National AIDS Control Programme

Debajani Nayak
Asst. Prof
SUM Nursing College, Bhubaneswar

1
Global summary of the AIDS EpidemicJuly 2015

Number of people living Total 35.0 million [33.1 million – 37.2 million]
with HIV Adults 31.8 million [30.1 million – 33.7 million]
Women 16.0 million [15.2 million – 16.9 million]
Children (<15 years) 3.2 million [2.9 million – 3.5 million]

People newly infected Total 2.1 million [1.9 million – 2.4 million]
with HIV Adults 1.9 million [1.7 million – 2.1 million]
Children (<15 years) 240 000 [210 000 – 280 000]

AIDS deaths Total 1.5 million [1.4 million – 1.7 million]

Adults 1.3 million [1.2 million – 1.5 million]
Children (<15 years) 190 000 [170 000 – 220 000]
 HIV and AIDS Estimates, India, December 2015
• Number of people living with HIV: 2 1.17 lakhs
• Adults aged 15 to 49 prevalence rate: 0.26% (M- 0.30%, F- 0.22%)
• Annual New HIV Infection : 86,000
• Adults aged 15 and up living with HIV: 19.78 lakhs
• Women aged 15 and up living with HIV: 8,46,800
• Children aged 0 to 14 living with HIV: 1,38, 450
• Deaths due to AIDS: 67,000
• ART need (adult) : 12,70,678
• ART need (Children) : 74,220

Source: HIV Estimate Committee Report, NACO, 2015

Trend of AIDS Related Deaths
 PLHIV burden in various states
New HIV Infections Proportion of PLHIVs
 Trend of high prevalent districts in India 2003-13
(Source: HSS, ANC)

2003 2006 2015

>1.0%
0.5% - 1.0%
<0.5%
 Total PLHIV detected in different districts till February 2016

Baudh 44
Debagarh 82
Sonapur 102
Kandhamal 107
Malkangiri 187
Jagatsinghapur 221
Jharsuguda 263
Dhenkanal 265
Kendujhar 389
Kendrapara 399
Nuapada 417
Jajapur 449
Bargarh 590
Sundargarh 616
Kalahandi 711
Puri 717
Gajapati 739
Mayurbhanj 748
Bhadrak 748
Rayagada 762
Nabarangapur 802
Nayagarh 850
Balangir 922
Baleshwar 1192
Anugul 1326
Khordha 1860
Koraput 2016
Sambalpur 2029
Cuttack 4977
Ganjam 13085
0 2000 4000 6000 8000 10000 12000 14000
 Trend of HSS ANC prevalence 2004-2015
1.000.95
0.9 Odisha India
0.90

0.80

0.70
0.6
0.60 0.55
0.50 0.49 0.49
0.48
0.50 0.50 0.42
0.4
0.40 0.35
0.30 0.29
0.30
0.20 0.23 0.24

0.10

0.00
2004 2005 2006 2007 2008 2010-11 2013 2015
 Trend of HIV Positivity among General Population and
pregnant women in ICTCs across the state
1.40 0.14
1.24 1.24
1.20
1.20 0.12
0.11
1.00 0.10

0.09 0.09 0.80

0.80 0.750.08

0.60 0.07 0.06

0.40 0.04
Gen Population positivity 0.03
ANC Positivity
0.20 0.02

0.00 0.00
2012 2013 2014 2015 2016
 HIV prevalence among High Risk Group Population in Odisha,
(Source: IBBS- 2014-15)

12

9.7 9.9
10 Odisha India

8
6.7
6
4.3
4
2.2
2 1.2

0
FSW MSM IDU
 Trend of HIV Prevalence among different
High Risk Group of Population, 2004-2013

12.00

10.4
10.00

8.00
7.37
7.33 7.2 7.16
Prevalence %

6.00
5.18

4.19
4.00 3.79
3.6
3.2
2.60 2.40
2.07
2.00
1.44
1.00
0.80
0.60 0.55 0.73
0.50 0.43 0.31
0.23
0.00
2004 2005 2006 2007 2008-09 2010-11 2012-13
 Modes of Transmission of HIV, 2014-15

Infected Blood
1%
Unsafe injections
Unprotected sex 2%
87% Mother to child
6%
Non-specific
3%
 HIV Transmission Risks

Half of all transmission

Wawer et al, 2005
 HIV Transmission Risk

Exposure Route HIV Transmission

Blood transfusion >98%
Perinatal 20-40%
Sexual intercourse 0.1 to 1%
Vaginal 0.05-0.1%
Anal 0.065-0.5%
Oral 0.005-0.01%
Injecting drugs use 0.67%
Needle stick exposure 0.3%
Mucous membrane splash to eye,
0.09%
Oro-nasal

Source: NACO PEP Guidelines

Relative Risk of Seroconversion
with Percutaneous Injury

Source: CDC. MMWR 2001;50(RR11): 1-42

 PEP Regimens
Revised Guidelines - December, 2014
a. Wherever PEP is indicated and source is ART naive or
unknown: recommended regimen is Tenofovir 300 mg +
Lamivudine 300 mg + Efavirenz 600 mg once daily for 28
days
– Wherever available, single pill containing these formulations should be used
– Dual drug regimen should not be used any longer in any situation for PEP

b. The first dose of PEP regular should be administered as

soon as possible, preferably within 2 hours of exposure
and the subsequently dose should be given at bed time
with clear instruction to take it 2-3 hours after dinner &
to avoid fatty food in dinner 
 PEP Regimens
Revised Guidelines - December, 2014
c. In case of intolerance to Efavirenz, regimen containing
Tenofovir + Lamivudine + PI (ATV/r or LPV/r) can be used
after consulting an expert (experienced physician)
d. In case of exposure where source is on ART, Tenofovir 300
mg + Lamivudine 300 mg + Efavirenz 600 mg should be
started immediately. And an expert opinion should be
sought urgently by phone/e-mail from CoE / ART plus
centre
e. Appropriate and adequate counselling must be provided
regarding possible side effects, adherence and follow up
protocol
Stages of Untreated HIV Infection

Viral transmission

Acute retroviral syndrome: 2-3 weeks

Seroconversion: 2-20 weeks

Asymptomatic chronic HIV infection: 8 yrs. (Avg.)

Symptomatic HIV infection/AIDS: 1.3 yrs. (Avg.)

 Association between OIs & CD4 Count

Herpes Zoster

Tuberculosis

Oral Candidiasis
CD4 cell count

PCP; Oesophageal Candidiasis;

Mucocutaneous Herpes

Toxoplasmosis;
Cryptococcosis;
Cryptosporidiosis;
PML; CMV; MAC
Time
 WHO Clinical Staging Adults & Children
Clinical Staging 1
Asymptomatic
Persistent generalized lymphadenopathy (PGL)
1. Painless enlarged lymph nodes >1 cm
2. In two or more non-contiguous sites (excluding
inguinal), in the absence of known cause
3. Persisting for 3 months

WHO ART Guidelines June, 2013

 WHO Clinical Staging Adults & Children
Clinical Staging 2
Adults Children
Moderate unexplained weight loss Unexplained persistent
(<10% of presumed or measured body hepatosplenomegaly
weight) Recurrent or chronic upper respiratory
Recurrent respiratory tract infections tract infections (otitis media,
(sinusitis, tonsillitis, otitis media, otorrhoea, sinusitis, tonsillitis)
pharyngitis) Herpes zoster
Herpes zoster Lineal gingival erythema
Recurrent oral ulceration
Angular cheilitis
Papular pruritic eruption
Recurrent oral ulceration Fungal nail infections
Papular pruritic eruption Extensive wart virus infection
Fungal nail infections Extensive molluscum contagiosum
Unexplained persistent parotid
Seborrhoeic dermatitis enlargement

Natural History of HIV

13
 WHO Clinical Staging Adults & Children
Clinical Staging 3
Adults Children
Unexplained severe weight loss (>10% Unexplained moderate malnutrition not
of presumed or measured body adequately responding to standard
weight) therapy
Unexplained chronic diarrhoea Unexplained persistent diarrhoea
for longer than 1 month (14 days or more)
Unexplained persistent fever Unexplained persistent fever (above
(intermittent or constant for longer 37.5°C, intermittent or constant, for
than 1 month) longer than 1 month)
Persistent oral candidiasis Persistent oral candidiasis
Oral hairy leukoplakia (after first 6 weeks of life)
Pulmonary tuberculosis Oral hairy leukoplakia
Severe bacterial infections (such as Lymph node tuberculosis
pneumonia, empyema, pyomyositis, Pulmonary tuberculosis
bone or joint infection, meningitis, Severe recurrent bacterial pneumonia
bacteraemia)
 WHO Clinical Staging Adults & Children
Clinical Staging 3
Adults Children
Acute necrotizing ulcerative stomatitis, Acute necrotizing ulcerative gingivitis or
gingivitis or periodontitis periodontitis
Unexplained anaemia (<8 g/dl), Unexplained anaemia (<8 g/dl),
neutropaenia (<0.5 x 109/l) and/or neutropaenia (<0.5 x 109/l) or chronic
chronic thrombocytopaenia (<50 x thrombocytopaenia (<50 x 109/l)
109/l) Symptomatic lymphoid interstitial
pneumonitis
Chronic HIV-associated lung disease,
including bronchiectasis

WHO ART Guidelines June, 2013

 WHO Clinical Staging Adults & Children
Clinical Staging 4
Adults Children
HIV wasting syndrome Unexplained severe wasting, stunting or
Pneumocystis (jirovecii ) pneumonia severe malnutrition not responding to
standard therapy
Recurrent severe bacterial
pneumonia Pneumocystis (jirovecii ) pneumonia
Chronic herpes simplex infection Recurrent severe bacterial infections (such
(orolabial, genital or anorectal of as empyema, pyomyositis, bone or joint
more than one month’s duration or infection, meningitis, but excluding
visceral at any site) pneumonia)
Oesophageal candidiasis (or Chronic herpes simplex infection (orolabial
candidiasis of trachea, bronchi or or cutaneous of more than one month’s
lungs) duration or visceral at any site)
Extra-pulmonary tuberculosis Oesophageal candidiasis (or
candidiasis of trachea, bronchi or lungs)
Extrapulmonary tuberculosis
 WHO Clinical Staging Adults & Children
Clinical Staging 4
Adults Children
Kaposi sarcoma Kaposi sarcoma
Cytomegalovirus infection (retinitis Cytomegalovirus infection (retinitis or
or infection of other organs) infection of other organs with onset at age
Central nervous system more than 1 month)
toxoplasmosis Central nervous system toxoplasmosis
HIV encephalopathy (after the neonatal period)
Extrapulmonary cryptococcosis, HIV encephalopathy
including meningitis Extrapulmonary cryptococcosis, including
Disseminated nontuberculous meningitis
mycobacterial infection Disseminated nontuberculous
Progressive multifocal mycobacterial infection
leukoencephalopathy Progressive multifocal
Chronic cryptosporidiosis leukoencephalopathy
Chronic isosporiasis Chronic cryptosporidiosis (with diarrhoea);
Chronic isosporiasis
 WHO Clinical Staging Adults & Children
Clinical Staging 4
Adults Children
Disseminated mycosis Disseminated endemic mycosis
(extrapulmonary histoplasmosis, (extrapulmonary histoplasmosis,
coccidioidomycosis) coccidioidomycosis, penicilliosis)
Lymphoma (cerebral or B-cell non- Cerebral or B-cell non-Hodgkin
Hodgkin) lymphoma
Symptomatic HIV-associated HIV-associated nephropathy or
nephropathy or cardiomyopathy cardiomyopathy
Recurrent septicaemia (including
nontyphoidal Salmonella)
Invasive cervical carcinoma
Atypical disseminated leishmaniasis

WHO ART Guidelines June, 2013

 After Initiation of ART
T-staging
Clinical monitoring and staging at each visit after
ART initiation: Use T Staging for the clinical events

Visit Symptoms and signs WHO staging

Patient improved, but

2nd T2
developed Herpes Zoster

3rd Patient asymptomatic T1

4th Patient asymptomatic T1

 Common OIs seen in India
Bacterial Viral Fungal Parasites
Tuberculosis Varicella Zoster Candida Toxoplasma

Respiratory Intestinal:
Pathogens: Pneumocystis Cryptosporidium
Herpes simplex jiroveci (PCP) Isospora
Streptococcus
H. influenza Microspora
Intestinal:
Giardia
Salmonella, Cytomegalo virus Cryptococcus Entamoeba H
Shigella
Human papiloma Penicillium M. Leishmania

Ebstein Barr Virus Histoplasma

(Oral Hairy Leukoplakia;
Lymphoma)
capsulatum
JC Virus (PML)
 Initiation of ART
in Adults and Adolescents
National Guidelines, 2011

Based on WHO Clinical Staging and CD4 Count

WHO
CD4 (cells/cu.mm)
Clinical Staging

I and II Treat if CD4 Count <350

III and IV Treat irrespective of CD4 Count

National AIDS Control Programme

 Initiation of ART in PLHIV
with TB c Co-infection

Eligible Timing of ART

Type of
Clinical Staging in relation to start of
Tuberculosis
and CD4 Counts TB treatment

Pulmonary TB Start ART Start ATT first;

irrespective of
(Stage III)
any clinical Start ART as soon as
stage TB treatment is
or tolerated
Extra pulmonary TB (after 2 weeks &
irrespective of
(Stage IV) CD4 counts before 2 months)
 Initiation of ART in PLHIV with
Hepatitis-B or Hepatitis-C Co-infection
WHO
Co-infection Clinical CD4 (cells/cu.mm)
Staging

HIV-HBV or HIV-HCV Start ART at CD4 Count

I and II
co-infection without any <350
evidence of chronic active Start ART irrespective
Hepatitis III & IV
of CD4 Count
HIV-HBV or HIV-HCV
co-infection with documented All Clinical Start ART Irrespective
evidence of chronic active stages of any CD4 count
Hepatitis
Preferred regimen for PLHIV with HBV or HCV co-infection:
Tenofovir + Lamivudine + Efavirenz
NACO First line ART Regimens for HIV infection
Regimen National ART Regimen Preference
First line regimen for patients with
Zidovudine +
Regimen I Hb >9 gm/dl and not on
Lamivudine + Nevirapine
concomitant ATT
First line regimen for patients with
Tenofovir +
Regimen I (a) Hb <9 gm/dl and not on
Lamivudine + Nevirapine
concomitant ATT
First line regimen for patients with
Zidovudine +
Regimen II Hb >9 gm/dl and on concomitant
Lamivudine + Efavirenz ATT
•First line regimen for patients
with Hb <9 gm/dl and on
concomitant ATT
•First line regimen for all patients
Tenofovir +
Regimen II (a) with Hepatitis B & Hepatitis C
Lamivudine + Efavirenz
co- infection
•First line regimen for pregnant
women, with no exposure to
sd-NVP in the past
 Paediatric First line ART Regimens
Paediatric
Regimen Remarks
Regimen
Zidovudine + Lamivudine + Preferred paediatric regimen
Regimen P I
Nevirapine for children with Hb >9 g/dL
Stavudine + Lamivudine +
Regimen P I (a) For children with Hb <9 g/dL
Nevirapine
preferred for children on anti-TB
Zidovudine + Lamivudine + treatment;
Regimen P II Efavirenz Hb >9 g/dL and
age >3 yr and weight >10 kg
for children on anti-TB treatment
Stavudine + Lamivudine + tuberculosis treatment;
Regimen P II (a)
Efavirenz Hb <9 g/dL and
age >3 yr and weight >10 kg
1. Efavirenz is the preferred drug over Nevirapine, whenever children are being
treated with Rifampicin containing drug regimen for TB co infection
2. In Children aged <3 years and in children weighing <10 Kg, Efavirenz is
contraindicated.
HIV Transmission Interface

HRG
Bridge
(FSW, MSM, General Population
Population
IDUs)
 Dynamics of HIV transmission in India

FSW
Clients MSM IDUs
Low or no risk
males
Low or no risk
Small # sex workers + females
Large # clients = many clients/night

High STD among sex workers & uncircumcised clients

High HIV transmission (1 in 10 contacts)

 HIV prevalence among ANC attendees by Migration
Status of Spouses
H IV Pre vale nce (% )

State Migr Non-

Migr
1.20 1.13 RAJ 887 9318
UP 1477 19172
1.00 0.96
0.91
BIH 1696 7254
0.80 WB 688 7500

0.60
JH 627 5215
0.47 0.47 ORI 660 11628
0.43
0.36 0.39
0.40
0.29 0.31 CH 177 6947
0.23 0.25 0.25
0.18 0.20 MP 13666
0.20 0.16 701

0.00
RAJ UP BIH WB JHAR ORI CHHT MP

Migrant Non-Migrant
 High Risk Behaviour among Migrants

No sex; 22.69 Paid Sex; 22.69 No MSM behaviour;

90.9 Paid MSM Sex; 1.9

Un-paid sex, Un-paid MSM Sex;

21.21 6.3
Received money for
MSM sex; 0.9

Both, 17.16

Not injected
drug; 95.5 Injected Drug;
4.5
National AIDS Control
Programme -IV
(2012-17)
Evolution of India’s National AIDS Programme

NACP III NACP IV

(2012-17)
(2007-2012)
Consolidate
Massive scale gains
NACP II up with quality
(1999-2006) assurance Focus on
mechanisms emerging
Decentralisation vulnerabilities
to states >50% reduction
NACP I in new Balance with
Limited growing
(1994-1999) coverage of infections
achieved treatment
Initial services needs, Quality
interventions assurance
 Objectives of NACP-IV
(2012-17)

Objective 1:  Reduce new infections by 50% (2007

Baseline of NACP III)

 Objective 2:  Comprehensive care, support and

treatment to all persons living with HIV/AIDS
 Components of NACP-IV
1: Intensifying and Consolidating Prevention services with a focus on
HRG and vulnerable populations 

2: Expanding IEC services for

(a) General Population and
(b) High Risk Groups with a focus on behaviour change and demand
generation 

3: Comprehensive Care, Support and Treatment

 
4: Strengthening institutional capacities

5: Strategic Information Management Systems (SIMS) 

 PACKAGE OF SERVICES UNDER NACP-IV
Preventive Services
1. Targeted Interventions for High Risk Groups (FSW,MSM,TG, IDU) and Bridge
Population (Truckers & Migrants)
2. Needle-Syringe Exchange Programme and Opioid Substitution Therapy for
IDUs
3. Prevention Interventions for Migrant population at source, transit and
destination
4. Link Worker Scheme for HRGs and vulnerable population in rural areas
5. Prevention & Control of STI/RTI
6. Blood Safety
7. HIV Counselling & Testing Services
8. Prevention of Parent to Child Transmission (PPTCT)
9. Condom promotion
10.IEC & BCC
11.Social Mobilisation, Youth Interventions and Adolescence Education
Programme
12.Mainstreaming HIV/AIDS response
13.Work Place Interventions, Employer Led Model
 Care, Support & Treatment Services

1. Laboratory services for CD4 Testing and other investigations

2. Free First-line & Second-line Anti-Retroviral Therapy (ART)
through ART centres and Link ART Centres (LACs), Centres of
Excellence (CoE) & ART plus centres.
3. Paediatric ART for children
4. Early Infant Diagnosis for HIV exposed infants and children
below 18 months
5. Nutritional and Psycho-social support through Care and
Support Centres (CSC)
6. HIV/TB Coordination (Cross-referral, detection and treatment
of co-infections)
7. Treatment of Opportunistic Infections
8. Drop-in Centres for PLHIV networks
 Components of Services
Prevention:  
Basic Services ICTC, Prevention of Parent to Child Transmission, HIV testing and referral to
ART centres, Early Infant Diagnosis (DNA PCR)
STI/RTI Services Syndromic STI/RTI case management at Surakhya Clinic, NHM Supported
health facilities, NGO led STI clinics, partner management , Follow up and
Syphilis screening
Blood Safety Quality control and Licensing of Blood Banks, Five mandatory tests(HIV,
HBV,HCV, Syphilis & Malaria), Blood Component Separation Units, Voluntary
Blood Donation, Blood storage and transport
Targeted Intervention / Through NGOs: Mapping, Need Assessment, Risk Profiling, Condom
Link Worker Scheme / promotion, HIV testing, Linking to ART Centres, STI treatment, Regular
Project Pehchan / SIA for Medical Check up, Syphilis screening among FSW, IDUs, MSM, TG/Hijra and
migrants at source Migrants, Enabling environment, Tracking at individual level.
Treatment:  
Care Support & Treatment Anti-Retroviral Therapy, Treatment for Opportunistic infections, Follow up,
nutritional and family counselling, Network of HIV +ve People, CSC and
Helpdesks
IEC & Mainstreaming
Information Education and Awareness among youth, women and other vulnerable population and
Communication migrants. (Mass Media, Mid Media, IPC and Group meetings)
Service specific IEC (STI, HIV testing and Treatment)
Mainstreaming Linking them to various Social Security Schemes like MBPY, AYY, Mo Kudia,
Free Ration, Free schooling, Free Bus Pass, Stigma reduction, Legal Aid,
Public private Partnership, Workplace intervention under CSR
 Divisions of State AIDS Control Society

Basic Service Division: IEC Division:

-ICTCs -IEC campaigns (RRE etc)
- PPTCT -Youth Affairs/ Red Ribbon Club/
- TB-HIV coordination Documentation & Publication

STI/RTI Division: Targeted Intervention Division:

-DSRC / PPP with NGO-TIs
- FSW/MSM/IDU/Migrants (Destination
-NHM supported STI/RTI clinics
& Transit) / Truckers
Care , Support & Treatment:
-ART Centres State Mainstreaming Unit:
-Link ART Centres -Mainstreaming (MBPY etc)
- Community Service Centres - Inter-sectoral coordination
-Help-desks -Link Worker Scheme
-Public Private Partnership
Blood Safety:
-Blood Banks / Voluntary Donation
- Lab. Quality / BCSU Technical Support Unit :
-Supportive supervision and capacity
SIMU: building of TIs:
-CMIS/ SIMS/ Surveillance/ M&E -Strategic Planning
- IBBS/ HSS
 NACP Strategies
Prevention is the mainstay Care, Support and Treatment

High risk Low risk People living with

populations populations HIV/AIDS

•Targeted Interventions for High Risk Groups (FSW, MSM, • First line & second line
IDU, Truckers & Migrants) ART in ART and LACs
•Link Worker Scheme for rural population • Care &Support Centres
•Prevention & Control of Sexually Transmitted Infections
• HIV-TB Coordination
•IEC, Social Mobilization & Mainstreaming
• Focus on PPTCT: EID
•Condom promotion
• Treatment of
•Blood safety Opportunistic Infections
•Counselling & Testing Services (ICTC, PPTCT, HIV/TB)

Strategic Information Management Institutional Strengthening

National AIDS Control Programme

 Linkages of ICTC: Gateway to HIV Care
STI TB Targeted Prevention Antenatal Walk-in
Services Services Interventions Services Care Clients

STI and TB Clients,

Pregnant Women, Key
Populations, and
General Populations
Referred

Integrated Counselling and Testing Centres (ICTC):

HIV Counselling and Testing
PLHIV linked to care, support
and treatment services
through referrals to

Onsite Services: PPTCT, TB/HIV, Basic OI ART Centres

Management, TB and STI Care, Reproductive
and Child Health, Routine and Emergency
CD4 testing,
Medical Care Care, support & treatment

Referral to home and community based

care
National AIDS Control Programme
 Early HIV detection in Infants & Children

Schedule of visits at ICTC

6 weeks 14 weeks 18 months
Birth 10 weeks 6 months 9 months 12 months

HIV Antibody test followed by

DNA PCR
DNA PCR if HIV+

DNA PCR for all

HIV exposed Final confirmatory
infants Antibody Test for all
HIV exposed infants at
18 months, irrespective
of earlier testing results /
treatment status

All HIV infected and / or symptomatic infants / children

are to be referred to ART centre
National AIDS Control Programme
 Risk of Peri-natal HIV Transmission

11% infected during breast feeding

17% infected
during birth

67%*
not infected

5% infected in
utero

*Without treatment for parents, most will be orphaned

 Common OIs seen in India
Bacterial Viral Fungal Parasites
Tuberculosis Varicella Zoster Candida Toxoplasma

Respiratory Intestinal:
Pathogens: Pneumocystis Cryptosporidium
Herpes simplex jiroveci (PCP) Isospora
Streptococcus
H. influenza Microspora
Intestinal:
Giardia
Salmonella, Cytomegalo virus Cryptococcus Entamoeba H
Shigella
Human papiloma Penicillium M. Leishmania

Ebstein Barr Virus Histoplasma

(Oral Hairy Leukoplakia;
Lymphoma)
capsulatum
JC Virus (PML)
 Initiation of ART
in Adults and Adolescents
National Guidelines, 2011

Based on WHO Clinical Staging and CD4 Count

WHO
CD4 (cells/cu.mm)
Clinical Staging

I and II Treat if CD4 Count <350

III and IV Treat irrespective of CD4 Count

National AIDS Control Programme

 Initiation of ART in PLHIV
with TB Co-infection

Eligible Timing of ART

Type of
Clinical Staging in relation to start of
Tuberculosis
and CD4 Counts TB treatment

Pulmonary TB Start ART Start ATT first;

irrespective of
(Stage III)
any clinical Start ART as soon as
stage TB treatment is
or tolerated
Extra pulmonary TB (after 2 weeks &
irrespective of
(Stage IV) CD4 counts before 2 months)
 Initiation of ART in PLHIV with
Hepatitis-B or Hepatitis-C Co-infection
WHO
Co-infection Clinical CD4 (cells/cu.mm)
Staging

HIV-HBV or HIV-HCV Start ART at CD4 Count

I and II
co-infection without any <350
evidence of chronic active Start ART irrespective
Hepatitis III & IV
of CD4 Count
HIV-HBV or HIV-HCV
co-infection with documented All Clinical Start ART Irrespective
evidence of chronic active stages of any CD4 count
Hepatitis
Preferred regimen for PLHIV with HBV or HCV co-infection:
Tenofovir + Lamivudine + Efavirenz
NACO First line ART Regimens for HIV infection
Regimen National ART Regimen Preference
First line regimen for patients with
Zidovudine +
Regimen I Hb >9 gm/dl and not on
Lamivudine + Nevirapine
concomitant ATT
First line regimen for patients with
Tenofovir +
Regimen I (a) Hb <9 gm/dl and not on
Lamivudine + Nevirapine
concomitant ATT
First line regimen for patients with
Zidovudine +
Regimen II Hb >9 gm/dl and on concomitant
Lamivudine + Efavirenz ATT
•First line regimen for patients
with Hb <9 gm/dl and on
concomitant ATT
•First line regimen for all patients
Tenofovir +
Regimen II (a) with Hepatitis B & Hepatitis C
Lamivudine + Efavirenz
co- infection
•First line regimen for pregnant
women, with no exposure to
sd-NVP in the past
 Paediatric First line ART Regimens
Paediatric
Regimen Remarks
Regimen
Zidovudine + Lamivudine + Preferred paediatric regimen
Regimen P I
Nevirapine for children with Hb >9 g/dL
Stavudine + Lamivudine +
Regimen P I (a) For children with Hb <9 g/dL
Nevirapine
preferred for children on anti-TB
Zidovudine + Lamivudine + treatment;
Regimen P II Efavirenz Hb >9 g/dL and
age >3 yr and weight >10 kg
for children on anti-TB treatment
Stavudine + Lamivudine + tuberculosis treatment;
Regimen P II (a)
Efavirenz Hb <9 g/dL and
age >3 yr and weight >10 kg
1. Efavirenz is the preferred drug over Nevirapine, whenever children are being
treated with Rifampicin containing drug regimen for TB co infection
2. In Children aged <3 years and in children weighing <10 Kg, Efavirenz is
contraindicated.
 Management of STI/RTI
Service delivery through 1114 designated STI clinics, 3942 Preferred Private
Providers for HRGs and 26,000 CHC/PHC under NRHM
Major Initiatives:
Enhanced12/2/2019 5:42 PM Syndromic Case Management through
standardised treatment protocols and colour-coded kits
Branding of STI services as “Suraksha Clinic” with TV & radio promotions for
demand generation
Challenge: Convergence with NRHM
 Blood Transfusion Services
Goal:
To ensure that no transmission of HIV occurs through blood in the country
Strategy:
Increasing regular Voluntary donation to meet the Safe blood requirements in
the country
Promoting Component preparation and availability with rational use of blood in
healthcare facilities
Establishing Quality Management Systems to ensure safe & quality blood

Indicator Target till March 2017 Achievement in 2014-15

No. of Blood Bank supported by
1300 1161
NACO(cumulative)
Blood collection in NACO supported
90 lakh/year 63.2 lakh
blood bank

Proportion of blood units collected

by Voluntary blood donation in 90% 84%
NACO Supported Blood Banks
 Continuum of Care for PLHIV

Secondary District -Health posts Primary

Health Hospitals -Dispensaries Health
HIV Clinics -Traditional Care
Care -Orphan care
Social/legal
Support
Hospice
Integrated
Counselling &
Testing
NGOs
Youth Groups
Specialists
Volunteers
and Specialised
e er rt
ICTC is the Care facilities P po
p
entry su
Community
point
Care & Support
Tertiary Health Palliative
emotional & (CSC)
Care spiritual support
self care
PLHIV Home care
Estimate of Maternal and congenital Syphilis, India

•Pregnant women with probably active Syphilis – 103, 960

•Adverse outcome of Pregnancy: 53,187

- Early Fetal deaths or Still births: 21,488

- Neonatal deaths: 9213
- Pre-Term or Low Birth Weight infants: 6161
- Congenital Syphilis: 16,324

Source: WHO Estimate for congenital Syphilis, 2013

Thank You