Transcript Epidemiology of HIV and National AIDS Control Programme

HIV/AIDS Scenario INDIA
Dr Milind Kulkarni
Dr DSA Karthickeyan
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Global estimates for
Adults and Children, 2008
Estimated
People living with HIV
New HIV infections in 2008
Deaths due to AIDS in 2008
Range
33.4 million
31.1 – 35.8 million
2.7 million
2.4 – 3.0 million
2.0 million
1.7 – 2.4 million
HIV estimates for India (2007)
Category
Estimation
Total population
1.027 billion
HIV prevalence (15-49 years)
0.34%
HIV prevalence among men (15-49 years)
0.40%
HIV prevalence among women (15-49 years)
0.27%
Number of people living with HIV (adults and
children)
2.31 million
Number of Children living with HIV (>15 years)
3.8% of total
Routes of Transmission of HIV
National AIDS Control Programme
Phase III (NACP III) 2006 – 2011
Goal 1:
Halt and reverse the epidemic in India over the
next five years
Reduce new infections by
60% in high prevalence states
40% in vulnerable states
National AIDS Control Programme
Phase III (NACP III) 2006 – 2011
Goal 2:
Prevent new infections
Increase proportion of PLHA receiving care, support, and
treatment
Strengthen capacity at district, state and national levels
Build strategic information management systems
Linkages for Care, Support & Treatment
Secondary
Health
Care
Primary
Health
Care
District
Hospitals
HIV Clinics
Integrated
Counselling
Testing
The entry
point
Specialised
Care facilities
ART
Centres
Tertiary
Health
Care
PLHA
Link ART
CENTRES
NGO &
Peer
Groups
Community
Care
Centres
Home
care
Facilities for Care, Support & Treatment
Facility
Sanctioned
Functional
ART Centres
297
228
Centres Of
Excellence
10
10
LAC
495
197
CCC
343
262
Updated: July, 2009
Strengthening Referrals and linkages for
improving Access to ART Services
Guidelines for eligibility of ART have been revised for timely access
to ART.
Community out-reach services have been strengthened to follow up
PLHA through counselors of ICTCs, out-reach workers of CCCs, PLHA
networks and NGOs.
Special attention is paid to pre-ART cases who missed follow-up
visits, who missed ART doses, who are lost to follow-up and those
with poor drug adherence.
Long distances, considerable travelling time and costs to access ART
for those living in rural and remote areas addressed through
strategic locations of Link ART Centres
Key points
• ICTC is the entry point for HIV-infected persons
• NACP phase III aims to halt and reverse the epidemic in India over
the next five years, to scale up care and support services, and to
strengthen capacity at all levels
• Link ART centres are developed in an attempt to provide ART
nearer to patients homes
• Link ART centres are expected to enhance treatment adherence
Current National ART Regimens
• AZT, 3TC & NVP
•
(For patients with Haemoglobin >8 gm/dl)
• d4T, 3TC & NVP
• (For patients with Haemoglobin <8 gm/dl)
• TDF, 3TC, & NVP in special situations only - when there is
toxicity/other contra- indications to AZT or d4t
• EFV should be given as priority to persons receiving antituberculous therapy
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Alternate First line ART
Alternate to Zidovudine & Stavudine
• In this case, TDF+3TC as fixed dose combination will
be provided, after consultation with the SACEP.
SACEP: State AIDS Clinical Expert Panel
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Alternate First line ART
Alternate to Zidovudine & Stavudine
Regimen
Regimen III
Regimen III (a)
Drug Combination
Tenofovir +
Lamivudine +
Nevirapine
Tenofovir +
Lamivudine +
Efavirenz
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Remarks
For patients not
tolerating
Zidovudine and
Stavudine
Alternate First line ART
Alternate to Nevirapine & Efavirenz
Regimen
Regimen IV
Regimen IV (a)
Drug Combination
Remarks
Zidovudine + Lamivudine
+ Lopinavir / Ritonavir
For patients not
tolerating both NVP
& EFV
Stavudine + Lamivudine +
Lopinavir / Ritonavir
For patients not
tolerating both NVP
& EFV and Hb < 8
g%
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Alternate First line ART
Alternate to Nevirapine & Efavirenz
•
Intolerance to both NVP and EFV: in this case, LPV/r as a
substitution ARV will be provided upon review and
approved by the SACEP. The patient shall be managed and
provided LPV/r by the COE
•
Mild toxicities do not require discontinuation of ART or
drug substitution.
•
This part is still in process of implementation
SACEP: State AIDS Clinical Expert Panel
Challenges
Initiation of ART
Eligibility : <250 CD4 Count
2nd Line ART
Need for more patient
High Risk Population
Increasing prevalence of HIV
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Challanges
• HIV/TB Co-Infection
Diagnosis of MDR TB
Diagnosis of Extrapulmonary TB(National
program Diagnosing only Sputum Positive
Pulmonary TB)
PPTCT/PMTCT
Triple Drug Regimen.
Still NVP?
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Thank you
Mercy