child transmission 25-30
 Case definition of AIDS
• ADULTS --Positive test for
HIV antibody by 2 separate
test using 2 different antigens
+
• Any one of the following
 Weight loss >10% of bw
 Chronic diarrhoea >1
month
 Chronic cough >1 month
 Disseminated ,miliary or
extrapulmonary TB
 Neurological impairment
 Esophageal candidiasis
 Kaposi sarcoma
CHILDREN—At least 2
major signs + 2 minor signs
 Major –Weight loss,Failure to
thrive,Candidiasis,Tuberculosis,
Herpes zoster
 Minor—Generalised
lymphadynopathy,Oropharynge
al candidiasis,Persistant cough
for >I month , Generalised
dermatitis, Confirmed maternal
HIV infection
 NACP
• Launched in India in 1987
• MOH has set up National Aids Control Orgzn.
(NACO) as separate wing to implement &
monitor various components of prog.
AIM:
• To prevent further transmission
• To reduce morbidity & mortality
• Minimise socio economic impact.
 Milestones of the prog.
• 1986 - first case detected
– AIDS task force set up by ICMR
– National Aids Committee established under MOH
• 1990 –Medium term plan (1990-92) launched for
4 states & 4 metros
• 1992- NACP- I(1992-99) launched to slow down
spread.
– National AIDS control board constituted
– NACO set up
• 1999- NACP- II (1999-2006) begins, focussing on
behaviour change, increased decentralization &
NGO involvement
– State AIDS control societies established
 Conti…
• 2002- National AIDS control policy adopted
– National blood policy adopted

• 2004- Anti retroviral therapy initiated

• 2006- National Council on AIDS constituted
under chairmanship of PM
– National policy on paediatric ART formulated

• 2007- NACP III launched for 5 yrs ( 2007-12)

• 2014- NACP IV launched for 5 yrs (2012-17)
 Components of national strategy:
• Establishment of surveillance centres
• Identification of high risk gr. & their screening
• Issuing spf. Guidelines for mgt. of detected cases
& their follow up
• Formulating guidelines for blood banks, blood
manufacturers, bold donors & dialysis unit.
• IEC- via., mass media
• Research for reduction of personal & social
impact of disease.
• Control of STDs
• Condom prog.
 NACP IV (2012-17)

• Goal: to halt & reverse epidemic in India over

next 5 yrs by integrating progs. For prevention,
care, support & treatment.
• Package of services NACP IV:
1. Prevention service
2. Care, support, and treatment service
 1. Prevention service
• Targeted intervention for high risk groups & bridge
population
• Needle syringe exchange prog. & opioid substitution
• Prevention intervention for migrant population at source,
transits & destination
• Link worker scheme for HRGs & vulnerable population in
rural area
• Prevention & control of STDs/RTI
• Blood safety
• HIV counselling & testing services
• Prevention of parent to child transmission
• Condom promotion
• IEC & BCC
• Social mobilization, youth interventions & adolescence
education
• Mainstream HIV/AIDS response
• Work place interventions
2. Care, support & treatment services:
• Lab services for CD4 test & others
• Free 1st & 2nd line ART through centres & link ART
centres, Centres of Excellence & ART plus centres
• Paediatric ART for children
• Early infant diagnosis for HIV exposed infants &
below 18 month babies
• Nutritional & psychosocial support through Care
& Support Centres.
• HIV/TB co-ordination
• Treatment of opportunistic infections
• Drop in centres for PLHIV networks
 KEY PRIORITIES UNDER NACP-IV ARE
• Preventing new infections by sustaining the reach of
current interventions and effectively addressing
emerging epidemics.
• Prevention of Parent to Child transmission.
• Focusing on IEC strategies for behavior change in
HRG, awareness among general population and
demand generation for HIV services.
• Providing comprehensive care, support and treatment
to eligible PLHIV.
• Reducing stigma and discrimination through Greater
involvement of PLHA(GIPA).
 Conti…
• De-centralizing rollout of services including
technical support.
• Ensuring effective use of strategic information at
all levels of programme.
• Building capacities of NGO and civil society
partners especially in states with emerging
epidemics.
• Integrating HIV services with health systems in a
phased manner
• Mainstreaming of HIV/AIDS activities with all key
central/state level Ministries/departments will be
given a high priority and resources of the
 Country scenario & classification of
States acc. to HIV PR
• Gr. I- High Prevalence states: MH, TN, KA, AP,
Manipur, NG (5% mark in HRGr & 1% in AN).
• Gr. II Moderate PR states: GJ, GA, PD (5% mark
in HRGr & <1% in AN).
• Gr III- Low PR states: remaining states.(<5%
mark in HRGr & <1% in AN)
 Classification of Dist. acc. To ANC &
PTCT
• A: More than 1% ANC/PTCT PR in 3 yrs
• B: < than 1% ANC/PTCT PR in 3 yrs
• C: < than 1% ANC in last 3 yrs with <5% in all
STD clinic attendees or HR Gs with known hot
spots.
• D: < than 1% ANC in last 3 yrs with <5% in all
STD clinic attendees or poor HIV data of HRGs
with unknown hot spots.
 Surveillance of HIV/AIDS
a) HIV sentinel surveillance
b) HIV sero-sentinel surveillance
c) AIDS case surveillance
d) STD surveillance
e) Behavioural surveillance
f) Integration of surveillance with other
diseases like TB
 Objectives of surveillance:
• To determine level of HIV inf. Among general
popu. & HRGr. In different states
• To understand trends of HIV epidemic among
general popu & HRGs.
• To understand geographical spread & to id.
emerging pockets
• To provide information for prioritization of
prog resources & its evaluation
• To estimate HIV PR & burden in country.
Counselling & HIV testing services:
• It is basic service division
• Offering services since 1997
• Goals:
To identify as many people living with HIV, as
early as possible.
To link them timely to prevention, care &
treatment services
•Stand Alone ICTC : A full-time counselor and laboratory technician on Contract Basis
•Facility Integrated ICTCs : Existing staff laboratory technician,expected to undertake HIV counseling and testing.
 Components:

(1) ICTC,

(2) PPTCT &

(3) HIV-TB collaborative activities.

 (1) ICTC
A person is counselled & tested for HIV, either client
initiated or provider initiated.
Functions:
• Early detection of HIV
• Provision of basic information on MOT,
preventive behavioural change & reducing
vulnerability
• Linking PLHIV with other HIV prevention
• Care & treatment service.
 Classification of ICTC:
1.Fixed facility ICTC- located within a hospital
a.Standalone ICTC: Fulltime counsellor, LT
b.Facility integrated: Staff from existing facility
2.Mobile ICTC: Van with a room to conduct
general exam, counselling & blood exam &
with team of paramedical staffs.
Community based HIV screening: done at SC
level to detect HIV in pregnant, by ANMs
 (2) PPTCT

• Started in 2002.

• 15000 ICTCs offer PPTCT

• Aim: HIV test for all pregnant women, So to

eliminate transmission to child.
PPTCT therapy for HIV +ve pregnant mother:
• Under NACP, in 2002, use of SD-NVP
(Singledose Nevirapine) during labour & for her
new born child immediately after birth started.
• WHO recommended MD- ARV in 2010 & India
also transitioned to ARV from Sept. 2012, in 3
High PR southern states- AP, KA, TN.
• National strategy was developed on ARV in May-
Jun 2013 & implemented nationwide in phased
manner.
• December 2013 AIDS control dept. decided to
initiate life long ART (using triple drug regimen)
for all pregnant mother & breast feeding mothers
living with HIV regardless of CD4 count or stage,
as per new WHO guideline
 Essential packages of PPTCT
• Routine offer of HIV counselling & testing to all pregnant
mothers
• Ensuring involvement of spouse & other family members-
Family centric approach.
• Provision of long term ART (TDF+3TC+EFV) to all pregnant &
breast feeding HIV women.
• Promotion of institutional deliveries of +ve.
• Provision of care for associated conditions- STDs
• Provision of nutrition, counselling & psychosocial support for
+ve Provision of counselling & support for exclusive breast
feeds within an hours of delivery as proffered option &
continue for 6 months
 Conti…
• Provision of ARV prophylaxis to infants from birth
up to 6 months
• Integrating follow up of HIV exposed infants into
routine health care
• Ensuring initiation of Co-trimoxazole prophylactic
therapy(CPT) & early infant diagnosis(EID) using
HIV-DNA PCR at 5 weeks
• Strengthening community follow up & outreach
through local community networks to support
HIV +ve women & families.
 HIV testing of TB patients:
• CFR remains 13-14% n HIV infected Tb cases.
• CFR: 4% in –ve HIV TB cases
• Detection of HIV by offering HIV test to TB
patients is being implemented by NACP &
RNTCP jointly since 2007-08.
• This is to expedite detection of HIV 2-4 weeks
of TB +vity for early treatment.
• HIV testing in presumptive TB was rolled out
in India in Oct 2012.
4 pronged strategy for HIV-Tb co-odination
 Care Support & Treatment- CST
• It is a component of NACP.
• Aim: to provide comprehensive service to PLHIV with,
o free ART,
o psychosocial support,
o prevention & treatment of OI(TB) &
o facilitating home based care &
o impact mitigation.
• It is provided through ART centres established by DAC
• These are linked to CoE & ART+ centres
• Some services are decentralized through Link ART
Centres(LAC)
As on march 2014:
• ART centres: 425
• LACs: 870
• CoE: 10
• Paediatric CoE: 7
• ART plus Centre: 37
• CSC: 224
 Services provided by centres
1. First line ART:
• Provided free of cost through ART centres
• Eligibility assessment for ART is done through c.
exam & CD4 count
• Counselling on treatment adherence, nutrition,
positive prevention & living are given.
• Follow up done by drug adherence, CD4 count
every 6 months.
• OI treatment is also provided.
• Till March 2014 7.68 L PLHIV were on FL ART.
 Conti…
2. Alternative First line ART:
• Acute/ chronic toxicity/intolerance to FL drugs
use this
• It is provided through CoE & ART + centres.
 Conti…
3. Second line ART:
• Began in January 2008
• Expanded in Jan 2009 through CoE
• Further expansion is through upgrading ART
centres to ART Plus.
• All ART centres are linked with ART plus & CoE
• State AIDS Clinical Expert Panel (SACEP)has been
constituted by DAC at all CoE & ART+ for initiation
of SL ART & Alt FL ART
• It meets once in a week to take decisions
 ART regimens
First-line Second-line

TDF + 3TC + EFV or NVP AZT + 3TC + LPV/r or ATV/r

AZT + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r

d4T + 3TC + EFV or NVP TDF + 3TC + LPV/r or ATV/r

• TDF: Tenofovir
• TC: Lamivudine (3TC, Epivir)
• EFV: Efavirenz
• NVP: Nevirapine
• AZT: Zidovudine
• LPV/r: Lopinavir/Ritonavir
• ATV/r: Atazanavir + ritonavir
• d4T:stavudine
National paediatric HIV/AIDS initiative:
• Launched on 30 Nov 2006.
• Till Mar 2014, 106824 children living with
HIV(CLHIV) were registered
• 42015 were receiving free ART
• Paediatric formula drugs are available at ART
centres
• Services: paediatric FL ART, Paediatric SL ART.
• Early Infant Diagnosis(EID): Launched by DAC &
all diagnosed children are linked to ART services.
 Target intervention for HR Gr.
Main objective of TI:
• To improve health seeking behaviour of HRG
• Reduce their risk of acquiring STI & HIV
High risk Gr:
• FSW
• MSM
• TG
• IDU
• Bridge populations- migrants & truck drivers
 Service offered through TI:
• Detection & treatment of STI
• Condom distribution
• Condom promotion
• BCC
• Community involvement & participation
• Linkages to ICTC
• Linkages with CST for +ve cases
• Community organization & ownership building
• Spf. Interventions for IDU-: clean needle & syringe
distribution, abscess prevention & mgt, opioid
substitution therapy, Linkage with rehabilitation centres
• Spf. Interventions for MSM/TG-: provision of lubricants,
provision of project based STI clinics
 • Link work scheme:
• Community based out reach strategy.
• To prevention & care needs of HRGs.
• Objectives:
 Reaching out to this Gr. With information on
prevention & risk reduction.
 Condom promotion
 Referral linkages
 Counselling
 Testing STI
 Creating enabling environment to PLHIV & families
 Reduce social stigma
 Blood transfusion services
• Testing of every blood is mandatory for HIV,
Hep B,C, malaria & syphilis
• NACO is supporting, enhancing awareness of
safe blood & equipment supply.
 Condom promotion
• Free distribution & social marketing
• Non traditional outlet
• Female condom.
 IEC
• To increase knowledge among general
population- women & youth
• Sustain behaviour change in HRG
• Generate demand on CST
• Make changes in social norms.
• Other:
(1)Adolescent education prog.
(2) Red ribbon clubs.