![EPIDEMIOLOGY OF HIV IN INDIA
9/1/2018 4
• 2015 : Adult {15-49 years, 0.26% (0.22% - 0.32%)}
• Males (0.30%)
• Females (0.22%)
• Manipur, Highest Prevalence (1.15%)
• Himachal Pradesh (<0.20%)
• Total number of People Living with HIV = 21.17 Lakhs (17.11 Lakhs-26.49 Lakhs)
v/s 22.26 Lakhs (18 Lakhs – 27.85 Lakhs) [2007]
• Highest : Andhra Pradesh and Telangana](https://image.slidesharecdn.com/nationalaidscontrolprogramivnew1-180901050622/85/National-aids-control-program-4-4-320.jpg)
National aids control program 4
- 1. BEYOND, CURRENT POLICIES AND STRATEGIES Presenter: Dr Rahul Gupta 9/1/2018 1 NATIONAL AIDS CONTROL PROGRAM IV
- 2. LAYOUT 9/1/2018 2 • HIV PROBLEM STATEMENT • BRIEF OVERVIEW OF NACP I,II AND III • NACP IV – OBJECTIVES – STRATEGIES – MTA OF NACP IV • NATIONAL STRATEGIC PLAN 2017-2024 • QUESTIONS
- 3. INTRODUCTION 9/1/2018 3 • India has a ‘concentrated’ epidemic (Prevalence , KP>GP). • FSW is 2.2%, • MSM is 4.2%, • H/TG is 7.5%, • IDU is 9.9%( National IBBS* 2014-2015). *IBBS- INTEGRATED BIO-BEHAVIOURAL SURVEILLANCE
- 4. EPIDEMIOLOGY OF HIV IN INDIA 9/1/2018 4 • 2015 : Adult {15-49 years, 0.26% (0.22% - 0.32%)} • Males (0.30%) • Females (0.22%) • Manipur, Highest Prevalence (1.15%) • Himachal Pradesh (<0.20%) • Total number of People Living with HIV = 21.17 Lakhs (17.11 Lakhs-26.49 Lakhs) v/s 22.26 Lakhs (18 Lakhs – 27.85 Lakhs) [2007] • Highest : Andhra Pradesh and Telangana
- 5. 9/1/2018 5 • TOTAL HIV INFECTIONS – Children : 6.5% – Females : 40.5% • Estimated number of New HIV infections • (86 Thousand) – 32% decline from 2007. – Children account for 12% (10.4 Thousand) – Remaining among adults.
- 6. Classification of states 9/1/2018 6 • High prevalence – >5% in HRG & >1% in ANC – Manipur, Maharashtra, TN, Andhra,Karnataka, Nagaland • Moderate prevalence – >5% in HRG & <1% in ANC – Gujarat, Puducherry, Goa • Low prevalence – <5% in HRG & <1% in ANC – All other states/UTs
- 7. ASIAN EPIDEMIC MODEL- TRANSMISSION DYNAMICS OF HIV/AIDS 9/1/2018 7 This model helps in understanding the patterns and trends of the epidemic and can help shape policy and programmatic changes.
- 8. 9/1/2018 8
- 9. AIDS Control Programme in India EVOLUTION- KEY MILESTONES 9/1/2018 9 •1992. •National AIDS Control Board and autonomous NACO set up •Awareness-generation on HIV/AIDS and STIs rolled out • HIV Surveillance systems set up •Safe blood transfusion services set up •Focussed preventive services for KP initiated •Voluntary Counselling and Testing (VCTC) Services launched (NACP I) •1999 •State AIDS Control Societies set up •PPTCT Services launched •Free Anti-Retroviral Therapy launched •Targeted Interventions expanded •VCTC services expanded NACP-II •2007 •1821 TIs set up •159 blood component separation units •15,538 ICTCs including F-ICTC •355 ART centres •516,412 PLHIV on ART NACP- III
- 10. NACP IV 9/1/2018 10 Launched in 2012 with two main objectives Objective 1: Reduce new infections by 50% (Baseline 2007) Objective 2: Comprehensive CST to PLHIV.
- 12. 9/1/2018 12 Mid Term Assessment 2016 ON NACP IV
- 13. HIV PREVALENCE OVER THE YEARS 9/1/2018 13 •The estimated number of new HIV infections per annum is also decreasing, though not uniformly, across the nation. •Some states and districts continue to record an increase in new infections, confirming the heterogeneity of the epidemic
- 14. 9/1/2018 14 • The HIV epidemic in India is predominantly sexually-driven. • However, injecting drug use continues to contribute to infections in an increasing number of geographical areas, including the North-East, Punjab, Uttar Pradesh, Bihar, Delhi and Uttarakhand. • Risk behaviours such as unprotected sexual encounters and injecting drug use are increasingly overlapping.
- 15. 9/1/2018 15 • A rising trend in annual new HIV infections among adults is noticed in otherwise low prevalence State/UTs, including Assam, Chandigarh, Chhattisgarh, Gujarat, Sikkim, Tripura, and Uttar Pradesh. • The prevalence in these State/UTs, barring Gujarat, is still lower than the national average.
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- 17. DISTRICTWISE HIV PREVALENCE,HSS 2014-2015 9/1/2018 17 FACTORS CONTRIBUTING TO HIV EPIDEMIC • Increase in mobility and migration. • Advent of information technology. • Rise in median income levels. • Persistent economic and gender inequalities.
- 18. ESTIMATED NEW HIV INFECTIONS AND DEATHS AMONG PLHIV, 2007-2015 9/1/2018 18 •Estimated new infections have fallen by over 66% between 2000 and 2015. •Estimated ARD in 2015 fell by 54% as compared to 2007. •The two lines cross each other in 2014 suggesting that ANHI will contribute to a slowdown in the pace of the ‘declining HIV prevalence’.
- 19. RECOMMENDATIONS 9/1/2018 19 • Adapt TI strategies to match changing dynamics of bridge and key populations. • Improving community based Screening and geo-prioritisation. • Introduce ‘Test and Treat’ for key population and sero-discordant couples where the system is robust to deliver them.
- 20. 9/1/2018 20 • Strengthen SIMS as an effective integrated tool for programme management. • Ensure linkages across all programme components for effective individual-level case tracking and retention. • Revitalise IEC strategies by shifting to interactive formats, harnessing channels for specific audience segments.
- 21. 9/1/2018 21 • Focus on institutional strengthening – filling vacancies, capacity building and strengthening supervision. • Streamline financial management at SACS for effective transfer and utilisation of financial resources. • Undertake a comprehensive upliftment of procurement and supply chain functions under NACP.
- 22. 9/1/2018 22 What is next?
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- 25. 9/1/2018 25 NATIONAL STRATEGIC PLAN 2017-2024
- 26. 9/1/2018 26 • Target 3.3 which includes ‘Ending of the AIDS epidemic as a public health threat’ by 2030. • To achieve this target, countries need to fast track their HIV- response by 2020. • India aims to achieve 90-90-90 as well as other Fast- Track targets by 2020.
- 27. GUIDING PRINCIPLES OF NSP 9/1/2018 27 • Evidence–informed and result-oriented. • Coverage and Quality. • Rights-based approach. • Investment. • Flexible and adaptive. • Multi-sectoral design and implementation.
- 28. OVERVIEW OF HIV NSP INDIA 2017-2024 9/1/2018 28 Vision: An AIDS Free India Goal: Achieving zero new infections, zero AIDS-related deaths and zero AIDS related stigma & discrimination. Objective 1: Reduce 80% new infections by 2024 (Baseline 2010) Objective 2: Ensure 95% of estimated PLHIV know their status by 2024 Objective 3: Ensure 95% PLHIV have ART initiation and retention by 2024, for sustained viral suppression Objective 4: Eliminate mother-to-child transmission of HIV and Syphilis by 2020 Objective 5: Eliminate HIV/AIDS related stigma and discrimination by 2020 Objective 6: Facilitate sustainable NACP service delivery by 2024
- 29. PRIORITIES 9/1/2018 29 1. Accelerating HIV prevention in ‘at risk group’ and key population. 2. Expanding quality assured HIV testing with universal access to comprehensive HIV care. 3. Elimination of mother to child transmission of HIV and syphilis. 4. Addressing the critical enablers in HIV programming. 5. Restructuring the strategic information system to be efficient and patient- centric.
- 31. EXPECTED ACHIEVEMENTS 9/1/2018 31 1. Estimated new infections will reduce from 102,226 (2010) to < 21,000 per year. 2. 2.14 million PLHIV of the total estimated PLHIV (2.25 million) would know their status. 3. 2.03 million PLHIV would be put on ART. 4. 1.93 million PLHIV would be retained on treatment and have HIV VL <1000 copies/Ml.
- 32. 9/1/2018 32 5. Fulfillment of<50 cases of new pediatric HIV infections per 100,000 live births. 6. Attainment of <50 cases of congenital syphilis per 100,000 live births . 7. HIV/AIDS will be perceived as chronic manageable disease with no stigma and discrimination attached to it. 8. 100% domestic funding.
- 33. CHALLENGES 9/1/2018 33 • Within a TI, individuals may have different risk and vulnerability profiles and needs. • Intervention intensity generally follows prevalence data, though greater focus needs to be on monitoring annual new HIV infections across various populations. • Available evidence reflects a rising epidemic of new HIV infections in certain hitherto low prevalence States and districts. These geographies need to be given priority. • ART adherence among KPs is a major challenge. Additionally, the HIV and TB co- infection rates are higher with low uptake of services.
- 34. POSSIBLE SOLUTIONS 9/1/2018 35 • The quickest way to increase coverage is to rapidly increase TI sites, and ensure efficient outreach and service quality. • Efficient linkage to care and treatment services are critical under the new ‘test and treat’ approach to ensure no leak in the HIV care continuum cascade. • Adapt TI strategy for interventions among newer static groups, including prisoner populations and adolescent PWIDs.
- 35. 9/1/2018 36 • The effective coverage of this ‘at risk’ group may not be possible before 2020, which is the end date for ‘fast track’ targets. • Use of mass media, mid media, social media and IEC. • Expand sexual and reproductive health education with a focus on HIV prevention across all public and private high schools and among youth, in and out of school.
- 36. 9/1/2018 37 • India is committed to achieving the 90-90-90 targets across the country and population groups by 2020. To reach the second and third 90, it is necessary to achieve the first target of 90%. • Satisfactory service to clients must be ensured. • High concordance among spouses: There is scope to reinforce couple counselling and HIV testing for early detection. – Geo prioritising the districts where higher positivity is noted but have a low coverage of testing; – Community based testing. – Active use of IEC to increase demand for HIV testing.
- 37. 9/1/2018 38 • Increasing the pace of expansion of ART coverage and improving ART adherence are the primary objectives of this NSP to reaching the second and third 90. a. Plugging the loss of clients from ICTCs to ART. Use of Care Support Centres (CSCs), PLHIV networks, NGOs and private sectors b. Improving access to ART. c. Addressing cross cutting issues of paucity of human resources and monitoring and evaluation.
- 38. 9/1/2018 39 • ART retention is a challenge. • Current retention rates (12 months) are close to 70%. a. Mobilise PLHIVs for better adherence and retention of PLHIVs on ART. b. Address quality assurance and quality improvement activities. c. Engaging the private sector. d. Strengthen monitoring of chronic HIV care and treatment including scale-up of viral load monitoring and surveillance for drug resistance. e. Strengthen treatment monitoring and evaluation of clinical complications and effects of long-term use of antiretroviral drugs.
- 39. 9/1/2018 40 • India accounts for about 29.7 million pregnancies annually. • Bridge the testing gap for HIV and Syphilis among pregnant women. • Universal access to ART and Syphilis treatment for HIV positive pregnant women and mothers. • Strengthen follow up of cohorts of positive pregnant mothers and uptake of Early Infant Diagnosis. • Improved linkage with the NHM for preventing HIV infection in young reproductive group through prevention messaging and to address unmet needs of family planning in HIV positives.
- 40. 9/1/2018 41 • Strategic information management system and evidence based decision making through a strong monitoring, evaluation and surveillance (MES) framework has been fundamental. • Implementation of one integrated MES system encompassing all information systems used . • Sustained generation analysis and dissemination of high quality strategic information using contemporary methods and technologies . • Systematic engagement with policy makers and programme managers at the national, State/UTs and district level. • Design and implement robust concurrent evaluation systems to measure progress and assess impact with regard to stated targets and goals of the NSP.
- 41. CONCLUSION 9/1/2018 42 • Over the past fifteen years, India has experienced a gradual decline in estimated new HIV infections, prevalence and mortality due to AIDS-related causes. • However, a comprehensive and sustained progress is now required to walk ‘the last mile’. • India has already met the goal set on AIDS-related MDGs from 2000 to 2015, and it has all the pre-requisites in place to reach sub-objective 3.3 including the ending of AIDS by 2030 as defined under the SDG 3. • To this effect, the NACO, in the Ministry of Health and Family Welfare has developed a seven- year National Strategic Plan on HIV/AIDS and STI for India. • This would result in reduction of new HIV infections and will eliminate mother-to-child transmission of HIV and Syphilis, ensuring a stigma and discrimination free environment at the same time.
- 42. References • K. Park 24th Edition. • National Strategic Plan 2017-2024, MOHFW, GOI. • World Health Organisation. • Report of MTA 2016.
- 43. THANK YOU