National AIDS Control Programme (NACP)

 




Natioanl AIDS Control Programmes:

  National  AIDS  Control Programme was launched  in India in the year 1987. The Ministry of Health and Family  Welfare  has set up National  AIDS Control Organization(NACO) monitor the various  components of  the programme.


  The aim  of the  programme is to prevent  further transmission  of HIV, to decrease  morbidity  and mortality associated  with HIV infection  and  to minimize  the socio _ economic  impact resulting  from HIV  infection. 

  The Government  of  India initiated programme of prevention and raising  awareness  under the  Medium Term Plan ( 1990_ 92) , NACP_ I ( 1992 _ 99)  and  NACP_ II ( 1999 __ 2006) and NACP __ III ( 2007__ 2012).Based on the lessons learnt and achievements  made in phase I, II and III , India has now developed  the ForthNational Programme Implementation Plan ( NACP_ IV, 2012_ 2017).

The package of services under NACP_ IV are as follows: 

1): Prevention Services:

☆    Targeted interventions for high _ risk groups  ( female sex workers, men who have sex with men, transgenders / hijras, injecting drug users) and bridge  population ( truckers and migrants)

☆   Needle _ syringe    exchange programme and opioid substitution therapy for   IDUs.

☆    Prevention intervention for migrant population at source, transit and destination. 

☆    Link worker scheme for HRGs and vulnerable  population  in rural areas.

☆ Prevention and control of sexually transmitted  infections/ reproductive tract infections. 

☆ Blood Safety 

☆ HIV counselling and testing services 

☆ Prevention of parent  to child transmission. 

☆   Condom promotion 

☆ Information  education  and communication and behavior change communication ( BCC)

☆ Social mobilization , youth interventions  and  adolescence education programm

☆   Mainstreaming  HIV/ AIDS response 

☆ Work place interventions. 


 2): Care, support and  treatment  services


☆   Laboratory services for CDA testing and other  investigations 

☆ Free first _ line and second _ line  Anti_ Retroviral Therapy  ( ART) through ART centres  and  Link  ART  Centres  ( LACs) , Centres of Excellence  ( CoE) and ART plus centres.

☆  Paediatric  ART for children 

☆ Early infant diagnosis  for HIV exposed infants and children  below 18 months.

☆   Nutritional and psycho__ social  support through  Care and Support Centre ( CSC)

☆ HIV / TB  coordination  ( cross __ referral, detection  and  treatment  of co_ infections).

☆   Treatment  of opportunistic infections 

☆  Drop_ in centres for PLHIV networks.

Annual Sentinel  Surveillance:

The data on statewise prevalence  rates  are collected  through annual sentinel surveillance. This information provides the basic for classification  of districts as well as to determine the trend of HIV infection in different  age groups . It also helps in estimation of HIV infected persons in the country. During 1994, there were 55 sentinel sites. The number increased  to 1,359 sites during 2010__ 11.These additional  sites are mainly located in the northern and central parts of the country. 

   In the country,  the districts have been classified according  to the epidemiological and vulnerability _ criteria using the sentinel surveillance data for the  last 3 years . Accordingly,  156 districts have been  classified  as category  A, 39 districts as   category  B, 296 as category C and 118 as category D districts. The  planning  for HIV related services  has also been graded as per categorization of districts. This approach has been implemented since March  2007.

AIDS launched:

The WHO has launched a " Global Programme on AIDS" on Feb, 1. 1987 to provide global leadership and to support the development of national  AIDSZ programmes. 

There is no specific  cure or vaccine  against AIDS, as of data.

Counselling  and HIV  testing services:

The  Basic Service Division  of the department  of AIDS control provides HIV counselling  and testing service for HIV infection. The national programme is offering these service since 1997 with the goal to  identify as many people living  with HIV, as early as possible  ( after acquiring the HIV infection), and linking them appropriately and in  a timely  manner to Prevention, care and treatment  services. The introduction of ART services for people living with HIV/ AIDS in 2004, gives a major boost to counselling and testing services in India. The HIV counselling and testing services include the following  components.

1): Integrated Counselling and Testing Centres ( ICTC).

2): Prevention of Parent __ to_ child transmission of HIV ( PPTCT)

3): HIV/ tuberculosis collaborative activities. 

INTEGRATED COUNSELING AND TESTING CENTERS:

  Diverse models of HIV counselling and testing services are available  to increase across to HIV diagnosis, these include testing services  in health care facilities , standalone sites and community _ based approaches at various  levels of public health systems in India from state, district, sub_ district and village/ community  levels as depicted 





PREVENTION OF PARENT _ TO_CHILD TRANSMISSION OF HIV

The prevention of parent_ to _ child transmission of HIV/ AIDS ( PPTCT) Programme was started in th country in the year 2002. Currently  there are more than 15,000 ICTCs in the country  which offer PPTCT  services to pregnant women. The aim of the PPTCT programme is to offer HIV testing  to every pregnant women ( universal coverage) in the country,so as to cover  all estimated transmission of HIV from mother_ to__ child.

   The national strategic plan for PPTCT service using multi__ drug ARVs in India was developed in May_ June 2013 for nationwide implementation in a phased manner. Based on the new WHO guidelines ( June 2013) and on the suggestions from  the technical resource groups during December 2013, department of AIDS control has decided to initiate lifelong ART ( using the triple drug regimen) for all pregnant and breast__ feeding women living with HIV, regardless of CD4 count or WHO clinical stage, both for their own health and to prevent  vertical HIV transmission, and for additional HIV prevention benefits. 


 The essential package of PPTCT services in India are as follows:

1):Routine offer of HIV counselling and testing to all pregnant women enrolled  into antenatal  care, with an 'Opt out'option.

2):Ensuring  involvement  of spouse and other family members, and move from an " ANC _ Centeic" to a " Family _ Centric " approach. 


3) Provision of life_ long ARTS ( TDF+ EFV) to all pregnant and breast_/ feeding HIV infected women, regardless of CD4A count and clinical  stage of HIV progression. 

4):Promotion of institutional deliveries of all HIV infected pregnancy women.

5): Provision of care for associated conditions  ( STI/ RTI,    TB   and  other   opportunistic infections).


6):Provision of nutrition, counselling  and psychosocial support for HIV infected pregnant women.


7): Provision of counselling  and support  for initiation  of exclusive breast__ feeds within an hour of delivery  as the preferred  option and continued  for 6 months.


8): Provision of ARV prophylaxis to infants from birth upto a minimum  of 6 months.

9): Integrating follow_up of HIV _ exposed infants into routine healthcare services including  immunization. 

10): Ensuring initiation of Co_ trimoxazole Prophylactic Therapy ( CPT)  and Early  infant Diagnosis ( EID) using  HIV_ DNA PCR at  6 weeks of age onwards, as per the EID guidelines. 

11): Strengthening community  follow_ up and outreach through local community networks to support  HIV__ positive pregnant women and their families. 

HIV and TB:

The risk of TB infection  in HIV positive persons increases manifolds. NACO is working closely  with RNTCP for promoting  cross referrals for early diagnosis and treatment  of tuberculosis in HIV patients and for HIV testing in tuberculosis patients. The four pronged strategy  for HIV_ TB coordination activity to reduce mortality  are summarized. 

STD Control Programme:

STD control is linked to HIV/ AIDS control as behaviors resulting  in transmission  of STD and HIV  are same. HIV is transmitted more easily in the presence of another STD. Hence , early diagnosis and treatment of STD is now recognized as one  of the major strategies to control spread of HIV infection. The following  approach is adopted  for the STD control.

a):   Management   of STDs through  sgndromic approach ( management  of sexually  transmitted  diseases based on specific  symptoms  and signs and not dependent on laboratory investigations) would be incorporated into the general health  service. Once the STDs case management  is integrated  in peripheral health system, unnecessary referral  can be avoided leaving  the specialized  services  free. 


b):   STDs among women, through highly  prevalent,  are suppressed  because  of the social stigma attached  to the disease. It  has, therefore, been decided to integrate  services for treatment of reproductive  tract infections ( RTIs) and sexually  transmitted  diseases ( STDs) at all level of health care. Department of Family  Welfare and NACO will  coordinate their activities  for an effective implementation of each integration. STDs Clinics at district / block/ First  Referral Unit ( FRU) level would function as referral centres for treatment of STDs referred  from peripheries. STDs clinics in all district hospitals , medical colleges and other centres would be strengthened by providing technical support, equipment, reagents and drugs. A massive orientation_ training  programme would be undertaken to train all the medical and paramedical workers engaged  in providing  STDs/ RTIs service through a syndromic approach .All STDs clinics would also provide  counseling services and good quality condoms to the STD patients. Services of NGOs would be utilized  for providing  such counselling services  at the STDs clinics. 





  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 centrally  and supplied to all State  AIDS Control Societies. 

       The colour code is 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 scrotal swelling. 

Blood Safety Programme:

  National and State/ UTs level Blood Transfusion Council  have  been  set__ up in the country. Professional blood donation has been prohibited in the country  since Ist January  1998. Only licensed blood banks are permitted  to operate, and voluntary blood donation is encouraged. The strategy is to ensure safe collection, processing, storage and distribution of blood and blood products. Zonal blood testing centres have been established to provide linkage with other  blood banks affiliated to public, private and voluntary sector. As per national blood safety policy, testing of every unit of blood is mandatory  for detecting infections like HIV, hepatitis, B malaria and syphilis. 


  In the country  2,177 blood banks have been licensed to supply blood, 1,137 blood banks have been modernized with provision of adequate facilities of equipment and development  of appropriate  manpower, 258  blood   component separation  units have been established. Besides district level and small blood banks with independent HIV testing facilities, 154 zonal blood testing  centres and 9 HIV Rederence Centres are functioning in the country HIV Test Kits are supplied upto district level blood banks.

Condom Programming :

Among the probable source of HIV infection in India, heterosexual  promiscuity constitutes the major route. About 87 per cent  of the infections occur due to unprotected  and multipartner sexual  contacts. This type of transmission  can be prevented  by consistent use of good quality  condoms. While the use of condom is easy, making a programme to cover the whole country need careful planning  on certain issues.  These issues  are mainly related to following  questions  :

(a) How to sensitize people for using condoms not only as a family planning method, but also as a protective step against HIV and STD,

(b) How to convince the commercial  sex workers and their clients about the importance of use of condom as a means for preventing HIV and STD transmission, 

(c) How to make available  low cost and good quality  condom for people, at the time and place when they need it most.

      The three major areas in which  NACO has made significant  progress in condom Programming are: quality  control of condom, social marketing of condoms and involvement  of NGOs  and  private voluntary  organizations in the programme. 


   NACO has brought  in the quality  control parameters as specified by WHO. The unlubricated condom NIRODH has already  been phased out and manufacturers  have started adhering  to the new specifications. 

Care  and Support:

      Government  of India  announced  a commitment for providing  free antiretroviral treatment ( ART) with effect from Ist  April  2004. ART is a combination of at least 3 ARV drugs that is given to HIV infected individuals,  once they have advanced  immunosuppression.ART suppresses viral replication, slows disease progression, sustain the balance within the immune system and improve their quality  of life. It delays the onset of AIDS. At present  there are 101 ART centres in 28 states.

         Targeted interventions for high risk groups: The main objective of targeted interventions ( TI) is to improve health_ seeking behaviour of high risk  groups ( HRG) and reduce their risk of acquiring sexually transmitted infections ( STI) and HIV infections. High risk groups under TI include female sex workers ( FSW), men who have sex with  men ( MSM), transgenders ( TG)/ hijras and injecting  drug users ( IDU), and bridge populations  include high risk behaviour migrants and long distance truckers.

     The services offered through targeted interventions include :

__     Detection and treatment  for sexually                transmitted  infections 

___   Condom distribution  ( except in TIs for           bridge population)

__   Codom promotion through  social                     marketing ( for  HRG  and bridge                        population)

__  Behavious change communication 

__ Creating an enabling  environment with community involvement and participation 

__  Linkages to integrated counselling and testing centres

__  Linkages with care and  support services       for HIV positive  HRGs 

__  Community Organization and ownership
       building 

__    Specific interventions for IDUs
     
___     Distribution of clean needles  and                   syringes
___  Abscess prevention and management 

___  Opioid substitution therapy 

___ Linkage with  detoxification                         rehabilitation services 

___ Specific interventions for MSM/ TGs

__ Provision of lubricants

___ Specific interventions for TG/ hijra                   populations 

__ Provision of project _ based  STI clinics


   Link worker Scheme: The   link worker scheme is a community _ based outreach strategy  to address HIV prevention  and care needs  of HRG and vulnerable population in rural areas. The specific  objective of the scheme include reaching  out to these groups with information and knowledge on prevention and risk reduction distribution, providing referral and follow_up linkages for various services.

Information, Education, Communication and Social Mobilization 

   This component include activities aimed at   the generation of awareness about HIV/ AIDS and bringing about positive changes in the behaviour. Educating the public  can be effectively carried out by removing many misconceptions and ignorance through we designed Communication system.This includes mass media campaigns, social mobilization, targeted interventions for high risk behaviour, inter_ sectoral collaboration, investment of NGOs, training  and research.













 

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