AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner

1. NATIONAL AIDS CONTROL
PROGRAMME(NACP) –PHASE IV
Dr.Meely Panda
JR,Dept of
Comm.Med
PGIMS.Rohtak

2. CONTENTS
 BASICS OF AIDS
 MODES & RISKS OF TRANSMISSION
 CASE DEFINITION
 TRACKING JOURNEY OF AIDS
 BURDEN
 LESSONS LEARNT FROM PHASE I, II & III
 NACP IV--
GOALS, OBJECTIVES, STRATEGIES ,
GUIDING
PRINCIPLES, COMPONENT WISE
TARGETS,
REPORTS OF INDIA & HARYANA
 NACP IV FOR YOUNG
 NACP IV FOR CHILDREN
 STUDY DONE IN HARYANA
 RECOMMENDATIONS

3. BASICS
HIV is the Human Immunodeficiency Virus- lentivirus -
retrovirus
 Leads to Acquired Immune Deficiency Syndrome, or AIDS.
Destroy specific blood cells, called CD4+ Tcells, which are
crucial for fighting diseases.
 No cure for HIV infection.
Currently, people can live much longer - even decades - with
HIV before they develop AIDS.
“Highly active” combinations of medications that were
introduced in the mid 1990s.

4. MODES OF TRANSMISSION
percentage
 Fig. 2.3: Routes of Transmission of HIV, India till
2011
Heterosexual 87.4
Parent to Child
5.4
others
3.3
Injecting Drug Use
1.6
Homosexual/
Bisexual
1.3
Blood and Blood
Products
1

5. RISK OF TRANSMISSION
percentage
transfusion of blood
products 90
mother to child
transmission 25-30
percutaneous route
0.4
sharing needles &
syringes 3-5
mucocutaneous
route 0.05
sexual 0.01

6. CASE DEFINITION OF AIDS
CRITERIAS FOR
ADULTS & CHILDREN

7. ADULTS --Positive test for HIV
antibody by 2 separate test using 2
different antigens +
Any one of the following
CHILDREN—At least 2 major
signs + 2 minor signs
 Weight loss >10% of bw
 Chronic diarrhoea >1
month
 Chronic cough >1 month
 Disseminated ,miliary or
extrapulmonary TB
 Neurological impairment
 Esophageal candidiasis
 Kaposi sarcoma
 Major –Weight loss,Failure to
thrive,Candidiasis,Tuberculosis,
Herpes zoster
 Minor—Generalised
lymphadynopathy,Oropharyngea
l candidiasis,Persistant cough
for >I month , Generalised
dermatitis, Confirmed maternal
HIV infection

8. 1981 first cases of AIDS (Acquired Immune Deficiency Syndrome)
were identified among gay men in the United States. Barré-
Sinoussi and Luc Montagnier were the discoverer of HIV &
were awarded nobel prize for it.
1986 India’s first case of AIDS was diagnosed among sex
workers in Chennai
1987 National AIDS Committee(NAC) was established under the
Ministry of Health
1989 First HIV +ve case was detected in village Bohar, District Rohtak,Haryana
1992 National AIDS Control organization(NACO) set-up &
NACP I launched to slow down the spread of HIV infection.
1999 NACP II launched, State AIDS Control Societies
(SACS)established. PPTCT introduced
2002 National Blood Policy adopted
2004 Anti Retro-viral Treatment (ART) initiated
2006 National Policy on Paediatric ART formulated
2006-2011 NACP III launched to halt and reverse the HIV
epidemic
2012-2017 NACP IV launched
Tracking the journey

9.  Medium term plan – 1990-92
 NACP I – 1992-99
 NACP II – 1999-2007
 NACP III – 2007 – 2012
 NACP IV – 2012 – 2017
 Four pronged strategy:
 Prevent new infection
 Support and treatment
 Strengthening infrastructure and human resource
 Strengthening nation-wide SIMS (Strategic
Information Management System)

11. People living with HIV/AIDS,India
23
23.5
24
24.5
25
25.5
26
26.5
2000
2001
2002
2003
2004
2005
24.1
25.18
25.82 26.08 26.05
25.8
HIV estimatio

12. People living with HIV/AIDS
23
23.5
24
24.5
25
25.5
2006
2007
2008
2009
2010
25.39
24.91
24.83
23.95
23.88

14. ANC HIV prevalence 3%
ANC HIV prevalence 2.5-3%
ANC HIV prevalence 2-2.5%
ANC HIV prevalence 1.5-2%
ANC HIV prevalence 1-1.5%
ANC HIV prevalence <1%
No data available

15. ANC HIV prevalence 1-1.5
ANC HIV prevalence <1%
No data

16. ANC HIV prevalence 3%
ANC HIV prevalence 2.5-3%
ANC HIV prevalence 2-2.5%
ANC HIV prevalence 1.5-2%
ANC HIV prevalence 1-1.5%
ANC HIV prevalence <1%

17. 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/FSW/MSM/IDU).
 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.
According to the revised district categorisation, there are 172 Category A
districts and 48 Category B districts (Total of 220 districts) that require
priority attention.

18. NACP
1
OBJECTIVE
 Slow and prevent the spread of HIV through a major effort to
prevent HIV transmission.
KEY STRATEGIES
 Focus on raising awareness, Blood safety, Prevention among
high-risk populations,
 Improving surveillance
ACHIEVEMENTS
 National AIDS response structures at both the national and state levels
and provided critical financing.
 Strong partnership with the World Health Organisation(WHO) and later
helped mobilize additional donor resources.
 Established the State AIDS Control Cells
 Improved blood safety.
 Expanded sentinel surveillance and improved coverage and reliability of
data.
 Improved condom promotion activities.
 National HIV testing policy.
NACP 1

19. OBJECTIVE
 Reduce the spread of HIV infection in India through
behaviour 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 NGOs implemented & 1,033
targeted interventions set up, 875 Voluntary counseling and
testing centers (VCTC) and 679 STI clinics at the district
level.
 Nation-wide and state level Behaviour Sentinel Surveillance
(BSS) surveys were conducted
 Prevention of parent-to-child transmission (PPTCT)
programme was expanded.
 A computerized management information system (CMIS)
created.
 HIV prevention and care and support organizations and
networks were strengthened.
 Support from bilateral, multilateral, and other partner
NACP 2

20. OBJECTIVE
 Reduce the rate of incidence by 60 per cent in the first year of the
programme in high prevalence states to obtain the reversal of the
epidemic, and by 40 percent in the vulnerable states to stabilise the
epidemic.
STRATEGIES
 Prevention – Targeted intervention (TI), ICTC, blood safety,
communication, advocacy and mobilisation, condom promotion.
 Care, support and treatment – ART, Pediatric ART, Center for
excellence, Community Care Centers.
 Capacity building – establishment, support and capacity
strengthening, training, managing programme implementation and
contracts, mainstreaming/private sector partnerships.
 Strategic information management – monitoring and evaluation.
NACP
3

21. ACHIEVEMENTS
 There are 306 fully functional ART Centres against the target of 250
by March 2012
 Nearly 12.5 lakh PLHIV are registered and 420000 patients are
currently on ART.
 612 Link ART centre (LAC) have been established wherein, 26023
PLHIV are taking Services
 There are 10 Centres of Excellence,
 7 Regional Pediatric centres are also functional.
 259 Community Care Centres across the Country
 6000 condomns & 6000 village information centres established
 3000 Red ribbon clubs established
 Link Workers training module updated

22. Lesson learnt from Phase I&II&III
 The epidemic continues to progress with the following
characteristics
 High risk groups to low risk groups
 Urban to rural areas
 High prevalence states to all states
 High vulnerability of young persons and women
 MSM and IUDs have not received appropriate attention
 Growing number of people living with HIV/AIDS has
increased the need for care , support and treatment

23. The draft strategy
paper for NACP IV
prepared after
consultation with
stakeholders.
The strategy paper
termed as “people’s
program” had positive
networks,communities,
technical experts, and
government
representatives from
state and other central
Ministries.
TI espc amongst HRG and
vulnerable sections of
population was stressed
The group reiterates
commitment to
achieving Millennium
Development Goals
(MDGs).
As part of the process of formulation of the XIIth Five Year Plan (2012-
17),
planningcommission constituted working group on AIDS Control at
NACO.
Planning Commision
April 2011

24. The Guiding principles for NACP IV, 2012-2017
Continued
emphasis on
Three Ones
One Agreed
Action
Framework,
One
Coordinating
Authority
and One
Agreed M&E
System
Equity
Gender
Respect
for the
rights of
the PLHA
public
private
partners
hips.
Civil
society
represen
tation

25. NACP IV
GOAL: Accelerate Reversal …
Integrate Response …
OBJECTIVES:
 Reduce new infections by 60%
 Comprehensive Care, Support and Treatment to all persons living
with HIV/AIDS.
The targets for NACP IV are being derived from recommendations of
working group( 12th April 2011) under chairmanship of Shri Sayan
Chatterjee Secretary Department of AIDS Control , analysis of program
data and NACP III achievement of targets and projections.

26. Goal>strategy>5 themes
The total budget for the programme works out to be Rs 12,824 crores.

27. HIV
prevention &
treatment
TI for
Migrant
National
truckers
project
HIV care &
support
Blood &
safety
STI
control
PPTCT
Advocacy
Communication &
stigma reduction
COMPONENT 1
COMPONENT 2

28. Governance
Reference
laboratory Capacity building
Monitering &
evaluation
COMPONENT 3

29. NACP IV
envisions to
achieve
objectives
through focus
on
five cross-
cutting themes
INTEGRATION INNOVATION
LEVERAGING IEC
QUALITY
HIV
CARE ,
SUPPORT &
TREATMENT

30. The delivery of care and treatment services for people living with HIV/AIDS is provided
through a three-tier structure.
1. Centre of Excellence (CoE) & ART Plus Centres
2. ART Centres
3. Link ART Centres & Link ART Plus Centre
INNOVATION
Increase access and promote programme initiatives through innovations,
mechanisms for comprehensive care, support and treatment.
ART COELAC
PLHIV at
ICTCs

31. ART CENTRES
 Medicine Departments of Medical Colleges and
District
Hospitals.
 Based on prevalence of HIV in the region.
 Provide free comprehensive services including
ART, CD4
testing & drugs required for treatment of
Opportunistic
Infections.
 “306 centres providing freeART to more than
4,12,125
patients in India”
1 ART centre in ward no. 26 , PGIMS, Rohtak,Haryana
HOD Medicine-Dr.B.S Gehlaut.

32. ART centre in Andhra Pradesh

33. Link ART Centres (LAC)
 Main constraints-- Distance, travel time and costs to access ART
services and adherence to treatment.
 Leads to--Poor drug adherence, lost to follow up and missed cases.
 Make -- Accessible and facilitate delivery of ARV drugs, Link ART
Centres are established , located at district level hospitals nearer to
the patient’s residence.
 Located -- Integrated Counseling and Testing Centres (ICTC) which
further helped in linkage between ICTC and ART
 April 2011-- “612 Link ART Centres facilitate delivery of services
nearer to the patients homes”

34. ART PLUS CENTRES
 Patients needed to travel long distance to access the second line
treatment. This issue has resulted in low uptake of second line treatment
 In View of these, it was decided to expand the number of facilities that
can provide second line ART.Previously till 2009 it was given in 2 COE.
 For this, some good functioning ART Centres were upgraded & labelled
as ‘ART Plus Centres’
NACP IV ---ART Plus Centres have been sanctioned at 13
more ART Centres and shall be further expanded in a need
based mannner so as to provide one ART Plus in each state
and 4 ‘ART Plus’ in high prevalance states of Karnataka,
Andhra Pradesh, Maharashtra and Tamil Nadu.

35. ART PLUS CENTRES
 ART Centre, GMCH, Aurangabad, Maharashtra
 ART Centre, GMCH, Nagpur, Maharashtra
 ART Centre, Sasoon Hospital & B J Medical
College, Pune, Maharashtra
 ART Centre, GMCH, Surat, Gujarat
 ART Centre, GMCH, Salem, Tamilnadu
 ART Centre, KIMS, Hubli, Karnataka
 ART Centre, GGH, Vijayawada, Andhra Pradesh
 ART Centre, Govt. Medical College, Thrissur,
Kerala

36. COE
 Their main responsibilities include, provision of second
line and alternative first line ART, training, research work and mentoring of
ART centres linked to them.
 Assessment of patients with suspected treatment failure to first line ART for
initiation of second line ART.
1.Maulana Azad Medical College, Delhi
2. Sir Jamshedjee Jejeebhoy Hospital, Mumbai
3. Byramjee Jeejabhoy Hospital, Ahmedabad
4. Post-Graduate Institute of Medical Sciences, Chandigarh
5.Gandhi Hospital, Hyderabad
6. Bowring and Lady Curzon Hospital, Bangalore
7. School of Tropical Medicine, Kolkata
8. Regional Institute of Medical Sciences, Imphal
9. Govt. Hospital of Thoracic Medicine, Tambaram
10. Banaras Hindu University, Varanasi

37. Community Care Centre(CCC)
Critical role in providing treatment, care and support to PLHIV.
Linked with ART Centres and ensure that PLHIV are provided
(a)counseling for ARV treatment ,preparedness
and drug
adherence, nutrition and prevention,
(b)treatment of Opportunistic Infections
(c) referral and outreach services for follow-up
(d) social support services.
Presently, there are 259 CCC operational across the country.
In Haryana , 1 CCC in PGIMS ,Rohtak
Project coordinator –Dr.Nahar singh Biswal

39. ICTC
 An integrated counselling and testing centre is a place
where a person is counselled and tested for HIV, on his
own free will or as advised by a medical provider.
 The main functions of an ICTC include:
Early detection of HIV.
Provision of basic information on modes
of
transmission and prevention of
HIV/AIDS for
promoting behavioural change and
reducing
vulnerability.
Link people with other HIV prevention,
care and

40.  Earlier Voluntary Counselling and Testing Centres (VCTCs) and
facilities providing Prevention of Parent-to-Child Transmission of
HIV/AIDS (PPTCT) services are now remodelled as a hub to deliver
integrated services to all clients under one roof and renamed a
“Integrated Counselling and Testing Centres” (ICTCs).
STAND ALONE ICTCs
Full-time counsellor and laboratory technician who undertake
HIV counselling and testing.
FACILITY INTEGRATED ICTCs
Does not have full-time staff and provides HIV counselling and
testing as a service along with other services; usually
established in facilities that do not have a very large client load
and where it is uneconomical to establish a stand-alone ICTC.
MOBILE ICTCs
Mobile ICTCs is one way of taking a package of health services
into the community

41. PPTCT
+

43.  IEC is done through newspapers, Radio, Televisions, Cable, Hoardings,
street plays, posters, pamphlets, booklets, workshops, meetings, functions.
eg: “Kalyani Health Magazine” and TV serial “Kyunki Jeena
IssiKaa Naam Hai”.
 Haryana AIDS Control Society has extended helpline facility from 20 to 64
Help-line numbers. 60 (One for each ICTC) one for ART Centre, one for
CCC and one each for DIC.
 Out Reach camps are organized on every Saturday by ICTC’s counselors.
 In each district Nukkad Natak are performed before the camps.
 For creating HIV/AIDS awareness and to promote ICTCs, ART, and CCC
services two spots daily are being relayed on Haryana News Channels.
IEC
Expanding IEC services for (a) general population and (b) High Risk groups with a focus
on behaviour change and demand generation.

45. Programme Title Days
Rural Youth 5 Down MohabbatExpress
Monday-Tuesday
Rural women Babli Boli
Wednesday-Thursaday
Migrant Youth Kitney Dur Kitney Pass
Saturday -Sunday
RADIO PROGRAMMES AIRED BY NACO

46. RED RIBBON EXPRESS
 Conceptualized by the Rajiv Gandhi Foundation.
 Implemented by NACO in collaboration with the Ministry of
Railways,Ministry of Youth Affairs, Nehru Yuva Kendra Sangathan
(NYKS), United Nations Children’s Fund (UNICEF) and other
stakeholders in NACP III.
 Special 7 bogey train supplemented by two exhibition buses, folk
troupes and cycle caravans assembled to create greater impact and
wider reach.
 The RRE with message, “One Train, One Message, uniting India
against AIDS” is theworld’s largest mass mobilisation campaign against
HIV/AIDS.
 The 3rd round of RRE has started its journey from Delhi on January 12,
2012 & is presently stationed in Guwahati

47. Description RRE-II (2009-10) RRE-I (2007-08)
People reached (includes
visitors to the train and
outreach
activities in villages)
80 lakh ( 19 lakh people
visited the train
exhibition while 61 lakh
were covered
through outreach
activities)
62 Lakh ( 12 lakh people
visited
the train exhibition, 40 lakh
were
covered through outreach)
District Resource Persons
trained
81,000 68,000
People tested for HIV 36,000 14000

48. INTEGRATION
 Education - Secondary and Primary (on a cost-sharing
basis, IEC programmes in private schools through leverage
model)
 Health (use of parallel policies in other programmes of the
health department to supplement NACO/ SACS core
activities)
 Labour (Involvement of Private Partners for Training)
 Panchayati Raj
 Railways (Training of Personnel on a cost-sharing basis)
 Rural Development (tying-up with Rural Development
policies to create a synergy)
 Transport (regular check-up in TI projects on a cost-
sharing basis)

49. The India HIV/AIDS Alliance (Alliance India) is a part of the International HIV/AIDS
Alliance and was established in India in 1999. Its vision is a world in which people
do not die of AIDS. The strategic goal of Alliance India is to reduce the spread of
HIV . This is achieved through strong internationally linked,national organisations
working effectively together
Vasavya Mahila Mandali (VMM):Vijayawada, Palmyrah
Workers Development Society(pwds) : Madurai MAMTA
Health Institute for Mother and Child: New Delhi LEPRA
India: Located in Secuderabad

50. SCHEMES
Catagory Scheme Agency
Health Insurance scheme Private Sector &Govt.
of Rajasthan
Transportation Free Transportation Ministry of Surface
Transport+private
sector
Social Security Pension Schemes Ministry of Social
Justice and
Empowerment.
Housing IAY Ministry of Rural
Development and Govt.
of Orissa, Karnataka
Legal Aid State govt. schemes Ministry of Law and
Justice
Education Scholarships Private sectors & Govt.
of Rajasthan,

51. Achievements
 There are 306 fully functional ART Centres
against the target of 250 by March 2012
 Nearly 12.5 lakh PLHIV are registered and
420000 patients are currently on ART.
 612 Link ART centre (LAC) have been
established wherein, 26023 PLHIV are taking
services
 There are 10 Centres of Excellence, 7
Regional Pediatric centres , 259 Community
Care Centres across the Country
HIV
CARE ,
SUPPORT &
TREATMENT

52. NACP IV
 Target for ART in public sector including children :
800,000 including 50,000 children.
 Total number of ARTCs : 600 at the end of NACP IV
from the present day figure of ~ 300 Centres.
 Optimal number of patients per ARTC: 1000-1500.
 Monthly dispensing visit for the patients to ARTC
during the first year of ART and then once in 3
months for stable patients (asymptomatic and
immunologicalresponse to ART)
 Every district of the country needs to have either
one ARTC or one LACPlus center
 LAC and LAC PLUS centers: 1500 LAC and up-
gradation of 50% of LACs into LAC Plus centers in
high prevalence places in a phased manner

53. Total 32 Targeted Interventions are being implemented by NGOs
supported by HACS: - 8 TIs with FSW population, 3 TIs with IDUs, 2 TIs
with MSM. 10 TIs: composite with FSW & MSMs, 9 TIS with
Migrants. Planning to upscale 13 more TIs to saturate the 100% High
Risk Groups in the State.
High Risk Behaviour Populations are chosen
for intervention i.e. Men having sex with Men,
Female Sex workers, Intravenous Drug Users,
Truckers and Migrant.Behaviour change is
brought about in these High Risk Populations
so that they become less vulnerable to
HIV/AIDS.
TARGET
INTERVENTI
ON

54. TI
DEFINITI
ON
People who move from
their place of origin to a
town or city
Return to their place of
origin at least once in 6-
12 months
Definition of IDU –
Any person
injecting drugs at
least once in 3
months
Physically male
person who
engage in various
types of same sex
activities for
money &pleasure
and who do not
like to reveal the
identity for fear of
being removed
fromsociety
STATU
S
&
CONCER
N
3.5 million of migrants
covered under TI
Number of migrant TIs
are 244
Mapping done in 22
states to detect
migration
Current
interventions
reach out to 80%
of IDUs as per
current definition
.
Provision for
detoxification not
available
274000
population
covered
150 MSM TI
sites present
MIGRANTS IDU MSM

55. TI
NA
CP
IV
GO
AL
To reduce HIV prevalence
from 2.6% to less than
0.5% among migrant
population
Nothing for us
without us.
Comprehensive
package of services
Zero new
infections among
MSM by 2017
Universal access
to care , support
& treatment
ST
RA
TE
GI
C
TA
RG
ET
S
Increase coverage of
migrants from 30% in
2011 to 90% by 2015
Increase consistent
condom use among
migrants from 25% to over
80%
Reduce curable STI
incidence among migrants
and their sexual partners
Increase HIV testing from
6 % in 2011 to 50% and
ensure 95% of HIV-
positive receive treatment
and care
Existing definition
should be broadened
from 3 months to ?12
months
Model should be
holistic and
encompass TI as well
as linkages and
mainstreaming with
other departments
All A and B
districts covered
with at least one
MSM TI
100% of anal sex
acts protected by
condoms
30% of MSM to
receive services
for female
partner or
spouses
70% of MSM TIs
to be transitioned
to CBOs

56. Scaling up targeted interventions under
NACP IV
Establish
denominator
Mapping of HRGs
conducted for the
first time
nationally
Reconfigure
non-core TIs
Contracting
new TIs
Improving
quality of TIs
•Supervision
•Improving
MIS
•Enhancing
referrals

57. 1995 2000
2005
2010

58. NACP IV
 It is a mandate to strengthen all public health facilities at and above
district level as designated STI/RTI clinics, with the aim to have at least
one NACO supported clinic per district.
 Presently - 1,033 designated STI/RTI clinics which are providing STI/RTI
services based on the enhanced syndromic case management. 90 new
clinics to be set up.
 Strengthen 7 regional STI training, reference and research centres.
 Role of these centres is to provide etiologic diagnosis to the STI/RTI
cases, validation of syndromic diagnosis, monitoring of drug résistance to
gonococci and implementation of quality control for Syphilis testing.
 Safdarjung Hospital acts as the Apex Centre in the country.
STI
CLINICS

60. BLOOD BANK NACP IV
 National blood transfusion(NBTA) to be set up as an autonomous
body.
 Establishment of Centre of Excellence in Transfusion Medicine in
four metro cities of Delhi, Kolkata, Mumbai and Chennai.
 Approval for setting up of one Plasma Fractionation Centre has
been obtained, for processing of 1.5 lakh litres of plasma
annually. Land for this purpose has been provided at Chennai.
 Achieve 90% of the annual requirement of blood by voluntary
donation.Presently -79.2%
 80% of blood collected to be converted to components for appropiate
use.Presently - 155 BCSU with 52% conversion
 Standardisation of testing protocol & reagents /kits in use.
 Establish blood storage centres in community care centres.
 Provide refrigerated vans in 500 districts for networking with blood
storage centres.

61.  Increase condom use during sex with non-regular partner,
which is the key to limiting HIV spread through sexual route.
 Increase the number of condoms distributed by social
marketing programmes.
 Increase the number of free condoms distributed through STI
and STD clinics, reaching those who are at the highest risk of
acquiring or transmitting HIV.
 Increase access to condoms, especially to men who have sex
with non-regular partners.
 Increase the number of non-traditional outlets for socially
marketed condoms, e.g., paan shops, lodges, etc. in
strategically located hotspots
CONDOMS NACP IV
Condom promotion continues to be an important
prevention strategy.

62. One of the achievements of NACP is a credible HIV
sentinel surveillance system.Information gathered through
HIV sentinel surveillance,
AIDS case surveillance,
Behavioural sentinel surveillance and
STD surveillance helps in tracking the
epidemic &
provides the direction to the
programme.
MONITER &
EVALUATION

63. SMIS-Strategic information management
system
The SMIS is a decentralized data collection system using pre-
programmed excel files input format from primary data generation units
(PDGU).Data entry occurs at the SACS and is forwarded to NACO, where
a centralized comprehensive database is maintained.This allows data
analysis by program managers, necessary for management.

64. CMIS REPORTING
Devel
pome
nt of
CMIS
CMIS
installe
d in all
SACS/
MACS
(4.5)
5
regional
worksho
p
organize
d to
review
theCMIS
NACO
outsour
ced the
mainte
nance
of CMIS
Installation
and
training for
NACO on
new
version of
CMIS
Updation
of CMIS
(5.5)
All
SACS
started
reportin
g
through
CMIS
Updation
of CMIS
(5.6)
2001 2002 2003 2004 2005 2006 2007
Source: NACO summary presentation of CMIS

67. Programme components Target
NACP III
Achieved
till 2011
Target
NACP IV
Targeted Interventions among High
Risk Groups
FSW
8,68,000 709,000 1,000,000
MSM 4,12,000 379,000 445,000
IDU 1,77,000 155,000 180,000
Number of TIs 2,100 1,741 1,800
Truckers 20,00,000 1,480,000 1,600,000
High Risk Migrants 42,00,000 3,670,000 5,600,000
Population accessing ICTCs 22,000,000 15,800,000 28,000,000
Pregnants tested under PPTCT 7,200,000 6800000 14,000,000
ICTC centers established 5,000 8,258 14619
No. adults with STI symptoms
accessing syndromic management
150,00,000 1,00,20,000 170,00,000

68. No of(BCSUs) 162 155 Workin
progress
No. of Blood Banks 1,177 1,127 1,500
No. of Blood Storage Units (BSU) 3,222 685 2,537
Units of safe blood available for
transfusion
10,000,000 8,010,000 12,000,000
Percentage of Voluntary blood donation 90% 78% 90%
No. of condoms distributed (Free +
Social + Commercial)
3,500,000,00
0
2,694,000,00
0
3,114,000,0
00
PLHIV requiring ART 340000 426,000 800,000
Children requiring First Line ART 40,000 31,391 50,000
Report of the working group on AIDS control for the 12th
five year plan

69. HARYANA REPORT
Blood Safety:- At present there are 56 licensed blood banks in the state of
Haryana. 16 in Govt. Sector, one in Red Cross at Panipat, 2 in military
Hospitals, 37 in Private sector.
STD Clinics: 24 STD clinics have been set up in Haryana i.e. 3 in Medical
Colleges, 20 in District Hospitals and one in CHC Bahadurgarh (Jhajjar).
STD drugs are given free of cost at all STD Clinics.
Target Intervention Programmes:- Total 32 Targeted Interventions are
being implemented by NGOs supported by HACS: - 8 TIs with FSW
population, 3 TIs with IDUs, 2 TIs with MSM. 10 TIs: composite with FSW &
MSMs, 9 TIS with Migrants. Planning to upscale 13 more TIs to saturate
the 100% High Risk Groups in the State.
Integrated Counselling and Testing Centers (ICTCs):- 84 ICTCs have
been established in the State of Haryana (4 in Medical Colleges, 20 in
District Hospitals and 60 in CHCs and Sub-district hospitals).
Anti-Retroviral Centre (ART): An ART center was set up in PGIMS, Rohtak
in July 2006. A CD4 Count machine has been installed at this center.

70. Community Care Center (CCC):- A Community Care
Center was established at District Yamunanager in 2005
and was later shifted to District Rohtak in February
2007. This CCC is a 10 bedded indoor facility for HIV
positive patients. Total HIV positive Patients registered at
CCC upto December are 936.
Drop-in-Center: Two Drop-in Centers have been
established, one at Gurgaon and one at Hisar.
Sentinel Surveillance: Since 1998 Surveillance is carried
out every year to determine the estimates of HIV positive
people in the State of Haryana. The Sentinel Surveillance
report of 2008 estimated the HIV positive at 42,000 in
Haryana. In the year 2007-08, 30 sentinel surveillance
sites were established and samples collected both from
general population and high risk groups.
Monitoring & Evaluation: For detailed reporting and
monitoring of the project implementation, a computerized
management Information System (CMIS) has been

71. Haryana Financial Commissioner and Principal Secretary,
Department of Health, Navraj Sandhu said that a new Sexually
Transmitted Infection Clinic at BPS Medical College for Women
at Khanpur Kalan in Sonepat would also be opened.
She said that seven new targeted intervention projects,
including two for truckers and five for migrants, and three new
OPIOID substitution therapy centres at Panipat, Faridabad and
Jhajjar would be made functional in 2012-13.
She said, “With a view to bringing the treatment to the
doorsteps of HIV/AIDS patients, six new Link Anti Retroviral
Treatment Centres would be set up at Fatehabad, Panipat,
Kurukshetra, Yamunanagar, Gurgaon and Faridabad, raising
the number to 18.”

72. Adolescence Education Programme (AEP)
Red Ribbon Clubs in colleges (RRC)
Progammes for Out-of-School youth through Link
workers
Nehru Yuvak Kendra Sangathan Youth Clubs
National Service Scheme (NSS)
Multi-media campaign focussing on youth in North-
Eastern India.
YOUNG PEOPLE
Under NACP-III following efforts were made for prevention
of HIV/AIDS among youth aimed at providing adolescents with
age appropriate information on the process of growing up
during adolescence, HIV/AIDS, STIs and substance
abuse.NACP IV aims at upgrading & strengthening them.

73.  Early diagnosis and treatment for HIV exposed children
 Guidelines on paediatric HIV care for each level of the health system
 Special training to counsellors for counselling HIV positive children;
 Linkages with social sector programmes for accessing social support for
infected
 Outreach and transportation subsidy to facilitate ART and follow up,
 Nutritional, educational, recreational and skill development support; and
 By establishing and enforcing minimum standards of care and protection
in institutional, foster care and community-based care systems
The Balsahyoga & CHAHA programs in 4 states since last 5 years.Others include the Samastha
& the Jatan projects in Gujrat for orphans
CHILDREN
Looking at the current trend of mortality among children i.e. an
estimated 50% of HIVpositive children die undiagnosed before
the age of 24 months. NACP IV has set up policies for:

74. EVALUATION OF ANTIRETROVIRAL THERAPY
(ART) SERVICES IN HARYANA
Dr.Mukesh Nagar
 The study was undertaken at ART centre in Pt BD Sharma PGIMS,
Rohtak, Haryana. The objectives of study were (1) to evaluate ART
services in Haryana (2) to determine patient adherence to ART and
associated factors (3) to assess the level of client satisfaction and
perceived quality of life
 A cross-sectional descriptive study design. A total of 400 HIV patients on
ART were interviewed.
 Out of total 400 clients, 226 (56.5%) were males and 174 (43.5%) females.
 (83%) of respondents were from rural background and 61% of respondents
were having nuclear family.
 According to WHO staging, more than half of patients (51%) were in stage
II, about one third (33.8% )in stage III while only 12% in stage I at the start
of ART, whereas at the time of interview majority (56%) were in stage I
followed by stage II (31.8%).
 At the time of starting ART most of the patients (65%) were having CD4
count less than 200/mm3 while at the time of interview about three fourth of
patients (76.5%) having CD4 count more than 200.
 (96.3%) of the respondents had disclosed their HIV status to someone
else. Majority of patients had disclosed their HIV status to Spouse (61.3%),
Parents (49.5%) and/or Brother/Sister (43.5%).

75.  Satisfaction level was more in clients with longer duration of
ART whereas it was reduced in highly educated as
compared to those educated upto primary and secondary
level.
 Most of the study subjects (89.2%) were informed about
ART centre by Health professional followed by relatives
(5.5%) and friends (3.3%).
 About two third of respondents (63%) had to travel more
than two hours in arriving at ART centre. About one fourth of
the clients had to spend more than Rs 200 per visit.
 Considering 95% adherence requirement, 306 (76.5%) of
the respondents adhered to their medication and the rest 94
(23.5%) didn‟t adhere to medication in last seven days.
 Among those who missed taking their dose 32 (27.6%)
attribute their reason to being away from home while 25

76. RECOMENDATIONS
 ART drug supply needs to be streamlined to ensure uninterrupted
supply to patients at regular intervals. Drugs for management of
opportunistic infections (OIs) also need to be provided
 Prescriptions of costly vitamins and nutritional supplements etc.
from market need to be discouraged and some provision of such
micronutrients if needed be made in the programme itself.
 The specialists of various disciplines need to be sensitised to
address the needs of the HIV patients properly as at times they
have to face a lot of problems in getting their opportunistic
infections and other problems treated.
 To minimize stigma,need to intensify health education campaigns
against stigma and promote family and community support for
people living with HIV and AIDS.
 Counselling needs to be given more priority and importance and
adequate space for privacy etc. be provided.

77. Red, like love, as a symbol of passion and tolerance
towards those affected.
Red, like blood, representing the pain caused by the many
people that died of AIDS.
Red, like the anger about the helplessness by which we
are facing a disease for which there is still no chance for
a cure.
Red as a sign of warning not to carelessly ignore one of
the biggest problems of our time."to carelessly ignore one of the biggest problems of our time."

78. REFERENCES
 Joint United Nations Programme on HIV/AIDS (UNAIDS) and World
Health Organization (WHO). AIDS epidemic update: December
2009 [document on the Internet]. Geneva: UNAIDS; 2009 [cited
2011 Dec 11]. Available from:
http://data.unaids.org/pub/Report/2009/JC1700_Epi_Update_2009_
en.pdf
 National AIDS Control Organization, Ministry of Health & Family
Welfare,Government of India. HIV/AIDS epidemiological
surveillance & estimation report for the year 2005, 2005. Available
at:http://www.nacoonline.org
 National AIDS Control Organization, Ministry of Health & Family
Welfare,Government of India. Annual Report 2002-2003, 2003-
2004. Available at:http://www.nacoonline.org.
 National AIDS Control Organization, Ministry of Health & Family
Welfare,Government of India. HIV estimates-2004. Available
at:http://www.nacoonline.org/facts_hivestimates04.htm
 National AIDS Control Organization. National baseline general
population behavioral surveillance survey-2007. Available
at:http://www.nacoonline.org

79.  National AIDS Control Organization. National baseline
high risk group and bridge population behavioral
surveillance survey-2007 Part II- (MSM and IDUs).
 Bhattacharya M, National AIDS Control Organization.
Annual Sentinel Surveillance for HIV infection in India,
2005: A country report: status of HIV Infection in the
country.
 National AIDS Control Organization, Ministry of Health
& Family Welfare,Government of India. Handbook of
Indicators for Monitoring National AIDS Control
Programme- II, 2006.
 National AIDS Control Organization. National baseline
high risk group and bridge population behavioral
surveillance survey-2008 Part I- (FSW and their
clients).
 WHO 2012, Health topics, HIV/AIDS. World Health
Organisation. [homepage on the Internet] [cited 2012

80. THANK
YOU