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HIV/AIDS Scenario INDIA
Dr Milind Kulkarni Dr DSA Karthickeyan
Estimated Range
People living with HIV 33.4 million 31.1 – 35.8 million
New HIV infections in 2008 2.7 million 2.4 – 3.0 million
Deaths due to AIDS in 2008 2.0 million 1.7 – 2.4 million
Global estimates for Adults and Children, 2008
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
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
National AIDS Control Programme Phase III (NACP III) 2006 – 2011
Goal 2:
Linkages for Care, Support & Treatment
Home care
Tertiary Health Care
Integrated Counselling
Testing
The entrypoint
Secondary HealthCare
CommunityCare
Centres
PLHA
DistrictHospitals
HIV Clinics
SpecialisedCare facilities
ARTCentres
Link ART CENTRES
Primary HealthCare
NGO &Peer
Groups
Facility Sanctioned Functional
ART Centres 297 228
Centres Of Excellence 10 10
LAC 495 197
CCC 343 262
Updated: July, 2009
Facilities for Care, Support & Treatment
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
• 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
Key points
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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 anti-tuberculous therapy
• In this case, TDF+3TC as fixed dose combination will
be provided, after consultation with the SACEP.
Alternate to Zidovudine & Stavudine
Alternate First line ART
SACEP: State AIDS Clinical Expert Panel
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Regimen Drug Combination Remarks
Regimen IIITenofovir + Lamivudine + Nevirapine
For patients not tolerating Zidovudine and StavudineRegimen III (a) Tenofovir +
Lamivudine + Efavirenz
Alternate First line ARTAlternate to Zidovudine & Stavudine
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Regimen Drug Combination Remarks
Regimen IVZidovudine + Lamivudine + Lopinavir / Ritonavir
For patients not tolerating both NVP & EFV
Regimen IV (a) Stavudine + Lamivudine + Lopinavir / Ritonavir
For patients not tolerating both NVP & EFV and Hb < 8 g%
Alternate First line ARTAlternate to Nevirapine & Efavirenz
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• 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
Alternate to Nevirapine & Efavirenz
Alternate First line ART
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
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