National STI/RTI Control and

Prevention Programme

NACP, Phase-III, India

NACP : Phase-III, India 1

2 National STI/RTI Control and Prevention Programme
CONTENTS

Background 5

Convergence of National Aids Control Programme with

Reproductive and Child Health Programme of National Rural
Health Mission 8

Syndromic Case Management through pre-specified Colour

Coded Drug Kits 10

Modalities of STI/RTI Service Delivery 12

Counseling in STI/RTI 16

Laboratory Tests at STI/RTI Service Providing Facilities 17

Capacity Building for Quality STI/RTI Management
19
Mentoring and Supportive Supervision 21
Strengthening Service Delivery through Information,
Education and Communication 22

Conclusion 25

NACP : Phase-III, India 3

4 National STI/RTI Control and Prevention Programme
Background

S
exually transmitted infections and Reproductive tract infections (STI/RTI) are an important
public health problem in India. The 2002 ICMR community based prevalence study of STI/
RTI has shown that 5% to 6% of sexually active adult population are suffering from some
form of STI/RTI. The 2005 ICMR multicentre rapid assessment survey (RAS) indicates that 12%
of female clients and 6% of male clients attending the out-patient departments for complaints
related to STI/RTI.

Individuals with STI/RTI have a significantly higher chance of acquiring and transmitting HIV. STI
prevalence is a good marker for HIV, as both share common modes of transmission.

Moreover, STI/RTI are also known to cause infertility and reproductive morbidity. Provision of
STI/RTI care services is a very important strategy to prevent HIV transmission and promote sexual
and reproductive health under the National AIDS Control Programme (NACP) and Reproductive
and Child Health programme (RCH) of the National Rural Health Mission (NRHM).

Strategies of STI/RTI prevention and control include

1. Provision of standardized STI/RTI management to general population
2. Provision of standardized STI/RTI management to high risk group population
3. Provision of laboratory surveillance of STI/RTI

Doctor providing STI services at a designated STI/RTI clinic

NACP : Phase-III, India 5

Background

Syndromic case management (SCM) with appropriate laboratory tests is the cornerstone of
STI/RTI management. SCM is a comprehensive approach for STI/RTI control endorsed by the
World Health Organization (WHO). This approach classifies common STI/RTI into syndromes
(easily identifiable group of symptoms and signs) and provides treatment for the most common
organisms causing the syndrome.

Other important components of STI/RTI management include treatment compliance and follow-
up, counseling, partner treatment and condom promotion. Implementation of a standardized
SCM simplifies training and supervision, reporting and drug management.

HIV scenario
As a national response to contain the HIV epidemic, Government of India set up the National AIDS
Control Organization (NACO), an integral constituent of the Ministry of Health & Family Welfare
to oversee the implementation of National AIDS Control Programme (NACP). The program is
implemented at the state level by the State AIDS Prevention and Control Societies (SACS).

According to the latest estimates, there are close to 2.4 million people living with HIV in India with
an adult prevalence of 0.3%. The prevalence of HIV is high in the 15-49 age group and accounts for
88.7% of all infections. More men are HIV positive than women. Nationally, the prevalence rate
for adult females is 0.29 %, while for males it is 0.43 % In India, There are 195 high priority districts
of which 156 are Category A districts (>1% ANC prevalence) and 39 are Category B districts (<1%
ANC prevalence and > 5% prevalence in any HRG site). The mode of transmission of STI and HIV
are same; presence of STI enhances the HIV acquisition and transmission risk by 4-10 times.

A peer educator explaining the use of female condom for STI and HIV prevention

6 National STI/RTI Control and Prevention Programme

 Background

How big is the STI problem?

• 11 % of women and 5 % of men in the age group 15-49 in sexual relationship reported of STI/
RTI related symptom in the last 12 months (The National Family Health Survey (NFHS-3).
• Community prevalence study show that 5% to 6% of sexually active adult populations are
suffering from STI/RTI (ICMR 2002)
• 12% of female and 6% of male clients attended outpatient department in primary care settings
for complaints of related to STI/RTI (Rapid Assessment Survey (RAS) 2005)
• Behaviour studies reveal low levels of STI awareness and treatment seeking behaviour among
all population groups (Behaviour Surveillance Survey (BSS 2006).
• There is a marked heterogeneity in the recorded epidemiology of different STIs/RTIs in the
country (Mid Term Report 2010).

Tenets of STI/ RTI control programme in India

• Meeting STI/RTI needs of general population and bridge population through:
ŠŠ Designated STI/RTI clinics at district hospitals and teaching hospitals attached to medical
colleges
ŠŠ Sub-district level health facilities (primary health centers (PHC) and community health
centers (CHC) )
• STI/RTI services to high-risk groups (HRG) by ensuring provision of Essential STI service
Package (ESP) through specified clinic settings involving preferred private providers
• Treatment of STI using syndromic approach and standardized STI treatment in form of pre-
packaged drug kits
• Counseling through a dedicated counselor at the designated clinics
• Demand generation for STI/RTI services through branding as ‘Suraksha Clinic’, mass and mid
media activities including RRC and radio campaigns.
• Strengthening of Regional STI Training Research and Reference Laboratories (RSTRRL)

NACP : Phase-III, India 7

Convergence of National Aids Control
Programme with Reproductive and
Child Health Programme of National Rural
Health Mission

T
he National Reproductive and Child Health (RCH) Programme – Phase 2 launched in April
2005 is a flagship programme of National Rural Health Mission (NRHM) 2005-2012 which
seeks provide accessible, affordable and quality health care to rural population, specially
women and children.

Technical strategies reflected in the RCH Programme Implementation Plan aims to make primary
health care delivery system as a hub of services targeted to improve health of women and
children. Government of India guidelines for 24 hours RCH services by Primary Health Centres
lists services for prevention and management of RTI including STI as a major component of
service package. Similarly, the strategy and implementation plan for NACP, within the fabric
of prevention strategy, makes a strong reference to services for prevention and management
of STI/RTI among high-risk groups, bridge populations and the general population, especially
women and youth.

Government of India has also positioned Adolescent Reproductive and Sexual Health (ARSH)
Strategy of RCH programme to meet the service needs of the adolescents. The NACP has also
given due emphasis on interventions focused on young people. This indicates that the programme
and policy environment is supportive of convergence of activities under RCH and NACP in terms
of addressing STI/RTI and the needs for young people for synergy in design and implementation
of interventions and bring about optimizing sharing of resources.

NACO and RCH under NRHM have developed a joint implementation plan to take forward the
activities for STI/RTI convergence at national, state and district levels.

• NACO and RCH oversee the implementation of STI/RTI programme both at district and sub
district level by utilizing existing health care infrastructure through close coordination. RCH
II provides accessible, affordable and quality health care to rural populations, especially
women and children in India.

• Convergence positions the experience and technical capacity in HIV/AIDS prevention and
care program with the infrastructure, human resources and wide spread community reach of
RCH II of NRHM to ensure standardized STI/RTI care.

8 National STI/RTI Control and Prevention Programme

Convergence of National Aids Control Programme with Reproductive and Child Health Programme of National Rural Health Mission

• Constitution of a joint working group at national level comprising of STI division NACO and
Maternal Health Division of Ministry of Health & Family Welfare-Government of India ensures
optimal utilization of resources under NRHM and NACP through development of
o Joint operational guidelines
o Joint training curriculum with modules prepared for all cadres of staff (doctors, nurses,
laboratory technicain and counsellor)
o Sensitisation of state and district level functionaries on STI/RTI

• Joint procurement of colour coded drug kits for syndromic management of STI/RTI and
ensuring their availability at all districts

• District RCH officer is the nodal person for overseeing programme implementation at district
level under the convergence operational framework.

• At state level convergence is monitored by STI focal persons of SACS, state RCH officer
and state programme manager of State Programme management unit of NRHM through
coordination meetings and joint monitoring.

• The national program has an annual target of treating 12 million episodes across the country
to be jointly reached by NRHM and NACP.

STI clinic at a Government Hospital

NACP : Phase-III, India 9

Syndromic Case Management through pre-
specified Colour Coded Drug Kits

T
here are seven pre-packed colour coded STI/RTI drug kits under NACP for syndromic
management of STI/RTI. These drug kits have been developed on the basis of the National
Guidelines on Prevention, Management and Control of Reproductive Tract Infections
including Sexually Transmitted Infections, Ministry of Health and Family Welfare, August 2007.
These colour coded STI/RTI drug kits are supplied free of charge in all public STI/RTI service
facilities including the STI clinics under targeted intervention projects.

Syndromic Case Management Protocol

Kit No. Syndrome Colour Contents

Urethral discharge (UD), Cervical

discharge (CD) , Ano-rectal discharge Tab. Azithromycin 1 g (1)
Kit 1 Grey
(ARD) Painful scrotal swelling (PSS) and Tab. Cefixime 400 mg (1)
Presumptive treatment (PT)

Tab. Secnidazole 2 g (1) and

Kit 2 Vaginal discharge (VD) Green
Tab. Fluconazole 150 mg (1)
Inj. Benzathine penicillin 2.4 MU
(1) and
Genital Ulcer Disease- Non herpetic Tab. Azithromycin 1 g (1)
Kit 3 White
(GUD-NH) and Disposable syringe 10 ml with
21 gauge needle (1)
and Sterile water 10 ml (1)

Genital Ulcer Disease- Non-Herpetic Tab. Doxycycline 100 mg (30)

Kit 4 (GUD-NH) –for patients allergic to Blue
penicillin. and Tab. Azithromycin 1 g (1)

Genital Ulcer Disease- Herpetic

Kit 5 Red Tab. Acyclovir 400 mg (21)
(GUD-H)

Tab. Cefixime 400 mg (1)

Kit 6 Lower abdominal pain (LAP/PID) Yellow and [Link] 400 mg
(28) and Cap. Doxycycline 100 mg
(28)

Tab. Doxycycline 100 mg (42)

Kit 7 Inguinal bubo (IB) Black
and Tab. Azithromycin 1 g (1)

10 National STI/RTI Control and Prevention Programme

Syndromic Case Management through pre-specified Colour Coded Drug Kits

Syndromic Case Management of STI/RTI

NACP : Phase-III, India 11

Modalities of STI/RTI Service Delivery to
Most at Risk Population

T
he national STI/RTI program makes provision for accessible and good quality STI/RTI
services to both general populations and high-risk groups. The services are made to
communities till PHC though various modalities.

Package of STI/RTI Services at various levels of care

Level of Care Service Provider Modalities Package of Services
• Information
Through their outreach
ASHA/Link worker • Condom provision and promotion
meetings and observance
Village • Screening for STI/RTI
Health worker (M/F) of village health and
• Referral for treatment
nutrition days

Through ANC clinics, In addition to above,

Sub-centre ANM/Health worker group meetings and • Provide counseling
household contacts • Referral to ICTC

In addition to above, .STI/RTI

PHC/Mobile Medical treatment through syndromic
Unit/ Dispensary/ approach and partner management
CHC/Urban Health Medical officer/ Staff Routine OPDs, ANC • Simple diagnostic tests (including
post /Rural Hospital/ Nurse/ LHV Clinics/ Camps Syphilis screening)
Sub- divisional • ARSH services
Hospital • Referral to ICTC
• Reporting to district RCH officer

Medical Officer Syndromic case management of STI/

RTI (provision of directly observed
Designated STI/ Staff nurse
STI/RTI clinic treatment for single dose regimens)
RTI clinic (District
• Minimal laboratory testing
hospital, Medical Counselor
Gynaecology/Obstetrics • Counseling
College hospitals,
Medical Officer, Staff clinics • Condom Promotion
select Rural
nurse • Partner treatment
Hospital/Sub- ANC Clinics • Syphilis screening
divisional Hospital) Counselor, laboratory • Referral to ICTC
Technician • Linkage with other services

Static clinic
Preferred provide
Microbiologist • Validation of syndromic diagnosis
Referral to Government
Regional STI centre • Monitor gonoccal drug resistance
Laboratory Technician Health Facility
and State Reference patterns
Experts from other Referral of patients/
Centres • Conduct syphilis EQAS
departments samples from all linked
• STI/RTI surveillance
centres (DSRC, TI STI
clinic, NRHM clinic)

12 National STI/RTI Control and Prevention Programme

 Modalities of STI/RTI Service Delivery

Designated STI/RTI Clinics:

• Located at the district hospitals, medical colleges and select sub-divisional hospitals
• Services provided through specialists and trained physicians through enhanced syndromic
management with minimal laboratory services.
• Free treatment of STI/RTI using Colour-coded standardized STI drug kits
• Exclusive STI counselor for counseling services
• Syphilis screening and referral for HIV testing
• STI/RTI services branded as “Suraksha Clinic”

Sub-district level:
• Standardized STI/RTI care in PHC and CHC of rural and semi-urban areas
• Free treatment of STI/RTI using Colour-coded standardized STI drug kits
• Syphilis screening for STI and ANC attendees

STI/RTI Services for Most at Risk Population

It is estimated that more than 90% of HIV transmission in India is related to unprotected sexual
intercourse or sharing of injecting equipment between an infected and an uninfected individual.
Not everyone in the population has the same risk of acquiring or transmitting HIV. Much of the
HIV transmission in India occurs within groups or networks of individuals who have higher levels
of risk due to a higher number of sexual partners or the sharing of injection drug equipment.
Saturated coverage of high risk groups with standardized, high quality and cost effective STI/RTI
clinical services is imperative for the same.

To ensure that uniform standardized service delivery protocols, training packages and resources,
reporting mechanism and supervisory system is followed for all STI/RTI facilities.

There are seven pre-packed colour coded STI/RTI drug kits under NACP for syndromic management
of STI/RTI. These drug kits have been developed on the basis of the National Guidelines on
Prevention, Management and Control of Reproductive Tract Infections including Sexually
Transmitted Infections, Ministry of Health and Family Welfare, August 2007. These colour coded
STI/RTI drug kits are supplied free of charge in all public STI/RTI service facilities including the STI
clinics under targeted intervention projects.
These core high risk groups (HRG) of individuals who are most at risk include:
• Female sex workers (FSW)
• Men who have sex with men (MSM), and transgender (TG)
• Injecting drug users (IDU)

The transmission of HIV beyond HRG often occurs through their sexual partners, who also have
lower risk sexual partners in the “general” population. For example, a client of a sex worker
might also have a wife or other partner who is at risk of acquiring HIV from her higher risk partner.
Individuals who have sexual partners in the highest risk groups and other partners are called
a “bridge population”, because they form a transmission bridge from the HRG to the general

NACP : Phase-III, India 13

Modalities of STI/RTI Service Delivery

population. NACO has intervention projects for two specific groups of bridge population namely
’Trucker’ and ‘Migrants’

Prevention and control of STI among HRGs is a critical component of NACP III to halt and reverse
the HIV epidemic.
●● Essential STI package of services includes
ŠŠ Symptomatic treatment
ŠŠ Presumptive treatment
ŠŠ Regular Medical Check up
ŠŠ Bi-annual Syphilis screening

Modalities of STI/RTI Service delivery in HRG

NGOs implementing the targeted intervention programme deliver the package of STI/RTI services
through the following modalities.
1. Static Clinic: This is a project linked clinic located in and around the red light area or in the
brothel setting where there is a large congregation of HRG population.
2. Preferred private providers: These are private providers who are identified based on a
focused group discussion with the target population, who are located in and around the hot
spots/ zone of the intervention area and are preferred by the community.

Counselor talking about safe sex with a group of MSM and transgenders

14 National STI/RTI Control and Prevention Programme

 Modalities of STI/RTI Service Delivery

3. Hybrid model: This model is applicable where the target population is scattered as well as
concentrated and a single approach cannot provide effective services. This is a mix of the
static clinic approach with inclusion of preferred providers so as to improve the access to
services.
4. Referral to government health facilities: This model is applicable in the case where the
nearest government health facility is the preferred location of accessing services by the
HRGs.
5. Health Camp: This model is applicable only for the migrant populations and serves to instill
health seeking behaviour among them. A camp is periodically organized at a specified location
and medical consultation made available on that particular day. The outreach team actively
refers patients with STI/RTI complaints to avail services from the camp.

Regional Research and Reference Laboratories:

●● Referral centre are established for providing evidence based inputs to the STI/RTI program :
ŠŠ Etiologic diagnosis for the of STI/RTI syndromes
ŠŠ Validation of syndromic diagnosis,
ŠŠ Monitoring gonococcal antimicrobial resistance patterns
ŠŠ Quality assurance for Syphilis testing.
●● 7 centers located at New Delhi (2), Chennai, Kolkata, Hyderabad; Nagpur and Baroda.

NACP : Phase-III, India 15

Counseling in STI/RTI

C
ounseling is a process of two way, face-to-face, personal, confidential communication
in which one person helps another to make decisions and then to act on them. Good
counseling enables coping and reinforcement of preventive behaviors. Counseling at
STI/RTI facilities helps to evaluate and reduce the clients’ personal risk of acquiring STI/RTI and
provide health education on sexual and reproductive health’.

Services of counselor are available in Designated STI/RTI clinics and TI NGO. At the sub-district
health facilities, the existing staff nurse and treating physician can provide counseling services to
the patient.

Counseling is provided in audiovisual privacy to enable the client to talk freely to counsellor on
issues related to sexual and reproductive issues. During a counseling session, provider talk to
the client about modes of transmission, recommended treatment, prevention, risk reduction,
behavior change, and partner referral. The clinics provide information brochures in simple local
languages with illustrations to reinforce messages. The counselors and doctors have jobaids and
IEC material to ensure effective communication.

Councelling being provided at the STI Clinic

16 National STI/RTI Control and Prevention Programme

Laboratory Tests for Sti/Rti

T
he programme envisages usage of minimal laboratory investigations wherever available,
which improves the sensitivity and specificity of syndromic diagnosis.

All STI/RTI attendees and ANC attendees are motivated to get screened for syphilis. All
RPR reactive samples by qualitative method, are subjected for quantitative testing (titers). All
STI/RTI attendees are referred to ICTC for HIV testing. Where facility for syphilis testing has been
made available at the nearest ICTC.

Laboratory tests at Designated STI/RTI clinics.

• RPR test for syphilis testing (qualitative and quantitative) for STI/RTI attendees and ANC
attendees
• Wet-mount slide preparations for microscopy:
• Normal saline slide preparation for detection of motile trichomonads
• KOH slide preparation for detection of Candida spores and pseudohyphae, and “Whiff test”
for detection of amines indicative of bacterial vaginosis. (Whiff test performed by examining
clinician.)
• Determination of pH level of vaginal secretions (performed by examining clinician)
• Gram stain of cervical/rectal specimen for white blood cell (WBC) and gram-negative
intracellular diplococci
• Gram stain of slides prepared from vaginal smears to diagnose bacterial vaginosis using
Nugent’s criteria

Laboratory testing uderway

NACP : Phase-III, India 17

 Laboratory Tests at STI/RTI Service Providing Facilities

Collection of blood sample for laboratory tests

Laboratory tests at Targeted Intervention project STI/RTI clinics

• HRG population (FSW, MSM and IDU) are motivated to undergo syphilis screening and
referral for HIV testing once in six months.
• HRG are referred to Designated STI/RTI clinic if further tests are required.

Laboratory tests at Sub District level NRHM Health Facilities.

• RPR test for syphilis testing (qualitative and quantitative) for STI/RTI attendees and ANC
attendees

• Wet-mount slide preparations for microscopy

• Normal saline slide preparation for detection of motile trichomonads

• KOH slide preparation for detection of Candida spores and pseudohyphae, and “Whiff test”
for detection of amines indicative of bacterial vaginosis. (Whiff test to be performed by
examining clinician.)

18 National STI/RTI Control and Prevention Programme

Capacity Building for Quality Sti/Rti
Management

S
tandardized STI/RTI service provision requires regular capacity building of all the staff
involved in service delivery. In order to ensure the same, a standardized training curriculum
has been developed for every cadre of staff. A common training curriculum is followed
for both NACO and NRHM supported facilities. Facilitator manual and participant handouts have
been developed for doctors, nursing staff, laboratory technicians and STI counselors.

Training is done through a cascade model using adult learning principles. Master trainers are
identified and trained at national, state and district level to roll out trainings of service providers.
Every state should have 8-10 state level trainers and 3-4 trainers in every district.

SACS and State NRHM officials coordinate and facilitate the trainings using the standardized
curricula and training material. All service providers are provided with at least one training (either
induction or refresher) every year. All recording and reporting formats as well as IEC material and
job aids are distributed during the trainings.

Training materials for trainers and participants

NACO has developed training material to ensure that the training needs at all levels that includes
Doctors, Staff Nurse/ANM and Laboratory Technician at Designated STI/RTI clinics and NRHM
health facilities. These include:

For Trainers For Participants

Facilitators Manual Participant’s Handbook (for Doctors/ Staff Nurse/
Laboratory Technician Respectively)
Technical Guidelines Operational Guidelines
Operational Guidelines
For STI Counselors
For Trainers For Participants
Facilitators Manual Participant’s Handbook
STI Film and Explanatory Book STI Film and Explanatory Book
Flip Book Flip Book
Job Aids Job Aids
For Doctors/Preferred Providers working with Targeted Intervention Projects
For Trainers For Participants
Facilitators Guide Participant’s Handbook
TI-STI Guidelines TI-STI Guidelines

NACP : Phase-III, India 19

Capacity Building for Quality STI/RTI Management

20 National STI/RTI Control and Prevention Programme

Mentoring and Supportive Supervision

S
upportive supervision is the process of directing and supporting staff so that they may
perform their duties more effectively. There are many functions of supervision, such as
monitoring and evaluating staff performance; motivating and training staff; sharing data
and guidelines; managing problems that may arise; and facilitating organizational support and
establishing linkages. The elements of supportive supervision include

• Mentoring
• Two-way communication
• Focus on process
• Joint problem-solving
• Ongoing process

Feedback is given continuously during a supervisory visit as positive feedback, when performance
is good and constructive feedback, when performance needs improvement.

The supportive supervisory visits to STI/RTI service delivery sites are conducted to ensure
and facilitate delivery of STI/RTI services as per guidelines and reinforce learnings of trainings
according to the field settings. Onsite mentoring and handholding exercise enables the staff to
perform their requisite roles in the programme. It also helps in establishing linkages of the clinic
with gynaecology department, laboratory and ICTC and facilitate coordinated functioning of
different staff. The visits are intended to be a problem solving exercise as per the need of the site.

Supportive supervision is done by

a) Supportive supervisory mentors b) SACS STI focal persons
c) TSU STI focal persons d) NACO STI team

Monitoring and evaluation, support, supervision and motivation to staff

NACP : Phase-III, India 21

Strengthening Service Delivery through
Information, Education and Communication

P
revention and treatment of STI is being promoted using multi-media communication
approaches. Mass media including TV and radio are used to promote the awareness of
STI and related services. Simultaneously, efforts are made to strengthen interpersonal
communication at designated STI clinics. Branding of STI clinics as ‘Suraksha Clinics is also done
to increase the utilisation of clinical services.
Branding of designated STI/RTI clinics: ‘Suraksha’ clinic (‘Protection in Hindi ’) brand is developed
and implemented across the country to enhance the credibility and visibility of the STI/RTI services
and encourage people to seek STI treatment.

Using Mass Media to promote utilization of STI services:

NACO is reaching out to the masses with information on STI treatment through campaigns on TV
and radio. To address the campaigns so far have used humor to address barriers to accessing STI
treatment.

Dil Ki Baatein: A friend, an expert and a comic duo come together to spread awareness about
sexually transmitted infections though five minute long radio capsules on matters of the heart.

Job Aids and IEC material: Job aids have been developed for doctors and counselors of clinics.
These include:
• Flip chart for counselors
• Poster on Oath of Confidentiality
• Poster on Syndromic Case Management
• Poster on Infection control
• Poster on Anaphylaxis management
• Poster on Condom use
• Poster on Counseling checklist
• Poster on Partner treatment
• Poster on STI and treatment at
Suraksha clinic
• Leaflet on prevention and
treatment of STI
• Leaflet on treatment compliance

A still from the Mass Media Compaign

22 National STI/RTI Control and Prevention Programme

 Strengthening Service Delivery Through Information, Education and Communication

Notes from My Diary: Select Case Studies to Train STI Counsellors

A thirty minutes long training film is developed as a part of a 12 day training package for counselors.
The film depicts four case studies that feature vulnerable communities with higher risk behaviour
in the context of STI/RTI and HIV/AIDS.

The interactive film along with job aids can be viewed at one stretch or can be used in a stop-and-
start mode to enable discussion after each case. It accompanies a facilitation guide that recaps
the case studies and also provides the facilitator with a series of discussion questions.

Notes from my diary

NACP : Phase-III, India 23

Strengthening Service Delivery Through Information, Education and Communication

Sexual and Reproductive Health Services

Room No __

24 National STI/RTI Control and Prevention Programme

Conclusion

D
uring the third phase of NACP III, there has been a paradigm shift in control and prevention
strategies of STI. The programme mainstreamed focusing reproductive health from stand
alone focus on STI; screening of pregnant women for syphilis, strengthening systems
for laboratory surveillance and STI service delivery to most at risk population; standardized
capacity building and treatment regimes and modalities to minimize emergence of drug
resistance. Universal syndromic case management and reporting has been primary foundation
of the programme. Convergence with RCH II under NRHM provides 70% of rural population with
standardized STI/RTI services through sub district health facilities. Computerized management
information systems and reporting is being received regularly month on month providing insights
into trends and changes in various syndromes prevalence across the country.

The programme has been scaled up from 550 STI clinics to 1033 designated STI/RTI clinics.
Reporting from TI NGOs scaled up from 300 to over 1600. Currently, there are 7 functional
regional STI centres providing insights into etiologies of various STI syndromes and monitoring
of anti-microbial resistance to gonococci. Programme conducted capacity building training to
more than 25000 service providers during NACP III from government sector and over 12000 in
private sector.

STI Episodes Treated

Achievement
Year Target (millions) % Achievement
(millions)
2007-2008 10 2.78 27.8 %
2008-2009 10 6.67 66.7 %
2009-2010 10 8.24 82.4 %
2010-2011 10 10.02 100 %
2011-2012 (till Sept. 2011) 12 6.11 50.1 %

Year wise programme targets and achievements Scale up of service providing facilities for most at risk
populations and general populations / bridge population

NACP : Phase-III, India 25

Acronyms

AIDS Acquired Immune Deficiency Syndrome

ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
CBO Community based Organisation
CHC Community Health Centre
CPR Cardiopulmonary Resuscitation
DSRC Designated STI/RTI Clinic
HIV Human Immunodeficiency Virus
HRG High-Risk Group
HSV Herpes Simplex Virus
ICTC Intgrated Counseling and Testing Centre
IDU Injecting Drug User
IEC Information and Education Communication
KOH Potassium Hydroxide
MSM Men who Have Sex with Men
NACO National AIDS Control Organization
NACP National AIDS Control Programme
NFHS National Family Health Survey
NGO Non-Governmental Organization
NRHM National Rural Health Mission
OPD Out Patient Department
PHC Primary Health Centre
RCH Reproductive and Child Health
RMC Regular Medical Check-up
RMP Registered Medical Practitioner
RPR Rapid Plasma Reagin
RSC Regional STI Centre
RTI Reproductive Tract Infection
SACS State AIDS Control Society
STI Sexually Transmitted Infection
STRC State Technical Resource Centre

26 National STI/RTI Control and Prevention Programme

NACP : Phase-III, India 27
28 National STI/RTI Control and Prevention Programme