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HIV/AIDS Scenario INDIA

HIV/AIDS Scenario INDIA. Dr Milind Kulkarni Dr DSA Karthickeyan. Global estimates for Adults and Children, 2008. HIV estimates for India (2007). Routes of Transmission of HIV. National AIDS Control Programme Phase III (NACP III) 2006 – 2011 Goal 1:.

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HIV/AIDS Scenario INDIA

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  1. HIV/AIDS Scenario INDIA Dr MilindKulkarni Dr DSA Karthickeyan

  2. Global estimates for Adults and Children, 2008

  3. HIV estimates for India (2007)

  4. Routes of Transmission of HIV

  5. National AIDS Control Programme Phase III (NACP III) 2006 – 2011Goal 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

  6. National AIDS Control Programme Phase III (NACP III) 2006 – 2011Goal 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

  7. Secondary Health Care Primary Health Care District Hospitals HIV Clinics Integrated Counselling Testing Specialised Care facilities ART Centres PLHA Community Care Centres The entry point Home care Tertiary Health Care Link ART CENTRES Linkages for Care, Support & Treatment NGO & Peer Groups

  8. Facilities for Care, Support & Treatment

  9. 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

  10. 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

  11. 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 11

  12. Alternate First line ART • In this case, TDF+3TC as fixed dose combination will be provided, after consultation with the SACEP. Alternate to Zidovudine & Stavudine SACEP: State AIDS Clinical Expert Panel 12

  13. Alternate First line ART Alternate to Zidovudine & Stavudine 13

  14. Alternate First line ART Alternate to Nevirapine & Efavirenz 14

  15. Alternate First line ART Alternate to Nevirapine & Efavirenz SACEP: State AIDS Clinical Expert Panel 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

  16. Challenges Initiation of ART Eligibility : <250 CD4 Count 2nd Line ART Need for more patient High Risk Population Increasing prevalence of HIV

  17. 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?

  18. Thank you Mercy

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