National AIDS Control

Program

Dr. KANUPRIYA CHATURVEDI

Lesson Objectives
 To know about the extent of the problem of
HIV/AIDS in India
 To learn about the evolution of India’s
response to HIV/AIDS: phases 1,2, 3 of
NACP(National AIDS Control Program)
 To know about the goals, objectives,
strategies of NACP
 To know about the achievements of NACP

Dr. KANUPRIYA CHATURVEDI

Global estimates for
Adults and Children, 2008

CATEGORY Estimated Range

People living with HIV 33.4 million 31.1 – 35.8 million

2.7 million 2.4 – 3.0 million

New HIV infections in 2008

Deaths due to AIDS in 2008 2.0 million 1.7 – 2.4 million

Dr. KANUPRIYA CHATURVEDI

HIV estimates for India (2007)

Category Estimation
Total population 1.027 billion

HIV prevalence (15-49 years) 0.34%

HIV prevalence among men (15-49 years) 0.40%

HIV prevalence among women (15-49 years) 0.27%

Number of people living with HIV (adults and

2.31 million
children)

Number of Children living with HIV (>15 years) 3.8% of total

Dr. KANUPRIYA CHATURVEDI

Current Scenario

 HIV situation in the country is assessed and monitored

through regular annual sentinel surveillance
established since 1992.
 There are 1.8 - 2.9 million (2.31 million) people living
with HIV/AIDS at the end of 2007. The estimated adult
prevalence in the country is 0.34% (0.25% - 0.43%)
and it is greater among males (0.44%) than among
females (0.23%).
 The overall HIV prevalence among different population
groups in 2007 continues to portray the concentrated
epidemic in India, with a very high prevalence among
High Risk Groups - IDU (7.2%), MSM (7.4%), FSW
(5.1%) & STD (3.6%) and low prevalence among ANC
clinic attendees (Age adjusted - 0.48%).

Dr. KANUPRIYA CHATURVEDI

Overview
 In India, after the first case of HIV was detected in Chennai in
1986, the virus spread rapidly across the nation in both urban
and rural areas.
 Since then, the HIV epidemic has traveled a long way,
establishing itself with the greatest speed in the six high
prevalence states of Andhra Pradesh, Maharashtra, Manipur,
Nagaland, Karnataka and Tamil Nadu.
 The natural history of the HIV epidemic has played out in
various forms - from the injecting drug use-driven epidemic of
the North East seen in Manipur and Nagaland, to the sex
work-driven epidemic of the south of India.
 Since, every country and every government needs to have a
solution to deal with such an issue; the government formulated
the National AIDS Control Program.
Dr. KANUPRIYA CHATURVEDI
National AIDS Control Program
( NAPC)
 1985 Govt. of India constituted a taskforce to study the
problem of HIV/AIDS as related to India
 1991-1999 A comprehensive HIV/AIDS Control Project
Phase I was launched during VIII Plan with an outlay of
222.6 crores with the assistance of World Bank & WHO
 1985 Govt. of India constituted a taskforce to study the
problem of HIV/AIDS as related to India
 1991-1999 A comprehensive HIV/AIDS Control
Project Phase I was launched during VIII Plan with an
outlay of 222.6 crores with the assistance of World Bank
& WHO
 NAPC Phase II (1999-200
 NAPC Phase III ( 2006- 11)

Dr. KANUPRIYA CHATURVEDI

National AIDS Control Programme
Phase I and II
 Phase-I (1992 - 1999) was implemented across
the country with objective to slow the spread of
HIV to reduce future morbidity, mortality, and the
impact of AIDS by initiating a major effort in the
prevention of HIV transmission.

 Phase-II (1999 - 2006) was aimed at reducing

spread of HIV infection in India and strengthen
India's capacity to respond to HIV epidemic on
long term basis

Dr. KANUPRIYA CHATURVEDI

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.
 Recognizing the need of care and support for
people living with HIV and AIDS and scaling up
of Community Care Centers.

Dr. KANUPRIYA CHATURVEDI

Contd.
 The effectiveness of the condoms as one of the
safest methods to prevent and control the spread of
HIV and other STIs has been well established.
 Initiating the process for developing draft legislation
on HIV and AIDS.
 Focus has shifted from raising awareness to
behavior change, from a national response to a
decentralized response and an increasing
engagement of NGOs and networks of people living
with HIV/AIDS.
 The National AIDS Prevention and Control Policy
and the National Council on AIDS (NCA), chaired by
the Prime Minister, provide policy guidelines and
political leadership to the response.

Dr. KANUPRIYA CHATURVEDI

Phase-III (2007-2012)
 Phase-III (2007-2012)is based on the
experiences and lessons drawn from NACP-I
and II, and is built upon their strengths. Its
priorities and thrust areas are drawn up
accordingly and include the following:
 Considering that more than 99 percent of the
population in the country is free from infection,
NACP-III places the highest priority on preventive
efforts while, at the same time, seeks to integrate
prevention with care, support and treatment.

Dr. KANUPRIYA CHATURVEDI

Contd.
 Sub-populations that have the highest risk of exposure
to HIV receive the highest priority in the intervention
programs. These would include sex workers, men-
who-have-sex-with-men and injecting drug users.
Second high priority in the intervention programs is
accorded to long-distance truckers, prisoners,
migrants (including refugees) and street children.
 In the general population those who have the greater
need for accessing prevention services, such as
treatment of STIs, voluntary counseling and testing
and condoms, will be next in the line of priority.

Dr. KANUPRIYA CHATURVEDI

Contd.
 NACP-III ensures that all persons who need
treatment would have access to prophylaxis and
management of opportunistic infections. People
who need access to ART will also be assured first
line ARV drugs.
 Prevention needs of children are addressed
through universal provision of PPTCT services.
Children who are infected are assured access to
pediatric ART.
 NACP-III is committed to address the needs of
persons infected and affected by HIV, especially
children.
Dr. KANUPRIYA CHATURVEDI
Contd.
 NACP-III also plans to invest in community
care centres to provide psycho-social
support, outreach services, referrals and
palliative care.
 Socio-economic determinants that make a
person vulnerable also increase the risk of
exposure to HIV. NACP-III will work with
other agencies involved in vulnerability
reduction such as women's groups, youth
groups, trade unions etc. to integrate HIV
prevention into their activities

Dr. KANUPRIYA CHATURVEDI

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

Dr. KANUPRIYA CHATURVEDI

Goals and Objectives of NACP-III
 The overall goals of NACP-III is to halt and
reverse the epidemic in India over the next five
years by integrating programmes for prevention,
care and support and treatment. This is achieved
through a four-pronged strategy

 The specific objective is to reduce the rate of

incidence by 60 per cent in the first year of the
programme in high prevalence states to obtain
the reversal of the epidemic, and by 40 percent
in the vulnerable states to stabilise the epidemic.

Dr. KANUPRIYA CHATURVEDI

Strategy

 Prevent infections through saturation of

coverage of high-risk groups with targeted
interventions (TIs) and scaled up interventions
in the general population.
 Provide greater care, support and treatment to
larger number of PLHA.
 Strengthen the infrastructure, systems and
human resources in prevention, care, support
and treatment programmes at district, state and
national levels.
 Strengthen the nationwide Strategic Information
Management System
Dr. KANUPRIYA CHATURVEDI
Guiding principles

 The unifying credo of Three Ones, i.e., one

Agreed Action Framework, one National
HIV/AIDS Coordinating Authority and one
Agreed National Monitoring and Evaluation
System.
 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).

Dr. KANUPRIYA CHATURVEDI

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

Dr. KANUPRIYA CHATURVEDI

Contd.

 Provide universal access to HIV prevention,

care, support and treatment services.
 For making the implementation mechanism
more responsive, proactive and dynamic, the
HRD strategy of NACO and SACS is based
on qualification, competence, commitment
and continuity.

Dr. KANUPRIYA CHATURVEDI

1: Prevent new infections

Dr. KANUPRIYA CHATURVEDI

Objective 1:To prevent new infections

 Saturation of coverage of high risk group

through targeted interventions. 

 Scaling up interventions among general

population

Dr. KANUPRIYA CHATURVEDI

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

Dr. KANUPRIYA CHATURVEDI

1.2 Scaling up interventions among
general population
 STD control program
 Voluntary counseling and testing
 PPTCT program
 Universal precautions and Post exposure
prophylaxis
 Blood safety
 Improved access to quality condoms

Dr. KANUPRIYA CHATURVEDI

Contd.

 Focused efforts on women,children and

Young people
 Expanding HIV/AIDS response at
workplace
 Focused efforts on migrants, mobile
populations and in cross border areas

Dr. KANUPRIYA CHATURVEDI

STD Control Program

 An estimated five percent adult population affected by

STDs, also has HIV infection.. Limited diagnostic
facilities to manage complicated STDs and drug
resistance to major STDs are the other issues of concern
that NACP-III addresses
 Under NACP-III, a demand for STD services is
generated through its awareness on one hand and on
the other STD services are expanded through its
integration with the Reproductive and Child Health
Programme..

Dr. KANUPRIYA CHATURVEDI

Voluntary counseling and testing
 HIV counselling and testing services were started in
India in 1997. There are now more than 4000
Counselling and Testing Centres, mainly located in
government hospitals.
 Under NACP-III, Voluntary Counselling and Testing
Centres (VCTC) and facilities providing Prevention of
Parent to Child Transmission of HIV/AIDS (PPTCT)
services are remodelled as a hub or ‘Integrated
Counselling and Testing Centre’ (ICTC) to provide
services to all clients under one roof.
 An ICTC is a place where a person is counselled and
tested for HIV, of his own free will or as advised by a
medical provider. The main functions of an ICTC are:

Dr. KANUPRIYA CHATURVEDI

PPTCT Program

 The Prevention of Parent to Child Transmission of

HIV/AIDS (PPTCT) programme was started in the
country in the year 2002 following a feasibility study
in 11 major hospitals in the five high HIV prevalence
states.
 Currently, there are more than 4000 Integrated
Counselling and Testing Centres (ICTCs) in the
country, most of these in government hospitals,
which offer PPTCT services to pregnant women.
 Of these ICTCs, 502 are located in Obstetrics and
Gynaecology Departments and in Maternity Homes
where the client load is predominantly comprised of
pregnant women

Dr. KANUPRIYA CHATURVEDI

Blood safety
 NACO is committed to bridge the gap in the availability and
improve quality of blood under NACP-III. To achieve these
objectives NACO plans to:
 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, blood components

and products
 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

Dr. KANUPRIYA CHATURVEDI

Blood safety contd.
 Establish additional model blood banks in 22 states; 10 are
functional already
 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
 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
 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

Dr. KANUPRIYA CHATURVEDI

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, HCV).
 This includes counselling, risk assessment, relevant
laboratory investigations based on informed consent
of the source and exposed person, first aid and
depending on the risk assessment, the provision of
short term (four weeks) of antiretroviral drugs, with
follow up and support

Dr. KANUPRIYA CHATURVEDI

Improved access to quality condoms
 Under NACP-III condom promotion continues to be an important
prevention strategy. The programme seeks to:
 Increase condom use during sex with non-regular partner, which

is the key to limiting HIV spread through sexual route.

 Increase the number of condoms distributed by social marketing

programmes.
 Increase the number of free condoms distributed through STI and

STD clinics, reaching those who are at the highest risk of

acquiring or transmitting HIV.
 Increase access to condoms, especially to men who have sex

with non-regular partners.

 Increase the number of commercial condoms sold.

 Increase the number of non-traditional outlets for socially

marketed condoms, e.g., paan shops, lodges, etc. in strategically

located hotspots of solicitation

Dr. KANUPRIYA CHATURVEDI

Care, support and treatment

Dr. KANUPRIYA CHATURVEDI

Objective 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
 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

Dr. KANUPRIYA CHATURVEDI

ART

 Adherence to ART is Critical

 ART is Accessible to All
 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/mm3For
Asymptomatic people *>350Defer treatment in
asymptomatic persons
 There are 127 ART centres operating in the country as of
June 2007. By 2012, 250 ART centres will become
functional across the country in order to provide people
living with HIV/AIDS better access to treatment.

Dr. KANUPRIYA CHATURVEDI

Strengthen the infrastructure, systems
and human resources

Dr. KANUPRIYA CHATURVEDI

Objective 3:Strengthen the
infrastructure, 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

Dr. KANUPRIYA CHATURVEDI

Strengthening strategic information
systems (SIMS

Dr. KANUPRIYA CHATURVEDI

Objective 4: Strengthening strategic
information systems (SIMS)
 One nationwide strategic information system
 Strengthening the comuterised 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

Dr. KANUPRIYA CHATURVEDI

Key Achievements under NACP
 Promotion of voluntary blood donation has enabled
reducing transmission of HIV infection through
contaminated blood from about 6.07% (1999), 4.61%
(2003), 2.07% (2005), 1.96% (2006) to 1.87% (2007).

 The number of integrated counseling and testing

centres increased from 982 in 2004, 1476 in 2005,
4027 in 2006, 4567 in 2007 and 4817 in 2008 (till
September, 2008). The number of persons tested in
these centres has increased from 17.5 lakh in 2004 to
37.9 lakhs in 2008-09 (August, 2008).
 .
Dr. KANUPRIYA CHATURVEDI
Contd.

 The number of STI clinics being supported by NACO

has increased from 815 in 2005 to 895 in 2008. The
reported number of patients treated for STI in 2005
was 16.7 lakh, in 2006, 20.2 lakh and in 2007, it has
increased to 25.9 lakh.
 . In the year 2007, a total of 3.2 million pregnant
women accessed PPTCT services at ICTCs across
the country of which 18449 pregnant women were
diagnosed to be HIV +ve. Of these 11460 (62%)
pregnant women and the infants born to them received
prophylactic single dose Nevirapine to prevent parent
to child transmission of HIV.

Dr. KANUPRIYA CHATURVEDI

Contd.
 As of September 2008, 5,61,981 patients have been
registered at ART centers and 1,77,808 clinically eligible
patients are receiving free ART in Govt. & inter-sectoral
health sector.
 This is achieved through 179 ART centers across 31
states. Total 159 Community Care Centers are
established across country of providing Care & Support
Services to PLHA's.
 The Targeted Intervention (TI) projects aim to interrupt
HIV transmission among highly vulnerable populations.
Such population groups include - commercial sex
workers, injecting drug users, men who have sex with
men, truckers and migrant workers.
 As on date, 1132 Targeted Interventions are operational
in various states and UTs in the country

Dr. KANUPRIYA CHATURVEDI