National std control programme 11
- 2. INTRODUCTION• The National SexuallyTransmitted Diseases Control Programme ( NSTDsCP) WAS STARTED IN 1946, prior to establishment of independent India, which was in operation until 1991. • The programme focused on the health seeking behavior of individuals with STDs and on combating social stigma associated with these infections. • With the emergence of HIV epidemic, the National STD Control Programme was made on integral part of the National AIDS Control Programme in 1992.
- 3. FROM 1946 TO 1991In 1949 – Pilot project for control of venereal disease. In 1955 - Establishment of at least onVD clinics in every district and one clinic and laboratory in every state. In 1957 - A centralVD organization was set up in the Directorate general of Health Services, New Delhi, for implementing and coordinating the programme in the country. Like :- Free supply of penicillin andVenereal Disease and Research Laboratory (VDRL) antigen were made available to theVD clinics. Since 1981, the strategy of the programme has been changed.The centrally sponsored component of supply of drugs to the state has been discontinued and focus has been on training, teaching and research on various aspects of STD.
- 4. • To provide training facilities to the in-service medical and paramedical personnel in venereology, the government in running two training centers, namely, the institute for Study of SID, Madras Medical College, MADRAS, and STDTraining and Demonstration Centre, Safdarjung Hospital, New Delhi. • A regional training centre is being established at Kolkata for the eastern zone. A regional reference laboratory has been functioning at the office of the serologist and the chemical examiner to the government. • The scheme was converted into a centrally sponsored scheme during the fourth five year plan and the central government assistance was limited to:- –Giving grant-in-aid for establishing new STD clinics. –Supplying of drugs (Benzathine Benzyl Penicillin) to the STD clinics.
- 5. • The scheme was again reviewed and during sixth and seventh five year plan it was decided to establish five regional STD training, teaching and research centres at Delhi, Madras, Nagpur, Hyderabad and Calcutta. • Recognizing STD as one of the major factors for transmission of HIV infection the programme has been merged with the AIDS control programme. The existing components of the programme viz. teaching, training, research and epidemiology, however have been retained outside the world bank assisted activities of the National AIDS control programme.
- 6. OBJECTIVES •Reduce the STD cases and there by control of HIV transmission by minimizing the risk factors. •Prevent the short term as well as long term morbidity and mortality due to STD.
- 7. STRATEGIES • Development of adequate and effective programme management. • Prevention of the transmission of STD/HIV infection through IEC and promotion of safer sexual behavior by the use of condoms. • Adequate and comprehensive case management including diagnosis, treatment, individual counseling, partner notification and screening for other disease. • Increasing access to health care for STD by strengthening existing facilities and creating new facilities. • Early diagnosis and treatment of mostly asymptomatic infections through case finding and screening. • The main strategy aimed at achieving the above outlined has been to integrate STD services into the existing health care system (public & private) with a special emphasis on integration at primary health care (PHC) level.
- 8. ACTION / ACTIVITIES• Training of health care workers in both public and private sectors in comprehensive STD case management. • Development of appropriate laboratory service for the diagnosis of STD. • Conduct microbiologist, social behavioral and operation research. • Surveillance to assess the epidemiology situation, and monitor and evaluate on going STD control programme. • One of the major actions taken along the lines suggested in the strategies was strengthening the existing facilities and structure of STD clinics.
- 9. CONTROL OF STDs• The aim of the STD control programme is the prevention of ill- health through various interventions. These interventions may have Primary prevention focus Secondary prevention focus Usually a combination of the two. The prevention of infection Minimizing the adverse health effects of infection
- 10. The control of STD may be considered under the following heads - •Initial planning •Intervention strategies •Support components •Monitoring and evaluation
- 11. INITIAL PLANNING • Control programmes have to be designed to meet the unique needs of each country and to be in line with that country's health care system, its resources and priorities. • This requires initial planning which comprises the following steps :- • Problem definition • Establishment priorities • Setting objectives • Considering strategies
- 12. INTERVENTION STRATEGIES • Case detection ( Screening, Contact tracing and C luster testing) • Case holding and treatment • Epidemiological treatment • Personal prophylaxis • Health education
- 13. SUPPORT COMPONENTS •STD clinics •Laboratory services •Primary health care •Information system •Legislation •Social welfare measures MONITORING AND EVALUATION
- 14. STDCP NACP • In 1992, with the emergence of HIV epidemic, the National STD Control Programme was made on integral part of the National AIDS Control Programme. • As perWHO estimate around 10% of all adults are infected with curable STI each year. • The department of NACP coordinates RTI and STD at all levels of the health care : Free standardized STI/RTI Services provided through 1160 clinics situated at government health care facilities, at district hospital level, and above.These clinics named as “ Suraksha Clinics” provide sexual and reproductive services.
- 15. FACILITIES IN SURAKSHA CLINICS • Standardized training to the medical and paramedical personnel based on syndromic care management approach. • Counseling services from trained counselor in Suraksha Clinics. • Color coded syndromic drug kits are being centrally procured and supplied to these clinics.
- 16. PRE- PACKED STI / RTI COLOUR CODED KITS : pre- packed color 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 color code is as follows : • KIT 1 – grey, for urethral discharge, ano-rectal discharge and cervicitis. • KIT2 –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.
- 17. Kit number Syndrome Color Content 1 UD, ARD, Cervicitis Grey Tab. Aazithromycin (1g) 1 stat Tab. Cefexine 400 mg 1 stat 2 Vaginitis Green Tab. Secnidazole 2 g (1) stat Cap. Fluconazole 150mg (1) stat. 3 Genito ulcerative disease (GUD)- non herpetic White Benzathine Penicillin (2.4 MU)- 1 vial Tab. Azithromycin (1g) single dose 4 GUD – non herpetic For patients allergic to penicillin Blue Doxcycline 100mg BD×15days Azithromycin 1g (single dose) 5 GUD –non herpetic Red Tab. Acyclovir 400mTDS for 7 days 6 Lower abdominal pain (LAP) Yellow Tab. Cefexime 400m OD stat Tab. Metronidazole BD for 14 days Deoxcycline 100m BD for 14 days 7 Inguinal Bubo Black Tab. Azithromycin 1g OD stat Tab. Doxcycline 100m BD for 21 days
- 19. Requirements to manage STIs •Accurate diagnosis •Treatment at first encounter •Rapid cure with effective drugs •Condom promotion •Partner notification •Education / counseling
- 20. Essential Steps in STI Management •Contact tracing •Compliance •Confidentiality •Condom use •Counseling
- 21. INFORMATION, EDUCATION & COMMUNICATION ACTIVITIES – NACP -4 • To raise or create awareness. • To improve knowledge and understanding. • Routes of transmission & method of prevention. • To promotes desirable practice . • To mobilize all sector of society to integrate message & programme on AIDS in their existing activities. • To generate demand for care, support and treatment services • To make appropriate changes in societal norms.
- 22. Adolescence Education Program• This program is mainly conducted with the objectives of building life skills in adolescents to prepare them cope with physical and psychological changes that accompanies while growing up. Red Ribbon Club Activities • To encourage peer to peer message on HIV prevention. • To provide safe space for young people to clarify their doubts on HIV / AIDS. • Promotion of blood donation among youth. • Conduction of blood donation.
- 23. ACHIEVEMENTS • As on July 1993, the regional STD centres have trained as many as 98 medical officers and 112 paramedical personnel. • About 56 medical colleges, hospitals, laboratories, public health laboratories had participated. • Regional STD five trained centers launched and under these 274 medical officers were trained.
- 24. THANK YOU