Strategy Document

National AIDS and STD

Control Programme
Phase-V
(2021-2026)
Anchoring the national response
towards ending the AIDS epidemic

National AIDS Control Organization

Ministry of Health & Family Welfare
Government of India
© NACO, MoHFW, GoI, 2022

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National AIDS Control Organization (2022). Strategy Document: National AIDS and STD Control Programme Phase-V
(2021-26). New Delhi: NACO, Ministry of Health and Family Welfare, Government of India.

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 Strategy Document
National AIDS and STD
Control Programme
Phase-V
(2021-2026)
Anchoring the national response
towards ending the AIDS epidemic

National AIDS Control Organization

Ministry of Health & Family Welfare, Government of India

GoI/NACO/Surveillance Epidemiology/NACP Phase-V: Strategy Document/21042022

Contents
Abbreviations 10

Executive Summary 13

1.National AIDS Response: Genesis and growth 18-24

2. The Context of NACP Phase-V: Current Status of the epidemic and the response 25-32

3. NACP Phase-V (2021-22 to 2025-26): An Overview 33-42

4. Goal 1: Reduce annual new HIV infections by 80% 43-46

5. Goal 2: Reduce AIDS-related mortalities by 80% 47-51

6. Goal 3: Eliminate vertical transmission of HIV and Syphilis 52-55

7. Goal 4: Promote universal access to quality STI/RTI services to at-risk and vulnerable 56-58
populations

8. Goal 5: Eliminate HIV/AIDS related stigma and discrimination 59-61

9. References 62-64
List of Figures
Figure 1. Evolution of the national HIV/AIDS response 18

Figure 2. District Prioritization (District-level HIV burden estimations, 2019) 27

Figure 3. Progress (in %) on 90-90-90 (2018-19, 2019-20 and 2020-21) 29

Figure 4. HIV and Syphilis testing coverage (in %) among pregnant women 30
(2018-19, 2019-20 and 2020-21)

Figure 5. NACP Phase-V Goals 33

Figure 6. Salient features of the HIV & AIDS (Prevention & Control) Act, 2017 34

Figure 7. Guiding Principles of NACP Phase-V 35

Figure 8. Goals, objectives, and strategic interventions under NACP Phase-V 38

Figure 9. Convergence architecture under NACP Phase-V 39

Figure 10. Implementation framework of Community System Strengthening 59

List of Tables

Table 1. Key highlights of initial National HIV/AIDS responses 18

Table 2. Key highlights of NACP Phase-I (1992-1999) 19

Table 3. Key highlights of NACP Phase-II (1999-2007) 20

Table 4. Key highlights of NACP Phase-III (2007-2012) 20

Table 5. Key highlights of NACP Phase-IV (2012-2017) 21

Table 6. Key highlights of NACP Phase-IV Extension (2017-21) 23

Table 7. Overview of HIV/AIDS Epidemic in 2020 26

Table 8. Progress on key performance indicators (2014-15 to 2020-21) 28

Table 9. Key recommendations of the evaluation of NACP Phase IV and Extension Period 31

Table 10. Component-wise and year-wise outlay under NACP Phase-V 41

Table 11. Year-wise output/outcome target under NACP Phase-V 42

Table 12. Reducing New HIV Infections: Strategies at a glance 44

Table 13. Reduce AIDS-related mortalities: Strategies at a glance 48

Table 14. Impact and process indicators and targets for elimination of vertical transmission of 52
HIV and Syphilis

Table 15. Eliminate vertical transmission of HIV and Syphilis: Strategies at a glance 53

Table 16. Promote universal access to quality STI/RTI services to at-risk and vulnerable 57
populations: Strategies at a glance

Table 17. Eliminate HIV/AIDS related stigma and discrimination: Strategies at a glance 60
 Abbreviations

AEP Adolescence education programme

AFHC Adolescent friendly health clinics
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal care
ART Antiretroviral treatment
ARV Antiretroviral
BPG Benzathine penicillin G
CBO Community-based organization
CBS Community-based screening
CD4 Clusters of differentiation 4
CLHIV Children living with HIV
CLM Community-led monitoring
CoE Center of Excellence
COVID-19 Coronavirus disease 2019
CS Congenital syphilis
CSS Community system strengthening
CST Care support and treatment
DAPCU District AIDS Prevention and Control Units
DISHA District Integrated Strategy for HIV/AIDS
DSDM Differentiated Service Delivery Model
DSRC Designated STI/RTI Center
EID Early infant diagnosis
ELM Employer-led model
EQAS External quality assurance system
FI-ICTC Facility-integrated counselling and testing center
FSW Female sex worker
GHSS Global Health Sector Strategy
HIV Human Immunodeficiency Virus

10 National AIDS and STD Control Programme Phase-V (2021-26)

 HMIS Health management information system
HRG High-risk group
HCTS HIV counselling and testing services
HSS HIV Sentinel Surveillance
H/TG Hijra/transgender people
ICTC Integrated Counselling and Testing Center
IDU Injecting drug user
IT Information technology
LWS Link worker scheme
MoHFW Ministry of Health and Family Welfare
MoSJE Ministry of Social Justice and Empowerment
MSM Men who have sex with men
MTCT Mother-to-child transmission
MTP Mid-term plan
NAC National AIDS Committee
NACB National AIDS Control Board
NACO National AIDS Control Organisation
NACP National AIDS and STD Control Programme
NERO Northeast regional office
NGO Non-government organization
NHM National Health Mission
NRL National Reference Laboratory
NTEP National TB Elimination Programme
NVHCP National Viral Hepatitis Control Programme
NVHSP National Viral Hepatitis Surveillance Programme
OST Opioid substitution therapy
p-MPSE Programmatic mapping and population size estimation

11 National AIDS and STD Control Programme Phase-V (2021-26)

 PEP Post-exposure prophylaxis
PLHIV People Living with HIV
PMR Programme management and review
PMU Project management unit
PPTCT Prevention of parent-to-child transmission
PSU Project support unit
RCH Reproductive and child health
RDT Rapid diagnostic test
RKSK Rashtriya Kishor Swasthya Karyakram
RMNCH+A Reproductive, Maternal, Newborn Child plus Adolescent Health
RPR Rapid Plasma Reagin
RRC Red ribbon club
RTI Reproductive tract infection
SACS State AIDS Control Society
SI Strategic information
SRC State Reference Center
STD Sexually transmitted disease
STI Sexually transmitted infection
STRC State training resource center
SRL State Reference Laboratory
SSS Sampoorna Suraksha Strategy
RSTRRL Regional STI Training, Research, and Reference Laboratories
TI Targeted Intervention
TRG Technical Resource Group
TWG Technical Working Group
WLHIV Women living with HIV

12 National AIDS and STD Control Programme Phase-V (2021-26)

 Executive Summary

Genesis and Growth

India’s response to the HIV/AIDS epidemic was initiated in the form of sero-surveillance in 1985. While initial
responses (1985-1991) focused on search of HIV in different population groups and locations, screening of
blood before transfusion, and targeted awareness generation; the launch of National AIDS and STD Control
Programme (NACP) in 1992 institutionalized beginning of a comprehensive response to the HIV/AIDS epidemic
in India. Thirty-five years since then, NACP has evolved as one of the world’s largest programmes through
five-distinct phases.

The first phase of NACP (1992-1999) focussed on awareness generation and blood safety. The second phase
witnessed launch of direct interventions across the prevention-detection-treatment continuum with capacity
building of States on programme management. The third phase (2007-2012) was story of scale-up with
programme management decentralised up to the district level. The fourth phase (2012-2017) was a period of
consolidation and enhanced Government funding.

The NACP Phase-IV (Extension)

The NACP Phase-IV (Extension) was first approved for the period of 2017-2020 and then further extended for
one more year i.e., 2020-21. Several gamechanger initiative were taken during NACP Phase-IV (Extension). The
Phase started with the passing of the HIV and AIDS (Prevention and Control) Bill, 2017 and the launch of the
‘Test and Treat’ policy for HIV patients in April 2017. The Bill ensured equal rights for the people infected with
HIV and AIDS in getting treatment and prevent discrimination of any kind. The Act came into force in September
2018. As the ‘Test and Treat’ policy was being scaled-up, the Programme implemented “Mission Sampark” in
2017 to bring back People Living with HIV (PLHIV) who have left treatment after starting ART. ‘Test and Treat’
was complemented by the launch of universal viral load testing for on-ART PLHIV in February 2018.

The year 2020-21 witnessed the onset of the COVID-19 pandemic. The national AIDS response was challenged
in the initial months like any other aspect of life. However, the Programme soon took many initiatives turning
challenges into opportunities. IT systems were leveraged to enhance programme review and capacity building.
This resulted in improved inter and Intra-State coordination. Initiatives like multi-month dispensation and
community-based ART refill ensured continuity in service provisions.

Context and formulation of NACP Phase-V

The impact of the national AIDS response has been significant. The annual new HIV infections in India have
declined by 48% against the global average of 31% (the baseline year of 2010). The annual AIDS-related mortalities
have declined by 82% against the global average of 47% (the baseline year of 2010). The HIV prevalence in India
continues to be low with an adult HIV prevalence of 0.22%. Despite the significant achievements and impact,
there is no place for complacency given the country's commitment to ending the AIDS epidemic as a public
health threat by 2030. HIV remains a national public health priority with new HIV infections happening at a rate
highethan the desired level. The annual number of new infections among adults has declined by 48% since
2010, but still has a long way to go to achieve a 90% decline by 2030. The progress on targets of 90-90-90 to be
achieved by 2020 has gauzed the country's progress on ending the epidemic. The full realization of 90-90-90 by
2020 would have meant that at least 73% of PLHIV have suppressed viral loads in 2020 cutting down the
transmission significantly. At the end of 2020, 78% of PLHIV knew their HIV status, 83% of PLHIV who knew their
HIV status were on ART, and 85% of PLHIV on ART were virally suppressed.

13 National AIDS and STD Control Programme Phase-V (2021-26)

 The formulation of NACP Phase-V was necessitated by the need for continuous action and the vigil in context
of the country commitment on ending of the AIDS epidemic as a public health threat by 2030. It was initiated
in alignment with Fifteenth Finance Commission for 2021-26 of the Government of India. The formulation of
NACP Phase-V coincided with formulation of UNAIDS Global AIDS Strategy 2021-2026, WHO Global Health
Sector Strategies (GHSS) on HIV, viral hepatitis, and sexually transmitted infections for the period 2022-2030
and The Global Fund cycle of 2021-24. NACP Phase-V takes into account the global contexts, targets and strategies.

Overview of NACP Phase-V (2021-26)

NACP Phase-V is a Central Sector Scheme, fully funded by the Government of India, with an outlay of Rs
15471.94 crore. The NACP Phase-V aims to reduce annual new HIV infections and AIDS-related mortalities by
80% by 2025-26 from the baseline value of 2010. The NACP Phase-V also aims to attain dual elimination of
vertical transmission, elimination of HIV/AIDS related stigma while promoting universal access to quality STI/RTI
services to at-risk and vulnerable populations.

The specific objectives of the NACP Phase-V are as below:

a. HIV/AIDS prevention and control

i. 95% of people who are most at risk of acquiring HIV infection use comprehensive prevention
ii. 95% of HIV positive know their status, 95% of those who know their status are on treatment and 95%
of those who are on treatment have suppressed viral load
iii. 95% of pregnant and breastfeeding women living with HIV have suppressed viral load towards
attainment of elimination of vertical transmission of HIV
iv. Less than 10% of people living with HIV and key populations experience stigma and discrimination

b. STI/RTI prevention and control

i. Universal access to quality STI/RTI services to at-risk and vulnerable populations

ii. Attainment of elimination of vertical transmission of syphilis

Under NACP Phase-V, while the existing interventions will be sustained, optimized, and augmented; newer
strategies will be adopted, piloted, and scaled-up under the programme to respond to the geographic and
community specific needs and priorities. The HIV and AIDS (Prevention and Control) Act, 2017 will continue to
be the cornerstone of the national response to HIV and STI epidemic in NACP Phase-V. The Act will be the
enabling framework to break down barriers driving delivery of a comprehensive package of services in an
ecosystem free of stigma and discrimination.

14 National AIDS and STD Control Programme Phase-V (2021-26)

 Guiding Principles of NACP Phase-V (2021-26)

Eight guiding principles will be central to strategies and activities to attain the specific targets.

1. Keep beneficiary and community in center

2. Break the silos, build synergies
3. Augment strategic information-driven planning, implementation, monitoring, and mid-course
corrections
4. Prioritize and optimize through high-impact programme management and review
5. Leverage technology and innovation as critical enablers
6. Enhance and harness partnership
7. Integrate gender-sensitive response
8. Continue fostering technical arrangements and institutions

Collaboration with public and private sectors

NACP Phase-V will build upon the systematized convergence with the existing schemes of Central Government
including synergy with National health programme, related line Ministries as well as State Governments
through mainstreaming and partnership extending the reach of various HIV related services in a cost-neutral
way. The collaboration framework of NACP Phase-V includes continued strategic engagement with private
sector.

Goal 1: Reduce annual new HIV infections by 80%

NACP Phase-V will accelerate reduction in new annual HIV infections through a basket of strategies tailored to
the high-risk, at-risk, and low-risk population groups.

1. Continue and evolve the existing peer-led targeted interventions (TI) and Link Worker Schemes (LWS)
strategies for integrated services
2. Promote evidence-backed comprehensive prevention packages tailored to location and population
3. Strengthen the population size estimation and field epidemiological intelligence for coverage
expansion and saturation
4. Expand and intensify the coverage of NACP interventions including OST among Injecting Drug
Users (IDU)
5. Universalize the NACP interventions in prisons and other closed settings through a mix of service
delivery models
6. Pilot and scale models for community-based integrated service delivery models
7. Redefine and expand coverage among the bridge population
8. Develop and roll-out new generation communication strategy suitable to current context
9. Cover ‘at-risk’ HIV negative through comprehensive prevention packages to keep them negatives
10. Develop and scale-up sustainable models for ‘at-risk’ Virtual Population
11. Maintain and augment the behavior change communications for general population
12. Sustain focus on adolescent and youth population

15 National AIDS and STD Control Programme Phase-V (2021-26)

 Goal 2: Reduce AIDS-related mortalities by 80%

NACP Phase-V will build upon the strong momentum from previous phases and further accelerate the
reductions on AIDS-related mortalities through strategies directed across care continuum.

1. Maintain the existing models of HIV counselling and testing services (HCTS) and expand through
strategic scale-up
2. Develop and roll-out tailored communication campaigns focusing on risk perception and HCTS
uptake
3. Augment the existing HCTS models with efficient approaches for active case findings promoting
early detections
4. Appropriately adapt evidence-backed newer technologies to supplement existing models
5. Maintain existing care, support, and treatment (CST) services models and expand further
through sustainable manner
6. Continue provisions of high-quality ARVs through differentiated service delivery models improving
through sustainable manner
7. Focus on rapid ART initiation and advanced HIV disease management augmenting quality of care
8. Suitably update the treatment guidelines periodically
9. Address linkage loss at all levels
10. Optimize the uses of public sector laboratories for viral load measurements
11. Offer integrated service delivery packages to ‘at-risk’ people and PLHIV
12. Prioritize sexual and reproductive health services for women at increased risk of HIV infection and
women living with HIV
13. Bring efficiencies and improve linkages through single window service delivery models
14. Maintain and expand laboratory quality assurance system

Goal 3: Eliminate vertical transmission of HIV and Syphilis

The NACP Phase-V takes into the account the global guidance towards elimination of vertical transmission of
HIV and Syphilis.

1. Augment comprehensive synergy with NHM for testing of pregnant women for HIV and syphilis
2. Strengthen the primary prevention through coordinated actions
3. Introduce and scale-up dual test kits (HIV & Syphilis) to fast-track progress on the dual elimination
4. Strengthen linkage from screening facilities to confirmatory centers and subsequently to the
treatment centers
5. Strengthen retention and on-ART adherence among eligible WLHIV
6. Prioritize family planning services for eligible PLHIV
7. Strengthen the early diagnosis of infants and all children living with HIV (CLHIV)
8. Engage with private sector augmenting their role in attainment of dual elimination
9. Strengthen the strategic information in the context of HIV positive pregnant women/mother
10. Prepare strategic roadmap to guide actions towards attainment of validation of elimination of
vertical transmission

16 National AIDS and STD Control Programme Phase-V (2021-26)

 Goal 4: Promote universal access to quality STI/RTI services to at-risk and vulnerable populations

NACP Phase-V will reinforce the STI/RTI component not only in terms of elimination of vertical transmission of
HIV and syphilis but also to augment access to quality STI/RTI services through maximizing its system and
opportunities for shared delivery models.

1. Strengthen the strategic information on STIs

2. Maintain the existing model of Designated STI/RTI Clinics (DSRCs) augmenting the role
3. Develop and implement integrated communication strategies
4. Dovetail dual testing at HCTS centers
5. Promote active case findings facilitating early detections
6. Improve collaboration with NHM on STI/RTI services provisions and reporting
7. Strengthen and streamline private sector engagement on STI/RTI management
8. Suitably update the STI/RTI management guidelines periodically
9. Augment the laboratory capacities
10. Strengthen the supply chain management

Goal 5: Eliminate HIV/AIDS related stigma and discrimination

NACP Phase-V will build upon the gamechanger initiatives of NACP-Phase IV (Extension) to accelerate the
progress on elimination of HIV/AIDS related stigma and discrimination.

1. Undertake bottom-up institutionalized community system strengthening

2. Accelerate the notification of State rules and appointment of Ombudsman in the context of the HIV
and AIDS (Prevention and Control) Act, 2017
3. Undertake sensitization of related stakeholders on HIV/AIDS related stigma and discrimination
4. Design and implement communication strategy on elimination of HIV/AIDS related stigma
and discrimination
5. Enhance strategic information on HIV/AIDS related stigma and discrimination
6. Engage with State governments promoting launch and scale-up of social protection schemes

17 National AIDS and STD Control Programme Phase-V (2021-26)

 1. National AIDS Response:
Genesis and growth

In 1981, rare forms of unexplained pneumonia new emerging global pandemic, the Indian
and cancer were reported among gay men in the Council of Medical Research (ICMR) initiated
United States of America in weekly surveillance sero-surveillance in October 1985; an outcome of
reports [1 ,2]. Further research into these illnesses which was detection of the first case of HIV in
led to the discovery of a virus, later named Chennai in April 1986 [4,5]. Since then, the
Human Immunodeficiency Virus (HIV), which was national AIDS response has travelled a long way
causing acquired immunodeficiency among the (Figure 1, Table 1-6).
infected [3]. Recognizing the threat posed by a

Figure 1. Evolution of the National HIV/AIDS response

Initial Response NACP Phase - II NACP Phase - IV NACP Phase - V

1985-1991 1992-1999 1999-2007 2007-2012 2012-2017 2017-2021 2021-2026

NACP Phase-I NACP Phase-III NACP Phase-IV

(Extension)

1.1 Initial Interventions (1985-1991)

With reporting of HIV/AIDS cases in India, the and four metropolitan cities (Chennai, Kolkata,
Ministry of Health and Family Welfare (MoHFW) Mumbai, and Delhi) in view of identified vulnerabilities.
constituted a high-powered National AIDS The initial responses focused mainly on surveillance
Committee (NAC) in 1986 [6]. A mid-term plan was in perceived high-risk areas and population
developed that focused on four States (Tamil groups, screening of blood before transfusion,
Nadu, Maharashtra, West Bengal, and Manipur) and targeted awareness generation (Table 1) [7].

Table 1. Key highlights of initial National HIV/AIDS responses (1985-1991)

Key Highlights

1. Launch and expansion of HIV Sero-Surveillance

2. Constitution of National AIDS Committee
3. Focus on blood screening and awareness generation
4. Mid-term plan for identified vulnerable areas

09 18 National AIDS and STD Control Programme Phase-V (2021-26)

 1.2 National AIDS and STD Control Programme (NACP) Phase-I
(1992-1999)

As the HIV epidemic in India seemed to be Societies (SACS) in the then 25 States and 7
expanding (through rounds of sero-surveillance), Union Territories (UT). NACP Phase-1 undertook
the first phase of the National AIDS and STD large-scale awareness generation campaigns. As
Control Programme (NACP) was launched in initially blood transfusion was the major source of
1992 [5,6,8,9]. The objective was to slow down the HIV transmission, licensing of the blood banks
spread of HIV infections, and decrease the and banning of professional donors was a
morbidity, mortality, and impact of HIV/AIDS in major priority under NACP Phase-I. Expansion
the country. The phase-I of NACP constituted the of surveillance network and collaboration
institutional structures of the National AIDS with non-government organizations (NGO)/
Control Board (NACB), the AIDS Control Organisation community-based organizations (CBO) for
(NACO) as well as State-level programme preventive interventions were also focused.
management unit calleds State AIDS Control

Table 2. Key highlights of NACP Phase-I (1992-1999)

Key Highlights

1. Establishment of NACB, NACO and SACS

2. Implementation of large-scale awareness generation campaigns
3. Licensing of blood banks and banning of professional donors
4. Collaboration with NGO/CBO for prevention interventions among high-risk groups (HRG)
5. Expansion of surveillance networks

1.3 NACP Phase-II (1999-2007)

The Government of India launched the NACP (VCT), interventions for prevention of parent to
Phase-II in 1999 with two objectives: (i) to reduce child transmission (PPTCT), antiretroviral (ARV)
the spread of HIV infection in India, and (ii) to medicines were introduced, and antiretroviral
increase India’s capacity to respond to HIV/AIDS treatment (ART) centers were established and
on a long-term basis. NACP Phase- II was critical eventually scaled up. The Constitution of the
as some international organizations stated that National Parliamentarian Forum generated
the HIV epidemic in India was ‘on African strong political support that culminated in the
trajectory’ with the world’s largest number of setting-up of the National Council on AIDS,
HIV-infected people [10]. While the assessment chaired by the Prime Minister of India. Systematic
was far-fetched, NACP Phase-II transitioned the interventions like the adoption of the National
national AIDS response through a sincere, AIDS Prevention and Control Policy (2002) and
intensive, and long-term commitment. the National Blood Policy (2003) reinforced the
national AIDS response. Programme management
The awareness generation activities were backed was strengthened with the capacity building of
by tailored and comprehensive service delivery SACS and the establishment of Project Support
packages [11]. Peer-led targeted interventions Units/Project Management Units (PSU/PMU)
(TI) through NGO/CBO offered a package of providing technical and managerial support for
preventive services to the key population [a]. quality interventions for high-risk groups (HRG).
Facilities for voluntary counselling and testing,
a
Includes Female Sex Workers, Men who have Sex with Men, Hijra/Transgender People, Injecting Drug Users, Migrants and Truckers

19 National AIDS and STD Control Programme Phase-V (2021-26)

 Table 3. Key highlights of NACP Phase-II (1999-2007)

Key Highlights

1. Launch and expansion of peer-led targeted interventions (TI) through NGO/CBO

2. Establishment of facilities for VCT and PPTCT
3. Introduction of ARV and establishment of ART centers
4. Constitution of the National Parliamentarian Forum and National Council on AIDS
5. Adoption of the National AIDS Prevention & Control Policy and National Blood Policy
6. Capacity building of SACS and establishment of PSU/PMU

1.4 NACP Phase-III (2007-2012)

The third phase of the NACP was launched in Programme management was decentralized up
2007 to halt and reverse the epidemic in India to the district level with the establishment of the
during the eleventh five-year plan (2007-12) of District AIDS and Prevention Control Unit
the Government of India. Rapid scale-up of the (DAPCU) in 188 high-priority districts based-on rich
service delivery facilities aiming for saturation epidemiological evidence generated under the
across the prevention-detection-treatment Programme [15]. Institutional strengthening also
spectrum was the key highlight of the third phase included the establishment of Strategic Information
[12]
. The VCT services evolved into integrated Management Unit (SIMU) at NACO and SACS, a
counselling and testing centers (ICTC). The dedicated North-East Regional Office (NERO)
Programme adopted the offering of HIV counselling for focused attention to the northeastern states,
and testing services to pregnant women as an and state training resource centers (STRC) to help
essential component of antenatal care (ANC) in capacity building of the state-level implementation
services [13]. Donor funded interventions for the units and functionaries [16]. By the end of NACP
key population were transitioned [14]. Mapping Phase-III, it was established that though there
and population size estimation of HRGs were was significant progress under the national AIDS
undertaken systematically. response in India, yet there ,
was no scope for
complacency [17,18]
.

Table 4. Key highlights of NACP Phase-III (2007-2012)

Key Highlights

1. Rapid scale-up of the service delivery facilities pan India

2. Offering of HIV counselling and testing services to pregnant women as an essential
component of ANC services
3. Transition of donor-funded interventions for the key population
4. Establishment of SIMU at NACO and SACS
5. Programme management decentralized up to the district level with the establishment of
DAPCU

20 National AIDS and STD Control Programme Phase-V (2021-26)

 1.5 NACP Phase-IV (2012-2017)

The fourth phase of NACP was planned for the support interventions in prisons and other closed
period 2012-17 in alignment with the duration of settings were launched. The commitment was
the twelfth five-year plan of the Government of backed-up by expanding the reach of HIV
India. Intending to accelerate reversal and screening services through strategies of facili-
integrate response, the Programme aimed to ty-integrated HIV counselling and testing centers
reduce new infections by 50% (2007 Baseline of (FI-ICTC) under the national health mission as
NACP Phase-III) and provide comprehensive well as in the private sector and the launch of
care and support to all persons living with community-based screening (CBS) [22]. The CD4
HIV/AIDS and treatment services for all those cut-off level for initiation of ART was raised from
who require it [19]. 350 to 500 cells/mm3[23]. The Human Immunodeficiency
Virus (HIV) and Acquired Immune Deficiency
NACP phase-IV consolidated the gains made in Syndrome (AIDS) (Prevention and Control) Bill
previous phases. The National HIV/AIDS toll free was introduced in the Rajya Sabha [24]. Mainstreaming
helpline – 1097 was launched on 1st December & partnerships were focused to strengthen the
2014 on the occasion of World AIDS Day by multi-sectoral response [25]. A mid-term review of
Hon’ble HFM. The northeastern States become a NACP Phase-IV was undertaken which informed
key priority for the country in view of the the formulation of the seven-year National Strategic
sustained level of high epidemic and emerging Plan [13]. Many of these initiatives primed the
new pockets [20]. The resolve to attain dual elimination Programme for the next generation of AIDS
of vertical transmission of HIV and syphilis got response.
adopted and rooted in programme guidelines
[13,14,21]
. Comprehensive HIV prevention, care and

Table 5. Key highlights of NACP Phase-IV (2012-2017)

Key Highlights

1. Momentous change in funding landscape with Government of India providing 73% of

the total budget for NACP
2. Launch of National HIV/AIDS toll free helpline – 1097
3. Adoption of dual elimination of vertical transmission (of HIV & Syphilis) in NACP guidelines
4. Launch of NACP interventions in prisons and other closed settings
5. Strategic expansion of the reach of HIV screening services with FI-ICTC and CBS
6. CD4 cut-off level for initiation of ART was shifted to 500 cells/mm3
7. The HIV and AIDS (Prevention and Control) Bill introduced in the Rajya Sabha
8. Mid-term review of NACP Phase-IV

The NACP Phase-IV witnessed a momentous Phase-I [17] . The phase also witnessed the
change in the funding landscape of national Government’s decision to continue funding the
AIDS response with the Government of India Programme as a Central Sector Scheme
(GoI) providing 73% of the total budget in comparison demonstrating the political ownership of the
to 15 per cent domestic financing under NACP national HIV/AIDS response [22].

21 National AIDS and STD Control Programme Phase-V (2021-26)

 1.6 NACP Phase-IV Extension (2017-2021)

The 12th five-year plan of the Government of under revamped strategies. Interventions to
India ended in 2017. A decision was taken that cover high-risk and at-risk populations seeking a
government schemes would be aligned with partner through virtual populations were tested
Finance Commission cycles improving the through demonstration projects [34]. The number
quality of the Government expenditure. The of regional languages under the National
decision necessitated that the ongoing scheme HIV/AIDS toll free helpline – 1097 increased to 12
would be aligned with the remaining Fourteenth and referral and online grievance redressal
Finance Commission period ending March 2020 mechanism was introduced.
after an outcome review [26]. Accordingly, the
NACP Phase-IV (Extension) was formulated for NACP continued to be primarily responsible for
the period April 2017 to March 2020. Later, the provision of safe blood in NACP-Phase IV
Programme was extended for one more year as Extension. A network of 3311 licensed blood
the final report of the 15th Finance Commission banks across all States and sectors, including
was still awaited [27]. 1131 NACO supported blood banks, were
operational in 2019-20 under Blood Transfusion
NACP Phase-IV Extension (2017-2021) was the Services of NACP. External quality assurance for
phase of the gamechanger initiatives. The Phase blood banks were undertaken through three
started with the passing of the HIV and AIDS proficiency testing providers. The success of
(Prevention and Control) Bill, 2017 and the launch NACP on provision of safe blood was evident
of the ‘Test and Treat’ policy for HIV patients in with HIV sero-positivity of as low as 0.12% and a
April 2017 [28 ,29]. The Bill ensured equal rights for negligible proportion of PLHIV reporting to
the people infected with HIV and AIDS in getting acquire HIV infections through blood and blood
treatment and prevent discrimination of any kind. products in 2020-21.
The Act came into force in September 2018. As
the ‘Test and Treat’ policy was being scaled-up, Strategic information expanded into newer
the Programme implemented “Mission programmatic areas (Pre-Exposure Prophylaxis,
Sampark” in 2017 to bring back People Living HIV Self Testing etc.), newer population groups
with HIV (PLHIV) who have left treatment after (prisoners, ‘at-risk’ people on virtual platform)
starting ART [30]. ‘Test and Treat’ was and additional biomarkers (Hepatitis B and
complemented by the launch of universal viral Hepatitis C) along with size estimations up to
load testing for on-ART PLHIV in February 2018 the district-level [35,36,37,38,39,40]. Beneficiary - centric,
[31]
. Differentiated Service Delivery Model (DSDM) information technology (IT)-enabled monitoring,
to strengthen follow up, adherence and evaluation and surveillance system with
retention were initiated. Transitioning of PLHIV embedded supply chain management was
on Dolutegravir-based regimen was initiated [32]. developed and rolled out for seamless
management of information systems across
The Extension phase witnessed revamped TI various service delivery points [41]. Third-party
interventions to focus on hard-to-reach evaluation of NACP Phase-IV and Extension was
populations [33]. Differentiated prevention, undertaken [42].
peer-navigator and index testing were introduced

22 National AIDS and STD Control Programme Phase-V (2021-26)

 Table 6. Key highlights of NACP Phase-IV Extension (2017-21)

Key Highlights
1. Enactment of the HIV and AIDS (Prevention and Control) Act, 2017
2. Launch and scale-up of the ‘Test and Treat’ policy for HIV patients
3. ‘Mission Sampark’ to bring back lost-to-follow-up PLHIV on ART
4. Launch and scale-up up universal viral load testing for on-ART PLHIV
5. Launch of DSDM for PLHIV to strengthen follow up, adherence and retention
6. Scale-up of NACP interventions in prisons and other closed settings
7. Revamped TI programme with differentiated prevention, peer-navigator, and index
testing strategies to focus on hard-to-reach populations
8. Initiation of transitioning of PLHIV on Dolutegravir-based regimen
9. Strategic information expansion into newer areas like Pre-Exposure Prophylaxis,
HIV Self Testing etc. through demonstration projects; newer and hidden population
groups (prisoners, ‘at-risk’ people on virtual platform etc.) and additional biomarkers
(Hepatitis B and Hepatitis C)
10. Population size estimation (PLHIV and HRGs) up to the district level
11. Development and roll-out of Client-centric, IT-enabled monitoring, evaluation, and
surveillance system with embedded supply chain management
12. Third-party evaluation of NACP Phase-IV and Extension
13. Successful mitigation of COVID-19 pandemic ensuring uninterrupted service delivery
to targeted beneficiaries

1.7 Coronavirus disease (COVID-19) mitigation and preparation

for NACP Phase-V

The year 2020-21 witnessed the onset of the Commission cycle. However, as the final report of
COVID-19 pandemic. The national AIDS the 15th Finance Commission was awaited, all
response was challenged in the initial months like ongoing schemes were given an interim
any other aspect of life. However, the Programme extension till 31.03.2021 or till the date of
soon took many initiatives turning challenges recommendations of 15th Finance Commission
into opportunities [43]. IT systems were leveraged come into effect (whichever is earlier). As the
to enhance programme review and capacity 15th Finance Commission submitted its report in
building. This resulted in improved inter and Intra November 2020 for the period 2021-22 to
State coordination. Initiatives like multi-month 2025-26, the process of formulation of NACP
dispensation and community-based ART refill Phase-V (2021-22 to 2025-26) was initiated
ensured continuity in service provisions. following directives from the Ministry of Finance
[44,45]
. Subsequently, the Union Cabinet approved
NACP Phase-IV extension was expected to be NACP Phase-V with an outlay of Rs 15471.94
co-terminus on 31.03.2020 with the 14th Finance crore [33].

23 National AIDS and STD Control Programme Phase-V (2021-26)

 The formulation of NACP Phase-V coincided with extensively in development of Global AIDS
formulation of UNAIDS Global AIDS Strategy Strategy, GHSS and proposal development for
2021-2026, WHO Global Health Sector Strategies the Global Fund 2021-24. NACP Phase-V takes
(GHSS) on HIV, viral hepatitis, and sexually into account the global contexts, targets and
transmitted infections for the period 2022-2030 strategies and takes forward the country
and The Global Fund cycle of 2021-24. National commitment on ending of the AIDS epidemic as
programme managers, communities and other a public health threat by 2030.
related stakeholders from India participated

24 National AIDS and STD Control Programme Phase-V (2021-26)

 The Context of NACP Phase-V:
2. Current Status of the epidemic
and the response

2.1 Current status of the Epidemic

2.1.1 The HIV/AIDS epidemic

Since the detection of the first case of HIV in national averages. Twenty-five districts in the
Chennai (Tamil Nadu) in April 1986, considerable whole of country have estimated adult HIV
progress has been made under NACP to halt and prevalence of 1% or more; all are in the
reverse the epidemic. As a result, the HIV northeastern States.
epidemic in India continues to be low (Table 7) [46].
The continued low prevalence may give an The prevalence rate among the HRG population
exaggerated sense of achievements leading to of female sex workers (FSW), prisoners, men who
complacency. In fact, HIV prevalence and have sex with men (MSM), hijra/transgender
incidence among key population remains at (H/TG) people and injecting drug users (IDU) is
much higher level than the general population 7-28 times of adult population. While almost 90%
[47]
. Hence the need for continuous action and the of infections are through the sexual route
vigil. nationally, at-least 25% are through infected
syringes and needles in the States of Manipur,
As a result of more and more PLHIV being initiated Mizoram, Tripura, and Punjab [52,53 ,
]. Higher
and retained on high-quality antiretrovirals (ARV) prevalence of Hepatitis, especially of Hepatitis C
medicines, PLHIV cohort is living longer and Virus among IDUs, has been noted [54].
growing older. It is estimated that almost
two-fifth of the PLHIV would be aged 50 years or In a concentrated HIV epidemic, the size of HRG
older in 2025[48]. This aging is anticipated to lead is a significant epidemiological indicator. The
to more non-AIDS morbidities, and thus an programme has launched the programmatic
inevitable need for multidisciplinary health-care mapping and population size estimation
services to ensure continued high-quality (p-MPSE) to periodically update the HRG size
survival. estimates in India. While p-MPSE is being
undertaken under the programme to do a local
The HIV/AIDS epidemic continues to be area mapping for launching and scaling up
heterogenic in terms of location, population, and services, recent evidence has suggested a much
route of transmission [47,49,50,51]
, , ,
. Almost 84% of the bigger size of HRGs than being currently covered
PLHIV are estimated to be in 299 districts of the under the programme ,
[55,56]. Further, the dynamics
country (Figure 2). The prevalence and incidence of seeking a sexual partner is changing with more
rate in the northeastern States of Manipur, and more use of online platforms fueled by
Mizoram and Nagaland is much higher than the widespread internet access [57, 58,59].

25 National AIDS and STD Control Programme Phase-V (2021-26)

 Table 7. Overview of HIV/AIDS Epidemic in 2020

Indicator Disaggregation Value

Adult (15-19 yrs.) Prevalence (In %) Total 0.22 [0.17-0.29]

Male 0.23 [0.18-0.31]
Female 0.20 [0.15-0.26]
Number of people living with HIV (In lakh) Total 23.18 [18.33-29.78]
Adults (15+ years) 22.37 [17.74-28.69]
Women (15+ years) 9.88 [7.82-12.68]
Children (<15 years) 0.81 [0.59-1.09]
HIV incidence per 1000 uninfected population Total 0.04 [0.02-0.09]
Male 0.05 [0.02-0.09]
Female 0.04 [0.02-0.08]
New HIV Infections (In lakh) Total 0.58 [0.29- 1.14]
Adults (15+ years) 0.52 [0.25-1.04]
Women (15+ years) 0.22 [0.11-0.45]
Change in new HIV infections since 2010 (In %) Total -47.89
Adults (15+ years) -46.96
Female (15+ years) -45.72
Children (<15 years) -55.02
AIDS-related mortalities (In lakh) Total 0.32 [0.20-0.52]
Adults (15+ years) 0.28 [0.18-0.46]
Women (15+ years) 0.07 [0.04-0.13]
Change in AIDS-related mortalities since 2010 (In %) Total -82.24
Adults (15+ years) -83.19
Female (15+ years) -89.17
Children (<15 years) -68.09

26 National AIDS and STD Control Programme Phase-V (2021-26)

 Figure 2. District Prioritization (District-level HIV burden estimations, 2019)

Priority level Description Number of

Epidemic Burden
Districts

High Adult prevalence of >=1% 144 63% of PLHIV, 49% of new infections
or PLHIV size of >=5000 and 55% of PMTCT need

Moderate Adult prevalence of 0.4% - 155 21% of PLHIV, 27% of new infections
<1% or PLHIV size of 2500 - and 25% of PMTCT need
<5000
Low Adult prevalence of 180 12% of PLHIV, 16% of new infections
0.20%-<0.40% or PLHIV size and 14% of PMTCT need
of 1000 - <2500

Very Low Adult prevalence of <0.20% 256 4% of PLHIV, 8% of new infections

or PLHIV size of <1000 and 6% of PMTCT need

2.1.2 The STI epidemic

There is limited recent evidence on the burden of The serum samples collected in HIV Sentinel
the STI epidemic in India. Except for syphilis, Surveillance (HSS) under NACP are tested for
large scale prevalence data is usually not syphilis using non-treponemal Rapid Plasma
available for other STIs. However, based on a Reagin (RPR) test. Overall, the syphilis
community-based study of 2002-03, it was noted seropositivity in India appears to be low and
that the STIs burden in India continues to be high stable to declining [48 , 61].
with an estimated 33 million STI episodes in India
in 2015-16[60]

27 National AIDS and STD Control Programme Phase-V (2021-26)

 In 2019, the syphilis seropositivity among into a case rate of CS of around 60 lakh per live
pregnant women was at 0.10% (95% CI: birth in 2012.
0.08–0.11) though some of the states in the
northeastern part of the country had a much The syphilis seropositivity appears to be low in
higher level. A study on the disease burden of other population groups also. Syphilis
maternal syphilis and associated adverse preg- seropositivity was 0.40% (95% CI: 0.3%-0.5%)
nancy outcomes estimated around 1.04 lakh among the inmates in central jails in 2019 [49].
pregnant women with probable active syphilis Among FSW and MSM, syphilis sero-positivity
infections and around 16,300 cases of congenital ranged from 0.20% to 0.40% in 2017[64].
syphilis (CS) in 2012 in India [62 , 63]. This will translate

2.2 Current achievements, impact, and challenges

2.2.1 Achievements

Evidence-driven AIDS response of India, through the link worker scheme (LWS) while 868
following a three-pronged strategy of employer-led models (ELM) interventions were
prevention-detection-treatment while keeping covering its worker in formal and informal
the community and gender in the center, has sectors. The Programme covered 1059 prisons
been a global success story [65]. As of March 2021, reaching out to 40% of the total admitted
there were 1,472 targeted interventions, 232 inmates in 2020-21. The service uptake at these
opioid substitution therapy (OST) centers, 33,862 facilities has increased significantly during NACP
ICTC, 619 ART centers, 478 CD4 testing sites and Phase-IV and Extension with more than 6 crore
64 Viral load laboratories offering prevention, HIV population being directly reached under the
counselling and testing, ART treatment, CD4 programme through these service delivery
testing and viral load monitoring services. Rural structures (Table 8) [51].
areas in 138 districts were directly being covered

Table 8. Progress on key performance indicators (2014-15 to 2020-21)

Achievement (In lakh)

Indicator 2014- 2015- 2016- 2017- 2018- 2019- 2020-
15 16 17 18 19 20 21
HRG, bridge and other vulnerable 59.51 55.63 49.3 74.72 87.65 103.16 81.80
population covered

No. of STI/RTI patients managed 75.46 88.39 85 86 88.35 95.38 68 .0

General clients tested for HIV 142.64 164 184.8 206.9 250.73 288.7 179.8
Pregnant women tested for HIV 106.10 125 161.2 203.2 223.4 265.3 222.2
PLHIV on ART (Cumulative) 8.51 9.4 10.5 12.03 13.98* 14.86* 14.94*
Viral load test conducted - - - 0.06 2.13 5.77 8.90
* Inclusive of 1.06 lakh PLHIV on ART in private sector

28 National AIDS and STD Control Programme Phase-V (2021-26)

 2.2.2 Impact

The impact of the national AIDS response has 82% against the global average of 47% (the baseline
been significant. The annual new HIV infections year of 2010). The HIV prevalence in India
in India have declined by 48% against the global continues to be low with an adult HIV prevalence
average of 31% (the baseline year of 2010) [47]. The of 0.22%.
annual AIDS-related mortalities have declined by

2.2.3 Challenges

Despite the significant achievements and impact, on targets of 90-90-90 to be achieved by 2020 has
there is no place for complacency given the gauzed the country's progress on ending the
country's commitment to ending the AIDS epidemic. The full realization of 90-90-90 by 2020
epidemic as a public health threat by 2030. HIV would have meant that at least 73% of PLHIV
remains a national public health priority with new have suppressed viral loads in 2020 cutting down
HIV infections happening at a rate higher than the transmission significantly. At the end of 2020,
the desired level. The annual number of new 78% of PLHIV knew their HIV status, 83% of PLHIV
infections among adults has declined by 48% who knew their HIV status were on ART, and 85%
since 2010, but still has a long way to go to of PLHIV on ART were virally suppressed (Figure
achieve a 90% decline by 2030 [47]. The progress 3) [b] [51].

Figure 3. Progress (in %) on 90-90-90 (2018-19, 2019-20 and 2020-21)

84 83 84 85
82
76 78
72 72

PLHIV who know their HIV PLHIV who know thier HIV PLHIV who are on ART and
status status and are on ART virally suppressed

2018-19 2019-20 2020-21

The denominator for first 90 informed by HIV Estimations 2020.

b

29 National AIDS and STD Control Programme Phase-V (2021-26)

 The country aimed to achieve the dual momentum was adversely impacted by the
elimination of vertical transmission of HIV and COVID-19 pandemic as the testing coverage
syphilis by 2020. One of the key process targets among pregnant women declined to 76% in
for dual elimination was to test 95% of pregnant 2020-21. The progress in syphilis testing among
women for HIV and syphilis. There has been pregnant women, although improving, is far from
significant progress in testing pregnant women the envisioned target. In 2020-21, around 37% of
for HIV and syphilis. The testing coverage of the pregnant women were tested for syphilis,
pregnant women for HIV increased from 69% in almost twice the level in 2017 but still missing the
2017-18 to 82% in 2019-20. However, the strong target of 95% coverage by a huge margin (Figure 4).

Figure 4. HIV and Syphilis testing coverage (in %) among pregnant women
(2018-19, 2019-20 and 2020-21)

82
77 76
69

37
34

26
20

HIV Testing Syphillis Testing

2017-18 2018-19 2019-20 2020-21

In the spirit of the provisions of the HIV and AIDS men were willing to buy fresh vegetables from a
(Prevention and Control) Act, 2017 and shopkeeper who has HIV/AIDS [66]. In
recognizing the HIV/AIDS-related stigma and comparison, 69-73% of women and men in
discrimination as a significant barrier to uptake of 2015-16 were willing to buy fresh vegetables from
HIV/AIDS-related services, the national AIDS a shopkeeper who has HIV/AIDS [67]. Despite the
response is committed to eliminate HIV/AIDS progress, the levels are still of concern and far
related stigma. In 2005-06, 60-63% of women and from elimination targets.

30 National AIDS and STD Control Programme Phase-V (2021-26)

 2.3 Key recommendations from the endline evaluation of NACP
Phase-IV and Extension

NACP Phase-IV and Extension Period were with the infection and those infected, the
independently evaluated by the Indian Institute independent evaluation of NACP Phase-IV and
of Public Administration. Recognizing the Extension Phase recommended NACP as a
unfinished agenda as well as the uniqueness of vertical programme meeting the service requirement
HIV/AIDS on one end as a manageable chronic of marginalized communities and PLHIV [68]. The
disease requiring life-long medication and on the key recommendations have been summarized
other end, the stigma and discrimination attached below (Table 9).

Table 9. Key recommendations of the evaluation of NACP Phase-IV and Extension Period

Key recommendations from the evaluation of NACP Phase-IV and Extension Period

Programme Management

1. Scale-up efforts through prioritization, reorganization, resource optimization, building

capacities and leveraging partnerships
2. Continue NACP as a vertical programme to do more justice to meeting the service
requirement of marginalized communities and people living with HIV/AIDS
3. Leverage synergy and resource optimization with related schemes and programmes under
the health systems and ensure smooth convergence
4. Develop network partners within and outside health system like the ministry of skill
development entrepreneurship, Fit India Initiatives, Ministry of Social Justice etc
5. Establish a ‘Strategic Unit’ at NACO to focus on programme management
6. Review and update policies, guidelines, and strategies to ensure the reduction in
implementation time, cost and fast response for integration
7. Leverage the presence of District AIDS Prevention and Control Units (DAPCU) to monitor
the HIV programme across priority districts
8. Continue and emphasize building State leadership with design and implementation
tailored to changing programme needs to ensure quality and desired outcomes
9. Build capacity of programme management and service delivery staff continuously to keep
them always updated
10. Rework policy towards matching staff requirements and salary/remunerations to attract
and retain talent better
11. Ensure filing of vacancies with appropriate measures and proactive follow up as well as
competitive compensation packages as well as other incentives, perks and benefits

31 National AIDS and STD Control Programme Phase-V (2021-26)

 Continued Table 9.

Service Delivery

1. Expand reach of NACP to the virtual platform through dedicated web-based and
App-based interventions involving communities and ‘at-risk’ populations
2. HIV testing continues to be linked to mandatory counselling, confidentiality, informed
consent, and an individualized linkage of those tested positive to treatment services.
This needs a dedicated, trained and skilled workforce to be recruited and retained in the
programme
3. Interventions on differentiated service delivery models, advanced disease management,
death audit, verbal autopsy need to be adopted for better patient management and
improving service delivery
4. The focus on STI/RTI programme needs to be strengthened

Strategic Information

1. Evidence driven planning and implementation under NACP with a complementary and
robust Strategic Information system shall be further enhanced and expanded to generate,
analyse and disseminate high-quality action-oriented evidence
2. The IT-enabled client-centric management system to be made operational to improve
programme management, monitoring and surveillance,ensuring tailored service delivery
and avoiding data duplication

32 National AIDS and STD Control Programme Phase-V (2021-26)

 NACP Phase-V (2021-26):
3. An Overview

National AIDS and STD Control Programme The NACP Phase-V consolidates the evidence
(2021-26) (NACP Phase-V) is a Central Sector and learnings from previous phases recognizing
Scheme, fully funded by the Government of the significant progress yet the unfinished
India, from 1st April 2021 to 31st March 2026 with agenda. The NACP Phase-V builds on the
an outlay of Rs 15471.94 crore. Recognizing the gamechanger initiatives of the HIV and AIDS
epidemiological and contextual shifts of recent (Prevention and Control) Act, 2017 and rules
years, the NACP Phase-V will anchor the national thereof, Test and Treat policy, Universal Viral
AIDS and STD response till 2025-26 towards the Load Testing, Mission Sampark, Community-Based
attainment of ending of the AIDS epidemic as a Screening, transition to Dolutegravir-based
public health threat by 2030. Treatment Regimen etc. with an integral vibrant
community engagement.

3.1 Goals and objectives

The NACP Phase-V aims to reduce annual new dual elimination of vertical transmission,
HIV infections and AIDS-related mortalities by elimination of HIV/AIDS related stigma while
80% by 2025-26 from the baseline value of 2010 promoting universal access to quality STI/RTI
(Figure 5). The NACP Phase-V also aims to attain services to at-risk and vulnerable populations.

Figure 5. NACP Phase-V Goals

Reduce Reduce AIDS-

Annual New related
HIV Infections Mortalities by
by 80% 80%

Eliminate Promote Eliminate HIV/

Vertical Universal Access AIDS-related
Transmission of to Quality Stigma and
HIV and syphilis STI/RTI Services Discrimination

To achieve the stated goals, the Programme will on related co-morbidities like TB and viral hepatitis.
focus on the epidemics of HIV and STIs while The specific objectives of the NACP Phase-V are
augmenting the synergies with national programme as below:

33 National AIDS and STD Control Programme Phase-V (2021-26)

 a. HIV/AIDS prevention and control

i. 95% of people who are most at risk of acquiring HIV infection use comprehensive
prevention
ii. 95% of HIV positive know their status, 95% of those who know their status are on treatment
and 95% of those who are on treatment have suppressed viral load
iii. 95% of pregnant and breastfeeding women living with HIV have suppressed viral load
towards attainment of elimination of vertical transmission of HIV
iv. Less than 10% of people living with HIV and key populations experience stigma and
discrimination

b. STI/RTI prevention and control

i. Universal access to quality STI/RTI services to at-risk and vulnerable populations

ii. Attainment of elimination of vertical transmission of syphilis

3.2 The HIV and AIDS (Prevention and Control) Act, 2017

The HIV and AIDS (Prevention and Control) Act, provides for a robust grievance redressal
2017 is a landmark legislation to provide for the mechanism in form of Complaints Officer at
prevention and control of the spread of HIV and establishments and Ombudsman at state level.
AIDS and for the protection of human rights of
persons affected by the HIV/AIDS. The Act aims The HIV and AIDS (Prevention and Control) Act,
to address stigma and discrimination so that 2017 will continue to be the cornerstone of the
people infected with and affected by HIV and national response to HIV and STI epidemic in
AIDS are not discriminated in household settings, NACP Phase-V. The Act will be the enabling
establishment settings and healthcare settings framework to break down barriers, driving
(Figure 6). The Act also reinstates constitutional, delivery of a comprehensive package of
statutory, and human rights of people infected services in an ecosystem free of stigma and
with and affected by HIV and AIDS. It also discrimination.

Figure 6. Salient features of the HIV & AIDS (Prevention & Control) Act, 2017

The HIV & AIDS Act, 2017. Prohibits discrimination against HIV
positive people

01. 02. 03.

Educational Health care
Employment establishments services

These include the denial, termination.

discontinuation or unfair treatment with regard to :

04. 05. 06.

Residing or renting Standing for public Provision of
property or private office insurance

34 National AIDS and STD Control Programme Phase-V (2021-26)

 3.3 Guiding Principles

The NACP Phase-V has specific outputs, principles will be central to strategies and
outcomes, and impact targets. Eight guiding activities to attain the specific targets (Figure 7).

3.3.1 Keep beneficiary and community in center

The NACP Phase-V strategies and activities will reproductive health, and mental health through a
be implemented with an aim to maximize the coordinated systems of referral and linkages.
benefits to its diverse target population in a The service delivery will be done protecting and
friendly ecosystem offering a basket of tailored securing the human rights of people infected
integrated services across prevention- and affected by HIV in line with the provisions of
detection-treatment spectrum. This mean the HIV and AIDS (Prevention and Control) Act,
offering of services for relevant communicable 2017.
diseases, non-communicable diseases, sexual &

3.3.2 Break the silos, build synergies

NACP Phase-V recognizes opportunities with functional and measurable referral and
available within the Programme as well as in linkages, within NACP and across national health
other national health programmes to catalyze programmes and related sectors, for an efficient
progress on stated goals. Break the silos, build service delivery. This will take into account the
synergies will promote coordinated actions, local contexts to ensure a suitable, functional
through single window delivery systems along and sustainable model.

Figure 7. Guiding Principles of NACP Phase-V

NACP Phase-V: Guiding Principles

Leverage
technology and
innovation
Break the Integrate
silos, build gender-sensitive
synergies response Continue
High-impact fostering
Beneficiary programme technical
and community management arrangements
in center and review & institutions
Strategic Enhance and
information- harness
driven partnership

35 National AIDS and STD Control Programme Phase-V (2021-26)

 The designing, implementation, and monitoring participation in national AIDS response. Structural
of the beneficiary-centric services will meaningfully interventions like community system strengthening
involve collaborators and leaders from the and community-led monitoring will navigate
community concerned, including those from beneficiary and community centric approaches
adolescent, youth and women living with HIV, under NACP Phase-V.
e n s u r i n g b e n e f i c i a r y f u l l o w n e r s h i p and

3.3.3 Augment strategic information-driven planning, implementation,

monitoring, and mid-course corrections

NACP Phase-V will continue to augment and terpretation-dissemination, will be fundamental

harness its robust strategic information (SI) to all strategies and activities under NACP
systems of programme monitoring, surveillance Phase-V. The augmented SI system will be vital to
& epidemiology, and research & evaluation for informed decision making at all levels. The
evidence-led interventions improving the system will be beneficiary centric encompassing
directions and results of a programme. The granular, real-time, and cross-sectional evidence
augmented complementary action-oriented SI while engaging and expanding various
systems, with in-built mechanisms of data stakeholders including institutional networks at
protection-sharing-quality assurance-analysis-in- district, State, regional and national level.

3.3.4 Prioritize and optimize through high-impact programme management

and review

The strategies and activities of the NACP delivery management with specific focus on
Phase-V will aim to achieve better return on the robust supply chain management structure at
investments by augmenting decentralized national, State and periphery level. Location and
programme management through District population specific repurposing/integration of
Integrated Strategy for HIV/AIDS (DISHA). The the existing service delivery models, backed with
oxygen function of programme management role upgradation, capacity building and
and review (PMR) will rationalize and optimize the upskilling, will be fundamental in the programme
resources through synchronizing and bringing management under NACP Phase-V.
together different aspects of high-impact service

3.3.5 Leverage technology and innovation as critical enablers

Ever-evolving communication and medical the efficiency. The Programme will promote local
technologies (across spectrum of prevention, evidence generation on communication and
diagnostics, and treatment) have proliferated medical innovations gaining the knowledge and
every aspect of life. The NACP Phase-V will leverage experience required to scale novel interventions
technology and innovations as critical enablers to entire populations in most cost-efficient
not only to expand the reach but also for manner.
re- shaping of existing HIV interventions improving

36 National AIDS and STD Control Programme Phase-V (2021-26)

 3.3.6 Enhance and harness partnership

The NACP Phase-V will continue to foster and include working with government ministries and
augment strategic partnerships to strengthen departments at national, state and district level,
and support a comprehensive and integrated multilateral and bilateral agencies, civil society
response at the most granular level. This will organizations and private sector.

3.3.7 Integrate gender-sensitive response

The NACP Phase-V will continue to integrate WLHIV, young and adolescent girls, vulnerable
appropriate gender sensitive HIV/AIDS services women and transgender people in planning,
improving programme responsiveness to the implementation and monitoring along with
need of the women living with HIV (WLHIV), gender-disaggregated analysis will be integral to
young and adolescent girls, vulnerable women, all strategies and activities across the cascade of
and transgender people. Greater engagement of prevention, testing, treatment, and care.

3.3.8 Continue fostering technical arrangements and institutions

The technical rigors in policy formulation, clinicians, communities, strategic information etc.
development, and institutionalization under The TRGs/TWGs provides independent advise to
NACP is ensured through arrangements of NACP on the given mandate. The technical rigor
Technical Resource Groups (TRG) and Technical in implementation at the most granular level is
Working Groups (TWG). The TRG/TWG, usually strengthened through technical support units.
under chairpersonship/ co-chairpersonship of a NACP Phase-V will continue fostering and
subject expert/community (as appropriate), are harnessing of its robust technical arrangements
multidisciplinary with representatives from and institutions network providing high quality
related stakeholders like programme managers, policy formulation and programme implementation.

3.4 Key highlights

The HIV and STI epidemic response will be at a very high level of HIV/AIDS epidemic in
very crucial stage in the NACP Phase-V given the north-eastern States, more and more of HRG
national commitment of achieving the end of the population using virtual platforms to solicit
AIDS epidemic by 2030. While the tenets of Test clients and rising prevalence of high-risk
and Treat, Viral Suppression, Prevention and behaviors among the general population.
Enabling Environment complying to the
HIV/AIDS Act and Rules will remain the backbone While the existing interventions will be sustained,
of the programme, the recent initiatives of community optimized, and augmented, newer strategies will
systems strengthening and differentiated models be adopted, piloted, and scaled-up under the
of treatment and prevention will continue to be programme to respond to the geographic and
built upon. community specific needs and priorities (Figure
8). The need for newer approaches has been well
The unprecedented momentum of the national reflected in epidemic heterogeneity, evolving
AIDS response under NACP Phase-IV and programmatic context, community expectations
Extension would be sustained to anchor the and in the provisions of the Human Immunodeficiency
country progress as newer challenges emerge in Virus and Acquired Immune Deficiency
the form of expanding epidemic in many States, Syndrome (Prevention and Control) Act, 2017.

37 National AIDS and STD Control Programme Phase-V (2021-26)

 Figure 8. Goals, objectives, and strategic interventions under NACP Phase-V

Goals
To reduce annual new HIV infections and AIDS-related death by 80% since the baseline value of 2010;
Eliminate Vertical Transmission of HIV and Syphilis; Eliminate HIV/AIDS-related Stigma and Discrimination;
Promote Universal Access to Quality STI/RTI Services

Objectives

95% of people who 95% of HIV positive 95% of pregnant and Less than 10% of
are most at risk of know their status, 95% breastfeeding women people living with HIV
acquiring HIV of those who know their living with HIV have and key populations
infection use status are on treatment suppressed viral load experience stigma and
comprehensive and 95% of those who towards attainment of discrimination
prevention are on treatment have elimination of vertical
suppressed viral load transmission of HIV

Promote universal access to quality STI/RTI services to at-risk and vulnerable populations;
Attainment of elimination of vertical transmission of Syphilis

Strategic Interventions
New generation Reaching the Missing Promoting integrated Provision of
communication strategy million - The virtual service delivery through comprehensive package
approach one-stop centers of services through
“Sampoorna Suraksha”

Augmenting contact Leveraging dual test Addressing linkage loss Differentiated care
tracing and index testing kits (HIV & Syphilis) for at all levels model augmenting
promoting early detection dual elimination and adherence
of undiagnosed infections integrated service
package to the people
who are at higher risk

Prioritize sexual and Adapting new Enhancement of private I.T. enabled client
reproductive health approaches to expand sector engagement centric integrated
services for women at the reach of viral load monitoring, evaluation,
increased risk of HIV testing services and surveillance system
infection and women
living with HIV

Enhancement of Building and Anchoring the response Enhancing the strategic

community support augmenting Synergies through focused information systems to
through community programme meet the evidence
system strengthening management and review needs in ever evolving
and dynamic
epidemiological and
programmatic context

Leveraging technology to bring efficiency and expand the reach of the services.

Consolidation and expansion of existing interventions across prevention-testing-treatment continuum with

critical enablers of IEC, laboratory services and strategic information management.

38 National AIDS and STD Control Programme Phase-V (2021-26)

 3.5 Collaboration with public and private sectors

NACP Phase-V will build upon the systematized Surveillance systems under the National AIDS
convergence with the existing schemes of Control Programme are also facilitating evidence
Central Government including synergy with generation for National Viral Hepatitis
National health programme, related line Surveillance Programme (NVHSP) with the
ministries like Ministry of Social Justice and integration of Hepatitis B and Hepatitis C as
Empowerment (MoSJE) as well as State additional biomarker. The NACP Phase-V and
Governments to increase the reach of the services National Viral Hepatitis Control Programme
while bringing efficiency to the programme (NVHCP) will engage and explore designing and
(Figure 9). It will maintain and augment its delivering of an integrated package of services,
convergence with National TB Elimination especially for key populations.
Programme (NTEP) through HIV-TB cross-referrals
and single window delivery of TB and HIV
services at all antiretroviral therapy centers.

Figure 9. Convergence architecture under NACP Phase-V

National
Health
Programmes

Line NACP State

Ministries Governments
Phase-V

Private
Sector

39 National AIDS and STD Control Programme Phase-V (2021-26)

 North-eastern States of Mizoram, Nagaland and sensitization, expansion of HIV related services in
Manipur have been severely impacted by existing health services of non-health Ministries,
HIV/AIDS epidemic with a rising trend at a very Public Sector Undertakings and extending social
high level. Then there are hot spots in States of protection benefits through active linkages of
Assam, Meghalaya, and Tripura. NACP will marginalized persons including people infected
engage with National Health Mission, the Ministry and affected by HIV and AIDS. As of now, NACO
of Development of Northeastern Region, the has formalized a partnership with 18 key
North Eastern Council and all other line Ministries & Departments of Government of India
departments to halt and reverse the epidemic to strengthen the multi-sectoral response to HIV.
curve in the region for community-led planning, NACP Phase-V will further mainstream and
implementation, and monitoring of integrated partnership extending the reach of various HIV
AIDS response in north-eastern States. related services in a cost-neutral way.

NACP Phase-V will continue to endeavor to link The collaboration framework of NACP Phase-V
its clients to all other related national health includes continued strategic engagement with
programmes in a cost-efficient manner. It will private sector. India’s private health sector is vast
include leveraging the existing NACP systems and heterogeneous, encompassing small clinics
through technology-enabled approaches for to large multi-specialty hospitals, laboratories
linking the beneficiaries to respond to their and pharmacies. Despite legislation such as the
mental health need. NACO will continue to work Clinical Establishments Act, the private sector
with MoSJE to extend the coverage of does not uniformly comply with programmatic
de-addiction centers and various social testing and treatment protocols, or report
protection schemes of MoSJE to the eligible diseases of public health relevance to the
high-risk group, bridge population as well as national health program. The NACP Phase-V will
PLHIV. engage with corporates and professional
medical associations to mainstream the HIV
Mainstreaming & partnerships under NACP has prevention-testing-treatment services under a
impacted positively in vulnerability reduction given framework providing a high quality of
through inclusion in programme & policy, prevention-testing-treatment services at private
awareness generation through training and sector in accordance with national guidelines.

3.6 Budget

The NACP Phase-V will be implemented for a whole of NACP Phase-IV Extension. The NACP
period of 5 years from 1st April 2021 to 31st Phase-V will be predominantly (~ 93%) supported
March 2026 with a total outlay of Rs. 15,471.94 through domestic budget. The outlay for NACP
crore (Table 10). This outlay is almost 12 times of Phase-V includes Rs 705 crore from the current
the expenditure incurred in FY 2014-15 and 1.63 grant cycle (01.04.2021 to 31.03.2024) of The
times of the expenditure incurred during the Global Fund.

3.7 Outputs and Outcomes

The NACP Phase-V will achieve the physical and line with the stated goals. Table 11 presents the
output targets along with the outcome targets in year-wise target under the NACP Phase-V.

40 National AIDS and STD Control Programme Phase-V (2021-26)

41
Table 10. Component-wise and year-wise outlay under NACP Phase-V*

Budget by years (INR in crore)

S. No Programme Components 2021-22 2022-23 2023-24 2024-25 2025-26 Total
A. State Grant in Aid (GIA)
1 Targeted Interventions including Link worker Scheme 421.11 433.75 446.76 460.16 484.92 2246.69
2 Blood safety 82.95 85.43 88.00 90.64 95.51 442.53
3 Sexually transmitted infections 29.17 30.04 30.94 31.87 33.59 155.61
4 Information, Education & Communication (IEC) & Mainstreaming 74.74 76.98 79.29 81.67 86.07 398.76
5 Lab Services 21.88 22.53 23.21 23.90 25.19 116.71
6 Care, Support & Treatment 241.55 248.79 256.26 263.95 278.15 1288.68
7 Integrated Counselling and Testing Centers (ICTC)/Basic Services Division (BSD) 337.25 347.37 357.79 368.52 388.35 1799.30
8 Institutional Strengthening and Programme Management 160.42 165.24 170.19 175.30 184.73 855.88
9 Strategic Information 10.93 11.27 11.60 11.95 12.60 58.35
10 Sub-total (State GIA) 1380.00 1421.40 1464.04 1507.96 1589.11 7362.51

B. Central Level Expenditure

11 Antiretroviral (ARV) Drugs 883.43 909.93 937.23 965.35 1017.30 4713.24
12 ICTC Kits and Prevention of Parent to Child Transmission of HIV/AIDS 77.14 79.45 81.84 84.29 88.84 411.56

National AIDS and STD Control Programme Phase-V (2021-26)

(PPTCT) Medicine & HIV Test Kits
13 Opioid substitution therapy (OST) Drugs 34.39 35.43 36.49 37.59 39.60 183.50
14 Blood Bags & Testing Kits 68.79 70.85 72.98 75.17 79.21 367.00
15 Sexually Transmitted Infections / Reproductive Tract Infections Kits 14.74 15.18 15.64 16.11 16.97 78.64
16 Viral Load, EID & CD4 Test Kits 230.93 237.86 244.99 252.35 265.93 1232.06
17 IEC 62.89 64.78 66.72 68.72 72.42 335.53
18 Human Resource 2.95 3.04 3.13 3.22 3.39 15.73
19 Supply Chain Function 29.48 30.36 31.28 32.21 33.95 157.28
20 Allied professional services/Institutional Strengthening at Central 94.13 96.96 99.86 102.86 108.39 502.20
Level including Surveillance, Research, and TSU
21 Capital 21.13 21.76 22.41 23.08 24.31 112.69
22 Sub-total (Central Level Expenditure) 1520.00 1565.60 1612.57 1660.95 1750.31 8109.43

C. Grand Total
23 Grand Total 2900.00 2987.00 3076.61 3168.91 3339.42 15471.94
* Blood transfusions services and NBTC transitioned to Directorate General of Health Services, MoHFW in the beginning of NACP Phase-V.
42
Table 11. Year-wise output/outcome target under NACP Phase-V

S No Indicator Year-wise targets

2021-22 2022-23 2023-24 2024-25 2025-26
A. Physical and output targets
1 No. of calls received at AIDS Helpline (1097) (In lakh) 5.5 6.1 6.7 7.3 8.1
2 No. of Targeted Interventions (TI) 1663 1735 1808 1880 1927
3 No of districts with the Link Worker Scheme (LWS) 165 175 185 195 200
4 No. of HRG, bridge and vulnerable population covered through TI/LWS (In lakh) 102.4 105.92 109.12 111.81 113.91
5 No. of OST Centers 400 450 500 550 600
6 No. of IDU on OST (In lakh) 0.38 0.42 0.48 0.54 0.63
7 No. of ‘Sampoorna Suraksha’ Centers 25 75 150 250 400
8 No. of contacts with ‘at-risk’ population through ‘Sampoorna Suraksha’ 0.22 0.65 1.31 2.18 3.48
Centers (In lakh)
9 No. of STI/RTI patients managed (In lakh) 100.16 106.7 112.1 117.7 123.5
10 No. of ‘at-risk’ population (excluding pregnant women) tested for HIV (In lakh) 252 265 278 292 306
11 No. of pregnant women tested for HIV (In lakh) 252 265 278 292 295
12 No. of pregnant women tested for Syphilis (In lakh) 176.4 190.8 205.72 221.92 230.1
13 No of ART Centers 597 627 657 683 703

National AIDS and STD Control Programme Phase-V (2021-26)

14 No of Link ART Centers 1294 1324 1354 1380 1400
15 No of Care Support Centers 100 200 300 350 400
16 No. of PLHIV on ART (Cumulative)* (in lakh) 15.30 16.77 18.25 19.72 21.20
17 No. of viral load test conducted among PLHIV on ART (in lakh) 11.00 13.50 16.00 18.50 21.00

B. Outcome targets
1 Percent of estimated PLHIV who know their HIV status 79 82 86 91 >=95
2 Percent of PLHIV who know their HIV status and are on ART 84 87 90 93 >=95
3 Percent of PLHIV who are on ART and are virally suppressed 84 87 90 93 >=95
4 Percent of estimated pregnant women tested for HIV 84 88 93 >=95 >=95
5 Percent of PLHIV reporting experiencing stigma and discrimination - - - - <10%
in healthcare and community settings#
6 % HRGs reporting use at least one of comprehension prevention - - - - >=95%
#
methods during last high-risk behavior act
* Including PLHIV on ART in private sector, # baseline and intermediate targets to be developed for these indicators
 4. Goal 1: Reduce annual
new HIV infections by 80%

More than 99.5% of adult population in India is 90% decline by 2030. NACP Phase-V will accelerate
HIV free. Still, the incidence rate is high in certain reduction in new annual HIV infections through a
States and among high-risk groups. Between basket of strategies tailored to the high-risk,
2010 and 2020, the new HIV infections declined at-risk and low-risk population groups.
by 48%, yet there is a long way to go to achieve

4.1 Continue and evolve the existing peer-led targeted

interventions (TI) and Link Worker Schemes (LWS) strategies for
integrated services

The peer-led TI and LWS have been extremely meeting the needs of people and communities.
successful reaching out to HRGs (FSW, MSM, Newer technology like dual test kits for HIV and
IDU, H/TG people), bridge population (migrants, Syphilis, will be introduced in the TI and LWS
and truckers) and other vulnerable groups at settings to break-down barriers in service uptake.
physical locations year after year. The The interventions would continue to evolve to
interventions have evolved offering a offer integrated package of services through
comprehensive package of services across referral and linkages for evidence-backed
prevention-testing-treatment spectrum through relevant co-morbidities such as viral hepatitis,
a revamped model. NACP Phase-V will build tuberculosis, sexual and reproductive health,
upon the time-tested strategy of peer-led mental health, and noncommunicable diseases.
interventions offering differentiated services

4.2 Promote evidence-backed comprehensive prevention packages

tailored to location and population

The toolbox for HIV prevention is ever growing diverse location and population settings on
with more and more options being made newer prevention models in Indian setting. The
available. With growing evidence, the dichotomy evidence-backed models will be promoted
between treatment and prevention is becoming under basket of prevention models through
more and more artificial. NACP Phase-V will context-specific differentiated approaches.
continue to facilitate evidence generation in

43 National AIDS and STD Control Programme Phase-V (2021-26)

 Table 12. Reducing New HIV Infections: Strategies at a glance

S. No. Strategy
1 Continue and evolve the existing peer-led targeted interventions (TI) and Link Worker Schemes
(LWS) strategies for integrated services
2 Promote evidence-backed comprehensive prevention packages tailored to location and
population
3 Strengthen the population size estimation and field epidemiological intelligence for coverage
expansion and saturation
4 Expand and intensify the coverage of NACP interventions including OST among Injecting Drug
Users (IDU)
5 Universalize the NACP interventions in prisons and other closed settings through a mix of service
delivery models
6 Pilot and scale-up models for community-based integrated service delivery models
7 Redefine and expand coverage among the bridge population
8 Develop and roll-out new generation communication strategy suitable to current context
9 Cover ‘at-risk’ HIV negative through comprehensive prevention packages to keep them negatives
10 Develop and scale-up sustainable models for ‘at-risk’ Virtual Population
11 Maintain and augment the behavior change communications for general population
12 Sustain focus on adolescent and youth population

4.3 Strengthen the population size estimation and field

epidemiological intelligence for coverage expansion and saturation

NACP Phase-V will continue to strengthen the networking will be fundamental to the strengthening
system of periodic, community-led, cross- sectional of p-MPSE activities. NACP Phase-V will further
programmatic mapping, and population size strengthen the reporting and use of field
estimation at the most granular level to inform epidemiological intelligence to inform the
the location and population-based interventions initiation, scale-up and modifications in the
initiation, shifting and scale-up. Capacity building, implementations as early as possible.
community engagements and institutional

4.4 Expand and intensify the coverage of NACP interventions

including OST among Injecting Drug Users (IDU)

HIV prevalence among IDUs continue to be and opioid substitution therapy (OST) through
unacceptably high. NACP Phase-V will respond direct offering and convergence with the MoSJE
to the IDU epidemic by expanding the coverage adopting evidence-backed implementation
based on the p-MPSE and local epidemiological modalities. The linkages and referrals with
intelligence. This will include expansion of NVHCP will be specifically developed and
comprehensive harm reduction services of harnessed to reduce morbidity from viral hepatitis
needle-syringe exchange programme (NSEP) among IDUs.

44 National AIDS and STD Control Programme Phase-V (2021-26)

 4.5 Universalize the NACP interventions in prisons and other closed
settings through a mix of service delivery models

HIV prevalence among inmates in some settings is services. In the facility settings, counselling,
higher than that among other HRGs and bridge testing, and treatment services will be focused for
population groups. Even among the inmates, the integrated package of HIV, TB, and Hepatitis when
prevalence is much higher among the under-trials inmates are inside the prisons. To the extent
than that of convicts. In the settings with high HIV possible, the facility-based services will be offered
prevalence among IDUs, higher prevalence of through the mainstreamed health systems of the
Hepatitis-C virus among prisoners has been noted. prisons. The outreach arm will offer the services,
NACP Phase-V will cover every prison in the directly or through the referral/linkages, for the
country through a mix of facility and outreach-based released inmates.

4.6 Pilot and scale-up models for community-based integrated service

delivery models

HRGs continue to face substantial structural and the community-based models like ‘One-Stop
interpersonal barriers to access NACP services, Centre’ among HRGs offering integrated services to
increasing their risk of HIV acquisition. Integrated or meet a wide range of healthcare needs of the
combination approaches to HIV prevention population group including mental health, drug
service provision may reduce stigma or logistical deaddiction, social protection, etc.
barriers. The NACP Phase-V will pilot and scale

4.7 Redefine and expand coverage among the bridge population

The HIV epidemic continues to be concentrated in broader umbrella of bridge population. NACP
nature in India. Migrants and truckers are covered Phase-V will generate evidence to understand the
as bridge population group under NACP through bridge population and its network better to inform
TI, Employer Led Models, and LWS. However, offering of the tailored package of services
there may be other population groups under the through suitable intervention models.

4.8 Develop and roll-out new generation communication strategy

suitable to current context
NACP Phase-V interventions for the population in and rolled out, leveraging the internet and
the urban and rural locations will work towards mobile-based applications, to expand the reach
offering of a comprehensive and integrated and impact of NACP services. The communication
service delivery package. Many of the target messages would be specifically tailored to young
population may not identify themselves as being people and ‘at-risk’ people focusing on risk
at risk and have poor risk perception. The perceptions and service uptake.
communication strategy would be suitably developed

4.9 Cover ‘at-risk’ HIV negative through comprehensive prevention

packages to keep them negative
The prevention under NACP has traditionally people, migrants, and truckers) through TI and
directly covered HRG people (female sex workers, LWS. However, new infections are happening
men who have sex with men, IDU, hijra/ tansgender among other population groups also. In 2015-16,

45 National AIDS and STD Control Programme Phase-V (2021-26)

 less than 5% of the total detections at NACP’s negative but non-TI population through a cyclical
Integrated Counselling and Testing Centers (ICTC) and comprehensive package of services as per
were HRG. The National Family Health Survey-IV their needs to keep them HIV free, thus boosting
(2015-16) reported around 7% of men and 1% of the country’s progress on prevention of new HIV
women in 15-49 yrs. age group, who were sexually infections. The direct-walk in clients at ICTCs, who
active in last 12 months, engaged in higher-risk perceives them at the risk of HIV infection because
sexual intercourse. As evident, there are other of their past/current HIV/AIDS related risk
population groups also who are ‘at-risk’ of acquiring behaviors are the primary targets for SSS. Besides,
HIV or STIs due to risky behavior of self or partner. the SSS will also cater to the need of ‘at-risk’ HIV
negative but non-TI population identified through
NACP Phase-V will implement the Sampoorna risk-screening at ICTC, STI/RTI clinics, virtual
Suraksha Strategy (SSS) to cover ‘at-risk’ HIV outreach and National HIV/AIDS toll free helpline.

4.10 Develop and scale-up sustainable models for ‘at-risk’

Virtual Population

In the last decade, India has experienced massive seek sexual partners, and find a sense of
growth in internet access and therefore social community. These persons do not perceive risk
media usage. There are over 280 million Facebook and are misinformed regarding HIV/STI and its
users and an estimated 2.7 billion WhatsApp users spread. The NACP Phase-V will develop and scale
in India, making it the leading country in terms of sustainable models to initiate and strengthen the
Facebook and WhatsApp audience. India ranked HIV prevention efforts, including access to HIV
second in the world with 88 million Instagram testing among key and vulnerable populations
users[69]. (High-risk groups and at-risk adolescents and
youth, men, and women with high-risk behaviors)
The massive internet access in India has not left seeking partners on virtual platforms. National
the key and vulnerable populations untouched. Toll-Free AIDS Helpline – 1097 would be anchoring
Increasingly MSM, sex workers, as well as many the linkage between the virtual platforms and
young persons are using internet-based platforms NACP service delivery points.
and communication technologies to socialize,

4.11 Maintain and augment the behavior change communications for

general population

With more than 99.5% of adult population free of to NACP Phase-V efforts to increase the reach in a
HIV, NACP Phase-V will maintain and augment the most cost-efficient manner. National Toll-Free
behavior change communications for general AIDS Helpline – 1097 would be anchoring not only
population through a mix of multimedia the information dissemination but would also
campaigns and outdoor activities. Continuous actively link the target population for access to
leveraging of social media would be fundamental services.

4.12 Sustain focus on adolescent and youth population

NACP has always provided high priority to through peer designed and led programme.
adolescent and youth population through specific NACP Phase- V will further augment access to and
interventions like adolescence education uptake of prevention, testing, and treatment
programme (AEP), red ribbon clubs (RRC) and out services in line with national laws, policies, and
of school youths programme. NACP Phase-V will context through mainstreaming of tailored age
continue to sustain the focus on adolescent and and gender appropriate context at each service
youth population to promote safe behavior practices delivery points.

46 National AIDS and STD Control Programme Phase-V (2021-26)

 5. Goal 2: Reduce AIDS-related
mortalities by 80%

The country has made significant progress on with HIV who know their status were accessing
reducing AIDS-related mortality with 82% decline antiretroviral therapy and 85% of people accessing
between 2010 and 2020. This has been made treatment had suppressed viral loads. NACP
possible with rapid expansion of screening, Phase-V will build upon the strong momentum and
testing, and treatment services along with the further accelerate the reductions on AIDS-related
game changer initiatives of the HIV/AIDS mortalities through strategies directed across care
(Prevention and Control) Act, Test and Treat, and continuum. This will also contribute to prevention
Universal Viral Load Testing. By 2020-21, country of new HIV infections through attainment of viral
has achieved 78–83–85 i.e., 78% of people living load suppression among PLHIV.
with HIV knew their status, 83% of people living

5.1 Maintain the existing models of HIV counselling and testing

services (HCTS) and expand through strategic scale-up

Under NACP, HIV counselling, and screening/ crore of HIV screening and testing in 2019-20.
testing services are provided through a mix-model NACP Phase-V will continue to maintain the
of standalone facilities, mobile vans, facility- existing models and focus on strategic scale-up in
integrated facilities (in both government and public as well as private sector, aligned with
private sectors) and community-based screening location and population context, through facility
(CBS). This has rapidly increased the reach of integrated and CBS models.
HCTC services tremendously with more than 5

5.2 Develop and roll-out tailored communication campaigns focusing

on risk perception and HCTS uptake

NACP Phase-V will complement the HCTS models demand generation. This will include the focus on
with communication campaigns, tailored to adolescent and youth while harnessing the
epidemiological contexts of location and platforms of adolescence education programme,
population, to augment self-risk perception and red ribbon clubs and out of school youths.

5.3 Augment the existing HCTS models with efficient approaches for
active case findings promoting early detections

The NACP Phase-V will improve the yield from undiagnosed infections. The efficient approaches
existing models with focus on the efficient to improve the case findings and bridge the
approaches like social-network based HIV testing, gap in first 95 will be implemented within data
index testing and repeat screening/testing among confidentiality-protection-sharing framework of the
discordant couples promoting early detection of HIV & AIDS (Prevention and Control) Act, 2017.

47 National AIDS and STD Control Programme Phase-V (2021-26)

 Table 13. Reduce AIDS-related mortalities: Strategies at a glance

S No Strategy
1 Maintain the existing models of HIV counselling and testing services (HCTS) and expand through
strategic scale-up
2 Develop and roll-out tailored communication campaigns focusing on risk perception and HCTS
uptake
3 Augment the existing HCTS models with efficient approaches for active case findings promoting
early detections
4 Appropriately adapt evidence-backed newer technologies to supplement existing models
5 Maintain existing care, support, and treatment (CST) services models and expand further through
sustainable manner
6 Continue provisions of high-quality ARV through differentiated service delivery models improving
access and retention to care
7 Focus on rapid ART initiation and advanced HIV disease management augmenting quality of care
8 Suitably update the treatment guidelines periodically
9 Address linkage loss at all levels
10 Optimize the uses of public sector laboratories for viral load measurements
11 Offer integrated service delivery packages to ‘at-risk’ people and PLHIV
12 Prioritize sexual and reproductive health services for women at increased risk of HIV infection and
women living with HIV
13 Bring efficiencies and improve linkages through single window service delivery models
14 Maintain and expand laboratory quality assurance system

5.4 Appropriately adapt evidence-backed newer technologies to

supplement existing models

NACP Phase-V will continue to adapt evidence-backed newer testing technologies like HIV self-testing in
newer testing technologies and innovative strategy diverse location and population settings for
to reach UNAIDS targets to end HIV by 2030. This informed decision making and implementation
will include facilitation of evidence generation on modalities.

5.5 Maintain existing care, support, and treatment (CST) services

models and expand further through sustainable manner

CST services under NACP is provided through follow-ups. PLHIVs are linked to Centers of
three-tiered structures. PLHIV enter the CST Excellence (CoE) and ART Plus Centers for timely
service models through Anti-retroviral treatment initiation of second and third-line ART. NACP
(ART) centers. Subsequently, PLHIVs are linked Phase-V will maintain the three-tiered model.
with link ART centers and care & support centers Further, NACP Phase-V will expand the CST service
for decentralized dispensation, counselling and delivery points in a sustainable manner tapping the

48 National AIDS and STD Control Programme Phase-V (2021-26)

 public as well as private sector. This will include delivery models through suitable engagement
saturation of medical colleges by opening ART with private sector comprising private physicians,
centers as per the clause in National Medical private hospitals, and private laboratories within
Commission Notification dated 28th October 2020. national frameworks.
NACP Phase-V will also expand the CST service

5.6 Continue provisions of high-quality ARV through differentiated

service delivery models improving access and retention to care

NACP adopted ‘Test and Treat’ policy in 2017 and suitably for Post-Exposure Prophylaxis (PEP). The
then introduced Dolutegravir-based treatment differentiated approaches like multi-month
regimen in 2020. NACP Phase-V will fast-track and dispensation, community-based refill etc. for
complete transition of PLHIV on high-quality eligible PLHIV will be scaled-up not only to bring
Dolutegravir-based treatment regimen ensuring the services closer to the PLHIV but also to
fewer side effects, better retention, rapid viral load decongest ART centers. This will further improve
suppression and improved quality of life. the adherence thus facilitating the attainment of
Dolutegravir-based regimen will also be considered viral load suppression.

5.7 Focus on rapid ART initiation and advanced HIV disease

management augmenting quality of care

A significant proportion of PLHIV continue to load suppression. NACP Phase-V will make all
present with very low CD4 counts and advanced efforts to facilitate ART initiation within seven days
disease. Rapid ART initiation will improve clinical from the day of HIV diagnosis. ART initiation would
outcomes not only for those with late diagnosis be offered on the same day to PLHIV who are
but also among the rest promoting better ready to start. People with advanced HIV disease
retention, improved adherence, and rapid viral would be given priority for assessment.

5.8 Suitably update the treatment guidelines periodically

The science of high-quality anti-retroviral are ever better retention and rapid viral load suppression.
emerging. Dual therapy options are in development NACP Phase-V will facilitate evidence generation
that reduce the burden of drug classes. Long-acting on more effective treatment technologies and
formulations in the form of injectables, implants adopt/advocate the suitable options under national
and once a month Injection has potential to treatment frameworks through appropriate
simplify disease management, thus facilitating implementation modalities.

5.9 Address linkage loss at all levels

In 2019-20, for every 100 people detected with HIV centers. There is further linkage loss from confirmatory
infection, only 65 are retained on ART at 12 months centers to the antiretroviral treatment (ART)
since detection. This linkage loss starts right from centers and finally, even after reaching ART
screening centers (facility integrated HIV centers, not all HIV positive individuals are initiated
counselling and testing centers) when those who or retained on lifelong antiretroviral. This linkage
are screen reactive do not reach to the confirmatory loss adversely impacts the progress on all the three 95s.

49 National AIDS and STD Control Programme Phase-V (2021-26)

 NACP Phase-V will mitigate linkage loss across step-up counselling and follow-up services to
screening-confirmation-treatment-retention clients at the risk of linkage loss. Adoption of
by leveraging technology, strengthening outreach, clinical decision support systems using artificial
upskilling field resources, improving counselling intelligence will also help in identification of PLHIV
and building synergy across service delivery requiring additional care and attend to the same
points. Predictive analysis will apply statistical timely. These initiatives, in turn, will promote retention
algorithms and machine learnings on the integrated and adherence towards rapid viral load suppression.
database to generate alert and offer customized

5.10 Optimize the uses of public sector laboratories for viral load
measurements
Currently, there are 64 public sector viral load programme will introduce and scale-up Dried
laboratories under NACP. The laboratories were Blood Spot method as a sample collection method
initially testing samples from co-located ARTCs for optimizing the use of public sector laboratories.
but in NACP Phase-V, the viral load testing at these Also, the capacity of select laboratories in public
laboratories will be optimized through systematic sector would be enhanced to initiate
mapping and linkages complementing the laboratory-based monitoring of HIV drug resistance.
public-private model of viral load testing. The

5.11 Offer integrated service delivery packages to ‘at-risk’

people and PLHIV

NACP Phase-V recognizes the need for integrated diseases, mental health etc. is well established.
service delivery approach to ‘at-risk’ people and NACP Phase-V will offer integrated service delivery
PLHIV for their overall wellbeing. The need for the packages through establishing referrals and
linking to services for communicable diseases linkages in coordination with related national
(Tuberculosis, Viral Hepatitis etc.), non-communicable health programmes.

5.12 Prioritize sexual and reproductive health services for women at

increased risk of HIV infection and women living with HIV
The offering of a comprehensive package of comprehensive package of sexual and reproductive
sexual and reproductive health services to women health services to those who are at increased risk
who are at increased risk of HIV infection as well as of HIV infection as well as to the women living with
to the women living with HIV/AIDS is increasingly HIV/AIDS. This will be achieved through upskilling
being recognized as fundamental to the at NACP service delivery points as well as
integrated AIDS response. The NACP Phase-V will augmenting synergies through National Health
offer age and population appropriate need-based Mission.

5.13 Bring efficiencies and improve linkages through single window

service delivery models
In a healthcare set-up, NACP services are provided focus on STI/RTIs. Then, there are Integrated
through different centers; each with its own Counselling and Testing Centers (ICTCs) offering
dedicated personnel for a given mandate. There HCTS. Many of the facilities also have ART, Link
are Designated STI/RTI Centers (DSRCs) which ART, CoE etc. for offering treatment services.

50 National AIDS and STD Control Programme Phase-V (2021-26)

 Medical colleges/district hospitals are provided Laboratories and Viral Load Laboratories. NACP
with one or more of dedicated laboratory Phase-V will undertake re-engineering of service
networks in the form of State Reference Centers delivery models in appropriate locations through
(SRC), State Reference Laboratories (SRL), role upgradation, space management,
Regional STI Training, Research, and Reference IT-enabled models etc. backed by suitable
Laboratories (RSTRRL), National Reference upskilling.
Laboratories (NRL), Early Infant Diagnosis (EID)

5.14 Maintain and expand laboratory quality assurance system

Delivering correct tests is fundamental to the other related components of the Programme like
success of any public health programmes. NACP STI/RTI management, especially given the
Phase-V will continue to have three-tiered context of the laboratory quality assurance as
external quality assessment system as one of the one of the foundational requirements of dual
key strategies under NACP Phase-V. The external elimination. This will include framing/
quality assurance system (EQAS) will be upgradation of proficiency testing, inter-lab
expanded beyond HIV testing and will include comparisons, laboratory accreditations etc.

51 National AIDS and STD Control Programme Phase-V (2021-26)

 Goal 3: Eliminate vertical
6. transmission of HIV and
Syphilis

The programme for prevention of vertical and 37% respectively. Even among identified
transmission of HIV was launched under the positives, not everyone was initiated or retained
second phase of the National AIDS and STD on ART. Similarly, only half of the ANC attendees
Control Programme (NACP) of the Government with a positive syphilis serology were treated
of India in the year 2002. Since then, elimination adequately. These progresses are far from global
of vertical transmission of HIV and Syphilis guidance on targets for elimination of vertical
remains as one of the key objectives under transmission (Table 14). The global guidance also
NACP. Initially, the aim was to attain elimination of refers to foundational requirements of data,
vertical transmission of HIV by 2015 which was laboratory, programme, human rights, gender,
subsequently shifted to 2020. and community. The NACP Phase-V takes into
account the global guidance towards elimination
However, in 2020-21, testing coverage for HIV of vertical transmission of HIV and Syphilis.
and syphilis among pregnant women was at 76%

Table 14. Impact and process indicators and targets for elimination of vertical transmission
of HIV and Syphilis

Infection Indicator Indicator Target

Type
HIV Impact HIV mother-to-child transmission (MTCT) rate, and <5% (breastfeeding
populations) OR <2%
(non-breastfeeding
populations)
Case rate of new paediatric HIV infections due to MTCT ≤50 per 100,000 live births

Process ANC-1 coverage (at least one visit) ≥95%

Coverage of HIV testing among pregnant women ≥95%
ART coverage of pregnant women living with HIV ≥95%

Syphilis Impact Case rate of Congenital Syphilis (CS) ≤50 per 100,000 live births

Process ANC-1 coverage (at least one visit) ≥95%

Coverage of syphilis testing among pregnant women ≥95%
Adequate treatment coverage of syphilis-seropositive ≥95%
pregnant women[c]

C
Syphilis seropositive pregnant women received at least one dose of intramuscular benzathine penicillin G at least 30 days prior to delivery

52 National AIDS and STD Control Programme Phase-V (2021-26)

 6.1 Augment comprehensive synergy with National Health Mission
(NHM) for testing of pregnant women for HIV and Syphilis

Screening of pregnant women for HIV and Augmenting synergy will also include
Syphilis was made an integral component of the mainstreaming of HIV testing data reported
routine ANC check-up in July 2010. NACP through NHM portal i.e., health management
Phase-V will further build upon this guidance and information system (HMIS) and reproductive and
work with NHM at the most granular level to child health (RCH) portal. Systems will be
increase the coverage of both, HIV and syphilis developed through which data about screened
testing. This will be done through focus on reactive are immediately transferred to NACP
various aspects such as capacity building, supply systems for immediate follow-up services of
chain management and review at the most confirmatory testing and subsequent linkages to
granular level. The universalization of HIV and CST services. For the progress on elimination of
Syphilis testing will be driven through district congenital syphilis, this will also include working
prioritization, as available under NACP, ensuring with NHM to develop a case reporting system for
saturation across all districts in a phased manner. the exposed children.

6.2 Strengthen the primary prevention through coordinated actions

Primary prevention of HIV and Syphilis among generation along with promotion of behavior
women is the foundation for achievement and change for adoption of safe practices suitably.
maintenance of dual elimination. NACP Phase-V Adolescents and young population would be
will build upon the strategies for primary specifically focused by working through available
prevention among general population with focus opportunities including that of NHM (Rashtriya
on elimination of vertical transmission as one of Kishor Swasthya Karyakram) and NACP (RRC,
the key thematic areas. Coordination and AEP etc.).
synergy with NHM will be leveraged for awareness

Table 15. Eliminate vertical transmission of HIV and Syphilis: Strategies at a glance

S No Strategy
1. Augment comprehensive synergy with NHM for testing of pregnant women for HIV and Syphilis
2. Strengthen the primary prevention through coordinated actions
3. Introduce and scale-up dual test kits (HIV & Syphilis) to fast-track progress on the dual elimination
4. Strengthen linkage from screening facilities to confirmatory centers and subsequently to the
treatment centers
5. Strengthen retention and on-ART adherence among eligible WLHIV
6. Prioritize family planning services for eligible PLHIV
7. Strengthen the early diagnosis of infants and all children living with HIV (CLHIV)
8. Engage with private sector augmenting their role in attainment of dual elimination
9. Strengthen the strategic information in the context of HIV positive pregnant women/mother
10. Prepare strategic roadmap to guide actions towards attainment of validation of elimination of
vertical transmission

53 National AIDS and STD Control Programme Phase-V (2021-26)

 6.3 Introduce and scale-up dual test kits (HIV & Syphilis) to
fast-track progress on the dual elimination

NACP Phase-V will use the extensive system of testing barriers and increasing uptake of testing
HIV testing of pregnant women to boost the for both HIV and Syphilis. This will include
screening and testing of ANC and direct-in-labor orientation of associated service delivery health
pregnant women for Syphilis. Rapid Diagnostic systems, on appropriate algorithms for referral,
Test (RDT) Kits in the form of dual test kit (HIV & follow-up testing and/or confirmatory testing,
Syphilis), with specific framework on follow-up and treatment and/or management of both HIV
testing and treatment algorithms, will allow for and Syphilis infection especially for co-infected
early diagnosis for HIV and Syphilis by reducing or severely sick patients.

6.4 Strengthen linkage from screening facilities to confirmatory

centers and subsequently to the treatment centers

Not every pregnant woman with a screened strengthen the linkage from screening facilities
reactive result for HIV reaches to a confirmatory to confirmatory and treatment centers through
center. Not every woman with a confirmed HIV targeted outreach, capacity building, leveraging
positive result is linked and initiated on ART. This technology and institutionalized review at the
is a missed opportunity. NACP Phase-V will granular level.

6.5 Strengthen retention and on-ART adherence among WLHIV

High retention and on-ART adherence among breastfeeding WLHIV towards attainment of 95%
WLHIV during the pregnancy and breastfeeding viral suppression through differentiated and
will significantly reduce the vertical transmission community-led services with full sensitivity and
risk for HIV. NACP Phase-V will offer intensified confidentiality avoiding any stigma and
counseling and follow-up among all pregnant and discrimination.

6.6 Prioritize family planning services for eligible PLHIV

Preventing unintended pregnancies is one of the by subsequent linkage to family planning

key components of elimination of vertical services. Volunteerism will be fundamental to this
transmission. NACP Phase-V will strengthen the strategy giving PLHIV the ability to make a full,
coordinated referral and linking of PLHIV with free, and informed choice about his/her family
family planning services. This will include planning needs, without any force, coercion or
assessment of all eligible PLHIV for their family undue incentivization.
planning needs at each visit to ART center followed

54 National AIDS and STD Control Programme Phase-V (2021-26)

 6.7 Strengthen the early diagnosis of infants (EID) and all children
living with HIV (CLHIV)

NACP Phase-V will continue to focus on EID and like point-of-care early infant diagnosis platform
family testing for the early diagnosis of CLHIV to promote early diagnosis of CLHIV and
under NACP. This will be supported by rapid adopt/advocate the suitable options under
initiation of ART among CLHIV. NACP Phase-V national frameworks through appropriate
will facilitate evidence generation on technology implementation modalities.

6.8 Engage with private sector augmenting their role in attainment

of dual elimination

Private healthcare sector is engaged under sector to offer testing in the context of the dual
NACP through MoU for offering of HIV elimination. This will further include the sensitization
counselling and testing services. However, the of the private sector about the uses of benzathine
focus of private sector till now is largely on the penicillin G (BPG) to treat identified pregnant
HIV testing. NACP Phase-V will engage with private women with Syphilis.

6.9 Strengthen the strategic information in the context of HIV

positive pregnant women/mother

Attainment of elimination of dual transmission is WLHIV in the perinatal and post-natal period as
a data driven process with integral role of well as tracking of WLHIV identified during
strategic information for evidence-based policy post-natal period through complementary
formulations. NACP Phase-V will respond to the systems of programme monitoring, surveillance
specific strategic information need of fertility & epidemiology, and research.
rates among WLHIV, tracking of known on-ART

6.10 Prepare strategic roadmap to guide actions towards attainment

of validation of elimination of vertical transmission

The country progress towards attainment of The progress on criteria is assessed using
elimination of the vertical transmission of HIV standardized tools. The validation process
Syphilis, and Hepatitis B is measured through consists of a series of national, regional, and
standard criteria and process for validation global-level reviews on the standardized process-
prescribed by WHO in its global guidance. While es and criteria of validation. NACP Phase-V will
there are specific numeric targets for validation, undertake assessment of country progress on
countries must also demonstrate progress on elimination using WHO recommended tools and
foundational requirements across four thematic prepare the roadmap on action points for the
areas of programme, laboratory, data and human attainment of the elimination of the vertical
rights, gender equality and community engagement. transmission with defined timelines.

55 National AIDS and STD Control Programme Phase-V (2021-26)

 Goal 4: Promote universal
7. access to quality STI/RTI
services to at-risk and
vulnerable populations

More than 30 different bacteria, viruses and management of STI/RTI is a key strategy under
parasites are known to be transmitted through NACP since its inception. NACP Phase-V will
sexual contact. Some of these pathogens are of reinforce the STI/RTI component not only in
public health importance not only due to their terms of elimination of vertical transmission of
prevalence and sequelae but also due to the HIV and syphilis but also to augment access to
epidemiological synergy with HIV. As STI and RTI quality STI/RTI services through maximizing its
enhances chances of acquiring and transmitting system and opportunities for shared delivery
HIV infection by 4-8 times; prevention and models.

7.1 Strengthen the strategic information on STI

Overall, strategic information (SI) under NACP on & epidemiology, and research & evaluation. The
STIs is less than that of HIV. NACP Phase-V will SI on STI will be beneficiary centric encompassing
strengthen the strategic information on STIs granular, real-time, and cross-sectional evidence
through the complementary, action-oriented while engaging and expanding various stakeholders
systems of programme monitoring, surveillance including institutional networks.

7.2 Maintain the existing model of Designated STI/RTI Clinics

(DSRC) augmenting the role

NACP provides quality standardized STI/RTI clinics. NACP Phase-V will maintain the DSRC
services at DSRC, branded as Suraksha Clinic. model while augmenting its role to anchor newer
DSRC offers syndromic management of STI/RTI initiatives like Sampoorna Suraksha Strategy and
through its two arms i.e. obstetrics & gynecology integrated service delivery tailored to the local
OPD and STI OPD under dermato-venereology contexts.

7.3 Develop and implement integrated communication strategies

HIV and STIs shares behavioral, social, and NACP Phase-V will develop and implement
structural determinants. Untreated syphilis and tailored integrated communication strategies on
HIV infections among pregnant and breastfeeding prevention, testing, and treatment of HIV and
women may lead to adverse outcomes and share STIs.
similar strategies to avoid the adverse outcomes.

56 National AIDS and STD Control Programme Phase-V (2021-26)

 7.4 Dovetail dual testing at HCTS centers

The extensive HCTS models (standalone, facility orientation of associated service delivery health
integrated and CBS) under NACP offer an systems, on appropriate algorithms for referral,
opportunity to significantly increase the coverage follow-up testing and/or confirmatory testing,
of syphilis testing. NACP Phase- V will introduce and treatment and/or management. NACP
and scale-up RDT dual test kit (HIV & Syphilis), Phase- V will continue to have the role of RPR for
with specific framework on follow-up testing and identification of active cases tailored to the
treatment algorithms, increasing testing uptake location and population needs as per the
in a very cost-efficient manner. This will include provisions of national framework.

Table 16. Promote universal access to quality STI/RTI services to at-risk and vulnerable
populations: Strategies at a glance

S No Strategy
1 Strengthen the strategic information on STI
2 Maintain the existing model of DSRC augmenting the role
3 Develop and implement integrated communication strategies
4 Dovetail dual testing at HCTS centers
5 Promote active case findings facilitating early detections
6 Improve collaboration with NHM on STI/RTI services provisions and reporting
7 Strengthen and streamline private sector engagement on STI/RTI management
8 Suitably update the STI/RTI management guidelines periodically
9 Augment the laboratory capacities
10 Strengthen the supply chain management

7.5 Promote active case findings facilitating early detections

Identification and detection of sexual partners of testing and index testing approaches.
a STI client helps early diagnosis and treatment Volunteerism and confidentiality would be the
averting further transmission and reinfection. The vital component of partner management
NACP Phase-V will promote active case findings services.
through approaches like social-network based

7.6 Improve collaboration with NHM on STI/RTI services provisions

and reporting

Under NACP, the healthcare facility for STI/RTI quality assurance systems.
services are usually limited to district-level
facilities while NHM has wider and more granular The care continuum framework of Reproductive,
presence up to the sub-district level. NACP Maternal, Newborn Child plus Adolescent Health
Phase-V will collaborate with NHM to scale-up (RMNCH+A) would be leveraged. Information,
the preventive and management services for STI screening, and management of STI/RTI
and linkages to quality diagnostics services and servicesamong adolescents would be facilitated

57 National AIDS and STD Control Programme Phase-V (2021-26)

 through Rashtriya Kishor Swasthya Karyakram on cervical cancer among WLHIV and FSWs.
(RKSK) dovetailing Adolescent Friendly Health Screening and management of cervical cancer
Clinics (AFHC). The collaboration will include the among WLHIV and FSWs in collaboration with
training and capacity building of healthcare National Programme for Prevention & Control of
personnel and coordination on health information Cancer, Diabetes, Cardiovascular Diseases &
systems promoting data sharing. Stroke (NPCDCS) through suitable implementation
arrangements would be facilitated.
NACP Phase-V will strengthen strategic information

7.7 Strengthen and streamline private sector engagement on

STI/RTI management

Healthcare providers in private sector have a projects. NACP Phase-V will strengthen and
significant share in STI/RTI management services. streamline the partnership with private sector to
Recognizing the reach and acceptance of private expand the reach of the STI/RTI services in
sector in offering of STI/RTI services, NACP has alignment with the national frameworks. This will
meaningfully involved private sector in the form include the training, capacity building, and
of preferred private providers to give services reporting of data through tailored implementation
to the high-risk group population through TI models.

7.8 Suitably update the STI/RTI management guidelines periodically

The science on diagnostics of STI/RTI is being recommended. New models for delivering
continuously growing with reliable and affordable STI/RTI services such as telehealth, self-care
new quality-assured diagnostic tests becoming strategies are being piloted. NACP Phase-V will
available. Rapid point-of-care multiplex tests for facilitate evidence generation on more effective
HIV, STIs and Hepatitis allow multiple benefits. STI/RTI management models and adopt/advocate
Based on improved diagnostics, transition from the suitable options under national frameworks
syndromic management to causative management is through appropriate implementation modalities.

7.9 Augment the laboratory capacities

The STI/RTI services under NACP are supported geographies. NACP Phase-V will review,
through a three-tier STI laboratory network of re-engineer/mainstream and strengthen this
SRC, RSTRRL and apex laboratory. The system is three-tier laboratory network for better outcome.
supposed to strengthen the etiological This will include the strengthening of antimicrobial
diagnosis of routine and treatment failure cases surveillance informing the periodic update of
of various syndromes diagnosed in their allotted national treatment guidelines and policies.

7.10 Strengthen the supply chain management

Central supply of color-coded STI/RTI drug kits done through institutional structures supported
for syndromic management and RPR kits for through IT-enabled supply-chain management
Syphilis, are key component of STI/RTI services information systems ensuring ensure timely and
under NACP. NACP Phase-V will strengthen the accurate data regarding commodity needs and
supply chain management services through consumption.
timely forecasting and procurement. This will be

58 National AIDS and STD Control Programme Phase-V (2021-26)

 Goal 5: Eliminate HIV/AIDS
8. related stigma and
discrimination

The strategies adopted under the NACP have changes to eliminate HIV/AIDS related stigma
always kept the HRG and PLHIV in center of its and discrimination. NACP Phase-V will build
response. With notification of the HIV/AIDS upon these gamechanger initiatives to accelerate
(Prevention and Control) Act 2017 and the progress on elimination of HIV/AIDS related
decriminalization of section 377 of Indian Penal stigma and discrimination.
Code, the country has brought significant structural

8.1 Undertake bottom-up institutionalized community system

strengthening

NACP recognizes the need for community - engaged NACP specifically through strengthening targeted
responses as key to elimination of HIV/AIDS interventions (TI) program, advocacy and rapid
related stigma and discrimination.NACP response reducing stigma and discrimination,
Phase-V will institutionalize the community enhancing treatment literacy, greater involvement
engagement and meaningful participation at of communities in decision making and finally
the most granular level in the form of community developing structured systems of community-led
system strengthening (CSS) (Figure 10). CSS monitoring (CLM).
will catalyze the improved health outcomes of

Figure 10. Implementation framework of Community System Strengthening

National State District Community Based

Community Community Community Organisations
Resource Group Resource Group Resource Group Capacity Building

Strengthening
Community
Community Community Led
Championship
Network & Monitoring
Initiative
Engagement

59 National AIDS and STD Control Programme Phase-V (2021-26)

 8.2 Accelerate the notification of State rules and appointment of
Ombudsman in the context of the HIV and AIDS (Prevention
and Control) Act, 2017

The HIV and AIDS (Prevention and Control) Act, placing Ombudsman at State level and
2017 is the primary legislation protecting and Complaints Officer at establishment level for a
promoting the rights of people infected and prompt resolution of complaints, related to
affected with HIV. The Act takes a multi-sectoral violations of the provisions of the Act. NACP
approach and prohibits discrimination in Phase-V will accelerate the notification of State
multiple settings. The Act also penalizes rules and placement of Ombudsman in the
propagation of hate and physical violence context of the HIV/AIDS (Prevention and
against a protected person. The Act further Control) Act, 2017.
provides for a grievance redressal mechanism by

8.3 Undertake sensitization of related stakeholders on HIV/AIDS

related stigma and discrimination
NACP prioritizes workplace, healthcare, and generation about the provisions of the HIV/AIDS
educational as key settings to respond to the (Prevention and Control) Act in these three
HIV/AIDS related stigma and discrimination. This settings as approaches for stigma and discrimination
will include educating the related stakeholders, reductions.
their skill-building initiatives and awareness

Table 17. Eliminate HIV/AIDS related stigma and discrimination: Strategies at a glance

S No Strategy

1 Undertake bottom-up institutionalized community system strengthening

2 Accelerate the notification of State rules and appointment of Ombudsman in the context of the
HIV and AIDS (Prevention and Control) Act, 2017
3 Undertake sensitization of related stakeholders on HIV/AIDS-related stigma and discrimination
4 Design and implement communication strategy on elimination of HIV/AIDS related stigma and
discrimination
5 Enhance strategic information on HIV/AIDS related stigma and discrimination
6 Engage with State governments promoting launch and scale-up of social protection schemes

8.4 Design and implement communication strategy on elimination

of HIV/AIDS-related stigma and discrimination
NACP undertakes HIV/AIDS related communica- strategy on elimination of HIV/AIDS related
tion campaigns through a mix model of stigma and discrimination. The campaigns will
mass-media, mid-media, and interpersonal have in-built mechanism to measure the reach of
behavior change communication strategies. these communication campaigns in conjunction
NACP Phase-V will build upon the previous with contributions to knowledge, attitudes, and
campaigns to develop/implement communication behavior change.

60 National AIDS and STD Control Programme Phase-V (2021-26)

 8.5 Enhance strategic information on HIV/AIDS related stigma
and discrimination

Evidence on the level, trends and determinants stigma and discrimination in four settings to
of HIV/AIDS related stigma and discrimination in inform the magnitude, directions and why of
settings of community, workplace, education, stigma and discrimination to inform the designing
and healthcare is an enabler for developing and implementation of suitable interventions in
comprehensive responses. NACP Phase-V will each setting.
enhance the strategic information on HIV-related

8.6 Engage with State governments promoting launch and scale-up

of social protection schemes

Social protection schemes mainstreams people empowered them to break the barriers on social
infected and affected with HIV, including the exclusion. NACP Phase-V will continue to
vulnerable population, through reducing engage with State governments promoting
inequalities and promoting inclusions. Many launch and scale-up of social protection
State governments has launched social protection schemes as a critical enabler to respond to
schemes which have not only facilitated the HIV/AIDS related stigma and discrimination.
services uptakes by target population but also

61 National AIDS and STD Control Programme Phase-V (2021-26)

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64 National AIDS and STD Control Programme Phase-V (2021-26)

The NACP Phase-V will take the national
AIDS and STD response till Financial Year
2025-26 towards the attainment of United
Nations’ Sustainable Development Goals
3.3 of ending the HIV/AIDS epidemic as a
public health threat by 2030. The strategy
document outlines the roadmap to
attain the goals to be achieved under
NACP Phase-V.