National STD/AIDS Control Programme

Dr. Ajith Karawita MBBS, PGDV, MD

National STD/AIDS Control Programme

Contributing to a healthier nation throughsexual health promotion, emphasizing the prevention, control and provision of quality

care for STIs including HIV and AIDS

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Mission

VisionQuality sexual health services

for a healthier nation.

STI service delivery points

Service delivery points

No

1 Full time STD clinics 29

2 Branch clinics 21

3 IDH 1

ART centers

1 Central clinic, Colombo

2 STD clinic, Kalubovila

3 STD clinic, Ragama

4 STD clinic, Kandy

5 IDH

PROGRAMME AREAS (includes clinical and preventive components)

1 Administration

2 Counselling and testing

3 Epidemiology

4 Financial management

5 HIV treatment, care and support

6 IEC and condom promotion

7 Multisectoral programme

8 Planning and coordination

9 Laboratory services & infection control

10 PMTCT

11 STD care

12 Strategic information management

13 Training and capacity building

HMPHealth Master

Plan (has 5 strategic

areas) (10 year)1. Health service delivery2. Community empowerment3. Human resource development4. Financing , Resource allocation & Utilization5. Stewardship & management of the health sector

Programme areas of Health service delivery1.1 Programme for organizational development1.2 Medical supplies1.3 National quality assurance1.4 Disease control programmes1.5 Programme for vulnerable populations1.6 National Nutrition programme1.7 Health promotion programme

1.4. Disease control

programmes (has 28 areas)

STD/AIDS CONTROLNational STD/AIDS Control Programme

National STD/AIDS Control Programme, Sri Lanka

National STD/AIDS Control Programme and the Central Clinic

Strategic Information Management Unit of the National STD/AIDS Control Programme

Partners in the STD/AIDS Control• Government

– National STD/AIDS Control Programme, NBTS, NDDCB, Epid unit, FHB, HEB

• Private sector partners (Business coalition)• Civil society organizations (NGOs, CBOs, FBOs)

– E.g. Sarvodaya, CSDF, COJ, Alliance Lanka, MMM– Family planning association

• Development partners (UN agencies, Other INGOs)

STRENGTHS FOR ACTION: POLICY AND LEGAL FRAMEWORK

National Policy Framework for HIV Prevention Interventions

• Constitution• National Health Policy• National AIDS Policy• National Policy on

HIV/AIDS in the world of work

• Draft MCH policy• Draft National Blood Policy• Health Promotion Policy

STRENGTHS FOR ACTION: INTERNATIONAL POLITICAL TOOLS AND

COMMITMENTS

Resolution adopted by the General Assembly related to HIV/AIDS

1989: Convention on the Rights of the Child (CRC) 2000: UN security council resolution 1308 2000: United Nations Millennium Declaration 2000: Review of the problem of HIV/AIDS in all its aspects2002: The rights of the child 2004: Follow-up - Declaration of Commitment on HIV/AIDS 2004: Access to medication in pandemics - HIV/AIDS, TB & M2004: Rights of the child 2004: Regional call for capacity-building in public health 2004: Scaling up treatment and care

Resolution adopted by the General Assembly related to HIV/AIDS

2005: International cooperation against the world drug problem 2005: 2005 World Summit Outcome 2006: Political Declaration on HIV/AIDS 2007: Trafficking in women and girls 2007: Rights of the child 2008: Towards global partnerships 2009: The protection of human rights in the context of HIV/AIDS 2010: Policies and programmes involving youth 2010: Achieving universal access for DU, PLHIV/affected by HIV 2010: WHO HIV strategy 2011-2015 2010: UNAIDS HIV strategy 2011-2015

The Millennium Development Goals (MDGs)

Eradicate Extreme Poverty and Hunger

Improve Maternal Health

Achieve Universal Primary Education

Combat HIV/AIDS, Malaria and other Diseases

Promote Gender Equality and Empower Women

Ensure Environmental Sustainability

Reduce Child Mortality

Develop a Global Partnership for Development

National Guidance of the Programme/Commitments

• Health Master Plan (10 year)– Supported by Mid-term

plan (3 year)– Annual Health Plan

• National Strategic Plan (NSP) based on external reviews

• GFATM performance frameworks (R6, R9)

National STD/AIDS Control Programme, Sri Lanka

National STD/AIDS Control Programme and the Central Clinic

Strategic Information Management Unit of the National STD/AIDS Control Programme

ORGANOGRAM, National STD/AIDS Control Programmes

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Committees

• National AIDS Council• National AIDS committee with subcommittees for each

programme components– Prevention sub committee– HIV clinical care and counseling sub committee– Laboratory and surveillance sub committee– Strategic Information Management (SIM)– IEC subcommittee– NGO sub committee– Legal and ethics sub committee

• Provincial AIDS Committees• Programme director and the senior management team (SMT)

PROGRAMME AREAS (includes clinical and preventive components)

1 Planning and coordination unit

2 Capacity building and training unit

3 STD unit

4 PMTCT unit

5 HIV Care and treatment unit

6 Multisectoral coordination unit

7 Counselling and testing unit

8 IEC and condom promotion unit

9 Laboratory services unit

10 Strategic information management (SIM) unit (M&E, Surveillance, Research)

11 Financial management unit

12 Administration unit

National Strategic Plan (NSP)2007-2011

Goals and Strategic Objectives in the National Strategic Plan

The goals of the National STD/AIDS Control Programme Maintain current low prevalence of HIV among most-at-risk-

populations (MARP) and the general population Improve the quality of life of people infected with, or affected

by HIVThe strategic objectives

1. Increase coverage and effectiveness of prevention interventions

2. Increase coverage and effectiveness of care, support and treatment interventions

Strategic Approach in the National STD/AIDS Control Programme

Strategy 1: PreventionStrategy 2: Treatment, care, and supportStrategy 3: Generating and using strategic informationStrategy 4 Multisectoral involvement and decentralizationStrategy 5 Policy development and legislationStrategy 6: Strengthening national coordination and management

capacity

Strategy 1: Prevention

Increased scale and quality of comprehensive interventions for MARPs:

FSW & clients, MSM, IDU/DU and prisoners.

• Routine interventions for MARPs by the network of National STD/AIDS Control Programme clinics through staff of the 28 fulltime STD clinics and 21 branch clinics.

• Mapping of MARPs as a pilot project and implementation of micro-planning

• Under GFATM R9 – Provision of sexual health services for MARPs including beach boys.

• Routine provision of services for prisoners through prison hospital network in Sri Lanka include management of SRH issues, referrals for STI care, HIV care and HIV counselling and testing services.

• Under GFATM R9-Provision of sexual health services for prisoners• Under GFATM R9-Social mapping of these populations for TIs

Increased scale and coverage of HIV communication interventions for general population and lesser risk populations

(youth, migrant workers, etc.)

• Routine IEC programmes through network of service delivery points in the NSACP

• Mainstreaming of SRH and STI and HIV issues to Education sector, inclusion of HIV/AIDS in to school curriculum through National Institute of Education (NIE)

• Under GFATM R6-education of school children in sabaragamuwa province

• Under GFATM R6-awarness programmes for plantation sector workers (60 estates in 5 districts)

• Mass media campaigns• World AIDS Day campaigns (public, private and civil society

organizations)

Increased quality and coverage of STI services.

• Provision of STI services through delivery points of NSACP and private practitioners

STI service delivery points

Total number of STI clinics 29Branch clinics, Yellow 21STI clinics with ART facility, (Blue pins) 4

Non STI units with ART facility (IDH) 1

Increased quality and coverage of PPTCT services

• Four prong approach is used– Prong 1: Primary prevention of HIV, especially among pregnant

women and young people;– Prong 2: Prevention of unintended pregnancies among HIV-infected

women;– Prong 3: Prevention of HIV transmission from HIV-infected women to

their children;– Prong 4: Treatment, care and support to HIV-infected women and

their families

• Opt out HIV screening among urban antenatal mothers (Colombo district hospitals, DMH, CSHW, Gampaha, Kalutara)

• Provision of prophylaxis through STD clinic delivery points (onsite and referred basis)

• Training of HCWs on PPTCT, Breast feeding options etc.

Increased quality of blood transfusion services.

• HIV screening commenced in 1987. (Now using 11 days window period ELISA for screening)

• No Blood transfusion related HIV infection reported since year 2000

• So far 3 cases of transfusion related HIV infections reported (0.4% of all HIV cases)

Reduced transmission in the health services

• Implementation of standard precautions for HCWs through infection control units

• Provision of post exposure prophylaxis• Developed SOPs for STI care services• Prevention of biohazards – use of safety

precautions e.g. Safety cabinets• Safe waste disposal systems• Training of STD clinic staff and infection control

unit staffs for PEP

Strategy 2: Care, treatment and support

Increased quality and use of counselling and testing services.

• Counselling and testing services are integrated to the service delivery points of the NSACP.

• Under GFATM R6-Counselling and testing model introduced to plantation sector workers (26 centres)

• Training on HIV counselling and testing for HCWs – International and national level.

Increased quality and coverage of HIV and AIDS treatment services

• ART is provided through 28 STD clinics (4 centres are on site drug dispensing units, others are referral and follow up centres)

• ART is also provided through one identified Base Hospital (former infectious disease hospital) in Angoda

• Slandered treatment protocols are use for treatments and M&E. E.g. WHO guidelines, BASHH guidelines etc

• All eligible patients are given ART.

Increased quality and coverage of home and community based care for PLHIV

• Low prevalent country – Not a huge issue• Home and community-based care is provided

through some NGOs• Training of family members for provision of

care• Home visits are done form Gov. STI service

providers if necessary

Strategy 3: Generating and using strategic

information

• National integrated behavioural and biological surveillance (IBBS) implemented, documented and disseminated

• Formative and operational research implemented, documented and disseminated

• HIV/AIDS related services monitored, documented and disseminated through national progress reports.

Strategy 4: Multisectoral involvement and

decentralization

Increased engagement and capacity of NGOs in prevention, care and policy development.

• Provision of training and capacity building for NGOs

• NGOs represent in the National AIDS Committees, sub committees, provincial AIDS committees.

Increased engagement and capacity of key ministries/departments.

• Mainstreaming of HIV/AIDS concerns in to the relevant wok plans of the ministries and other departments – Department of Education and National Institute of

Education (NIE)– Foreign employment bureau– Department of fisheries and aquatic resources

Strategy 5: Policy development and legislation

Policy development and legislation

• Supportive National HIV/AIDS policy passed• Sectoral HIV/AIDS policies developed in

accordance with the NAP• Compassionate and supportive attitudes

improved among lawmakers, advocates, law enforcers etc

Strategy 6: Strengthening national coordination and

management capacity

ORGANOGRAM, National STD/AIDS Control Programmes

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The “Three Ones” principles

• The "Three Ones" are a set of principles for the coordination of national AIDS responses

• These principles were endorsed at a high-level meeting held on 25 April 2004 and co-hosted by UNAIDS, the United Kingdom and the United States.

The “Three Ones” principles are:

• One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners.

• One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.

• One agreed country-level Monitoring and Evaluation System.

One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners.

National Strategic plan

One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.

National AIDS Council

National AIDS Committee

Sub committees

One agreed country-level Monitoring and Evaluation

System. National AIDS

Council

National AIDS Committee

Surveillance, M&E subcommittee

GFATM and other Project Frameworks

PROJECT OR PROGRAMME AREASProgress of GFATM R6 activities in GFATM R9.con R6 proposal (HIV component)School sector project (GFATM R9.con R6), Sabaragamuwa Province

Plantation sector project

Treatment, care and support for people living with HIV/AIDS under GFATM R6

Other projects and programmesPolice awareness programme under UNFPA funds in the Colombo and Gampaha DistrictsDevelopment of National HIV/AIDS policyNational World AIDS day programmeProgramme for the Elimination of congenital syphilis by 2015 (WHO funded project)

PROJECT OR PROGRAMME AREASMajor activity areas under GFATM R9 (HIV component)

1. Provision of Sexual health services for FSWs

2. Provision of Sexual health services for MSM

3. Training of STD clinic staff

4. Provision of Sexual health services for BB

5. Provision of harm reduction Sexual health services for BB

6. Provision Sexual health services for prisoners

7. Procurement of health products

8. Increase quality of VCT services

9. Increase quality and coverage of HIV/AIDS treatment services

10. Formative and operational research

11. Planning and administration on M&E

12. National size estimation of MARPs

What next and future?

2011 Political Declaration: Targets and elimination commitments

• Achieve universal access to HIV prevention, treatment, care and support by 2015

• Targets and commitments

Thank you