Community Health Nursing - II

NACP: A Comprehensive Guide to the National AIDS Control Program and Its Impact

The National AIDS Control Program (NACP) is essential in India’s fight against HIV/AIDS, focusing on prevention, treatment, and care. Learn about its historical milestones, objectives, and the extensive services offered to manage and reduce the impact of HIV/AIDS.

Published

4 months ago

19/08/2024

Mr. Umar

The National AIDS Control Program (NACP): Fighting HIV/AIDS with Comprehensive Strategies and Support

Explore the National AIDS Control Program (NACP) – its historical milestones, objectives, and comprehensive services provided for HIV prevention, care, and treatment. Learn how NACP is working to combat HIV/AIDS in India.

The National AIDS Control Program (NACP) is a crucial initiative in combating the HIV/AIDS epidemic in India. Launched in 1987, NACP aims to prevent HIV transmission, reduce morbidity and mortality, and mitigate the socioeconomic impact of the disease.

National AIDS Control Program (NACP)

Overview:

HIV/AIDS Impact: HIV is a life-threatening infection with 34 million lives claimed so far. In 2014, 1.2 million global deaths were due to HIV/AIDS.
AIDS: The most advanced stage of HIV infection.

Historical Milestones:

1986: First case of HIV detected. National AIDS Committee established under the Ministry of Health.
1990: Medium-term plan launched for four states and four metros.
1992: NACP-1 launched to slow down HIV spread.
1999: NACP-II Initiated Focusing on behavior change
2002: National AIDS Control Policy and National Blood Policy adopted.
2004: Anti-retroviral treatment adopted.
2007: NACP-III launched for 5 years (2007-2012).
2014: NACP-IV launched for 5 years (2012-2017).
2021: NACP-V (2021-2016)

Program Details:

NACP Launch: The National AIDS Control Program was initiated in 1987.
PLHIV Estimates: In 2015, there were 21.17 lakhs people living with HIV (PLHIV) in India, compared to 22.26 lakhs in 2007.
NACO: National AIDS Control Organization was set up by the Ministry of Health and Family Welfare to oversee NACP components.

Objectives:

Prevent Transmission: Reduce the spread of HIV.
Reduce Morbidity/Mortality: Lower the health impacts of HIV/AIDS.
Minimize Socioeconomic Impact: Address the broader effects of the disease.

Preventive Services under NACP-IV:

Targeted Interventions: High-risk groups (e.g., female sex workers, men who have sex with men, transgenders, injecting drug users, truckers, migrants).
Needle Syringe Exchange Program (NSEP) & Opioid Substitution Therapy (OST): For injecting drug users.
Prevention for Migrants: At source, transit, and destination.
Link Worker Scheme (LWS): For high-risk groups and vulnerable populations in rural areas.
STI/RTI Prevention: Control sexually transmitted and reproductive tract infections.
Blood Safety: Ensure safe blood practices.
HIV Counseling and Testing: Provide testing and counseling services.
Prevention of Parent-to-Child Transmission: Reduce transmission risk from mother to child.
Condom Promotion: Encourage use to prevent HIV.
IEC & BCC: Information, education, and communication; behavior change communication.
Social Mobilization & Youth Interventions: Engage youth and communities in awareness and prevention.
Mainstreaming HIV/AIDS Response: Integrate HIV/AIDS strategies into various sectors.
Workplace Interventions: Implement HIV/AIDS policies and programs in workplaces.

Care, Support, and Treatment Services

Laboratory Services:

CD4 Testing: Essential for monitoring immune system health in HIV patients.
Other Investigations: Additional diagnostic tests as required.

Anti-Retroviral Treatment (ART):

First and Second Line ART: Available through ART centers, Link ART Centers (LACs), Centers of Excellence (COE), and ART Plus Centers.
Pediatric ART: Specialized ART for children.
Early Infant Diagnosis: For HIV-exposed infants and children under 18 months.

HIV-TB Coordination:

Cross-Referral: Linking HIV and TB care services.
Detection and Treatment: Managing co-infections effectively.

Treatment of Opportunistic Infections:

Management: Address infections that occur due to weakened immune systems.

Drop-In Centers:

PLHIV Networks: Provide support and services for People Living with HIV (PLHIV).

Types of Facilities for HIV Testing and Counseling

1. Integrated Counseling and Testing Centers (ICTCs):

Facility-Based Services: Offered within hospitals or health centers during OPD hours.
Community-Based Services: Conducted by ANMs at Health Subcenters.

2. Types of ICTCs:

Client-Oriented ICTC: Testing and counseling are initiated by the individual’s request.
Provider-Initiated ICTC: Testing and counseling are recommended by healthcare providers.

3. Stand-Alone ICTC (SA-ICTC):

Location: Typically in medical colleges, district hospitals, etc., with clear signage.
Facilities: Two rooms (one for counseling and one for testing).
Staff: Full-time counselor and laboratory technician.

4. Mobile ICTC:

Services: Provided in a van for hard-to-reach areas.
Team: Includes a counselor, health educator, ANM, and laboratory technician.

These services aim to provide comprehensive care, support, and treatment for individuals affected by HIV, improving accessibility and quality of care.

Prevention of Parent to Child Transmission of HIV (PPTCT) Program

Overview:

Initiation: Started in India in 2002.
Current Status: Approximately 15,000 Integrated Counseling and Testing Centers (ICTCs) are operational, mostly in government hospitals.

Objectives:

Universal Coverage: Aim to provide services to all pregnant women to prevent HIV transmission from mother to child.
HIV Diagnostic and Care: Offering comprehensive services including prevention, care, and treatment for HIV-positive pregnant women.

Package of PPTCT Services in India:

HIV Testing and Counseling: Early detection and guidance for pregnant women.
Family-Centric Approach: Involving spouses and family members in the care process.
Lifelong ART Provision: For HIV-positive pregnant and lactating women, regardless of CD4 count.
Promotion of Institutional Deliveries: Encouraging HIV-positive mothers to deliver in institutions.
Care for Associated Conditions: Addressing STIs, RTIs, TB, and other opportunistic infections.
Nutritional and Psychological Support: Providing holistic support to HIV-positive pregnant women.
Breastfeeding Counseling: Initiate breastfeeding within 30 minutes of birth and continue for 6 months.
ARV Prophylaxis for Infants: Administer ARVs to infants until 6 months.
Follow-Up: Routine health care services for HIV-exposed infants.
Cotrimoxazole Prophylactic Therapy: For infants to prevent infections.
Community Support: Strengthening networks to support HIV-positive pregnant women and their families.

WHO Criteria for HIV Treatment:

CD4 Count: Treatment recommended if CD4 count is less than 500 cells/mm² (as of 2013).

Antiretroviral Treatment Recommendations:

Combination Therapy:

Definition: Use of two or more antiretroviral drugs simultaneously.
Highly Active Antiretroviral Therapy (HAART): Combination of three or more anti-HIV drugs.

First-Line Therapy:

Recommended Regimen: Two nucleoside reverse transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse transcriptase inhibitor (NNRTI).
Fixed Dose Combination:
- TDF (Tenofovir)
- 3TC (Lamivudine) or FTC (Emtricitabine)
- EFV (Efavirenz)

Second-Line Therapy:

Recommended Regimen: Two NRTIs plus a ritonavir-boosted protease inhibitor (PI).

These protocols aim to reduce the transmission of HIV from mothers to their babies and ensure effective management and support for those affected by the virus.