Human immunodeficiency virus (HIV) is a tent virus that belong to the retrovirus group may cause (HIV) infection/(AIDS) Acquired immunodeficiency syndrome. It has emerged as one of the most serious public health problem in the country.
The first case of (HIV) was detected in Chennai in (1986) in female sex workers. The greatest speed in the sex high prevalence state of Andhra Pradesh, Maharashtra, Manipur, Nagaland, Karnataka and Tamil Nadu.
NATIONAL AIDS CONTROL PROGRAMME
The Government forming the National AIDS committee (NAC) headed by the union health secretary.
The National AIDS Control Programme was Launched in the year (1987)
NATIONAL AIDS CONTROL ORGANIZATION
National AIDS Control Organisation (NACO) 1992 is a organization of Government of India under the Ministry of Health and Family welfare. with the primary objective to control the epidemic in India.
NACO also aims at facilitating and improving access to treatment for HIV+ people and also be Phase to promote and protect their human rights.
Ever since its establishment, NACO has been working to create awareness about HIV/AIDS, giving accurate and reliable information on the menace, clearing existing myths and misconceptions and providing. practical skills that can be implemented at the individual's level so as to lead to behaviour changes that minimize the risk of HIV infection.
MILESTONES
1986-First case of HIV detected and National AIDS Committe established by Ministry of Health.
1990-Medium term plan launched for four state and fourmetros.
1992-NACP I Phase launched.
National AIDS control board constituted.
NACO set-up.
1999-NACP II Phase launched SACS (state AIDS control societies)established.
2002 -National AIDS control policy.
-National blood policy. .
2004-Antiretroviral treatment initiated.
2006-National council on AIDS constituted under chairmanship of Prime Minister.
National policy on pediatric ART
2007-NACP III phase launched for 5 year(2007-2012)
2014 - NACP IV phase launched for 5 years (2012- 2017)
2017- National strategic plan for HIV/AIDS and 2017-2024
NACP I Phase (1992-1999)
During these phase, the National AIDS control project was developed for prevention and control of AIDS in the country.
Objective:
Slow and prevent spread of HIV through a major efforts to prevent its transmission.
Strategies:
1.To attain a satisfactory level of public awareness on HIV transmission and prevention..
2.To screen all blood unites collected for blood transfusion.
3.To decrease the practice of professional blood donation.
4.To strengthen and control of sexually transmitted disease.
5.To monitor the development of the HIV AIDS.
Achievement:
1. Awareness level that were almost insignificant have increased to about 70-80%in urban areas even through the level of awareness in rural areas remain low at about 30%.
2.Modernization and strengthening of blood banks
› Introduction of licensing system of blood banks and gradual phasing out of professional blood donors.
3.Availability of good quality condoms through social marketing has made a significant increase in its use.
NACP II Phase (1999-2006)
NACP has become effective in 1999. It is a 100% centrally sponsored scheme implemented in 32 state UT and municipal corporation namely Chennai, Ahmedabad and Mumbai through AIDS control societies.
Objective:
1.To reduce the spread of HIV infection in India through a behaviour change.
Strategies:
2.To shift the focus from raising awareness to changing behaviour through intervention.
Prevention among high risk population.
3.To protect human rights by encouraging voluntary counselling and testing.
Achievement:
1.At the operational level 1,033 targeted intervention set up, 875 voluntary counselling and testing centres (VCTC) and 679 clinics at the district level.
2.Nationwide and state level behaviour sentinel surveillance (BSS) surveys were conducted.
3.Prevention of parents to child transmission (PPTCT) programme was expanded.
National AIDS prevention and control policy:
In April 2002 Government of India approved the National AIDS prevention and control policy
Objective:
1.Zero transmission rate.
2.Prevent further spread of the disease.
3.Improve services for PLWA.
Care of PLWA
1. Protection of there rights.
2.Proper care and supports in the hospital and community.
3.Keeping confidentiality.
4.Proper counselling of HIV positive mothers.
5.Clinical management of HIV AIDS.
Components of Programmes
1.Blood safety:
- Only licensed blood banks to operate.
- To encourage voluntary blood donation.
- Ensure safety in collection, processing, storage and distribution of blood and blood product.
- Establishment of zonal blood centre.
- Testing every unit of blood for HIV, hepatitis B, Malaria, Syphilis and HCV is mandatory.
2.Control of STDs:
- Integrating service for treatment of reproductive tract infection and sexually transmitted infection.
- Training of all the medical and paramedical workers engaged in providing STDs\RTIs services.
Hence, early diagnosis and treatment of STDs is now recognised as one of the major strategies to control spread of HIV infection.
Following measures are taken for STD control
A) Management of STDs through syndromic approaches by colour coded kits
B) Integration of services for treatment of reproductive tract infections & STDs at all levels of health care
STDs Clinics at district/block/ First Referral Unit (FRU) level would function as referral centres for treatment of STDs referred from peripheries. All STDs clinics would also provide counselling services and good quality condoms to the STD patients.
NACO has branded the STI/RTI services as "Suraksha Clinic", and has developed a communication strategy for generating demand for these services.
PRE-PACKED STI/RTI COLOUR CODED KITS:
Pre packed colour coded STI/RTI kits have been provided for free supply to all designated STI/RTI clinics. These kits are being procured and supplied to all State AIDS Control Societies.
The colour codes as follows:
Kit 1- grey, for urethral discharge, ano-rectal discharge and cervicitis.
Kit 2- green, for vaginitis.
Kit 3-white, for genital ulcers.
Kit 4-blue, for genital ulcers.
Kit 5-red, for genital ulcers.
Kit -6 yellow, for lower abdominal pain.
Kit 7-black, for inguinal bubo
3.Condom promotion :
- 85% of HIV infection are due to unprotected sex and multi partner contact.
- This can be prevented by constitute use of good quality condom.
- Progress made by NACO in condom programming:
a. Quality control of condom by specifying parameters as prescribed by WHO.
b. Using social marketing strategy for condom promotion.
C.Involvement of NGOs and private voluntar organization in the programme.
4.IEC (Information, education and communication)
Information education and communication is the key to generating awareness on prevention as well as motivation access to testing, care and supports.
a. To increase knowledge about general population (especially youth and women) on safe sexual behaviour.
b.To sustain behaviour change in high risk group and treatment.
C.To generate demand for care, support and treatment service. To make appropriate change in societal norms
d. reinforce positive attitude.
5.School AIDS education programme:
The school AIDS education is one of the important activities are :-
1.To raise awareness level and develop a safe and responsible life style in student youth.
2. State AIDS control societies cover the student of secondary and higher secondary school.
3.Talk AIDS project cover the collages and universities.
6.Family health awareness campaign:
The objectives of the campaign are :-
- To raise the awareness level regarding HID/ AIDS in rural and slum areas and other vulnerable groups of the population.
- To make people aware about the services available under the sector for management of RTI\STD.
- To facilitate the early detection and prompt treatment of RTI STD cases.
- To aware that HIV can be transmitted from the infected mother to her baby during pregnancy, delivery and breastfeeding.
7.HIV surveillance:
Surveillance are being carried out to detect spread of the disease and to make appropriate strategy for prevention and control.
For identification of geographical spread of HIV.
For determining the major modes of transmission.
Types of surveillance:
1.HIV sentinel surveillance
2. HIV Sero surveillance
3.AIDS case surveillance
4.STDs surveillance
5.Behavioural surveillance
8.COUNSELLING AND HIV TESTING SERVICES
These services started in India since 1997
Components:
A. ICTC( integrated counseling and testing centre)
B. Prevention of parent-to-child transmission of HIV (PPTCT)
C.HIV/TB collaberative activities
A. Integrated Counselling and Testing Centres
This is available to increase access to HIV diagnosis It includes testing services & community approaches at various level of health system in India like state, district, sub district, & village/community level.
FUNCTIONS
1. Early detection of HIV,
2. Provision of basic information on modes of transmission, prevention of HIV for promoting behavioral change and reducing vulnerability and linking the PLHIV to care, support & treatment.
A person is counselled and tested for HIV at ICTC, either of his own free will (client initiated) or as advised by a medical provider (provider initiated).
Two Types of ICTC
1.Fixed facility ICTC
2. Mobile ICTC
1. Fixed facility ICTC: are located within an existing healthcare facility/hospital/health centre are of of 2 types
a. Standalone ICTC (SA-ICTC)
b. Facility-integrated ICTC (F-ICTC)
SA-ICTC: The client load is high in the center with full time counsellor and lab technician who provide HIV counselling & testing services
F-ICTC:
• These are set below the block level in 24x7 PHCS
- Staffs are trained in counselling and testing services of HIV
• Similar to this Public Private Partnership ICTCs are also established in private facilities
• The above center are supported by SACS & DACS
2. MOBILE ICTC:
- It is a van with a room to conduct general examination, counselling and collection and processing of blood and blood products
- These are set in hard to reach areas as temporary clinics
- They also provide counselling and services about regular health check up, antenatal check up & immunization.
- Community based HIV screening is done by ANM at sub centre level to provide HIV testing to all pregnant women.
- It is done to prevent transmission of HIV from parents to child.
B.Prevention of HIV transmission for mother to child:
- Among HIV positive women: 5 to 10 infant will be infected during pregnancy.
- 10 to 20 infant will be infected during labour and delivery.
- 20 to 30 infant will be infected during breast feeding.
Prevention:
- A short course anti retroviral regimen given to the mother it can substantially reduce the risk of Perinatal transmission of HIV during pregnancy and child birth.
- Women who are found to be HIV positive are given single dose of prophylactic Nevirapine at the time of labour and new born infant is also given a single dose of Nevirapine within 72 hours of birth.
It has been started from 1st October 2001.
The major components of the PPTCT programme :-
The government of India started the National ART programme on 1 April in 2004.
Antiretroviral treatment (ART) is a combination of a least 3 Arv drugs that is given to HIV infected individual once they reach a stage of advanced immuno suppression.
▸ Antiretroviral treatment:
HIV antiretroviral treatment is the main type of treatment for HIV or AIDS. It can stop people from becoming ill for many year and increase the body ability to fight disease by keeping the level of HIV low in the blood.
It helps both the adults and children in managing the HIV infection.
Goals of ART:
1.To help the patients to have a longer and better quality of life.
2.To increase the level of CD4 count and immunity.
3.To reduce the chances of transmission from one to another.
Can be taken life long.
Common drugs:
ZIDOVIDINE
LAMIVUDINE
STAVUDINE
NEVIRAPINE
TENOFOVIR
NACP III Phase (2007-2012)
Objective:
Reduce the rate of incidence by 60% in 1st year of program in high prevalence states and by 40% in vulnerable states.
Strategies:
1.Prevention of new infection in high risk population group.
2. Provide greater care, support and treatment of PLWHA.
3.To strengthen the nationwide strategic information management system.
4.Prophylactic treatment for HIV (ART treatment).
Achievement:
- 306 Fully functional ART centre and 612 link ART centre 10CoE, 259 community cares were established. 12.5lakh PLHIV were registered and 42 lakh patient were on ART.
- Link workers training module updated and condoms promotion programme was strengthened.
- 3000 red ribbon clubs were established.
NACP IV Phase (2012-2017)
The cabinet committee on economic Affairs chaired by the Prime Minister has given its approval for continuation of National AIDS control programme-(NACP IV) beyond 12th five year plan for a period of three year from April, 2017 to March, 2020.
Objective:
1.To reduce new infection by 50% (2007 Baseline of NACP III).
2.Provide comprehensive care and supports to all person living with HIV AIDS and treatment service for all those who required it.
Key Strategies:
Strategy 1: Intensifying and consolidating prevention services.
Strategy 2:Comprehensive care, support and treatment.
Strategy 3:Expanding IEC services.
Strategy 4: Strengthening institutional capacities.
Strategy 5: Strategic Information Management system.
Strategy 1: Intensifying and consolidating prevention services
- Prevention will continue to be the core strategy of NACP-IV as more than 99% of the people are HIV negatives.
Activities:
- Saturating quality HIV prevention service to all HRG groups, based on emerging behaviour patterns and evidence.
- Strengthening needle exchange programme, drug substitution programme and providing Opioid substitution therapy (OST).
- Providing quality STIs RTI services.
- Strengthening management structure of blood transfusion services.
- Expand the ICTC services and strengthen referral linkage.
Strategy 2 :- Comprehensive care, support and treatment
Additional centres of excellence (COES) and upgraded ART plus centres will be established to provide high quality treatment.
Activities:
- Scale up ART centres and COES ART services.
- Strengthening follow up of patients on ART and improving quality of counselling services at ART services delivery points.
- Comprehensive care and supports services for PLHIV through linkages.
- Provide guidelines and training for integration in health care settings to NRHM.
Strategy 3: Expanding IEC services
- Increasing awareness among general population in women and youth.
- Behaviour change communication strategies for HRG and vulnerable groups.
- Continued focus on demand generation of services.
- Reach out to vulnerable population in rural settings.
- Extending services to tribal groups and hard to reach population.
Strategy 4: Strengthening institutional capacities
The programme management structure established under NACP will be strengthened.
- Programme planning and management responsibilities will be enhanced at National, state, district and facility levels.
Strategy 5 Information management system
This will ensure:
- High quality of data generation system such as surveillance, programme monitoring and research.
- Strengthening systematic analysis, synthesis, development and dissemination of knowledge products in various forms.
Guiding principle of NACP IV:
- Continued emphasis on three ones one agreed action framework, one National HIV AIDS coordinating authority and one agreed National system.
- Equity.
- Gender
- Respect for the rights of the PLHIV.
- Civil society representation and participation.
- Improved public private partnerships.
Key priorities under NACP IV
- Preventing new infection by sustaining the reach of current intervention and effectively addressing emerging epidemics.
- Prevention of parent to child transmission
- Focusing on IEC strategies for behaviour change.
- Providing comprehensive care, supports and treatment of PLHIV.
- Ensuring effective use of strategic information at all levels of programme.
- Integrating HIV services with health systems in a phased manner.
National strategic plan (2017-2024)
Ensure a more effective, sustained and comprehensive coverage of AIDS related services NACO has implemented a seven year National strategic plan on HIV AIDS and STI, 2017-24.This National strategic plan (NSP) will herald the country to the midpoint of the 2030 goals
Vision-:
The vision of the NACO is that of 'paving the way for an AIDS free India through attaining universal coverage of HIV prevention, treatment to care continuum of services that are effective, inclusive, equitable and adapted to needs.
Goals-:
The goals remain those of the Three zero i.e. zero new infection, zero AIDS related deaths and zero discrimination which from the basis of this strategic plan. By 2020, the focus of the National programme will be on achieving the following fast targets.
Targets-:
▸ The 75% reduction in new HIV infection.
▸ Elimination of mother to child transmission of HIV and syphilis.
▸ Elimination of stigma and discrimination.
90-90-90:
>90% of those who are HIV positive in the country know their status,
‣ 90% of those who know their status are on treatment, >90% of those who are on treatment experience effective viral load suppression.
Conclusion
▸ To reduce the spread of HIV infection in India. > Strengthen India capacity to respond to HIV/AIDS on a long term basis.
▸ State level AIDS control societies and improve drug and equipment practice.
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