The HIV epidemic in the country has been categorized as a concentrated form of an epidemic as HIV prevalence among high risk population has been observed to be persistently high in comparison to the general population. According to the Sentinel Survey figures released in 2006, there are an estimated 5.206 million HIV infected person in the country in the age group 15-49 years giving an adult prevalence of HIV infection as 0.9%.. Out of the total estimated HIV infections, 38.4% are women and 57% of these infections are in rural area. During 2006, a total of 95 ANC sites showed an HIV prevalence of more than 1% and 34 STD sites showed an HIV prevalence of more than 10% indicating the Heterogeneity of the epidemic. Therefore, under NACP III, districts have been categorized as per the level of infection and the risk. Out of 610 districts, 140 districts are in category A, 47 districts are in category B and the rest of the districts are in category C & D.

The specific objective of the programme is to reduce new infections by:

• Sixty per cent (60%) in high prevalence states so as to obtain the reversal of the epidemic and
• Forty per cent (40%) in the vulnerable states so as to stabilize the spread of the epidemic.

Since more than 99% of population is uninfected, India has an opportunity to prevent an explosive epidemic as witnessed in Sub- Saharan Africa or South East Asian countries by adequately investing in prevention and treatment. Accordingly, during NACP III, two thirds of the resources and efforts have been committed to prevention with the remaining dedicated to care, support and treatment. However, converting money into program activities and desired out comes requires an adequate and appropriate mix of human resources and institutional structures to supervise the quality of implementation, monitor the logistics and provide financial oversight. Accordingly, the objectives of NACP III are proposed to be achieved through four key strategies:

1. Prevention of new infections in high risk groups and general population through:
1. Saturation of coverage of high risk groups with targeted interventions (TIs), and
2. Scaled up interventions in the general population
2. Providing greater care, support and treatment to a larger number of people living with HIV/AIDS.
3. Strengthening the infrastructure, operating systems and human resources in prevention, care, support and treatment programmes at the district, state and national levels.
4. Strengthening a nation-wide Strategic Information Management System. The National AIDS Control Programme has 5 components and the status of programme activities are as follows:
   
   
1. Priority targeted intervention for populations at high risk:-
This component of the project aims to reduce the spread of HIV in groups at high risk like Female Sex Workers (FSW), Injecting Drug Users (IDU) and Men having Sex with Men (MSM) populations, and providing per counseling, condom promotion, treatment of sexually transmitted infections etc. This activity is being delivered through nongovernmental organizations and community based organizations. During the year 2005-06, 1088 TIs were operational, and have increased to 1220 by March 2007. In NACP III, the High Risk Groups are proposed to be accessed with the help of NGO's and community based organizations through approximately 2100 intervention projects. Experience has demonstrated that addressing issues of empowerment of high risk groups is a successful strategy for obtaining their adherence to safe sex behaviour. During NACP III high risk groups will be supported to organize themselves into Community Based Organizations (CBOs) (i.e. organizations managed by the target beneficiaries themselves) so as to ensure sustainability and reduce their continued dependence on NGOs for accessing critical services. The target is to bring 50% of interventions (1050) under CBO management.

An amount of Rs. 2288 Crores will be spent on this activity during NACP III.


2. Preventive interventions for the general population:-
The main activities include: (a) IEC and awareness campaigns; (b) provision of voluntary testing and counseling services; (c) Safety of Blood and Blood products for transfusion; and (d) Prevention of occupational exposure.

Under IEC activities, multimedia campaigns are being taken up. Special communication packages are developed for groups like Sex workers, IDUs, Truckers and Street children etc. Focused radio programmes are broadcast on a regular basis, to provide information about prevention and control of HIV/AIDS. Field publicity units and song and drama division had undertaken extensive campaigns in rural areas. Over 4000 universities had covered over 3.5 million students under "University Talks AIDS" programmes. AIDS hotlines with 1097 toll free numbers have been established in 65 major cities in the country.

Integrated counseling and testing services (ICTC) including prevention of parent to child transmission centers (PPTCT).

There are an estimated 22 million at risk people in the country (6% of sexually active population). In 2006, only 3 million people could be tested and counseled at 3409 ICTCs. Thus only 13% of the at risk population could access counseling and testing services. Beside this, 13.5 million deliveries in the country are institutional. Out of this, only 2.1 million mothers could be counseled and tested and 16876 were detected with HIV positive in the PPTCT centers in 2006. Thus only 15% of the pregnant women could access PPTCT services. At present, there are 4132 Integrated Counseling and Testing Centers providing prevention and testing services to high risk population as well as pregnant women.

Under NACP-III, existing VCT and PPTCT centers have been remodeled as a hub to integrate all HIV related services and are called integrated counseling and testing centers. During NACP-III, all the Community Health Centers in the country will have ICTC with a total target of 4955 in the Public Health facilities. Besides this, ICTC services including PPTCT services will also be extended to 24 hour PHCs and private sector hospitals by training the available manpower and training. During 2007-08, ICTC up to the CHC level will be established in all category A & B districts on a priority basis. In hard to access areas and tribal areas, mobile ICTCs will be made available to provide counseling and testing services. The quality of tests will be assured by internal and external quality assurance mechanisms. All category A and B districts will have a co-coordinator who will oversee the functioning of ICTCs and PPTCT centers in a district. This co-coordinator will be appointed on a contractual basis and will not only supervise the functioning of ICTCs and PPTCTs in a district but will also work out strategies to enhance the client load in all ICTCs so as to achieve the target of 8-10 tests per day per center. In order to prevent the vertical transmission mother to child, an institutional mechanism will be established to know the CD4 count of all pregnant HIV positive women by sending the blood samples to the nearest ART centre. The total budget allocated for this activity is Rs. 836 crores.

STI Services

A total of 30 million episodes of STI are occurring every year whereas 1.7 million have been reached through 866 STI clinics established in district hospitals and medical colleges by the end of financial year 2006-07. Besides this, the STI services are also being provided at Sub-districts level under the RCH programme. The utilization of STI services in these clinics has been found sub-optimal indicating that most of the vulnerable population may be accessing STI services from private service providers. During NACP-III, STI services are being expanded though effective integration with the RCH-II programme, and through involvement of private sector. During the financial year 2007-'08 existing STI clinics will be strengthen and quality STI services will be ensured at all sub-district health facilities by convergence with NRHM. A scheme for involvement of 5000 preferred private service providers will also be implemented particularly in category A and B districts. The ICMR STD network will also be utilized to monitor drug resistance and deciding on Syndromic Protocol. An amount of Rs. 150 crores will be spent on this activity during NACP-III.

Blood Safety

The Blood Safety component of the Programme ensures supply of adequate and safe blood in the country. It is mandatory to test all donated blood for hepatitis B and C, HIV, Syphilis and Malaria. NACO modernized and upgraded existing blood banks up to district level. Presently, there are 2211 operational licensed blood banks in the country of which 1230 blood banks including 82 Blood Component Separation Units are supported by NACO by providing one time equipment and an annual recurrent grant. A total of 10 model blood banks are operational in the country. The Voluntary Blood Donation Camps were organized every year to augment voluntary blood donation programme in the country. During 2006-07, the proportion of voluntary blood donation has increased from 52% in 2005 to 56.4%.

Under NACP-III, it is proposed to establish a plasma fractionation plant, 39 district level blood banks where at present there are no blood transfusion facilities; blood storage centres in 3222 CHCs (equipment grant by RCH-II & annual recurrent grant by NACO); provide Blood Bank vans in 500 districts for networking with blood storage centres to be operated by the Indian Red Cross Society or other established not for profit and trust organizations; 32 blood mobiles in various states; 22 additional model blood banks etc.

In order to improve access to safe blood, the following activities will be undertaken during 2007 - 08:


• The voluntary blood donation will be augmented to more than 65% of the total blood collection in the next financial year.
• 3070 Blood Storage Centres will be established. The equipment grant for these centres will be provided through NRHM, while NACO will provide training and annual recurring grant as well as the transport facilities for transportation of blood to these Storage Centres.
• Initiate the process of establishment of Centre of Excellence in four Metropolitan Cities.
• Initiate the process of establishment of One Plasma Fractionation Centre
• Initiate the process of establishment of One Model Blood Bank (in each of the States).
  
  
An amount of Rs. 955 Crores will be spent on this activity during NACP III.


3. Low Cost care for people living with HIV/AIDS:-
Under this, component activities would provide financial assistance for home based and community based care, including increasing the availability of cost effective interventions for common opportunistic infections. Necessary funds have been provided to all medical colleges and large hospitals in the country to ensure availability of drugs for management of opportunistic infections in HIV/AIDS patients. 122 Community care centers have been established in high prevalent States to provide palliative care to terminally ill AIDS patients, in these States.

At present there are 126 ART centres in 29 states of country. In addition, 5 centres are being supported by state Governments (Kerala, Jharkhand, J&K). At present, about 73,000 patients are receiving free ART in the country. In addition nearly 2,600 patients are receiving ART in hospitals run by other departments such as Defence, Railways and the NGO sector and another 20-25,000 in the private sector. NACO has already procured and supplied drugs for treatment of 85,320 adult and 10,000 children for the year 2006-07.

The National Pediatric ART Initiative was launched on 30th November 2006 to enhance coverage of Children Living with HIV/AIDS and providing them specific pediatric formulations. 4127 children are receiving treatment in pediatric formulations. Pediatric drugs have been provided to 86 ART centres and arrangements are being made to supply the rest of the centres with these drugs, as it is anticipated that children will enroll for treatment if drugs are available.

Under NACP-III it is proposed to provide universal access to a continuum of care. Accordingly, prevention will go hand in hand with access to prophylaxis, management of opportunistic infections and ART. Given the low levels of coverage, focus will also be on assuring universal access to first line ARV drugs in the first instance. The Community Care Centres, which under Phase II were established as hospices for providing treatment to the terminally ill, will now be reconfigured to function as a bridge between patients and the Anti-retroviral Treatment (ART) centres for providing psycho-social support, adherence counseling through strong outreach services, referrals and palliative care. Home based care will be an integral part of this strategy.

Care, support and treatment services will include management of opportunistic infections including TB, anti-retroviral treatment (ART), safety measures, positive prevention and impact mitigation. By 2011, the programme will be able to treat 3.2 lakh OI episodes in a year, provide TB referrals to 28 lakh PLHA and ART treatment to 3.4 lakh PLHAs in the public sector.

In 2007-08, the focus will be on providing greater care and support and treatment services to larger number of People Living with HIV/AIDS through:


• Expansion of Anti-retroviral Treatment, Care and Support to cover the entire country under GFATM Round VI (Project Approved)
• Expansion of ART services through hospitals in other sectors (Railways, ESI, Army etc.), PSUs, Corporate Hospitals and NGOs.
• It is also planned to provide free ART to 100,000 patients by end 2007 and 300,000 patients by 2012.
  
  
An amount of Rs. 1953 Crores will be spent on this activity during NACP III.


4. Institutional strengthening:-
It is proposed to strengthen Human Resource Capacity at NACO by enhancing strategic planning skills, disseminating best practices for TIs, establishing and managing a network of technical expertise through Technical Resource Groups (TRGs) in STI/HIV/AIDS, conducting OR and to oversee R&D activities nationwide. These are some of the thrust areas for strengthening institutional capacity. NACO has also developed Project's financial management system for effective financial management of the programme.

Training: Regional and state level training were organised as part of capacity building for health care providers under NACP-II. NACO prepared a team of trainers (TOT) who worked closely with SACS where more than 95% training is conducted in a decentralized manner. An estimated 88,954 doctors and health workers were trained in HIV/AIDS during the current Financial Year. As on March, 2007, a total of 794,000 personnel were trained, including specialist doctors of medical colleges, general DMOs, nurses, IEC officers, counselors, NGOs, lab technicians, blood bank officials and district nodal officers. During this period, review and printing of training curricula/module/materials was undertaken, guidelines for District Action Plans were laid down, training of national and sate level trainers was completed and refresher/induction training of TOTs held.

An amount of Rs. 497 Crores will be spent on this activity during NACP III.


5. Build Capacity for M&E Programme Activities:-
An independent National M&E agency was selected and each SACS was asked to have its own M&E officer. The Performance and Expenditure Annual Review (PEAR) involved a review by NACO with SACS on expenditure, financial flows, annual action plans, PMRs and project input, outcome and process indicators. PEAR will be on the basis of allocation of funds by NACO to SACS.

As part of M&E under NACP-II, BSS was carried out amongst general population and HRGs across 35 States and UTs in the country in 2001 providing baseline information on behaviour risk patterns. End line BSS has been completed and results are presently being compiled.

An amount of Rs. 360 Crores will be spent on this activity during NACP III. Development of indigenous vaccine and Operational Research are the main activities under research priorities of the programme.


6. Inter-sectoral collaboration:-
This component aims at promoting collaboration amongst the public, private and voluntary sectors. The activities are collaborated with other programmes within the Ministry of Health & Family Welfare and other central ministries and departments. collaboration is focussed on; (I) Learning from the innovative HIV/AIDS programmes that exist in other sectors; and (II) sharing in the working of generating awareness, advocacy at delivering interventions.

A high level National Council on AIDS has been constituted under the chairmanship of Hon'ble Prime Minister with representation of 33 ministries and departments to ensure mainstreaming of HIV / AIDS prevention activities in ongoing programmes of concerned ministries and departments. The 1st meeting was held on 16th February 2006.


7. Financial allocation:-
The details regarding allocation of funds and utilization during last three years are as follows:



(Rs. in crore)
S.No.	Year	Funds allocated	Funds utilized
1.	2003-04	225.00	231.75
2.	2004-05	426.00	422.00
3.	2005-06	533.50	532.70
4.	2006-07	705.00	512.00




Next Page >