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MSc. Nursing 2nd year
INTRODUCTION
Suniti Solomon
Diagnosed the first Indian cases in Chennai in 1986.
In 2009 she was awarded “National Woman
Bio-scientist Award ” by the Indian Ministry
of Scence and Technology.
On 25th January 2017, Government of India
announced “Padma Shri” award for her
contribution towards medicine.
“what is killing people with AIDS more is the stigma and
discrimination ”
STIGMA
AND
DISCRIMINATION
DEFINITION OF AIDS
AIDS stands for Acquired Immune Deficiency Syndrome. It
is the later stage of HIV infection.
It is a condition in which a group of symptoms appear as the
immune system becomes very weak.
It can take around 8-10 years from the time of HIV infection to
the stage of AIDS.
HIV infected people can lead
symptom–free and productive lives for
years.
MODE OF TRANSMISSION
NATIONAL AIDS CONTROL PROGRAMME IN INDIA
HIV infection first detected in India in 1986, when 10 HIV
positive samples were found from a group of 102 female sex
workers from Chennai.
In 1986 Government set up an AIDS Task Force under ICMR
and established a National AIDS Committee (NAC) chaired by
Secretary, Department of Health and Family Welfare.
In 1987, National AIDS Control Programme was initiated, with
help from the World Bank.
CONTD……
In 1989, a Medium Term Plan for AIDS Control was developed
with the support of the WHO.
First National AIDS Control Programme (NACP-I) was
launched in 1992.
NACP-II launched in 1999 decentralization of programme
implementation to State level and greater involvement of
NGOs.
NACP- III implemented during 2007-2012.
NACP-IV has been developed for the period 2012-2017
MILESTONES
National AIDS Control Programme Phase - I (1992-99)
During this phase, the National AIDS Control Project was
developed for prevention and control of AIDS in the country.
OBJECTIVE:
The ultimate objective of the project was to slow the spread of
HIV to reduce future morbidity, mortality, and prevention of
HIV transmission.
Contd……
THE SPECIFIC OBJECTIVES WERE:
Involve all States and Union Territories in developing
HIV/AIDS preventive activities.
Public awareness on HIV transmission and prevention
Develop health promotion interventions
Screen all blood units collected for blood transfusions
Decrease the practice of professional blood donations
Develop skills in clinical management, health education and
counseling, and psychosocial support
Strengthen and control of Sexually Transmitted Diseases (STD)
Monitor the development of the HIV/AIDS epidemic
KEY STRATEGIES
Focus on raising awareness, Blood safety, Prevention among
high-risk populations, Improving surveillance.
ACHIEVEMENT OF PHASE I
Introduction of
Awareness licensing system
of blood banks
Modernization Availability of
and good quality
strengthening of condoms
blood banks.
NACP II 1999-2006
OBJECTIVE
Reduce the spread of HIV infection in India through behavior
change and increase capacity to respond to HIV on a long-term
basis.
KEY STRATEGIES
Targeted Interventions for high-risk groups
Preventive interventions for general populations
Involvement of NGOs
Institutional strengthening
ACHIEVEMENT
At the operational level 1,033 targeted interventions set up, 875
Voluntary counseling and testing centers (VCTC) and 679 STI
clinics at the district level.
PPTCT Expanded.
Computerized management information system (CMIS).
HIV prevention, care and support organizations.
Support from partner agencies increased substantially.
PROJECT STRATEGIES
Priority targeted intervention for groups at high risk
Preventive Intervention for the general community
IEC and awareness campaigns.
Providing voluntary testing and counseling.
Reduce transmission by blood transfusion and occupational
exposure.
Low cost AIDS care.
NACP III
OBJECTIVE
• Reduce the rate of incidence by 60 per cent in the first year
of the programme.
NACP III
STRATEGIES
ACHIEVEMENTS
There were 306 fully functional ART Centres .
Nearly 12.5 lakh PLHIV were registered and 420000 patients
were on ART.
612 Link ART centre (LAC) had been established wherein,
26023 PLHIV were taking Services
7 Regional Pediatric centres also functional.
259 Community Care Centres across the Country
6000 condoms & 6000 village information centres established
3000 Red ribbon clubs established
NACP IV
Launched on 12 February 2017
Total budget outlay Rs 14295 crores.
Goal: Accelerate Reversal and Integrate Response
OBJECTIVE 1:
Reduce new infections by 50% (2007 Baseline of NACP III)
OBJECTIVE 2:
Provide comprehensive care and support to all persons living
with HIV/AIDS
STRATEGY
• Strategy 1: Intensifying and consolidating prevention services
• Strategy 2: Comprehensive care, support and treatment
• Strategy 3: Expanding IEC services
• Strategy 4: Strengthening institutional capacity
• Strategy 5: Strategic Information Management System
Guiding principles
Equity
Gender
Respect for the rights of the PLHIV
Improved public private partnerships
Evidence based and result oriented programme implementation.
Areas of focus
Quality
Innovation
Integration
Stigma and Discrimination.
KEY PRIORITIES
PRIORITISATION OF DISTRICTS FOR
PROGRAMME IMPLEMENTATION
• Category A: More than 1% ANC prevalence in district in any
of the sites in the last 3 years
• Category B: Less than 1% ANC prevalence in all the sites
during last 3 years with more than 5% prevalence in any HRG
site (STD)
CONT…
• Category C: Less than 1% ANC prevalence in all sites during
last 3 years with less than 5% in all HRG sites, with known hot
spots (Migrants, truckers, large aggregation of factory workers,
tourist etc.)
• Category D: Less than 1% ANC prevalence in all sites during
last 3 years with less than 5% in all HRG sites with no known
hot spots OR no or poor HIV data
Classification of states
Moderate Low
High prevalence prevalence prevalence
>5% in HRG & >5% in HRG <5% in HRG
>1% in ANC & <1% in & <1% in
ANC ANC.
THE PACKAGE OF SERVICES UNDER NACP-IV
Prevention Services:
Targeted interventions for high-risk groups.
Prevention and control of sexually transmitted
infections/reproductive tract infections
Contd…
CONTD……
Prevention of parent to child transmission
Information, education and communication and behavior change
communication (BCC)
Social mobilization, youth interventions and adolescence
education programme
Mainstreaming HIV/AIDS response - Work place interventions.
Care, Support and Treatment Services
Laboratory services for CD4 testing and other investigations
Free first-line and second-line Anti-Retroviral Therapy (ART)
Early infant diagnosis for HIV exposed infants and children
below 18 months
Nutritional and psycho-social support through Care and Support
Centres (CSC)
HIV/TB coordination (cross-referral, detection and Treatment of
co-infections) Treatment of opportunistic infections.
HIV SURVEILLANCE TYPES
HIV Sentinel HIV Zero-
Surveillance Surveillance
AIDS Case Behavioral
Surveillance Surveillance
Integration with
STD
surveillance of
Surveillance
other diseases
HIV SENTINEL SURVEILLANCE
To determine the level of HIV infection among general
population as well as high risk groups in different states.
To understand the trends of HIV epidemic among general
population as well as high-risk groups in different states
To understand the geographical spread of HIV infection and to
identify emerging pockets.
To provide information for prioritization of programme
resources and evaluation of programme impact.
To estimate HIV prevalence and HIV burden in the country
COUNSELING AND HIV TESTING SERVICES
Prevention of
Integrated HIV/tuberculo
parent-to-
Counseling sis
child collaborative
and Testing
transmission activities
Centers
of HIV
1. INTEGRATED COUNSELING AND TESTING CENTRES
(ICTC)
TYPES OF ICTC
WORKING PATTERN OF ICTC
PPTCT
ESSENTIAL PACKAGE OF PPTCT
SERVICES
SERVICES TO HIV EXPOSED INFANTS (HEI)
Exclusive breastfeeding up to 6 months
ARV prophylaxis up to 6 weeks with Nevirapin syrup
CPT initiated after 6 weeks.
For HIV negative babies at 6 months- continue breastfeeding +
complementary feeding after 6 months up to 1 yr.
EID positive babies Continue breast feeding up to 2 yrs., who
receiving Pediatric ART.
Confirmatory test done at 6m, 12 m, and 6 weeks after
cessation of breast feeding
HIV TB CO-INFECTION:
Out of 2.1 million PLHIV in India, 95000 co-infected with TB
15-18% of all deaths among HIV infected individuals
Active TB is the commonest opportunistic infection
All HIV TB co-infected patients regardless of the CD4 count
should be ART
First priority is to start TB treatment
National framework for joint HIV/TB collaborative activities-
November 2013.
Prevention Early detection of HIV/TB
1. Isoniazid preventive treatment 1. 100% coverage of PITC in TB patients
2. Air borne infection control 2. PITC in presumptive TB cases
3. Awareness generation 3. Rapid diagnosis for detection of TB and
DR-TB in PLHIV
4. IC activities at all HIV settings – ICTC,
ART and LAC
TB/HIV co-ordination to reduce mortality
Prompt treatment of TB/HIV Management of special TB/HIV cases
1. Early initiation of ART 1. TB/HIV patients on PI based ARV
2. Prompt initiation of TB treatment 2. TB/HIV in children
3. TB/HIV pregnant women
4. Drug resistant TB/HIV
MODEL OF HIV TREATMENT SERVICES
SERVICES PROVIDED
First-line ART
Alternative first-line ART
The second-line ART
NATIONAL PEDIATRICS HIV/AIDS INITIATIVE
The national pediatrics HIV/AIDS initiative was launched on 30
November 2006.
Pediatric formulations of ARV drugs are available at all ART
centers
PEDIATRIC SECOND-LINE ART
While the first-line therapy is efficacious, certain proportion of
children do show evidence of failure.
There is not much data available on the failure rate of
Nevirapine-based ART in children. However, WHO estimates
that the average switch rate from first to second line ART is 2-3
3 per year for adults.
It is likely that similar rates are applicable for children as well.
Currently, second line ART for children has been made available
at all CoE and ART-Plus centers
TARGETED INTERVENTIONS FOR HIGH RISK GROUPS
Detection and treatment for sexually transmitted infections
Condom promotion through social marketing (for HRG and
bridge population
Behavior change communication
Creating an enabling environment with community
involvement and participation
Linkages to integrated counseling and testing centers
Linkages with care and support services for HIV positive
HRGs
Community organization and ownership building
CONTD…..
Specific interventions for IDUs
Distribution of clean needles and syringes
Abscess prevention and management
Opioid substitution therapy
Linkage with detoxification/rehabilitation services
Specific interventions for MSM/TGs
Provision of lubricants –
Specific interventions for TG/hijra populations
Provision of project-based STI clinics
LINK WORKER SCHEME
BLOOD TRANSFUSION SERVICES
Access to safe blood for the need
is the primary responsibility of NACO.
It is supported by a network of 1,137 blood banks, including
258 Blood Component Separation Units (BCSU) and 34 Model
Blood Banks.
NACO supported the installation of BCSU and has given funds
for modernization of all major blood banks at state and district
levels
CONDOM PROMOTION
STD CONTROL PROGRAMME
PRE-PACKED STI/RTI COLOUR CODED KITS:
Pre packed color coded STI/RTI kits have been provided for free
supply to all designated STI/RTI clinics
Kit 1 - Grey, For Urethral Discharge, ano-Rectal Discharge and
Cervicitis.
Kit 2 - Green, for Vaginitis.
Kit 3 - White, for Genital Ulcers.
Kit 4 - Blue, for Genital Ulcers.
Kit 5 - Red, for Genital Ulcers.
Kit 6 - Yellow, for Lower Abdominal Pain.
Kit 7 - Black, for Scrotal Swelling.
INFORMATION, EDUCATION AND COMMUNICATION
To increase knowledge among general population (especially
youth and women) on safe sexual behavior;
To sustain behavior change in high risk groups and bridge
populations.
To generate demand for care, support and treatment services;
To make appropriate changes in societal norms that reinforce
positive attitude, beliefs and practices to reduce stigma and
discrimination.
ADOLESCENCE EDUCATION PROGRAMME
RED RIBBON CLUBS
The purpose of Red Ribbon Club
formation in colleges is to encourage peer-to-peer messaging on
HIV prevention and to provide a safe space for young people to
seek clarifications of their doubts and myths surrounding
HIV/AIDS.
The RRCs also promote voluntary blood donation among youth
SERVICES AT DISTRICT PHC AND CHC:
Core Services at District level
Srevices at CHC and PHC
PONDICHERRY AIDS CONTROL SOCIETY(PACS)
Dr. S. Jayanthi is the project director for PACS
Free services:
If found positive, they can avail free medical services at the
major government hospitals for a healthy and long life.
She added that without any hesitation, people could get free
testing done at Indira Gandhi Government General Hospital and
Postgraduate Institute, Jawaharlal Institute of Postgraduate
Medical Education and Research (JIPMER), Indira Gandhi
Medical College (IGMC), CHCs at Mannadipet and
Karikalampakkarn, Rajiv Gandhi Women and Children Hospital
and other primary health centers.
CONT…
People who would want to test for Sexually Transmittable
Infections (STIs) can go to the hospital at Odiansalai, JIPMER,
IGMC, Rajiv Gandhi Women and Children Hospital,
government hospital in Karaikal. This is a curable disease and
patients can avail treatment at the hospitals.
SUSTAINABLE DEVELOPMENT GOALS
NATIONAL HEALTH POLICY
2017
World AIDS Day was first observed in 1988.
The theme for the 2019 observance is “Ending the
HIV/AIDS Epidemic: Community by Community”.
THEORY APPLICATION
JOURNAL REFERENCE
SUMMARY
CONCLUSION
ANY DOUBTS ???
