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Vulnerable population
Women having
sex with casual
partners
Spouses of high risk
groups
Classification of
states
GROUP I:HIGH PREVALENCE STATES
Prevalence more than 5% in HRG and 1% or
more in ANC.
Maharashtra, Tamilnadu, Karnataka, Andhra
Pradesh, Manipur and Nagaland
GROUP II:MODERATE PREVALENCE
Prevalence 5% or more among HRG but
below 1% in ANC
Gujarat, Goa, Puducherry
GROUP III:LOW PREVALENCE STATES
Prevalence less than 5% in any HRG and less
than 1% in ANC
Classification of districts
CATEGORY A:
More than 1% ANC/PPTCT prevalence in district in any of the sites in the last 3 years.
156 distracts
CATEGORY B:
Less than 1% ANC/PPTCT prevalence in all the sites during last 3 years with more than 5%
prevalence in any HRG site (STD/FSW/MSM/IDU)
39districts
CATEGORY C:
Less than 1% ANC/PPTCT prevalence in all sites during last 3 years with less than 5% in all HRG
sites,
with known hot spots (Migrants, truckers, large aggregation of factory workers, tourist etc.,)
296 districts
CATEGORY D:
Less than 1% ANC prevalence in all sites during last 3 years with less than 5% in all HRG sites with
no known hot spots OR no or poor HIV data
118 districts
Routes of
transmission
NACP I(1992 to
1999)
• OBJECTIVES: To slow down and prevent the spread of HIV transmission through a major effect to
prevent HIV transmission
• KEY STRATEGIES:
Focus on raising awareness, Blood safety, Prevention among high risk populations,
Improving surveillance
• ACHIEVEMENTS:
National aids response structure at national and state level and provided critical
financing
Strong partnership with WHO and later helped mobilize additional donor resources
Established the state AIDS control cell
Improved blood safety
Expanded sentinel surveillance and improved coverage and reliability of data
Improved condom promotion activities
National HIV testing policy
NACP II(1999 –
OBJECTIVE
2007)
Reduce the spread of HIV infection in India through behavior change and
increase capacity to respond to HIV on a long-term basis.
KEY STRATEGIES
Halt and reverse the epidemic by integrating programmes for prevention, care,
support and treatment
OBJECTIVES
Provide comprehensive care and support to all persons living with HIV/AIDS and
treatment services for all those who require it
Intensify and
consolidate
prevention
services Promoting
comprehensiv
Strengthenin e care,support
g SIMS treatment
Key
strategie
s under
NACP IV
Capacity Expanding
IEC services
building
A. INTENSIFYING AND CONSOLIDATING PREVENTION SERVICES,
WITH A FOCUS ON HIGH RISK GROUPS AND VULNERABLE
POPULATION
Activities
Scale up ART centres, Linked ART centres, Centres of Excellence ART services
Comprehensive care and support services for PLHIV through proper linkages
Provide guidelines and training for integration in health care settings to NRHM
staffs
C. EXPANDING IEC SERVICES FOR (A) GENERAL POPULATION AND (B) HIGH RISK
GROUPS WITH A FOCUS ON BEHAVIOUR CHANGE AND DEMAND GENERATION
Programme planning and management responsibilities will be enhanced at national, state, district
and facility levels to ensure high quality, timely and effective implementation and supervision of
field level activities to achieve desired outcomes
The planning processes and systems will be further strengthened to ensure that the annual
action plans are based on evidence, local priorities and in alignment with NACP IV objectives.
Phased integration of the HIV services with the routine public sector health delivery systems,
streamlining the supply chain mechanisms and quality control mechanisms.
E. STRENGTHENING STRATEGIC INFORMATION MANAGEMENT
SYSTEMS
National Integrated Biological & Behavioural Surveillance(IBBS) among HRG & Bridge
Groups.
Transforming SIMS into an integrated decision support system with advanced analytic
and Geographic Information System capabilities
Equity
Gender
Building capacity of NGO and civil society partners especially in states with
emerging epidemics
ii. Scale up and strengthening of migrant interventions at source, transit and destination
including roll out of migrant tracking system
Launch of third line ART and scale up of first and second line ART
Survival of AIDS patients on ART: Percentage of adults and children with HIV known to
be
on treatment at 24 months after initiation of antiretroviral therapy at select ART Centres
Outcome Indicators
Behavioural Change among Female Sex Workers:
Percentage of female sex workers who report using a condom with their last client (Target: 80% to
85% increase by 2017; 5% increase over the baseline of IBBS 2012-13)
Over 16 lakh truckers and 56 lakh high risk migrant workers will be targeted separately
as bridge population
140 lakh women will be targeted in collaboration with NRHM to prevent mother to
child transmission
Supply of 90 lakh units of safe blood and enhanced use of blood products will be
ensured
Link
PPTCT PREVENTION
SERVICES
Worker
Scheme
HIV
counselling Treatment
of
& testing Blood STI/RTIs
safety
Targeted intervention(TI)
Objective:
Also focuses on improving sexual and reproductive health and general health of HRG
and bridge population
Services provided by
TIs
BCC
COMMUNITY
ORGANIZATIO CONDOM
N & PROMOTION
OWNERSHIP
BUILDING
HRG
DIAGNOSIS
ENABLING AND
ENVIRONMENT TREATMENT OF
STI
LINKING WITH
OTHER
SERVICES
Coverage of Core HRGs (FSW, MSM,IDU) during 2015-16 (Up to Sept
2015)
Non-traditional outlets
Female condoms
Objectives
Providing information and knowledge on prevention and risk reduction of HIV &
STI
(a) Symptomatic Treatment using standardized STI colour coded treatment kits
Started with single dose Nevirapine to HIV positive mother in labour and for the new born
immediately after birth
Provision of life long ART to all pregnant and breast feeding HIV positive women
regardless of CD4 count and clinical stages of HIV
Integrating follow up of HIV infected children into routine health care services
and immunization
Case fatality among HIV infected TB patients are 13-14%,as compared to HIV negative TB
cases, where it is less than 4%
NACP & RNTCP has jointly decided to offer HIV testing during evaluation on TB patients,
when they present with TB symptoms
Early infant diagnosis for HIV exposed infants and children below 18 months
Follow up is done by assessing drug adherence, regularity of visits, periodic examinations and CD4
count 6 monthly
Over the years some percentage of PLHIV on first line ART develop resistance to these drugs due to
mutations in virus
Till August 2015, 12,823 PLHIV are receiving second line drugs at CoEs and ART Plus Centres.
Scaling up of service provisioning under CST component since march 2015.
National Paediatric HIV/AIDS Initiative
The national paediatric HIV/AIDS initiative was launched on 30th November 2016.
Till September 2015, nearly 77,729 Children Living with HIV/AIDS (CLHIV) are active
in HIV care at ART centres and of whom, 49,909 are receiving free ART.
Currently, provision of second line ART for children has been made available at
all
CoEs and ART plus Centers.
ART Scale up for Children Living with HIV/AIDS in India, 2005 – 2015
Revised guidelines on initiation of Anti Retroviral treatment
As per the revised guideline it has been decided to treat all PLHIV with ART
regardless of CD4 count, clinical stage, age or population.
Patients who are in pre ART care should undergo a fresh CD4 count if it is more
than 3 months old, and baseline investigations before ART initiation.
4. COUNSELLING SERVICES:
Counselling services are provided by both ART Centres and Care and Support
Centres.
5. MANAGEMENT OF OPPORTUNISTIC INFECTIONS:
ART centres provide clinical care to both Pre-ART and On-ART clients. The clinical
care includes diagnosis, management as well as primary and secondary
prophylaxis of opportunistic infections.
To raise awareness, improve knowledge and understanding among the general
population about HIV and AIDS
To promote desirable practices such as avoiding multiple partner sex, use of
condom, sterilization of needles and syringes and voluntary blood donation
To mobilize all sector and society to integrate massages and programs on AIDS
into their activity
To create a supportive environment for the care and rehabilitation of persons
with HIV and AIDS
Launch of National AIDS Helpline (1097) in eight
languages
While a helpline in some form existed earlier,
this was strengthened and revamped with the
launch of the National AIDS Help line (1097) on
1st December 2014.
•90% of all people with diagnosed HIV infection will receive sustained
antiretroviral therapy;
•90% of all people receiving antiretroviral therapy will have durable viral
suppression
There is a gap of 33% in the progress towards the first 90 of the treatment targets. Out of
the estimated 21.2 lakh PLHIV, around 14.2 lakhs are aware of their status
India will be able to reach the fast track target of 90% of PLHIV being aware of their HIV
status by 2020
India reached 66% level in terms of ensuring those who are aware of their status
currently receiving ART. Out of the estimated 14.2 lakh PLHIV who are aware of their
status, 9.4 lakh (66%) PLHIV are currently alive on ART.
With implementation of ‘Test and Treat’ policy, this gap will be largely filled
India currently does not have reliable data on the number of PLHIV on ART who are
virally suppressed.
REFERENCE
S
1. DK Taneja’s Health Policies And Programmes In India
2. J.Kishore’s National Health Programs Of India
3. Park’s Textbook Of Preventive And Social Medicines
4. NACO annual report 2015-16
5. NACP-IV strategy document
6. Official website of NACO: http://naco.gov.in/