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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