Chapter

24 National AIDS Control

Organization (NACO)
Chapter - 24

24.1 INTRODUCTION (IDU), Truckers & Migrants; Needle-Syringe

Exchange Programme (NSEP) and Opioid
In order to control the spread of HIV/AIDS, the Substitution Therapy (OST) for IDUs; Migrant
Government of India is implementing the National population at source, transit and destinations;
AIDS Control Programme (NACP) as a 100% centrally Link Worker Scheme (LWS) for High Risk
sponsored scheme. Prevention and Care, Support Groups (HRGs) and vulnerable population in
& Treatment (CST) form the two key pillars of all rural areas; Prevention & Control of Sexually
HIV/AIDS control efforts in India. The programme Transmitted Infections/Reproductive Tract
succeeded in reducing the estimated number of annual Infections (STI/RTI); Blood Transfusion
new HIV infections in adults by 57% during the last Services; HIV Counseling & Testing Services;
decade through scaled up prevention activities. Wider Prevention of Parent to Child Transmission;
access to ART has resulted in a decline of the estimated Condom promotion; Information, Education
number of people dying due to AIDS related causes. & Communication (IEC) and Behaviour
Launched in 1992, followed by NACP-II in 1999, Change Communication (BCC) – Mass Media
NACP-III in 2007 and NACP-IV in 2012, the focus Campaigns through Radio & TV, Mid-media
of the National AIDS Control Programme is on campaigns through Folk Media, display
achieving the seventy five percent (75%) reduction in panels, banners, wall writings etc., Special
new HIV infections; 90-90-90 (90% of those who are campaigns through music and sports, Flagship
HIV positive in the country know their status and that programmes, such as Red Ribbon Express;
90% of those who know their status are on treatment Social Mobilization, Youth Interventions
and 90% of those who are on treatment experience and Adolescence Education Programme;
effective viral load suppression); elimination of Mainstreaming HIV/AIDS response; Work
mother-to-child transmission of HIV and syphilis Place Interventions.
and elimination of discrimination and stigmatization
• Care, Support & Treatment Services
of people living with HIV in the next three years and
Laboratory services for CD4 Testing, Viral
within seven years will reduce the new HIV infections
Load testing, Early Infant Diagnosis of HIV in
by 80% and 95% of those who are HIV positive in the
country know their status and that 95% of those who infants and children up to 18 months age and
know their status are on treatment and 95% of those confirmatory diagnosis of HIV-2; Free First
who are on treatment experience effective viral load line & second line Anti-Retroviral Treatment
suppression. (ART) through ART centres and Link ART
Centres, Centres of Excellence & ART plus
The package of services includes two types of services centres; Paediatric ART for children; Early
i.e. Prevention services and Care Support & Treatment Infant Diagnosis for HIV exposed infants and
services. children below 18 months; Nutritional and
• Prevention services Targeted Interventions Psycho-social support through Community
(TI) for High Risk Groups and Bridge and Support Centres; HIV-TB Coordination
Population (Female Sex Workers (FSW), (Cross-referral, detection and treatment of
Men who have Sex with Men (MSM), co-infections; Treatment of Opportunistic
Transgenders/Hijras, Injecting Drug Users Infections).

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Chapter - 24

24.2 OVERVIEW OF HIV PREVALENCE IN 24.2.1) showed the HIV prevalence among Antenatal
INDIA Care attendees and high risk groups:
As per 2015 HIV Estimation report, the adult (15–49 Figure 24.2.1: HIV Prevalence (%) among ANC Client
years) HIV prevalence was estimated at 0.26% (Male- (HSS 2014-15), FSW, MSM, IDU, TG (IBBS 2014-
0.30% and Female-0.22%) in 2015 in India. The 2015), Migrants and Truckers (HSS 2010-11), India
adult HIV prevalence at national level has continued
its steady decline from an estimated peak of 0.38%
in 2001-03 through 0.34% in 2007 to 0.26% in ANC 0.29
Migrants 0.99
2015. Similar consistent declines were noted among
FSW 2.2
men and women at the national level. Among the Truckers 2.59
States/UTs, in 2015, Manipur has shown the highest MSM 4.3
estimated adult HIV prevalence (1.15%), followed TG 7.2
by Mizoram (0.80%), Nagaland (0.78%), Andhra IDU 9.9
Pradesh & Telangana (0.66%), Karnataka (0.45%), 0 2 4 6 8 10 12
Gujarat (0.42%) and Goa (0.40%). Besides these HIV Prevallence (%)
States, Maharashtra, Chandigarh, Tripura and Tamil
Nadu have shown an estimated adult HIV prevalence
greater than the national prevalence (0.26%), while 24.3 TARGETED INTERVENTIONS
Odisha, Bihar, Sikkim, Delhi, Rajasthan and West Considering the concentrated nature of the HIV
Bengal have shown an estimated adult HIV prevalence epidemic in the country, NACO has targeted its
in the range of 0.21– 0.25%. All other States/UTs have preventive efforts towards sub-groups of population
adult HIV prevalence below 0.20%. identified to be at high risk of acquiring HIV infection.
The total number of people living with HIV (PLHIV) in These High Risk Groups (HRGs) are provided with a
India was estimated at 21.17 lakhs (17.11 lakhs–26.49 number of preventive services through NGO/CBO led
lakhs) in 2015 compared with 22.26 lakhs (18.00 Targeted Interventions (TIs).
lakhs-27.85 lakhs) in 2007. Children (< 15 years) At present, around 1500 such interventions are
accounted for 6.54%, while women contributed around providing HIV prevention, treatment, care and support
two fifth (40.5%) of total HIV infections. Undivided services to various High Risk Groups including
Andhra Pradesh and Telangana have the highest Female Sex Workers (FSWs), Men who have Sex
estimated number of PLHIV (3.95 lakhs) followed with Men (MSM), Injecting Drug Users (IDU), Hijra
by Maharashtra (3.01 lakhs), Karnataka (1.99 lakhs), and Transgenders (HTG), and Bridge Populations
Gujarat (1.66 lakhs), Bihar (1.51 lakhs) and Uttar such as Migrants and Long Distance Truckers. Target
Pradesh (1.50 lakhs). These seven States together Interventions (TIs) projects provide a package of
account for two thirds (64.4%) of total estimated prevention, support and linkage services to HRGs
PLHIV. Rajasthan (1.03 lakhs), Tamil Nadu (1.43 through drop-in-centre (DIC) and outreach-based
lakhs) and West Bengal (1.29 lakhs) are other States service delivery model which includes screening for
with estimated PLHIV numbers of 1 lakh or more. In and treatment of Sexually Transmitted Infections
India, the estimated number of new HIV infections in (STI), free condom and lubricant provision among
2015 were around 86 (56 – 129) thousand. core groups, Social Marketing of condoms, Behaviour
Since 2007, when the number of AIDS related deaths Change Communication (BCC), creating an enabling
(ARD) started to show a declining trend, the annual environment with community involvement and
number of AIDS related deaths had declined by 54%. participation, linkages to Integrated Counselling and
In 2015, an estimated 67.6 (46.4 –106.0) thousand Testing Centres (ICTC) for HIV testing, linkages
people died of AIDS-related causes nationally. This with care and support services for HIV positive
decline is consistent with the rapid expansion of access HRGs, community mobilization, ownership building
to ART in the country. The given below figure (fig. and specifically for IDUs, free distribution of
sterile needles and syringes, abscess prevention and

356 Annual Report | 2017-2018

 Chapter - 24

management, Opioid Substitution Therapy (OST) STI Diagnosed and Treated against Clinic Visit
and linkages with detoxification / rehabilitation
services. The national programme adopts the peer led As per NACO guidelines every HRG should visit STI
approach in partnership with NGOs/CBOs along with clinics every quarter, especially for regular medical
State AIDS Control Societies (SACS) and Technical check-up and for treatment of Sexually Transmitted
Support Unit (TSU) for mentoring and supporting Infections (STI) / Reproductive Tract Infections
the TIs for quality service delivery and enhancing the (RTI). The clinic footfall for STI screening was over
overall program performance. 70% among all core groups, however STI/RTI cases
diagnosed and treated was high among FSWs while
Mid Term Appraisal (MTA) of NACP IV carried TG population has recorded nearly 1% against the
out in 2016 had recommended commissioning an clinic visit made by them. The clinic footfall amongst
Options Paper for TI. In order to develop options Migrants and Truckers (Bridge population) was more
paper, and operational plans for implementing than 50% of the targets fixed for this reporting period
various recommendations of MTA, the following and STI positivity among bridge population continues
sub committees were formed: Governance; Design to remain high.
next generation TIs; Immediate course correction in
implementation of TI and Monitoring, Evaluation and Fig 24.3.2: Percentage Distribution of STI Diagnosed
Size Estimation. and Treated against the Clinic Visit made by HRGs
under the Targeted Interventions programme during
Performance of TI Programme (Sept. 2017) the FY 2017-18(April-September, 2017).

Coverage of High Risk Groups (HRG): The 90

performance of TIs with regard to coverage is 80 76.41

72.73
79.06 77.04

consistent over the years. As far as the coverage 70

of HRG & HTG populations, NACO is making 60

in percentge

consistent efforts to scale up the programme and

50
Clinic Visit
40
improve the coverage in high priority States. Based 30 STI Diagnosed &
on the recommendations of MTA, States were guided 20 17
Treated

to re-structure the TIs keeping in parameters such 10

1.11 0.61 0.95
6.01
2.43 2.93
0.28
as positivity, number of years of HRG’s association 0
FSW MSM HTG IDU Migrant Trucker
with TI programme, changing dynamics in sex work
and injecting practices, etc. These strategies will help HIV testing and ART linkages among HRGs
enrolling new and young HRGs across typology.
Technical Support Units (TSUs) have been directed to As per the NACO guidelines, all core HRGs should
provide on-site assistance and handholding to revise be tested for HIV once every six months. Fig 24.3.3
the outreach plan so as to cover hard-to-reach and depicts the percentage of HIV tests performed among
hidden population. HRGs through referrals from targeted intervention
programmes. The percentage of testing across all
Fig 24.3.1: Coverage of Core HRGs (FSW, MSM, IDU typology has been consistent over the years. The
and HTG) under the Targeted Interventions programme
positive detection amongst HRGs has been low (ranges
during the FY 2017-18 (April-September, 2017).
from 0.1% to 0.4%) except among IDUs (0.9%). The
10
8.68
programme data reveals that HRGs who are associated
9
8
with TIs for more than five years have been regular
7 for testing and taking consistent efforts to remain
Coverage (in Lakhs)

5.87
6
Estimate
negative across majority of the States. However, the
5
4 Coverage positivity among IDUs and HTG population continues
2.97
3
2.02 1.77
to remain a concern. Testing among Bridge Population
2
0.7
1.13 continue to remain a challenge owing to their mobility.
1 0.3
0 Positivity among migrants and truckers continues to
FSW MSM HTG IDU
be the same as in last year (0.2%).

Annual Report | 2017-2018 357

Chapter - 24

Fig 24.3.3: Percentage Distribution of HIV testing correct usage of condoms in all sexual encounters
and HIV positivity among HRGs under the Targeted through one-to-one and one-to-group interpersonal
Interventions programme during the FY 2017-18 communication. Fig 24.3.4 shows the typology-
(April-September, 2017). wise number of condoms (free and social marketing)
distributed to the HRGs.
80 73.06
71.75 71.36 70
70
68.97
65.21 Fig 24.3.4: Distribution of Condoms (in pieces)
60
among HRGs by Typology-wise under the Targeted
Interventions programme during the FY 2017-18 (April-
50
in percentage

September, 2017).
40 ICTC Testing
30 Positivity rate 500.00 497.18

20
400.00
10
0.1 0.25 0.46 0.9 0.22 0.21
0 300.00

in Lakhs
FSW MSM HTG IDU Migrant Trucker
Condom Pieces
200.00
139.33 Distributed

100.00
More than 80% of the PLHIV identified among 17.31 30.03

core group and bridge population are linked to ART -

FSW MSM IDU HTG
centres except HTG (74%). NACO has been making
continuous efforts to improve post-test counselling and
enhance ART linkages across typologies. Community Needle and Syringe distribution among IDUs
based HIV testing and Test and Treat policy approved
As part of the overall Harm Reduction strategy, to
recently by NACO would eventually address the gaps
prevent HIV amongst IDUs, free clean needles and
identified in the programme.
syringes are distributed to IDUs as per their requirement
Table 24.3.1: Percentage Distribution of PLHIV through NGOs implementing TI programme. Peer
from HRGs linked to ART centre under the educators at the field as well as at the Drop-In-Centres
Targeted Interventions programme during the FY and IDUs are encouraged to return the used syringes
2017-18 (April-September, 2017). and needles, which ensures availability of sterile
syringes and needles and reduces the possibility of
HRGs Typology PLHIV identified and sharing injecting equipment, thus decreasing risk for
linked to ART HIV transmission and other blood borne diseases.
Programme data shows distribution of Needles and
FSW 100% Syringes consistently high (more than 90%), while the
MSM 92.28% return rate is marginally increased over the last year
(more than 75%).
IDU 81.20%
HTG 73.85% Fig 24.3.5: Distribution and Return of Needles and Syringes
among IDUs under the Targeted Interventions programme
Migrant 91.88% during the FY 2017-18 (April-September, 2017).
Trucker 81.69%
12000000
10347492
Condom distribution among High Risk Group 10000000
Number of Syringes &

8054115
(HRG) 8000000 7206037
Needles

5883512
6000000 Distributed
Condoms are distributed to HRGs as per their Returned
4000000
requirement through NGOs/CBOs implementing TI
2000000
programme. Peer Educators and Outreach workers
0
engaged in TI programme emphasis consistent and
Syringes Needles

358 Annual Report | 2017-2018

 Chapter - 24

Capacity Building National, Regional and State levels to create Resource

Pools specific to all typologies. Currently Master
NACO has identified development partners for Trainers are conducing trainings across the country for
building capacity of staff engaged in delivering various the staff implementing TI programme and providing
prevention services (NGOs/CBOs/OST). Table 24.3.2 OST services.
shows the partners who were given responsibility to
conduct Training of Trainers (ToTs) workshops at

Table 24.3.2: Region and Typology wise Distribution of Training Programme

among Development Partners/Organisation

Organization Typology Region/States

Public Health Foundation of India Female Sex Workers/ Truckers Pan-India except North-east
Family Health International All typologies and IDUs North-east region & IDU TIs pan India
Voluntary Health Services (VHS) Transgender/ Hijra Pan-India except North-East
Humsafar Trust Men who have sex with Men Pan-India except North-East
PIPPSE Migrants Pan-India except North-East

Table 24.3.3:State-wise and Typology-wise distribution of Targeted Interventions (TIs) supported by

NACO during the FY 2017-18 (April-September, 2017).

State/UT FSW MSM IDU HTG Core Migrants Truckers Total TIs
Composite (Dest.) functional
Andhra Pradesh 8 - 3 - 71 8 2 92
Arunachal Pradesh 4 1 2 - 7 6 - 20
Assam 29 1 6 - 11 2 2 51
Bihar 4 3 8 - 12 - 1 28
Chandigarh 4 2 2 - 1 2 1 12
Chhattisgarh 9 - 3 - 16 5 3 36
Dadra & Nagar - - - - - 1 1 2
Haveli
Daman & Diu - - - - 2 2 1 5
Delhi 32 11 13 6 - 13 4 79
Goa 6 3 1 - 1 2 2 15
Gujarat 13 13 3 2 22 31 6 90
Haryana 2 2 1 - - - - 5
Himachal Pradesh 9 - 1 - - 3 - 19
Jammu & Kashmir 2 1 3 - 3 3 2 14
Jharkhand 18 - 2 - 8 1 3 32

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Chapter - 24

State/UT FSW MSM IDU HTG Core Migrants Truckers Total TIs
Composite (Dest.) functional
Karnataka 31 19 2 2 11 8 4 77
Kerala 20 13 6 6 - 13 2 60
Madhya Pradesh 18 5 9 - 26 5 3 66
Maharashtra 59 16 1 9 30 52 12 179
Manipur 2 1 37 - 13 2 - 55
Meghalaya 3 - 4 - 2 - - 9
Mizoram 1 1 18 - 7 4 - 31
Nagaland 2 3 23 - 15 1 1 45
Odisha 12 - 6 1 22 9 2 52
Puducherry 1 1 - - 2 1 - 5
Punjab 11 - 20 - 19 4 2 56
Rajasthan 12 2 4 2 9 7 3 39
Sikkim 3 - 3 - - - - 6
Tamil Nadu 11 11 1 2 37 6 4 72
Telangana 16 - 2 - 27 6 2 53
Tripura 8 - 2 - - 1 3 14
Uttar Pradesh 12 3 10 2 47 4 6 84
Uttarakhand 6 - 5 - 8 7 3 29
West Bengal 21 3 4 1 2 2 4 37
Total 389 115 205 33 437 211 79 1469

Table 24.3.4: State-wise and Typology-wise Coverage of High Risk Groups under the Targeted
Interventions programme during the FY 2017-18 (April-September, 2017).

Name of State/UT Core Group Bridge Population

FSW MSM IDU HTG Migrants Truckers
(Dest.)
Andhra Pradesh 84018 17068 789 1480 95521 6345
Arunachal Pradesh 2194 620 1062 - 66022
Assam 15699 2558 2800 291 1192 5417
Bihar 10075 2271 4076 - -
Chandigarh 2846 1716 1307 103 33630 3327
Chhattisgarh 19203 1584 2462 472 243768 17927
Dadra & Nagar Haveli - - - - 7526 6580

360 Annual Report | 2017-2018

 Chapter - 24

Name of State/UT Core Group Bridge Population

FSW MSM IDU HTG Migrants Truckers
(Dest.)
Daman & Diu 626 726 - - 5445 1202
Delhi 40148 12891 9278 5368 65492 -
Goa 3845 2907 275 30003 2776
Gujarat 18969 22147 904 1479 676990 37118
Haryana 1831 2158 434 - - -
Himachal Pradesh 5159 530 313 - 4252 -
Jammu & Kashmir 1349 338 1385 - 8154 3221
Jharkhand 71755 703 490 59 - 4885
Karnataka 80708 26678 1846 2062 11863 5715
Kerala 15185 11191 2360 1825 395599 108233
Madhya Pradesh 22773 7364 6331 - 106578 29329
Maharashtra 72871 23920 704 7118 1770708 -
Manipur 5727 1137 16703 - 4640 -
Meghalaya 1268 270 1946 - - -
Mizoram 690 532 8579 - 87992
Nagaland 2884 1273 15614 - 470 422
Odisha 10667 2595 2447 2242 67782 13940
Puducherry 1861 1863 - 99 30797 -
Punjab 12793 2110 11745 51031 6685
Rajasthan 12492 3691 1361 618 253305 7730
Sikkim 809 - 1138 - - -
Tamil Nadu 40575 28679 516 3978 - -
Telangana 51557 12366 1051 483 - -
Tripura 5016 196 581 - 32411 -
Uttar Pradesh 20619 8063 13168 2634 59995 14863
Uttarakhand 5131 1789 1753 101 152431 46103
West Bengal 17761 1321 1036 234 9914 13537
All India 6,59,104 2,03,255 1,14,454 30,646 42,73,511 3,35,355

Annual Report | 2017-2018 361

Chapter - 24

Opioid Substitution Therapy (OST) Programme Name of State/UT No. of Coverage

for IDUs Centers
For providing and assuring quality services, a Nagaland 31 2164
continuous process of capacity building is being Odisha 4 234
followed under Opioid Substitution Therapy (OST) Puducherry - -
programme for IDUs. The operational guideline on
Punjab 28 7961
OST for clinical staff has been revised incorporating
new development in the area. A training manual on Rajasthan 2 174
special needs of Female Injecting Drug Users (FIDU) Sikkim 3 215
has been developed. Quality Assurance Protocol Tamil Nadu 1 53
(QAP-Medical) of OST in India has been developed. Telangana - -
The protocol serves as a resource material for mentors,
Tripura 3 349
entrusted with the task of carrying out periodic
‘Quality Assurance (QA) visits’ to OST centres. Uttar Pradesh 11 1374
Uttarakhand 5 315
Table 24.3.5: Number of Opioid Substitution
West Bengal 8 536
Therapy (OST) Centres for IDUs under the
Targeted Interventions programme during the FY India 215 24,603
2017-18 (April-September, 2017).
HIV Prevention and Treatment Services in Prison
Name of State/UT No. of Coverage Settings
Centers Analysis of Indian prison data (2015) indicate that
Andhra Pradesh 1 164 across 1,401 prisons, there were 4, 19,623 prison
Arunachal Pradesh 2 112 inmates including 2, 82,076 under trial (67.2% of total
Assam 2 175 inmates). 88% of the under-trial prisoners were below
the age of 50 years and will eventually return to the
Bihar 2 214
community outside the prison. Therefore spread of HIV
Chandigarh 4 372 in prisons has significant public health implications as
Chhattisgarh 6 622 almost all prisoners return to their community thereby
Dadra & Nagar Haveli - - facilitating the spread of HIV infection to the general
Daman & Diu - - population. In order to address this critical issue
with a comprehensive HIV prevention and treatment
Delhi 11 1970
service, the recently approved (June 2017) National
Goa 1 37 Strategic Plan for HIV/AIDS and STI (2017–2024)
Gujarat 2 76 titled “Paving the Way for an AIDS Free India”
Haryana 9 759 included prison HIV component under NACP-IV.
Himachal Pradesh 1 22 Followed by the formal launch of prison HIV
Jammu & Kashmir 2 223 interventions as a part of project “Sunrise” by
Jharkhand 2 192 the Hon’ble Union Minister of Health & Family
Welfare Shri Jagat Prakash Nadda on 6th February,
Karnataka 2 100
2016 at Imphal, Manipur HIV prevention and
Kerala 10 488 treatment services have been initiated in prisons
Madhya Pradesh 12 943 across Manipur, Mizoram, Meghalaya, Nagaland,
Maharashtra 1 106 Assam, Sikkim, Punjab and Chandigarh Emmanuel
Manipur 27 2191 Hospital Association provides technical assistance
for implementing prison HIV interventions in Punjab,
Meghalaya 5 816
Chandigarh and Haryana.
Mizoram 17 1646

362 Annual Report | 2017-2018

 Chapter - 24

Progress made under Prison HIV interventions found to be HIV Positive of 35,691 inmates tested
Programme for HIV; 603 inmates have already been linked to
ART services (2.4% positivity in Punjab and 7.1% in
The results achieved through phase-I implementation North-East States). Overall, 31.9% of 13282 prisoners
of HIV interventions in 15 prison sites across 7 were infected with HCV of which 869 inmates treated
States (10 central jails from Punjab and Chandigarh: for Hep-C with the support of medical facilities
Amritsar, Ludhiana, Kapurthala, Ferozpur, Faridkot, provided by State Government (20.5% and 18.3%
Gurdaspur, Hoshiarpur, Patiala, Bathinda, Chandigarh; Hep-C positivity registered in Punjab and North-East
and 5 central jails from North-East States: Imphal, respectively). Around 110 inmates have been linked
Aizwal, Dimapur, Shillong, and Guwahati) provides for TB treatment of 120 inmates diagnosed with TB.
strong evidence to scale up the interventions across During this reporting period, 90 inmates were treated
other prisons in the country. Nearly 922 inmates were for STI.
Table 24.3.6: Prisoners testing for HIV, TB & STI under the Prison HIV interventions programme during
the FY 2017-18 (April-September, 2017).

Central Total Tested Found Linked Diagnosed Treated Screened Diagnosed Treated Treated
Prisons prisoners for HIV HIV to ART with for for TB with TB for TB for STI
Positive Hep-C Hep-C
Amritsar 2500 7206 271 197 1548 37 65 56 47 1
Bathinda 1500 2090 9 9 31 8 8 4 4 0
Faridkot 2000 3792 113 98 151 0 64 1 1 1
Firozpur 1380 1625 131 62 519 68 17 17 17 0
Gurdaspur 1000 2187 30 20 179 212 134 14 14 75
Hoshiarpur 1000 1933 48 40 268 85 25 8 8 0
Kapurthala 2500 5154 165 77 710 74 30 4 4 2
Ludhiana 2600 6929 76 70 710 380 12 0 0 0
Patiala 2800 3735 24 22 118 5 75 14 14 1
Chandigarh 875 288 1 0 0 0 0 0 0 1
Manipur 577 37 1 0 0 0 0 0 0 0
Mizoram 624 91 0 0 0 0 0 0 0 0
Meghalaya 404 403 51 3 0 0 2 0 0 0
Nagaland 131 43 0 0 1 0 25 2 1 3
Assam 1143 178 2 5 8 0 0 0 0 6
Total 21,034 35,691 922 603 4243 869 457 120 110 90

State level inter-departmental meetings between OST service implemented in Tihar Prisons by Delhi
SACS and State prisons departments were organized State AIDS Control Society. Communication from
to develop prison HIV interventions joint action plan Addl. Sec. & DG, NACO has been recently sent to
for Bihar, Uttar Pradesh, Uttarakhand and Rajasthan Director General/Inspector General of Prisons and
during this reporting period. These States are currently SACS of the following States to initiate the process
operationalizing phase-II implementation of HIV of implementing phase-III Prison interventions:
interventions in 67 prison sites which will cater to nearly Andhra Pradesh, Telangana, Odisha, Jharkhand, West
98300 inmates. The process has already commenced Bengal, Maharashtra, Madhya Pradesh, Haryana and
to formalize the ongoing HIV interventions including Chhattisgarh.

Annual Report | 2017-2018 363

Chapter - 24

also reiterated that Harm Reduction services provided

by NACO through NGOs and Govt. Health facilities
are legitimate, recognized and approved by the law
under Section 71 of the NDPS Act.
Other Initiatives under Targeted Interventions

NACO in collaboration with development partners,

bilateral and multilateral agencies has been taking
concerted efforts to pilot newer initiatives. Following
are some of the key highlights:
State level inter-departmental meetings between SACS and
State prisons departments i) Sunrise Project: The project Sunrise is
complementing the ongoing National AIDS
Control Programme (NACP) primarily by
Strengthening partnerships between law
improving coverage, quality and scale of HIV
enforcement agencies & civil society organizations:
Section 71 of the Narcotics Drugs and Psychotropic interventions in the North-Eastern (NE) States
Substances (Amendment) Act 2014 now allows among People Who Inject Drugs (PWID). The
for ‘management’ of drug dependence, thereby project activities are being implemented through
legitimizing opioid substitution, maintenance and the existing system in close coordination with
other harm reduction services in the country. In order to State AIDS Control Societies (SACS) in the 8
sensitize officials enforcing law; NGOs implementing North-East States (CDC through FHI 360).
TI interventions and senior officials working with
State Health System, series of State/district-level ii) Linkages: The project is aimed at ensuring and
workshops were organized especially in north-eastern enhancing treatment cascade in 6 Districts of
States. There were 26 such workshops organized and Andhra Pradesh & Maharashtra. It has a specific
more than 1100 officials were sensitized on various focus to accelerate the ability of Govt. and Civil
aspects of drug use and HIV and NDPS Act. These Society Organizations to achieve global targets,
workshops provided a stage for discussion and of i.e. 90-90-90 through the HIV cascade of reach,
experience sharing in promoting partnerships between test, treat & retain Key Populations (USAID
key functionaries of law enforcement Agencies (LEA), through FHI 360).
TI-NGOs and the State health department. During the
workshop, the role of LEA in enhancing access to iii) Cluster Strategy: The cluster strategy is
Harm Reduction services has been highlighted. It was aimed at intensifying efforts in high burden
areas. USAID and CDC in collaboration with
NACO jointly developed Cluster strategy and
implementing various activities to enhance
HIV/AIDS Care Prevention and Treatment
services in select districts.

iv) Project Hridaya: Project Hridaya was

designed to fill in the implementation gaps
of TIs through its approach in Uttarakhand,
Uttar Pradesh, and Bihar. The India HIV/AIDS
Alliance (Alliance India) supports the delivery
of effective, innovative, community-based HIV
harm reduction programmes to key populations
Sensitization meeting with Law Enforcement Officials in
the North-Eastern States
affected by the HIV epidemic, through the

364 Annual Report | 2017-2018

 Chapter - 24

network of partners in these States. ix). Employer Led Model: In order to reach
informal migrants at industries an employer led
v) Nirantar: This is a civil society Capacity model is being implemented. Under this model
Building project for advocacy and response more than 400 industries have partnered with
to the HIV/AIDS epidemic among Key various State AIDS Control Societies for HIV
Populations (KPs) (Female Sex Workers, Men related activities. More than 8 Lakh migrants
having sex with Men, Transgenders/Hijras and have been covered through these programs.
Injecting Drug User) in Chhattisgarh, Madhya
Pradesh and Odisha primarily focusing on District AIDS Prevention and Control Units
building the local capacity initiatives of TI- (DAPCU)
NGOs and SACS. The goal is to enhance the
Around 188 DAPCU were established to coordinate,
capacity of CSOs (NGOs, CBOs) and other
facilitate & monitor NACP activities at district & sub
local institutions to improve access to HIV
district level.
prevention to care and treatment continuum
services including social protection schemes in During the period of April to August, 2017, two
an enabling environment for KPs. themes were posted in the DAPCU Blog (http://
[Link]/) as a part of generating
vi) Multi-country South Asia HIV program for
discussions: DAPCU's role in addressing stigma and
MSM & HTG: The regional HIV programme
discrimination and mobilizing support for high risk
is to reduce the impact of HIV on men who
groups and people living with HIV; and Improving
have sex with men (MSM) and Hijra and
data quality in the reports. Brief case studies were
Transgender (HTG) in South Asia funded
developed by DAPCUs to illustrate problems
by GFATM under Round 9. The regional
encountered by the community and the role played by
programme is community-driven and centered
them in facilitating necessary action by the concerned
around sexual diversity and access to health,
department. Among several responses received from
focusing on community systems strengthening
DAPCUs, few of the suitable narratives were selected
(CSS) as a mechanism to enable MSM and
and posted on DAPCU Blog.
HTG organizations to improve the quality of
their interventions (Global Fund through VHS DAPCU Surat, in coordination with District Level
and Humsafar Trust). Network, assisted an HIV positive woman renew
her work contract. The woman had been denied a
vii) Community System Strengthening: A
contract by the school Principal on the basis of her
focused initiative on vulnerability reduction
HIV positive status. The matter was placed before
and Community System Strengthening (CSS)
the DAPCC and a complaint made to the District
(87 CBOs in the southern States) in Andhra
Magistrate and Collector who directed the Principal
Pradesh, Telangana, Karnataka, Maharashtra
to renew the contract. DAPCU Kozhikode brought
and Tamil Nadu for Female Sex Workers
together and sensitized local government officials,
program (BMGF through SWASTI).
health functionaries and community leaders to help
viii) Methadone Based Opioid Substitution address stigma and discrimination related issues and
Treatment: The Methadone based opioid establish a supportive environment for people living
substitution treatment launched at RIMS has with HIV and their families.
increased the treatment options for people who
DAPCU Kanyakumari conducted sensitization and
inject drugs. NACO in coordination with SACS
training programmes for Government staff, which
and other key stakeholders currently firming up
resulted in improved delivery of social welfare services
the plan to scale up the service in other high
to high risk groups and people living with HIV. They
priority States in the country.
also took steps to organize sensitization programs in

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Chapter - 24

villages involving local community members to raise The scheme involves highly motivated and trained
awareness, improve acceptance and reduce cases of community members – 20 Cluster Link Workers
stigma and discrimination. in each district for clusters of villages (usually 5
villages each) – responsible for establishing linkages
Link Worker Scheme (LWS) - Reaching-out to
between the community on one hand and information,
Rural Populations
commodities and services on the other. These Cluster
In fourth phase of National AIDS Control Program Link Workers are supervised by 2 Zonal Supervisors
(NACP-IV), the Link Worker Scheme (LWS) has in each district.
been designed to intensify and consolidate the
Progress made under LWS programme during the
prevention services focusing on at risk population in
FY 2017-18
the rural areas with a mandate to work in 131 districts
across 17 States of India in the FY 2017-18. The Up to August, 2017, LWS is being implemented in
Link Worker Scheme aims to address complex needs 109 districts. Through this intervention, over 68,119
of rural HIV prevention, care and support through HRGs (FSWs, MSMs, TGs and IDUs) are reached in
identification and training of village level workforce rural areas nationally. In addition, the Scheme also
of Zonal Supervisors, Cluster Link Workers and other covers nearly 8.29 lakhs Bridge Population members
stakeholders on issues of HIV/AIDS, gender, sexuality (truckers and migrants) and vulnerable population
and Sexual Tract Infections. members. The programme has also reached out
to 26,988 people living with HIV (PLHIV) with
The scheme envisages creation of demand for various
services. Around 43,054 HRGs have been tested
HIV/AIDS related services, linking of the target
for HIV under this intervention during the FY 2017-
population to existing services (as the scheme itself
18. Over 1,562 HRGs have sought treatment for STI
does not create any service delivery points), creating
symptoms under this intervention. This has been done
an enabling and stigma free environment, ensuring
by establishing linkages with existing services. Also,
the target population continue to access information,
about 29,99,577 free condoms and approximately
services in a sustained manner, creating linkages
2,48,328 socially marketed condoms were distributed
with services of other departments through ASHA
during the FY 2017-18 in the villages covered through
volunteers, anganwadi workers, panchayat heads etc.
this intervention.

100% 93%
84% 82%
80% 69% 68%
62% 62% 63%
60% 53%
48%
52%
46%
37%
40% 28% 29%
23%
20% 12% 15%
6.06%
0.08% 0.57% 0.13% 0.19% 0.13% 0.29% 0.05% 0.18%
0%
FSW IDU MSM TG Migrant Trucker TB patients ANC Other VP

Covered Tested for HIV Positivity

366 Annual Report | 2017-2018

 Chapter - 24

Table 24.3.7: Typology-wise Performance of Link Worker Schemes in terms of Coverage, HIV testing,
and Positivity during the FY 2017-18 (as on September, 2017)

Typology Covered HIV testing HIV Detection Linkages to ART

Line Covered % HIV % Positive % of Total %
listed coverage tested tested detected positive linked linked
detected with ART
FSW 70385 58912 84% 37430 53% 31 0.08% 24 77%
IDU 3966 3,686 93% 2456 62% 14 0.57% 12 86%
MSM 6529 5,361 82% 3102 48% 4 0.13% 4 100%
TG 233 160 69% 66 28% 4 6.06% 4 100%
Migrant 7,99,181 2,99,457 37% 97833 12% 188 0.19% 179 95%
Trucker 1,04,000 64,247 62% 23974 23% 31 0.13% 26 84%
TB patients 13,187 8,352 63% 3791 29% 11 0.29% 10 91%
ANC 1,17,918 80,424 68% 54676 46% 25 0.05% 21 84%
Other Vulnerable 7,27,231 3,76,870 52% 110840 15% 202 0.18% 178 88%
population
PLHIV 29,346 20,585 70% - - - - - -

Condom Promotion Programme social media, outdoor media etc. to ensure countrywide
footprints. This year, a new mass media campaign was
Condom promotion by the Ministry of Health & developed in Hindi and other regional languages.
Family Welfare, Government of India has a long
history. In the initial period, condom was promoted The new integrated campaign is based on theme
under National Family Planning Program. With the of ‘making regular condom use a habit’ to ensure
emergence of HIV as a serious health threat, promotion its consistent use. The basic premise of this
of condom for preventing HIV/AIDS was taken up communication is to encourage audience to adopt
under National AIDS Control Programme (NACP). safe sex practice by using condom every time. This
With nearly 86 percent of HIV infection transmitted campaign has been developed in two parts depicting
through unsafe sex, significant efforts have been made various common incidents and events occurring in
by NACO to increase the awareness and usage of daily life of ordinary individuals. The essence of each
condoms to prevent the transmission of HIV/AIDS. of these episodes is to highlight benefits of good habits
National AIDS Control Programme (NACP) has and thus appealing for making condom use a habit in
consistently focused on prevention from HIV/AIDS order to play safe while having sex.
through safe sex practices. Given the significant role
of condoms in the prevention of STI/HIV infections, Free Supply of Condoms
the National AIDS Control Organisation (NACO) Condom programme implemented by NACO focuses
promotes condom use for controlling the epidemic. on optimizing the supply of free condoms to ensure
NACO promotes safe sex and regular condom use availability to the vulnerable population and minimize
through its mass media campaigns. These condom the wastage of free condom. The institutional
promotion campaigns are aired on national networks mechanism has been established to: regularly
of Doordarshan, leading cable & satellite channels, track free condom to State AIDS Control Societies
All India Radio, private FM channels, digital cinema, (SACS) to avoid stock out situation at SACS; to
analyse free condom from SACS to TI-NGOs and

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Chapter - 24

subsequent distribution from various TI-NGOs to total of 18,17,454 RPR tests were conducted among
Most at Risk Populations (MARPs); and estimate attendees of DSRCs of which only 0.4% (8872) were
free condom demand at TI-NGO and SACS levels reactive. Number of patients referred to the Integrated
based on previous data analysis. The annual condom Council and Testing centres (ICTC) were 16, 50,608
demand is estimated at SACS based on High Risk of which 0.4% (7411) were found tested positive for
Group (HRGs) coverage, past condom usage trends HIV. Among the pregnant women attending antenatal
and reviews of existing inventory of free condoms care 21, 28,310 ANC women were registered, of them
at SACS as well as at TI-NGOs covered by SACS. 17,17,894 were screened for syphilis of which 81%
NACO in close collaboration with respective SACS of the total registered ANC attendees. The Syphilis
ensures availabilities of free condoms under National ANC positivity is 0.10% and those was found reactive
Health Mission (NHM) and stocks were transferred for syphilis and were provided treatment. The sero-
from NHM to SACS wherever feasible. prevalence of Syphilis is observed to be declining
steadily among patients with STI/RTI, Pregnant
Capacity Building women and high risk groups.
Project Managers, Counsellors, M&E Officers, ORWs NACO target is to manage 90 lakh episodes of STI/
and PEs working with TI-NGOs have been trained/ RTI in 2017-18, out of which the program has achieved
oriented on effective implementation of condom 47.45 (51%) lakhs till September, 2017.
programme. These trainings are also aimed at building
confidence of TI staff in addressing key barriers in Pre-packed STI/RTI colour-coded Kits
condom usage, dispelling myths and misconceptions The colour coded STI/RTI kits have been provided for
associated with condom use. free supply at all DSRCs and TI NGOs to standardize
24.4 SEXUALLY TRANSMITTED INFECTIONS the treatment. The pre-packaging of the drugs is
(STI) AND REPRODUCTIVE TRACT being recognized as one of the global innovation in
INFECTION (RTI) CONTROL & STI programme management. The drugs used to treat
PREVENTION PROGRAMME common STI/RTI are included in the National/State
List of Essential Drugs. The division also procured
The Prevention and control of sexually transmitted Injection Benzathine Penicillin 2.4 million units for
infections is a well-recognised, cost effective strategy all health facilities including NHM facilities.
for controlling HIV transmission and reducing
reproductive morbidity. Early diagnosis; appropriate Regional STI/RTI Training, Research and
and complete treatment of STI/RTI reduces the Reference Laboratories
transmission rate of HIV infection by more than
There are 10 functional Regional STI Training,
40%. Syndromic Case Management (SCM), with
Reference and Research Laboratories supported
minimal laboratory tests is the cornerstone of STI/RTI
& strengthened by NACO. These are located at 1)
management under National AIDS Control Program.
Osmania Medical College Hyderabad, 2) Medical
The key strategies for STI prevention and control are
College Kolkata and Institute of Serology Kolkata,
to (a) interrupt transmission where it spreads fastest
3) Government Medical College Nagpur, 4)
and (b) provide services for all who may need them.
Government Medical College Baroda, 5) Institute of
Currently, there are 1165 NACO supported Designated Venereology, Chennai and 6) Maulana Azad Medical
STI/RTI Clinic (DSRC) across the country (at least College, New Delhi, 7) BYL Nair Hospital, Topiwala
one DSRC per district). There are two arms of DSRC National Medical College, Mumbai 8) Government
are (a) Obstetrics & Gynaecology OPD and (b) STI Medical College, Guwahati, Assam, 9) Post Graduate
OPD under Dermato-venereology clinics and provide Institution of Medical Education and Research,
services through existing public health care delivery Chandigarh 10) Safdarjung Hospital, New Delhi acts
system. During the period April-September’2017, a as the Apex Centre as well as Regional Laboratory for

368 Annual Report | 2017-2018

 Chapter - 24

the country. in the curriculum developed for trainings of ANM at

FICTC and laboratory technicians of ICTC, wherein
The key functions of these laboratories are to provide
the related curriculum has been incorporated into their
etiologic diagnosis of common STI/RTI syndromes,
existing curriculum so as to make service delivery
validation of syndromic diagnosis, monitoring of
comprehensive. To enable screening of pregnant
drug sensitivity of gonococci and implementation
women accessing labour room directly, a training
of Syphilis EQAS .
module was designed to orient labour room nurses for
NACO and CDC with SHARE have conducted screening of direct walk in pregnant women both for
assessment of all the Regional STI Centre last year, HIV and Syphilis.
during assessment Quality management system and
Convergence with NHM
programme component.
STI/RTI services are also an integral part of services
During the period May-August, 2017, Apex Regional
provided at all government health facilities including
center, (Safdarjung Hospital) has conducted STI
PHC/CHC. At each of these health facilities, a
Surveillance and community based study in High
standardized service delivery protocol is followed.
Risk Groups to find out the susceptibility & sensitivity
Medical and paramedical staffs are trained, free STI
pattern of Gonococci (GASP) first line drug used for
treatment is provided to patients and monthly reports
the Gonorrhoea.
on STI/RTI indicators are reported by these facilities
Training and Capacity building and regular onsite through existing HMIS.
mentoring of STI/RTI service providers
In addition of earlier indicators, the following
Standardized training curriculum for doctors, staff indicator of Syphilis have been incorporated in the
nurse, laboratory technician and counselor is in place. Health Management Information System (HMIS):
The training to these staff is provided in a cascade
1. Number of PW tested using POC test for
form through a cadre of national, state and regional
Syphilis
resource faculties across all states. All faculty
members have been trained using the same training 2. Out of above, number of PW found sero-
material, following adult learning methods. The state positive for Syphilis
and regional resource faculties in turn have conducted
training of STI/RTI clinic staff in the designated clinic 3. Number of pregnant women tested for Syphilis
and TI NGO. A total of 1531 personnel were trained 4. Number of pregnant women tested found sero-
including 61 doctors, 40 staff nurses, 113 laboratory positive for Syphilis
technicians, 906 counsellors and 411 preferred
providers. The States could not conduct the training 5. Number of syphilis positive pregnant women
due to non-availability of funds. treated for Syphilis

Additionally each district has district resource 6. Number of babies diagnosed with Congenital
facilities for training doctors, nurses and laboratory Syphilis
technicians on STI/RTI management for sub district
7. Number of babies treated for congenital
health facilities (PHC, CHC, and Sub –divisional
Syphilis.
Hospital). Till September’ 2017, a total of 2293
persons from sub-district health facilities were trained National operational guidelines and training modules
in syndromic case management which includes 822 for medical officers and paramedical staff for STI/RTI
doctors and 1471 nursing staff. About 85 doctors were services have been developed jointly by NACO &
also trained in private sector. NHM and disseminated. A joint convergence meeting
between NACO and NHM is conducted once every
Basics of STI programme activities were included

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Chapter - 24

quarter. STI curriculum is integrated in the training few successful initiatives globally.
module for nurses and an integrated package of STI/
Partnering with PSU and Professional Organization
HIV training is imparted by Indian Nursing Council
for nursing staff as per the standardized curriculum. The major proportion of patients with STI/RTI seek
services from the vast network of private health care
NACO has revised national STI/RTI technical
delivery systems ranging from freelance private
guidelines, 2014 in consultation with NHM. STI
practitioners to large public hospitals. Also, many
Division and NHM are jointly implementing populations are accessing services from public health
Elimination of Parent to Child Transmission of care systems under other sectors like railways, ESI,
Syphilis and has done joint procurement of Inj. Armed forces, CGHS, Railways, Port hospitals as
Benzatrhine Penicillin for NHM. well as health facilities of public sector undertakings
like Coal India Ltd, SAIL etc. It has been felt that
Provision of STI/RTI Services in High Risk Group
reaching out to maximum number of people suffering
Population
from STI/RTI is not possible without partnership with
The provision of a standardized package of STI/RTI private sector and organized public sector. NACO
services to High Risk Group (HRG) population is an has initiated partnership with organized public sector
important component of the TI projects. All the core and private sector through professional associations
group population receives packages of services which to support the delivery of STI/RTI services with
include: the objective to reach the populations presently not
covered by the public health care delivery system.
1. Free consultation and treatment for their STI/RTI services have been rolled out in major port
symptomatic STI complaints hospitals, ESIC, private medical colleges.
2. Quarterly medical check-up New Initiative under STI/RTI Programme
3. Asymptomatic treatment (presumptive 1. Elimination of Parent to Child Transmission
treatment) of Syphilis
4. Bi-annual syphilis and HIV screening The STI/RTI division in collaboration with Maternal
Health Division under MoHFW and WHO/SEARO has
Preferred Private Provider approach has been rolled
drafted National Strategy on EPTCT of Syphilis and
out to scale up STI/RTI services to HRG population
launched this programme initiative in collaboration
under TI Projects. These providers are selected by
with the National Health Mission.
the community members through group consultation.
This approach has enhanced access to services for Under the EPTCT of syphilis, NACO and Maternal
the HRG. Under this approach, all the HRG receives Health Division are aiming for early registration, early
free STI/RTI treatment and the providers receive a screening for both Syphilis and HIV and treat those
token fee of Rs.75 per consultation. A total of 3400 found reactive, promote institutional delivery and
preferred provider are providing STI/RTI services to follow up the new born up to 24 months of age.
the HRG. All these preferred providers are trained
using a standardized curriculum on syndromic case Key Strategy for implementing the elimination
management. Colour coded STI/RTI drug kits have Strategy:
also been made available to these providers for free
• Ensuring universalization of ANC check-up
treatment of sex workers, MSM and IDU and data
(>95%)
collection tools are also provided to them. During
the period of April-September, 2017, a total of about • Testing for Syphilis and HIV together and both
17.35 lakhs visits have been made by HRG and 10.53 the tests to be an essential test in ANC service
lakhs regular medical check-up have been conducted. packages.
The involvement of private practitioners for providing
STI services to HRG at such a large scale is one of the • Treatment of all sero reactive mothers, partners

370 Annual Report | 2017-2018

 Chapter - 24

and new borns for Syphilis. ensure greater convergence and ownership of STI/
RTI management in the general health system and
• Reporting and line listing of all the cases of
partnership with private sector.
maternal syphilis and HIV and institutional
delivery of them. Follow up of the new born 24.5 BLOOD TRANSFUSION SERVICES
and child for 24 months.
The annual requirement of blood for the country
• Collaboration and functional convergence
is estimated at 12.8 million units of blood and the
between NACO and NHM.
endeavour is to meet the blood needs of the country
• Allocation of resource (line item in APP, through voluntary non-remunerated donation through
purchase of commodities, training, monitoring a well-coordinated and networked blood transfusion
etc) for elimination of congenital syphilis and service.
HIV.
Current Scenario
• Introduction of newer and simple technologies
in scaling up of testing for Syphilis (Point of The blood transfusion services comprise of 2903
care test) licensed blood banks across all States and sectors,
of which a network of 1,131 blood banks, which
• Making availability and supply of commodities comprises of 398 Blood Component Separation Units
like syphilis test kits, HIV test kits, inj. (BCSU), 34 Model Blood Banks, 108 Major Blood
benzathine Penicillin, etc. Banks & 591 District level blood banks and are further
TRG for STI has recommended STI program to supported by NACO by way of one time equipments,
liaise with Non-Communicable Disease division supplementary manpower and consumables, in
MoHFW to expand screening for cervical cancer of addition to support received under State Governments.
women attending STI/ RTI clinics, ART centres and All blood banks collecting more than 3000 blood units
female sex workers by strengthened referral linkages are also provided with one Blood Bank Counselor to
between these facilities and NCD clinics. TRG also provide pre and post donation counseling and improve
recommended to explore feasibility and introduction donor retention.
of vaccination for HBV and HPV to most at risk NACO has been primarily responsible for ensuring
populations by working together with Immunization provision of safe blood for the country since 1992.
division, MoHFW. TRG, further, suggested that During NACP, the availability of safe blood increased
program should work towards elimination of chancroid from 44 lakh units in 2007 to 110 lakh units by 2016-
and donovanosis in-addition to congenital syphilis. 17. During this phase, incidence of donor HIV sero-
National Strategic Plan 2017-2024 (NSP) reactivity has declined from 1.2% to less than 0.12%
in NACO supported Blood Banks. NACO supported
The vision of STI/RTI control and prevention blood banks are functional across the country in all
programme is to provide standardized STI/RTI barring 74 districts. Access to safe blood however
services and Sexual and Reproductive Health continues to be limited especially in rural areas in
services (SRH) at all levels of health system through States like Uttar Pradesh, Uttarakhand, Jharkhand,
convergence with NHM and private sector; especially Bihar, and Chhattisgarh. Till September, 2017,
focusing on women, adolescent and marginalized 33.66 lakh units were collected among these NACO
population. supported Blood Banks, 77% of these blood units
were collected through Voluntary Blood Donation
The strategies propose to provide comprehensive
(VBD). HIV sero-reactivity has remained low in tune
STI/RTI services not only to vulnerable populations
of 0.14% in these blood banks. At present, component
and HRGs but also to the general population and
separation is 50% in NACO supported Blood Banks.
communities at large. In doing so, NACO will

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Chapter - 24

Fig. 24.5.1: Percentage Distribution of Voluntary Blood Donations in collections made through NACO
Supported Blood Banks during the years (from 2007-08 to 2016-17)

Government has adopted a comprehensive approach & DG (NACO) & President, NBTC. The guidelines
towards strengthening blood transfusion services, key for blood donor selection and blood donor referral
strategies for which include: have been approved by the NBTC. It has also been
directed that Standards for Blood Banks and Blood
• Increasing regular voluntary non-remunerated
Transfusion Services be reviewed and revised. A
blood donation to meet the safe blood
Standing Committee has been constituted under
requirements of safe blood in the country;
joint chairpersonship of Joint Secretary (Policy) and
• Promoting component preparation and Joint Secretary (NACO) to look into coordination of
availability along with rational use of blood in activities to strengthen Blood Transfusion Services of
health care facilities and building capacity of the country.
health care providers to achieve this objective;
Promotion of Voluntary Blood Donation
• Enhancing blood access through a well
networked regionally coordinated blood It has been recognized world over that collection of
transfusion services; blood from regular (repeat) voluntary non remunerated
blood donors should constitute the main source of
• Establishing Quality Management Systems to
blood supply. Definition of Voluntary Blood Donor
ensure safe and quality blood; and
has been revised as per recommendations of NBTC
• Building implementation structures and referral governing body to exclude family donors. Special
linkages. days such as World Blood Donor Day and National
Voluntary Blood Donation Day were observed at
National Blood Transfusion Council (NBTC) national and state level recognizing the contribution
The 26th Meeting of Governing Body of NBTC was of repeat non-remunerated repeat voluntary blood
held on 1st June, 2017 under the chairpersonship of AS donors.

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 Chapter - 24

Inauguration of Voluntary Blood Donation Camp at Dr. RML Hospital New Delhi by Former Secretary-HFW
on 3rd March, 2017

14th June, 2017 was celebrated as World Blood from voluntary non-remunerated repeat blood donors.
Donor Day with theme “What can you do?” The
slogan was “Give blood, Give now, Give often”. Metro Blood Bank
A half page advertisement was published in more First phase of Metro Blood Bank Project is approved
than 150 National & Regional Newspapers. State
for Chennai and Kolkata. MoU was signed with
Blood Transfusion Councils also receive support to
Government of West Bengal to establish Metro Blood
conduct activities for promotion of voluntary blood
Bank at Kolkata on 10th July, 2017, which is envisaged
donation, conduction of Blood Donation Camps and
as state of art model of centralized blood services and
provisioning of donor refreshment. Around 37,744
blood donation camps were held across the country center of excellence from Central Sector Scheme. A
from April to August 2017 to support blood collection Project Implementation Committee has been set up to
expedite the implementation of the Project.

Signing of MoU with Govt. of West Bengal for Metro

Theme of Blood Donor Day-2017 Blood Bank

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Chapter - 24

State wise Baseline Assessment of Licensed Blood Technicians, Nurses and Counselors) through 26
Banks NACO identified training centres across the country
based on a standardized curriculum through the
In the recent, Review Meeting of North East States and coordination with State AIDS Control Societies.
Western Region, State specific Assessment Reports of Training programmes in all 26 centres are ongoing
Licensed Blood Banks were released. Reports are also as per the revised standardized curriculum across
prepared for all other States. the country. Around 4030 Blood Bank staff (Medical
Officers- 1125, Laboratory Technicians- 2097 and
Nurses- 808) were trained till September, 2017.
NACO/NBTC along with project partners and
leading experts in Transfusion Medicine has devised a
standardized training curriculum (Trainers Guide and
Trainee's Handbook) for building capacities of BB
staff designated as Technical Manager and Quality
Manager together with one Medical Officer in selected
NACO supported Blood Banks. 66.59% of the staff
from the total of 470 selected NACO supported blood
banks were trained till September, 2017.
Research Study
In order to plan and develop appropriate strategies,
programmes and policies related to BTS, knowledge
Release of State specific Assessment on the requirement of blood in the country is essential.
Reports of Licensed Blood Banks Looking towards the need of the estimation of the blood
requirement in the country, a study was undertaken
Blood Mobile Vans on the “Estimation of National Blood requirement in
India” through CDC- CMAI project. The protocol for
Thirty two state of the art Blood Mobile Vans have the study was designed with assistance from National
been provisioned with mobile blood banks for Institute of Medical Statistics, CMC Vellore and other
increasing voluntary blood collection. These vans are transfusion Medicine experts and approved by the
stationed at strategic locations and have four beds to Technical Resource Group of BTS and Research. The
simultaneously collect blood from four blood donors. preliminary findings on this study have been shared.
They are fully air-conditioned and equipped with
refrigerators to transport blood to the blood bank. Strategic Information Management System (SIMS)

Blood Transportation Vans Looking towards the need of the estimation of the
blood requirement, monthly programmatic data from
Blood needs to be transported under proper cold chain all blood banks is reported on Strategic Information
maintenance from the linked mother blood bank to the Management System (SIMS) on a web based format
Blood Storage Centre (BSC). NACO has provided 250 to National AIDS Control Organization. Presently,
refrigerated blood transportation vans to the RBTC/ 2585 blood banks are registered and 2204 blood
District blood banks, which are being maintained banks reporting on SIMS. The information procured
through provisioning of fuel & manpower cost. These and data generated from SIMS forms the backbone for
vans transfer blood units to the BSC on a regular basis spelling out the Annual Action plans and programme
and also on demand/emergency situations. management. India is amongst the very few countries
that have such a comprehensive national level
Capacity Building
reporting in transfusion services.
Training for capacity building is given to the
Blood Bank Staff (Medical Officers, Clinicians,

374 Annual Report | 2017-2018

 Chapter - 24

Monitoring and supervision of Blood Transfusion at Chennai with a capacity of processing 150,000
Services (BTS) litres of plasma per annum and prepare plasma
products for use within the country. Keeping in
State Transfusion Services Core Coordination view, that large volume of unutilized plasma is being
Committee teams have been constituted in every State discarded; plasma policy has been formulated, as an
to carry out the periodic supervision of all NACO addendum to national blood policy, so as to utilize
supported blood banks and voluntary blood donation this plasma by existing fractionators. NBTC has also
camps. During the FY 2017-18, the States visited approved modalities including exchange value for
include Assam, Maharashtra, Meghalaya, Andhra plasma exchange with indigenous fractionators. These
Pradesh and Madhya Pradesh. guidelines have been adopted by respective State
Plasma Fractionation Centre Blood Transfusion Councils. The project of setting up
Plasma Fractionation Centre has therefore been kept
It was proposed to set up a Plasma fractionation centre on hold.

Table-24.5.1: Details of Blood Collections made through all blood banks and NACO supported blood
banks under the blood transfusion services during the FY 2017-18 (as on September, 2017)

Sl. State/UT Total % Annual % Collection % Collections %

No. Blood Collection Collection through in NACO Component
Collection through of NACO NACO supported Separation
VBD supported supported Blood Banks
Blood Banks Blood Banks through VBD
1 Andhra Pradesh 2,58,505 77% 127,419 49% 83% 26%
2 Telangana 1,90,881 61% 62,047 33% 60% 36%
3 Arunachal Pradesh 2,101 86% 2,101 100% 86% 0%
4 Assam 1,06,364 44% 73,577 69% 52% 18%
5 Bihar 97,949 49% 66,351 68% 60% 23%
6 Chandigarh 46,047 87% 40,929 89% 85% 95%
7 Chhattisgarh 96,940 43% 48,717 50% 61% 13%
8 Dadra & Nagar Haveli 4,690 100% 4,690 100% 100% 93%
9 Delhi 1,90,179 39% 122,444 64% 37% 65%
10 Daman & Diu 372 77% 372 100% 77% 33%
11 Gujarat 4,16,539 77% 315,895 76% 81% 78%
12 Haryana 1,94,312 62% 90,606 47% 92% 32%
13 Himachal Pradesh 21,208 78% 20,888 98% 78% 13%
14 Jammu & Kashmir 36,638 74% 36,636 100% 74% 42%
15 Jharkhand 95,305 48% 68,879 72% 61% 44%
16 Karnataka 4,41,508 75% 186,690 42% 89% 73%
17 Kerala 2,08,459 80% 114,034 55% 89% 75%
18 Madhya Pradesh 2,41,878 76% 162,232 67% 93% 27%
19 Maharashtra* 5,84,381 98% 369,881 63% 99% 72%
21 Manipur 10,977 40% 10,025 91% 41% 50%
22 Meghalaya 8,096 30% 8,096 100% 30% 47%

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Chapter - 24

Sl. State/UT Total % Annual % Collection % Collections %

No. Blood Collection Collection through in NACO Component
Collection through of NACO NACO supported Separation
VBD supported supported Blood Banks
Blood Banks Blood Banks through VBD
23 Mizoram 11,732 86% 11,627 99% 86% 68%
24 Nagaland 5,881 40% 5,881 100% 40% 0%
25 Odisha 1,76,062 70% 170,467 97% 71% 20%
26 Puducherry 24,203 35% 13,479 56% 25% 77%
27 Punjab 2,24,333 82% 119,766 53% 90% 41%
28 Rajasthan 3,32,762 60% 197,272 59% 57% 49%
29 Sikkim 2,352 79% 2,352 100% 79% 0%
30 Tamil Nadu 4,55,180 92% 194,494 43% 100% 45%
31 Tripura 10,677 85% 10,677 100% 85% 29%
32 Uttar Pradesh 5,36,893 27% 300,717 56% 38% 64%
33 Uttarakhand 65,578 72% 35,349 54% 71% 31%
34 West Bengal 5,84,524 85% 360,488 62% 87% 27%
35 Goa 10,133 79% 9,332 92% 78% 64%
36 Andaman & Nicobar 2,094 88% 2,094 100% 88% 72%
Islands
Total 56,95,733 71% 33,66,504 59% 77% 50%
*Including Mumbai

24.6 BASIC SERVICE DIVISION (BSD) C. HIV/Tuberculosis collaborative activities

The Basic Services Division of the NACO provides
A. Integrated Counselling and Testing Centre
HIV counselling and testing services for HIV
(ICTC):
infection, the critical first step in detecting and linking
people with HIV to access treatment cascade and care. There are different types of HIV counselling and
It also provides an important opportunity to reinforce testing services in India which include standalone
HIV prevention. The national programme is offering ICTC (SA-ICTC), Mobile ICTC, Facility Integrated
these services since 1997 with the goal to identify Counselling and Testing Centres (F-ICTCs) and
as many people living with HIV, as early as possible Public Private Partnership ICTCs (PPP ICTCs). In
(after acquiring the HIV infection), and linking them order to offer HIV testing to every pregnant woman in
appropriately and in a timely manner to prevention, the country, so as to detect all HIV positive pregnant
care and treatment services. The introduction of ART women and eliminate transmission of HIV from
services for people living with HIV/AIDS in 2004, parent to child, the community-based HIV screening
gave a major boost to counseling and testing services is conducted by frontline health workers Auxiliary
in India. Nurse Midwives (ANM)) at the sub-centre level.
There is an increase in the number of ICTCs in the
The HIV Counseling and testing services include the
country, clearly portraying integration of counselling
following components:
and testing services under general health services,
A. Integrated Counseling and Testing Centres (ICTC) increase in geographical coverage of these services
below block level, better accessibility and addressing
B. Prevention of Parent-To-Child Transmission of
sustainability (Fig. 24.6.1)
HIV (PPTCT)

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 Chapter - 24

Fig 24.6.1: Scale-up of ICTCs during the period from 2007-08 to 2017-18 (till August, 2017)

25000 22222 23400

19800
18369
20000
15606
12897
Numbers

15000 17850
10515 16677
13022 14415
10000 6480 7541 10788
4567 5027 8389
5982
1270 2302
5000 0 0
4567 5027 5210 5239 4533 4508 4818 5347 5385 5545 5550
0
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
Years ( till Aug
2017)
Stand Alone (including Mob & PPP ICTC). FICTC(Including PPP-ICTC) Total Facility

HIV Counselling and Testing Services of General during the FY 2017-18 (till Aug.2017), around 80.3
Individuals lakhs general individuals have been tested for HIV
against annual target of 180 lakhs and out of which
During the FY 2016-17, around 186.2 lakhs general 80,955 were diagnosed HIV Positive. The below Fig.
individuals were tested for HIV out of against the 24.6.2 shows year wise general individuals tested for
annual target of 140 lakhs and out of which 184,092 HIV and the positivity.
general individuals were detected HIV positive. While,

Fig 24.6.2: Scale-up of General Individuals tested and positivity in ICTCs during the period from 2007-
08 to 2017-18 (till Aug 2017)

200
5.0 186 6.0
180 165
160 150 5.0
140 3.6 130

Positivity (%)
3.2 109 4.0
120 104
Number Tested (in Lakhs)

100 2.2 80 3.0

80 83 90 1.8
2.5 1.4 2.0
60 56 1.2 1.0 1.0
40 1.0
20
0 0.0
2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18
(till Aug
Years 2017)

General Individual Tested (In Lakhs) Positivity (in %)

B. Prevention of Parent to Child Transmission is to offer HIV testing to every pregnant woman
of HIV (PPTCT) (universal coverage) in the country, so as to cover all
estimated HIV positive pregnant women and eliminate
The Prevention of Parent to Child Transmission transmission of HIV from mother-to-child. During the
of HIV/AIDS (PPTCT) programme was started in FY 2015-16, NACO has decided to implement EID
the country in the year 2002. As on August, 2017, service through all 5,237 SA-ICTCs (fixed) across the
23,400 ICTCs in the country offer PPTCT services to country.
pregnant women. The aim of the PPTCT programme

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Chapter - 24

In the FY 2016-17, out of the target of 140 lakhs pregnant women were tested for HIV and 4,443 were
pregnant women, 165.6 lakhs were tested for HIV. diagnosed HIV positive as new cases and out of which
Out of which, 9,064 (new detection) pregnant women 3,780 (85.1%) initiated lifelong ART, the known
were found HIV positive. During FY 2016-17, out HIV positive pregnant women availed HCTS service
of 14,350 registered pregnant women on ART 91% during this period is 2,267. During 2017-18 (till
were initiated on lifelong ART and out of 10,715 August, 2017), around 4,589 HIV exposed live birth
HIV exposed babies 88.5% were initiated ARV were reported, out of which 4,003 (87.2%) received
prophylaxis. During FY 2017-18, till August, 2017, ARV drug.
out of the annual target 180 lakhs, 82.1 Lakhs of
180 0.74 0.72 166 0.8
0.65
Number Tested (in Lakhs)

160 0.7
140 127
0.47 117 0.6

Positivity (%)
120 97 0.5
100 0.33 84 83 82.1
69 0.4
80
60 46 61 0.18 0.3
0.15 0.12
40 23 0.11 0.09 0.2
13 20 0.25 0.05 0.05
20 0.1
0 0

Years
Pregnant Women Tested (In lakhs) Positivity(in %)

1. Early Infant Diagnosis (EID) Andhra Pradesh, Assam, Bihar, Himachal Pradesh,
Karnataka, Maharashtra, Meghalaya, Mizoram, Uttar
HIV exposed infants born to infected pregnant Pradesh, Tamil Nadu, Telangana and Tripura.
women have to undergo DNA-PCR tests using
dried blood spot and whole blood specimen. Details II. Quality assurance and EQAS: The diagnostic
on EID programme are mentioned in the section on services provided through ICTCs across the country
Laboratory Services. During the FY 2017-18 (till are strictly monitored by a strong Internal and External
Aug. 2017), a total of 2,485 HIV exposed babies (6 Quality Assurance Scheme (EQAS).
weeks to 6 months) were initiated on CPT and 3,440
babies (6 weeks to 6 months) were tested under the III. Supply Chain Management: A strong
EID Programme using DBS DNA PCR and 80 (2.3%) monitoring mechanism for inventory management is
babies were found reactive. However a total of 3,395 in place. The inventory status for all commodities at
babies were undergone for 18 month test and only 150 the State, District and Facility level is monitored on
were diagnosed as HIV positive and 128 were initiated monthly basis at the National level.
on Pediatric ART. IV. PLHIV-ART Linkage System (PALS):
2. Quality Improvement Initiatives under NACO has implemented PLHIV-ART linkage
Basic Services System (PALS) in India for tracking & monitoring of
cascaded of services provided to HIV Positive general
I. Supervision and Monitoring Mechanism: individuals including pregnant women and their
Officers from NACO along with the State AIDS child. PALS allows the tracking services provided
Control Societies and partners visit States/UTs and by different health facilities at different time points
service delivery centres as part of routine monitoring. & geo-locations. All States/UTs were implemented
During 2017-18, NACO officers visited the States of PALS and reporting data in it.

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V. Community Based Screening approach: Engagement of Private Health Sector for

Community-Based Screening (CBS) is an important elimination of Mother to Child transmission of
approach for improving early diagnosis, reaching HIV and Syphilis on 7th July, 2017 at New Delhi.
first-time testers and people who seldom use clinical The objective of this workshop was to enhance
services, including men and adolescents in high- the active collaboration with private health
prevalence settings and HRG populations. To improve sectors with support of SAATHII, who is the
HCTS access and coverage, community-based HIV technical partner for this activity. The national
screening is carried out through various approaches consultation workshop was fully supported by
such as:- SAATHII.
a) Mobile HCTS; iv. National TB/HIV Co-ordination Committee
(NTCC) meeting held under the chairmanship
b) Screening by ancillary health-care providers of Secretary (H&FW), MOHFW on 31st July,
(ANC); 2017 at New Delhi. Representatives from
c) Screening for HIV by targeted intervention (TI- MOHFW, DGHS, Addl. Secretary NACO, EA
ICTC); (TB), CTD, WHO, IMA, TB Association of
India, NARI, NIRT NCPI Plus, NACO and State
d) HCTS for prison inmates; and representatives from UPSACS participated in
the meeting.
e) HCTS at the workplace.
v. A “National Workshop to review the IEC
VI. Meetings
prototype & Development of Communication
1. Review meetings Strategies for HIV Counselling and Testing
Services (HCTS) & STI” has been conducted
As a part of Programme Monitoring, the Basic by Basic Services Division, NACO on 2nd &
Services Division has been conducting review 3rd August, 2017 at India Habitat Centre, New
meetings on BSD components at regular intervals Delhi.
both at National and State level.
vi. Data verification at field level for EMTCT data
i. The 3rd meeting of the National Core Group on validation has been done for Tamil Nadu during
Elimination of Mother to Child Transmission 20th - 25th August, 2017, for States - Karnataka,
(EMTCT) of HIV/Syphilis was held on 19th Andhra Pradesh ,Mizoram & Telangana from
May, 2017 under the chairmanship of Dr. 28th August to 1st September, 2017 and for
Ashok Kumar, (Ex. Addl. DGHS, MoHFW) Maharashtra 4th - 8th September, 2017. The
at New Delhi. The objective of the meeting field visit for data validation & verification
was, to finalize the protocol for EMTCT data completely supported by NIE, Chennai.
validation in the 6 identified States (Andhra
Pradesh, Karnataka, Maharashtra, Mizoram vii. A Meeting on “Action Plan for Universal
Telangana, and Tamil Nadu). Members from Coverage of Pregnant Woman for HIV and
development partners, Population Council Syphilis” has been convened at NACO on
India, representatives from above said States 25th September, 2017 for 5 high priority states
and NACO officials were presented in the (Assam, Bihar, Madhya Pradesh, Rajasthan
meeting. and Uttar Pradesh). The meeting was chaired
by Dr. Alok Saxena, Joint Secretary, NACO
ii. National Technical Working Group for TB-HIV (MoHFW). The objective of the meeting was
Collaborative Activities (NTWG) meeting held to evaluate the action plan put forwarded by
at NACO under the chairmanship of DDG/BSD the States to achieve the universal coverage of
on 19th June, 2017. Pregnant Woman for HIV and Syphilis.
iii. A National consultation workshop on

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Chapter - 24

VII. Training known that TB being a major public health problem in

India accounts for 25% of deaths among PLHIV. It is
a) Regional Training of Trainers (ToT) on known that nationally about 3% TB patients registered
revised HIV Counseling and Testing Service under the Revised National Tuberculosis Control
(HCTS) guideline 2016: BSD-NACO has recently Programme (RNTCP) also have HIV infection. In high
updated the National HIV counseling and testing prevalent States/UTs and Districts, positivity among
Services Guideline (HCTS) 2016. Training of Trainers TB patients is more than 10% in selected Districts.
has been for all States/UTs by July, 2017. Thus, while the country is dealing effectively with
b) Training on PLHIV- ART Linkage System: HIV burden, TB associated HIV epidemic is posing a
BSD NACO has implemented PLHIV- ART linkage great challenge.
System (PALS) in India for tracking & monitoring Broadly the national HIV/TB response includes
of cascade of services provided to HIV Positive activities to reduce burden of HIV among TB patients
General Individuals as well as HIV Positive pregnant and TB among HIV infected individuals. These
women & their child by the different health facilities activities are closely guided through duly constituted
at different time points & geo-locations. Currently all National HIV-TB Coordination Committee, National
ICTC and ART counsellors, DAPCU officials and all Technical Working Group and State and District
BSD & M&E officials of SACS of 35 States/UTs have level Coordination Committees. The National AIDS
received hands on training on PALS. Control Organization and Revised National TB
C. HIV/TB Collaborative Activities control programme have been successful in increasing
access and uptake of HIV testing and counseling for
TB disease is the commonest opportunistic infection all TB patients.
among HIV-infected individuals. Further, it is also

TB-HIV Collaboration on World AIDS Day on 1st December, 2017 inaugurated by Hon’ble Union Minister of State for
Health & Family Welfare Smt. Anupriya Patel in the presence of Secretary (HFW) Ms. Preeti Sudan
and Additional Secretary (Health) Shri Sanjeeva Kumar, WR India and JS (NACO)

380 Annual Report | 2017-2018

 Chapter - 24

The co-location of Designated Microscopy centres 3066 PLHIVs were diagnosed with TB i.e.12% as per
(DMCs) and HIV testing facilities was 80% as on monthly ART centre report (August, 2017).
June, 2017. The trend of Known HIV Status among
TB is increasing i.e. 86 % (ranging from 40% – 100%) Use of Rapid Diagnostics (CBNAAT) for early
in the FY 2017-18 knew their HIV status which has diagnosis of TB & Rif Resistance among People
increased from 84% (ranging from 29% – 100%) living with HIV
in the FY 2016-17. The trend in proportion of TB Cartridge Based Nucleic Acid Amplification Test
patients notified in private sector knowing their HIV (CBNAAT) is used as rapid TB diagnostic tool
status is also improving from 2% in 2015-16 to 4% in established in nearly all districts of the country. In
2017-18 (upto June, 2017). The Linkage of TB HIV addition to TB diagnosis, this also helps in early
co-infected patients to CPT and ART is also showing diagnosis of Rif Resistance among People living
healthy trend in India. 88% & 92% of co-infected with HIV. For upscaling of linkages of PLHIV for
patients received CPT and ART respectively during early diagnosis of TB & Rif resistant TB in India,
2017-18 (till June, 2017) whereas 84% of TB HIV co- total 628 CBNAAT are available nationwide with 507
infected patients were linked to CPT and ART during new CBNAAT equipments planned to be installed in
FY 2016-17. districts in the coming months. 343 ART centres are
Intensified TB Case Finding (ICF) functionally collocated with the CBNAAT sites, with
the remaining ART centres linked to the CBNAAT site
Under ICF, all ICTC clients are screened by ICTC through sputum collection and transport mechanism.
counsellors for presence of TB symptoms at every
encounter (pre, post, or follow-up counselling). Clients As per the recommendation of NTCC & NTWG HIV-
who have symptoms or signs of TB, irrespective of TB, Rapid molecular TB diagnostic test (CBNAAT) is
their HIV status, are referred to RNTCP diagnostic used for early diagnosis of TB among PLHIV at ART
and treatment facility located in the same institution. centres and ICTC and 559 ICTC/F-ICTC have been
Similar to 2016-17, nearly 7% (1% -10%) of general linked with CBNAAT.
clients (except pregnant women) receiving pre-test Isoniazid (INH) Preventive Therapy
counseling/information have been referred for TB
testing from ICTC during 2017-18 (Apr-Aug 2017) Isoniazid Preventive therapy (IPT) services launched
and detection of about 30540 i.e. 7% TB cases out of on World AIDS Day 2016 is one of the 3I strategy
which 3619 are found co-infected with TB /HIV at globally recommended for prevention of incident TB
ICTC in FY 2017-2018 (till Aug, 2017). among HIV infected individuals. IPT is a key public
health intervention for the prevention of TB among
To reduce the burden of TB among people living people living with HIV and has been recommended as
with HIV ‘Innovative Intensified TB case finding and part of a comprehensive HIV and AIDS care strategy
appropriate treatment at high burden ART centres by WHO, UNAIDS.
in India’ project to support the three I’s for HIV/TB
(Intensified case finding, Isoniazid preventive therapy Isoniazid is the most effective bactericidal drug.
(IPT), and Infection control) was scaled up to cover It protects against both progression of latent TB
all ART centres in the country on World TB Day 2016. infection (LTBI) to active disease (reactivation) as
Patients diagnosed with Tuberculosis are linked to well as from re-infection when exposed to active TB
first line anti TB drugs daily regimen for TB patients case. Nearly 31 among 33 States/UTs reporting and
diagnosed in the respective ART centers. 84% PLHIV 348 ART centres were implementing IPT services.
attending ART centre were screened for ICF for 4 TB 18% (2,16,754) PLHIV who are unlikely to have
symptoms at ART centres and subsequently 29,341 active TB were initiated on IPT at ART centres as part
presumptive TB cases were referred to RNTCP, of a comprehensive package of HIV care till August,
among whom 85%(25083) were tested for TB and 2017 (Figure 24.6.4).

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Chapter - 24

Fig. 24.6.4: Month-wise cumulative number the country.

of PLHIV on IPT, ART centres and States
implementing IPT •• Expansion of ICTC/F-ICTC linkage with
CBNAAT for the early detection of TB through
ICF at ICTC’s
•• Social support & Nutritional support services
for TB-HIV patients
24.7 CARE, SUPPORT AND TREATMENT
The Care, Support and Treatment (CST) component
of the National AIDS Control Programme aims to
improve the survival and quality of life of Person
Living with HIV (PLHIV) with Universal access
to Comprehensive HIV care. The policy package
includes:
•• Free universal access to lifelong standardized
Anti Retro Viral Therapy (ART)
TB Active Case Finding campaign:
•• Free lab diagnostic and monitoring services
Revised National Tuberculosis Control Program
(baseline tests, CD4 testing, targeted viral load)
(RNTCP) has adopted systematic active tuberculosis
(TB) case finding strategy among prioritized vulnerable •• Facilitating long term retention in care
groups, for reaching the un-reached. Two phases of the
campaign have been completed in January and July, •• Prevention, diagnosis and management of
2017, which also included the high risk groups among opportunistic infections
HIV and the high priority TB HIV districts. As a result
•• Linkages to care and support services and
of this campaign 4.3 lakh population were mapped,
linkage to social protection scheme.
among whom 78% (3.4 lakh) were screened for TB
symptoms, following which nearly 1.7% (5672) were Country has adopted fast track targets of 90-90-90
examined and subsequently 4% (216) patients were which aims at ending AIDS as public health threat by
diagnosed with tuberculosis. 2030 by achieving fast track targets by 2020 as below:
Newer Initiatives and way forward: •• 90 % of PLHIV knows their Status, of which
•• Expansion of TB HIV collaborative activities in •• 90 % of PLHIV are on ART, of which
private sector health facilities.
•• 90 % of PLHIV have viral suppression.
•• Country-wide coverage of policy for HIV
testing among all presumptive TB cases. A significant step of rolling out “test and treat” policy
•• Nationwide implementation of TB infection has been taken toward achieving these targets.
control activities at all ART centers
•• District specific intervention in high priority
districts identified as per Pragati Review in
seven States (Andhra Pradesh, Karnataka,
Maharashtra, Mizoram, Chhattisgarh and Tamil
Nadu).
•• TB active case finding campaign among high
risk groups of HIV across various districts of

382 Annual Report | 2017-2018

 Chapter - 24

Service Delivery Mechanism for Care, Support & Fig. 24.7.2: Distribution of ART centres across the
Treatment (CST) country under the Care, Support and Treatment
Programme
CST services are provided through a spectrum of
service delivery models including ART Centers,
Centers of Excellence (CoE), Pediatric Centers of
Excellence (PCoE), Facility Integrated ART Centers
(FI-ART), Link ART Centers (LAC), Link ART
Plus Center (LAC Plus and Care & Support Centers
established by NACO in health facilities across the
country with aim to provide universal access to free
and comprehensive CST Services. There are active
linkages and referral mechanism for monitoring,
mentoring, decentralization and specialized care.
CST Services are also linked to ICTCs, STI clinics,
PPTCT services and other clinical departments in
the institutions of their location as well as with the
RNTCP programme in order to ensure proper and
comprehensive care and management.

Link ART Centres (LAC): In order to facilitate the

delivery of ART services nearer to the beneficiaries,
it was decided to set up Link ART Centers located
mainly at ICTC in the district/sub-district level
hospitals nearer to the patients’ residence and linked
to a Nodal ART center within accessible distance. The
LAC helps in reducing cost of travel; time spent at the
center and hence helps in improving clients’ adherence
to ART.

• Antiretroviral Therapy Centres: Provision of • Centres of Excellence (CoE): To facilitate

free antiretroviral therapy (ART) for eligible persons provision of tertiary level specialized care and
living with HIV/AIDS was launched on 1st April, 2004 treatment, second line and alternative first line
in eight Government hospitals located in six high ART, training & mentoring and operational
prevalence States. Since then, the programme has research, ten Centers of Excellence have been
been scaled up significantly both in terms of facilities established in different parts of the country.
for treatment and number of beneficiaries. The ART
• Pediatric Centres of Excellence: The
centres are established in the Medicine department of
Regional Paediatric ART Centres established
Medical colleges and District Hospitals mostly in the
under NACP III have been upgraded now as
Government sector. However, some ART centres are
Paediatric Centers of Excellence for Paediatric
functioning in the sub-district and area hospitals also,
care including management of complicated
mainly in high prevalence States. The ART centers
opportunistic infections, training and research
are set up based on prevalence of HIV in the district/
activities. These centers have varying roles and
region, volume of PLHIV detected and capacity of the
responsibilities for delivery of care and support
institution to deliver ART related services.

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Chapter - 24

to infected children including specialized ‘ART Plus’. All the States have been covered
laboratory services, early diagnosis of HIV under this scheme.
among infants, ART to children infected with
HIV, counseling on adherence and nutrition, etc. • Care & Support Centres (CSC): It provides
These centres also provide technical support to linkages and access to essential services,
the other ART centers in Paediatric care. supports treatment adherence, reduces stigma
and discrimination and improves the quality
• ART Plus Centres: In order to provide easy of life of PLHIV across India. More than 60%
access to second line ART, NACO expanded of CSC are implemented by PLHIV network
the number of centres that provide second line making it the biggest community led care and
ART by upgrading some of the ART centers as support intervention.

Fig. 24.7.3: Scale-up of Care, Support & Treatment services across the country under the Care, Support
and Treatment Programme

12,00,000 ART SCALE UP IN INDIA (PLHIV) 1,133,950 600

1,050,326
No. of patient on ART No of ARTC
10,00,000 940,187 500
851,883
768,000
8,00,000 632,397 400
No. of Patients

6,00,000 516,412 300

404,882
4,00,000 315,640 200
223,223
2,00,000 140,654 100
6,845 69,016
37,368
0 0
Mar.200 Mar.200 Mar.200 Mar.200 Mar.200 Mar.201 Mar.201 Mar.201 Mar.201 Mar.201 Mar.201 Mar.201 Mar.201
Aug.2017
5 6 7 8 9 0 1 2 3 4 5 6 7
No. of patient on ART 6,845 37,368 69,016 140,654 223,223 315,640 404,882 516,412 632,397 768,000 851,883 940,187 1,050,326 1,133,950
No of ARTC 25 54 107 147 211 269 300 355 400 425 475 525 531 532

Comprehensive HIV care under Care Support and irrespective of CD4 count and WHO clinical stage,
treatment after preparing client for life long therapy. National
programme is providing standardized, quality
• Baseline Evaluation: All positive clients assured, fixed dose combinations of drugs free of cost
registered at ART centres, undergo a comprehensive through facilities like ART centers and Link Centers.
baseline evaluation focusing on medical as well as The treatment is provided after ensuring proper
psychological State. A list of essential blood tests, management/prophylaxis of opportunistic infections
CD4 count and other medical examination are done and preparedness of client for life long therapy.
for all clients to assess current health status, diagnosis
of co-infections or co-morbidities and establishing a  First Line ART: First-line ART is the initial
baseline profile. The clients having co-infection/co- regimen prescribed for an ART naïve patient.
morbidities are managed accordingly. Simultaneously As per current guidelines, combination of
counsellors at ART centers provides pshyco-social Tenofovir, Lamivudine and Efavirenz is
support through focused counselling and linkages preferred first line regimen.
with PLHIV networks and prepares clients for life
long therapy.  Alternate first line ART: Few patients develop
toxicity/contraindications to first line regimen.
• Standardized Anti Retro Viral Therapy: In such cases the offending/ contraindicated
Anti-Retro viral therapy is provided to all PLHIV drug is substituted. These regimens are called

384 Annual Report | 2017-2018

 Chapter - 24

alternate first line. CD4 testing is done every six months to monitor
the response of ART. During each visit, patients
 Second Line ART: In some clients ART loses are encouraged to visit care and support centers for
its efficacy over time, commonly due to poor psycho-social support and availing various social
adherence. In such cases after confirmation of beneficiary scheme.
treatment failure complete regimen is switched.
The next regimen used subsequently to first • Management of Opportunistic infection:
line is termed as second line ART. Protease Screening, Prophylaxis and Management of various
inhibitors are used for second line in most cases. opportunistic infections is an important part of
comprehensive HIV care. Following intervention are
 Third Line ART: Some clients on second line done at ART centers for this:
ART also experience treatment failure. National
programme rolled out third line regimen  HIV-TB: TB is the most common opportunistic
for them in 2015. Currently Raltegravir and infection among PLHIVs. All patients attending
Darunavir are used for third line regimen. ART centers including new registrations, pre-
ART and on ART patients are screened verbally
 Paediatric ART: The ART in pediatric for 4 symptom complex. In case any one of the
population needs special consideration due to symptom is present patients are referred for
factors as weight, palatability, adherence, etc. TB testing. Those diagnosed with co-infection
National Programme is providing Paediatric are initiated on Anti TB treatment from ART
formulations of Anti Retro Virals. center followed by ART. When TB is ruled
Table- 24.7.1: ART Drugs available for People out, Isoniazide prophylaxis is offered. NACP
Living with HIV/AIDS (PLHIV) in India under the works in close coordination with RNTCP for
Care, Support, & Treatment Programme managing co-infections.
 HIV- Kala Azar: Kala Azar or Visceral
Nucleoside reverse Non-nucleoside Protease Leishmaniasis is endemic in the some districts
Transcriptase reverse inhibitors
of States like UP, Bihar and Jharkhand. All
inhibitors (NsRTI) transcriptase (PI)
PLHIVs with symptoms suggestive of kala
inhibitors
(NNRTI) azar are screened for kala azar and those found
infected are referred for appropriate treatment.
Zidovudine (AZT/ Nevirapine Atazanavir
ZDV) (NVP) (ATV)  Other OIs: PLHIVs are regularly screened
Lamivudine (3TC) Efavirenz (EFV) Lopinavir for co-infection and co-morbidities.
(LPV) Those diagnosed having these are treated
Abacavir (ABC) Ritonavir appropriately at ART center or are referred to
(RTV) concerned facility. Those who are vulnerable
Nucleotide reverse Integrase Darunavir to opportunistic infections due to low CD4
Transcriptase Inhibitors (DRV) count or any other reasons are provided with
inhibitors (NtRTI) prophylaxis, for eg. Co-trimoxazole.
Tenofovir (TDF) Raltegravir
(RGV) • Facilitating long term retention:

• Follow up and monitoring: Patients initiated  Following Retention cascade: The HIV
on ART are regularly followed up on monthly basis. care continuum— also referred to as the HIV
The basic examination including weight measurement, retention cascade—is a model that outlines the
clinical evaluation, and screening for opportunistic sequential steps or stages of HIV medical care
infections is done on every visit. Assessment of that people living with HIV go through from
adherence is done by counsellor on every visit and initial diagnosis to achieving the goal of viral
necessary support is providing as per requirement. suppression (a very low level of HIV in the

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Chapter - 24

body), and shows the proportion of individuals  MIS/LFU Tracking Mechanism: The
living with HIV who are engaged at each stage. information on patients lost to follow up
CST division is closely monitoring retention (LFU) is captured in the CMIS through
cascade as quality indicator at State and Facility the monthly reports from the ART
level. This has been added as an agenda point for Centers. This information is monitored
all reviews. Over last three years improvement very closely and centers with high rates
has been noticed significantly on testing to of LFU are visited by senior officers
treatment linkage and ART initiation rate. Both of NACO. Presently the cumulative
the indicators have reached almost 90% at LFU is about 10%. The responsibility
National level. Currently division is focusing to of tracking and providing home-based
improve 12 months retention. counseling for LFU patients is shared
with CCC through outreach workers,
Fig. 24.7.4: Continuum of Care/Retention Cascade PLHA networks and counselors of ICTC
of People Living with HIV/AIDS (PLHIV) under the in some places.
Care, Support & Treatment Programme during the FY
2017-18 • Linkage and referrals: Comprehensive HIV
care aims to provide quality life to PLHIV
in terms of health, social and emotional
wellbeing. Hence, there are a wide spectrum
of needs that the PLHIV might have and that
can be met through effective linkages to various
service providers. To maintain the continuum
of care, linkages are crucial to ensure retention
in various stages which may be located at
different facilities. To ensure optimum linkages
mechanisms like line list sharing, feedback
forms, referral forms and regular meeting are
established at ART centers with ICTCs/LACs/
CSCs/RNTCP etc.

Fig. 24.7.5: Flow Diagram for People Living with HIV/AIDS (PLHIV) in the country under the Care,
Support and Treatment Programme

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 Chapter - 24

Table- 24.7.2 Current Status of the Care, Support & Treatment Programme in India (as on August, 2017)

Number of ART Number of Link Number of Care & Patients on Patients in pre-
Centers ART Centers Support Centers ART ART care
537 1108 361 11,33,950 1,24,811

Capacity Building  National Distance Learning Seminar

(NDLS): HIV/AIDS National Distance
• Standardized and uniform guidelines: As
Learning Seminar Series (NDLS) was
part of continuous capacity building efforts, technical
introduced in September 2010. The series is
guidelines and training modules have been developed
aimed at building capacities of health care
which are available for use at various facilities and
professionals that provide HIV/AIDS care and
SACS.
treatment services at ART Centres, Link ART
The documents, revised from time to time with the Centres, Care and support Centres (CSCs) and
recommendations of the Technical Resource Groups, other private physicians in coverage of the
can be accessed on the NACO website ([Link]. COEs. During 2017-18 (April – September
[Link]). 2017), 13 NDLS sessions (including one special
NDLS on ‘Recent Updates in ART’) have been
• Training curriculum: To ensure uniform conducted with a total of 3,513 participants
standards of services, adherence to operational with an average of over 1039 participants per
guidelines and treatment protocols, induction/ session, with regular participation from ART
refresher training is provided to various personnel centres, Centre of Excellence and Paediatric
using standard curriculum, training modules and tools Centre of Excellence and CSCs. Average
at identified institutions. Various training programmes participation from ART centres during NDLS
organized under CST programme include: sessions is 245.
 Orientation of faculty of Medical Colleges/  Regional Distance Learning Seminar
District Hospital (4 days) (RDLS): Regional Distance Learning Seminar
Series (RDLS) was launched in year 2012
 Training of Medical Officers (SMO/MO) of
aimed at training healthcare workers at ART
ART centers (12 days)
Centres, Link ART Centres and Care and
 Training of Medical Officers of Link ART Support Centres on locally relevant topics,
Centers (3 days) unique case studies and treatment guidelines
often in local/regional languages. RDLS is
 Training of ART Counselors (12 days) conducted at the regional level and specifically
addresses the issues pertaining to the respective
 Training of Data Managers of ART Centers (3
state and/or region. The lectures are presented
days)
by regional experts on the topics chosen by
 Training of Laboratory Technicians for CD4 the regional medical. During 2017-18 total 50
count (2 days) RDLS sessions have been conducted, reaching
to total of 5,014 participants with average of
 Training of Pharmacists (3 days) 100 participants per session. Besides these,
 Training of Nurses (6 days) with the launch of ‘Implementation of Treat All
policy at ART centres’ 11 special RDLS sessions
• Distant Learning: As an innovative approach were also conducted during July-August 2017
toward efficient capacity building, NACO with which had a total of 1,642 participants from all
support from I-TECH has introduced distant learning over the 393 ART & ART plus centres, 10 CoEs
platforms and e-library. The details are as following: & 7 pCoEs.

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Chapter - 24

o E-Articles: I-TECH provides all CoEs with the Nodal Officers of the ART center, representative
free subscriptions and access to key e-journals. of Civil Society/ positive network and NACO. This
In addition, I-TECH senior medical advisors mechanism ensures that issues pertaining to grievances
select and circulate recent, pertinent e-articles of PLHIV are brought to the notice of state authorities
every week to all Centres of Excellence which and SACS in a systematic manner for timely response.
then disseminate these articles to designated
ART centres and other facilities in their • Monitoring and Mentoring
respective catchment areas. E-articles are also  National Review Meeting: Review meetings
sent as on request by any SACS or CoE or pCoE. of all the CST officers from the state and all
During 2017-18 (April – September, 2017), 94 NACO Regional Coordinators are held on a
e-articles have been shared by I-TECH. regular basis in a standard format. During these
• PG Diploma: NACO, in collaboration with meetings, the State officers give an update on
IGNOU, has rolled out a one-year PG Diploma the various CST related activities in their state
programme in HIV Medicine. This programme is and wherever required remedial measures are
expected to bridge the gap in trained manpower for taken.
ART centers. Objectives of this programme are:  State Review Meeting: Regular State level
 To imbibe comprehensive knowledge on basics review meetings of the programme are
of HIV as related to details of management of conducted at SACS level. These meetings are
HIV/AIDS in tertiary care set up; attended by representatives of NACO, SACS,
Regional Coordinators, Medical Officers and
 To manage all complications as well as
staff of ART centers and other facilities. Review
opportunistic infections due to HIV/AIDS at
of the performance of individual centers is
the time of need; and
undertaken during such meetings. Participants
 To recognize and handle emergencies related are given refresher/reorientation sessions also
to HIV/AIDS and its complication and take during such meetings
bedside decision for management whenever
required.  Quarterly Feedback: The current need of
programme is to focus on quality improvement
Endeavors to enhance and ensure the provision of to provide better services to the community.
high quality services Data monitoring and analysis can be an
effective tool for identifying the gaps and plan
• TRG: Technical Resource Groups have been intervention for quality improvement. Based on
constituted on ART, Pediatric ART and Care & Monthly Progress Report and IMS data of April
Support services. These groups consist of national to June 2017, basic analysis of key indicators is
and international experts and representatives of being done on quarterly basis and shared with
organizations like WHO, CDC, Clinton Health Access States. The purpose of this analysis is to provide
Initiative and Networks of Positive People. They feedback and flag key issues to the States for
review the progress and give valuable suggestions and their understanding and further planning.
recommendations on various technical and operational
issues relating to the programme. Meetings of TRGs New Initiatives in Care Support and Treatment
are held periodically with clearly drawn agenda and
issues for discussion. Test and Treat Policy: The Guidelines on when to
start ART has been changing over the years as newer
• SGRC: At the State level, Grievance Redressal evidence became available from time to time. NACO
Committee has been constituted to routinely review has revised its policy regarding ART based on WHO
the functioning of the ART Centers. The Committee recommendations, scientific evidences and TRG
is headed by the Health Secretary of the State and recommendations. Guidelines have changed from
consists of Project Director of the SACS, Director of ART initiation at CD4 200 in 2004 to CD4 500 in
Medical Education, Director of Health Services and 2016.

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Launch of Test and Treat All Policy, February, 2017

Hon’ble HFM approved Treat All policy in Feb-2017 TB, Isoniazid preventive therapy (IPT) for all PLHIV
and declared the commitment of Government towards and robust airborne infection control (AIC) at ART
this in Parliament in March, 2017. The policy was centres to ensure early detection and reduce the risk
rolled out in April, 2017. of TB transmission.
Moving from CD cut off 500 to Treat All is a major Intensified LFU Drive: Since ART is not really a
way to reduce new HIV infections, reduce progression cure, but a lifelong treatment – it is imperative that
to AIDS and prevent TB among PLHIV. once initiated, the patients’ need to take the treatment
throughout their lives and adhere to strict norms. But
To ensure optimum benefit of the policy, all ART due to many compounding factors, some individuals
centers have been instructed to actively follow up who initiated their treatment with the ART centres
clients under “Pre-ART care” and initiate ART in stop coming back and discontinue therapy –these
these clients. 1 lakh PLHIV has been initiated on ART are termed as Lost to Follow-up (LFU). This poses a
from May-2017 to Aug-2017. significant challenge to the national programme. One,
Single window HIV-TB management: NACO and if the individuals stop taking the drugs will lead to a
Central TB Division (CTD) had made the decision to faster progress of the disease causing morbidity and
provide single window services for management of mortality. Second, the interruption in the treatment
HIV-TB co-infections at ART centres so as to improve may lead to drug resistance and resistant viral strains.
access to HIV-TB care and ensure seamless services to Third, critically affects the prevention programme as
PLHIV. Further, to reduce the risk of TB transmission, viral suppression because of ART becomes ineffective
NACO has also initiated measures to strengthen TB and the individual becomes infectious.
infection control practices at ART centres. These The national programme has made some significant
measures include intensified case finding (ICF) for

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Chapter - 24

efforts to track the LFU cases include however • Focusing on prevention of LFU
systemic challenges such as maintaining accurate
and complete addresses of the patients, duplication • Deduplication exercise on National data to
of patients’ record, registration of patients at multiple check if untraceable clients are re-registered
ART centres, completeness of records at centers, somewhere in the programme.
and regular use of data for improvement in service LPV/r pellets: Lopinavir boosted with ritonavir is
provision still needs to be strengthened further. part of preferred regimen for HIV positive children
The preliminary analysis of existing records showed below 3 years of age as per current guidelines.
that out of approximately 4.9 lakh reported LFU, 67% However, challenges presented by the currently
were in pre-ART stage and 32% were on ART during available formulations, LPV/r oral syrup, make this
their last visits in programme. Following graph shows recommendation difficult to implement. The LPV/r
year of last visit for LFU: oral solution requires a cold chain until the point of
dispensing and has an unpleasant taste. The complexity
of dosage calculation and adherence assessment of
Fig. 24.7.6: Distribution of Lost-to-follow-up LPV/r oral solution makes its use further difficult and
(LFU) among reported Lost-to-follow-up (LFU) leads to the limited uptake of LPV/r based first line
according to their last visit under the Care, regimen. Recently CDSCO approved a heat-stable oral
Support and Treatment pellet formulation of LPV/r which has the potential
to improve availability of optimal LPV/r containing
Year of last Visit among reported LFU 2016 first-line regimens to a vulnerable population. NACO
11% has introduced this formulation for use in National
Programme to benefit children living with HIV in
2015 country.
Before 2010 11%
40%
2014 24.8 LABORATORY SERVICES
10%
2013 Laboratory Services division functions at the cross-
2011 2012 9% cutting interface of all other divisions. It is recognised
9% 10% that work related to laboratory services are not just
confined to HIV testing, but are overarching and
Programme Outcome so far: The analysis suggests have an impact on other interventions included those
following results under prevention, care, support and treatment, STI
management, blood safety, procurement and supply
• 36.5% of reported LFU are untraceable; either chain management. Emphasis on quality assured
valid contact details are not available or client laboratory service delivery is important to the success
has migrated without a forwarding address of the National AIDS Control Programme (NACP).
Universal availability and routine access to quality
• 10% has a definite outcome (tracked back/
assured HIV related laboratory services is ensured in
confirmed death) and another 10% are
all service delivery points through this division. In
contacted successfully and are being counselled
NACP IV, laboratory services have been positioned as
for rejoining care.
an independent division at the state level as well.
• 36% have not yet been contacted through
The assurance of quality in HIV testing services
outreach.
through the implementation of External Quality
Next steps planned by the division in context of LFU Assessment Scheme (EQAS) for HIV and CD4
drive includes testing has been addressed in NACP with special
focus. NACO launched “National External Quality
• Tracking clients who have not been contacted Assessment Scheme” (NEQAS) in the year 2000 to
yet, focusing on recent LFUs first assure the standard quality of the HIV tests being

390 Annual Report | 2017-2018

 Chapter - 24

performed in the programme. 17 and 8,15,055 CD4 tests were performed from 1st
April-31st August, 2017
EXTERNAL QUALITY ASSESSMENT SCHEME
(EQAS): To strengthen the implementation of Quality
Management System all Lab Technicians of CD4
The External Quality Assurance Scheme (EQAS) was labs undergo annual training conducted by NACO
set up to ensure high reliability and validity to the HIV and SACS. Around 238 ART Laboratory Technicians
and CD4 tests under the programme and higher levels operating these machines have been trained from
of proficiency in the participating laboratories. April to October, 2017.
NEQAS categorized the laboratories into four tiers, as CD4 EQAS
follows:
NACO established EQAS for CD4 count estimation
•• Apex Laboratory (first tier) - National AIDS for the laboratories linked to NACO ART centers
Research Institute, Pune with a pilot run in April, 2005 for 24 participating
•• National level: 13 (NRLs) (second tier). laboratories. National AIDS Research Institute
(NARI), Pune functions as an apex laboratory for
•• State level: 117 State Reference Laboratories conducting the EQAS for all these laboratories
(SRLs) (third tier) with three rounds every year. NARI, is engaged in
CD4 proficiency program nationwide, that provides
•• Districts-level: all standalone ICTC
stabilized blood samples as proficiency panels to
Thus, a complete network of laboratories has been the participating laboratories, analyzes the data
established throughout the country. Each NRL has received from participating laboratories and provides
attached SRLs for which it has the responsibility proficiency reports to the respective laboratories. The
of supervision. Each SRL, in turn, has ICTC which apex laboratory is co-coordinating all these activities
it monitors. One Technical Officer at each SRL with the support from NACO, Delhi.
is supported by funds from NACO to facilitate
Improvement in Quality Management Systems
supervision, training and continual quality
(QMS) and accreditation of HIV testing
improvement in all SRLs and linked ICTCs.
Laboratories
In last four quarters, the average percentage of
In an effort to strengthen quality of HIV testing,
participation of ICTCs is 87 %, and average percentage
continuous mentoring and supervision to implement
concordance is 99.88%. Apart from the above, NCDC
and improve the QMS of HIV testing laboratories is
Delhi; NICED Kolkata and NIMHANS Bangalore,
undertaken. Lab Service Division is providing support
under supervision of NARI have been identified for
to NRLs/ SRLs for accreditation. Out of 130 referral
panel preparation and evaluation of HIV, HCV and
laboratories (13 NRLs and 117 SRLs), 76 laboratories
HBV kits procured by NACO. These laboratories
(13 NRLs and 63 SRLs) have been accredited
form ‘Consortium for Quality’ developed by NACO
by National Accreditation Board for Testing and
for kit evaluation. In 2017, total 110 batches of kits
calibrating Laboratories (NABL) as per ISO 15189:
are evaluated (including 85-HIV; 11-HBV; and 14-
2012 standards. Apart from this, another 6 SRLs have
HCV).
applied for NABL accreditation.
CD4 Testing
Improvement and Implementation of Quality
There are 278 CD4 testing centres serving 528 ART Management System (QMS) at CD4 laboratories
Centres. These include 165 FACS Count Machines,
To extend the scope of QMS to CD4 laboratories,
28 Calibur machines, 67 Partec machines, 2 Beckmen
NACO has laid Quality standards and implemented a
Coulter 20 Point of Care CD4 machines. All machines
checklist for implementation of Quality in CD4 labs.
procured by NACO are under warranty or maintenance.
A training module was developed in consultation with
18,87,935 CD4 tests were performed in the year 2016-
CST division to train the CD4 lab staff on QMS.

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Chapter - 24

For this, Laboratory Service Division conducted 24.9 INFORMATION, EDUCATION

training of SRL and NRL In-charges, In-charges of & COMMUNICATION &
CD4 labs in case the SRL/NRL is not co-located, MAINSTREAMING
Technical Officer, CD4 Lab Technicians, (through 13
such trainings) total 489 participants were trained. Information, Education & Communication is the
key to create awareness on prevention as well as to
Viral Load Testing to Support Second-Line ART motivate to access treatment, care and support.
The Viral Load (VL) assays are provided for patients Key activities undertaken during the FY 2017-18:
failing first line ART. NACO piloted VL testing at two
centres for ten months from January 2008. Currently, Mass Media Campaigns:
there are ten viral load labs, supporting clinical An annual calendar was prepared to strategize,
decision-making at 17 COEs (including ten paediatric streamline and synergise mass media campaigns with
COEs)-second line centres and 88 ART plus centres other outreach and mid-media activities. A multimedia
for patients estimated to transit to second line therapy. campaign on Condom Promotion "Condom-Ek Aachi
NACO is now planning to expand the Viral Load testing Aadat”, was implemented in two phases across the
for monitoring of all patients on the ART once in a country through various medium.
year. For immediate scale-up, NACO has proposed to
outsource viral load testing on “Turn Key” model basis NACO has bagged three awards for the campaign in
to private providers. Simultaneously, NACO intends the recently held, Outdoor Advertising Awards (OAA,
to institutionalize viral load testing under the program 2017) in Mumbai during 28th - 29th July, 2017. The
through strengthening public labs. This would involve details of awards with theme and categories are given
upgrading public sector laboratories and setting up below table.
necessary equipment to perform molecular testing.
Table-24.9.1: Details of awards with theme and
Additionally, a quality assurance mechanism, similar
categories
to HIV testing laboratory network with inclusion of
EQAS, will be developed for Viral Load.
[Link]. Theme Award
It is proposed to set up 80 units of Viral Load testing 1 Public & Social Service - "Condom Gold
in the country to test nearly 16,00,000 patients. The - Ek Achi Aadat"
proposed 80 sites, will be planned such that the
patients have to travel less for getting their VL test 2 Innovation of the Year - "Signalling Gold
done. a better tomorrow"
3 Best Use of Ambient Media - "A Bronze
National Programme on Early Infant Diagnosis
Bus Stop to Stop AIDS"
(EID) for children under 18 Months
Early Infant Diagnosis of HIV is a National HIV/ Three campaigns on PPTCT and Test & Treat Strategy
AIDS care and treatment program in India with the have been implemented nationally during this financial
objective to diagnose HIV-1 infection in infants and year. Innovative technologies (like advertisements by
children <18 months. Currently, there are 6 EID synchronizing with the traffic signals with outdoor
referral laboratories. The current test of choice is backlit boxes, screenings at movie theatres and
the HIV-1 PCR which detects HIV pro-viral DNA & installation of sun boards at public utilities etc.) were
RNA. Hence, it is used to diagnose HIV-1 infections used to amplify the reach of the campaigns across the
in infants less than 18 months. Initially, there were country.
1157 EID centres where Dried Blood Spot (DBS) of Outdoors
infants are collected. This is being upscale to 5266
standalone ICTCs. From April to September, 2017, Outdoor activities like hoardings, bus panels, pole
total 5725 tests were performed. kiosks, information panels, and panels in railways
and metro trains were implemented by the State AIDS

392 Annual Report | 2017-2018

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Control Societies to disseminate information on HIV XI. SACS have further adapted the NCERT module
prevention and related services. for training of teachers and transaction of AEP in
classroom. Currently, the programme is running in
Folk Media and IEC Vans more than 55,000 schools. The programme which was
National AIDS Control Program has extensively used earlier suspended in Mumbai and Chhattisgarh has
the folk media as an innovative tool for developing been resumed due to continuous efforts at National as
an effective communication package to reach the well as State level. State-wise details of AEP is given
unreached in the remote and media dark areas and in the table 9.2.
especially in rural areas. Folk troupes have been Red Ribbon Clubs (RRC): Red Ribbon Club
selected and trained on standardize scripts prepared (RRC) Programme is a comprehensive promotional
by SACS and vetted by NACO. Folk performances and preventive intervention to harness the potential
are completed by folk troupes in remote villages of youth in educational institution, specifically to
as per route plan as planned by SACS. Budgets are mainstream HIV & AIDS prevention, care & support
earmarked to 21 State AIDS Control Societies for the and treatment, Impact mitigation, stigma reduction
State level folk workshops and folk performances for and enhance voluntary blood donation. It also prepares
the current financial year. State level Folk Workshop and promotes youth peer educators within and outside
has been organised in 7 States (out of 21 as planned in the campuses. More than 12000 clubs are functional
the Annual Action Plan of the States). The campaign and are being supported for these activities. State-wise
has been rolled out in these 7 States (till September, details of RRC is given in the table 24.9.2.
2017).
Table-24.9.2: Adolescence Education Programme
(AEP) and Red Ribbon Clubs (RRC) across the
country during the FY 2017-18

States/UT No. of No. of

AEP RRC
Andaman & Nicobar Islands 101 8
Andhra Pradesh 6783 600
Arunachal Pradesh 50 25
Folk performance by folk troupes Assam 0 209
Helpline Bihar 0 391
Chandigarh 133 25
The National Toll Free AIDS Helpline 1097 has
received more than 19 lakhs calls till September Chhattisgarh 0 50
27, 2017. The helpline is available Hindi, English, Dadra & Nagar Haveli 26 3
Punjabi, Bengali, Telugu, Tamil, Marathi, Kannad, Daman & Diu 35 6
Oriya, Assamese, Malayalam and Gujarati. This Toll Delhi 0 82
Free Helpline no. 1097 is being promoted in all the
outdoor activities. Goa 429 140
Gujarat* 10266 300
Adolescence Education Programme (AEP): AEP is
Haryana 3351 226
a key intervention to build life skills of young people
and help adolescents cope with negative peer pressure Himachal Pradesh 0 285
and develop positive behaviour improving awareness Jammu & Kashmir 500 116
on sexual health preventing HIV infections. Under Jharkhand 1400 127
the programme, sixteen hour sessions are scheduled
Karnataka 5398 1527
during the academic terms of classes VIII, IX and

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Chapter - 24

States/UT No. of No. of Department of Internal Security

AEP RRC The 15th Memorandum of Understanding (MoU) was
Kerala 4000 375 signed NACO and Department of Internal Security
on 1st September, 2017. The MoU was signed by Shri
Madhya Pradesh 0 650
Sanjeeva Kumar, Additional Secretary & Director
Maharashtra# 183 1170 General, NACO and Dr. Mukesh Saxena, Additional
Manipur 22 46 Director General Medical CAPFs, NSG & AR,
Meghalaya 50 50 Department of Internal Security, Ministry of Home
Affairs, Govt. of India. Senior officials from NACO
Mizoram 0 41
and MHA were presented during the signing of MoU.
Nagaland 958 71
The MoU aims to a) Reach large number of Central
Odisha 0 662
Armed Police Forces with information on preventions
Puducherry 250 70 and control of STI/HIV/AIDS; b) Facilitate building
Punjab 5000 500 of humane perspective and appropriate skills among
Rajasthan 0 600 police force to reduce stigma and discrimination
against PLHIV and MARPs; c) Integrate STI/HIV/
Sikkim 60 90 AIDS services in the medical and health services
Tamil Nadu 9580 2021 under the control of Department of Internal Security,
Telangana 6783 770 Ministry of Home Affairs; and d) Direct all forces
Tripura 200 26 under purview of Department of Internal Security to
include the issue of HIV/AIDS in the training.
Uttar Pradesh 0 443
Roll out of MoUs in States/UTs
Uttarakhand 0 250
West Bengal 0 424 The progress in roll out of MoUs at the state level
has been quantified based on the process indicators
India 55,558 12,379
and output indicators. The process indicators
*Including Ahmedabad District AIDS Control Society; and were nomination of nodal officer by department,
#Including Mumbai District AIDS Control Society constitution of joint working group, meeting of joint
Signing of Memorandum of Understanding (MoU) working group, & action plan developed etc.
between National AIDS Control Organization and

Signing of Memorandum of Understanding (MoU) between National AIDS Control

Organization and Department of Internal Security, September, 2017

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 Chapter - 24

Table-24.9.3: State-wise details of Roll Out of MoUs with the Output Indicators during the FY 2017-18
(till September, 2017)

Sl. No. Indicators Number

Trainings
1 Number of People Trained (Govt. Departments, PSU/Private Sector, Civil Society) 54877
2 Number of Resource persons trained (TOT) 2135
3 Number of Institutions incorporated HIV Module in training 76
IEC
4 Number of hoarding erected by Dept./PSUs 211
5 IEC material developed/displayed 46
6 No. of IEC material developed electronically 6
7 Any other IEC activities 30
Services
8 Number of ICTC established 16
9 Number of FICTC established 27
10 Number of STI clinic established 8
11 Integration of TB detection or treatment in any facility 7
PSU/Private Sector
12 Number of PSUs and Private Sector mapped 595
13 Number of PSUs and Private Sector approached and meetings held 270
Social Protection
14 Number of Directives issued by Govt. to include HIV (Inclusive) 27
15 Number of Directives issued by Govt: for specific schemes (Exclusive) 23
Directives from Other Departments
16 Number of Directives issued by other Departments 126
Knowledge Product
17 Directory of HIV Sensitive Social Protection 13

HIV/AIDS Act, 2014 environment for availing services, and is a people

- centric initiative aimed at improved welfare of all
On 11th April, 2017, the Lok Sabha passed the long those affected by HIV. The main objective of the Act
awaited HIV/AIDS Bill, 2014. The Bill was earlier are to address stigma and discrimination, to safeguard
passed by the Rajya Sabha on 21st March, 2017. rights of People Living with HIV (PLHIV) & those
Terming the unanimous passage of the Bill in the Lok affected by HIV, to create an enabling environment
Sabha as "historic", the Hon’ble Union Minister for for enhancing access to prevention & treatment
Health & Family Welfare, Shri J P Nadda said the services, to promote safe workplace in healthcare
government "stands committed for free treatment of setting to prevent occupational exposure to HIV and
HIV patients." The Bill seeks to ensure an enabling to strengthen the system of grievance.

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Chapter - 24

NACO Website redeveloped (NACO), Ministry of Health and Family Welfare,

Government of India organized a mega event in
The official website of NACO was re-developed by Jawaharlal Nehru Stadium (JLN) in Delhi. The
NIC in accordance with the Guidelines for Indian event was attended by more than 2500 people from
Government Website (GIGW) Compliance. The civil society organizations, Central Govt. Hospitals,
Standardisation Testing Quality Certification (STQC) community members, students from schools and
has granted Website Quality Certificate to NACO in colleges, volunteers from NYKS, High Risk Groups
respect of the organisation's official website (URL- (HRGs) & PLHIVs representatives from NGOs,
[Link] on 24th April, 2017, valid for 3 Bilateral and Multilateral Development Partners,
years. officials from different government departments. Smt.
World AIDS Day 2017 Anupriya Patel, Hon’ble MoS for Health & Family
Welfare, Government of India as the Chief Guest , Ms.
World AIDS Day (WAD) is observed on 1st December Preeti Sudan, Secretary (HFW), Dr. Bilali Camara,
every year across the World. The observance of WAD Country Coordinator, UNAIDS, Dr. Henk Bakedam,
is the commitment of the Government in order to WHO Representative to India, Shri Sanjeeva Kumar,
strengthen HIV/AIDS response and providing care & Additional Secretary (Health) & Director General,
treatment to those infected and affected by HIV and NACO and Shri Alok Saxena, Joint Secretary,NACO
AIDS. The day is an opportunity for people worldwide graced the occasion.
to unite in the fight against HIV, show their support for
people living with HIV and to commemorate people During the event, two key initiatives (National
who have died. On WAD, awareness activities are Strategic Plan on HIV/AIDS and STI, 2017-2024;
implemented at ground root level by States involving and Short clip showcasing Mission Sampark) were
communities, NGO’s, Youth etc. Like every year, launched by Hon’ble Minister of State for Health
this year also, National AIDS Control Organisation & Family Welfare along with the various e-reports,
monographs and National Blood Transfusion Website.

Inagural Function of World AIDS Day on 1st December, 2017 in the presence of Hon’ble Union Minister of State for
Health & Family Welfare Smt. Anupriya Patel in the presence of Secretary (HFW) Ms. Preeti Sudan
and Additional Secretary (Health) Shri Sanjeeva Kumar, WR India and JS (NACO)

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Smt. Anupriya Patel, Hon’ble MoS for Health & Family Welfare launching report on World AIDS Day 2017 Event

National level workshop for Developing

Communication Strategy towards 100% Voluntary
Blood Donation
A National level workshop for Developing
Communication Strategy towards 100% Voluntary
Blood Donation was organized on 8th & 9th May,
2017 at Vishakapatnam under the banner of NACO,
NBTC and CDC-CMAI Project with the objective to
review the various existing IEC materials, which were
developed to strengthen the BTS activities across the
country during the different phases of the National
AIDS Control Programme. Around 60 participants
from various capacities like Central & State Officers
of BTS, VBDs, SACS Youth and IEC officers along
with field experts in Transfusion Medicine, Blood
Donor Counseling, Blood Donor motivation and
recruitment and representatives of Non-Governmental
Organizations engaged in promotion of Voluntary
Blood Donation from different States actively
participated in the workshop and shared their expertise
and concerns to standardize the communication National level workshop for Developing Communication
strategies for 100% VBD. Strategy towards 100% Voluntary Blood Donation

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National Workshop to Review the IEC Prototype Private Sector Response in NACP IV’ was organized
and Development of Communication Strategies by NACO in collaboration with ILO and Goa State
AIDS Control Society on 6th & 7th September, 2017 in
Keeping in view of the shift in need and perception of Panjim, Goa. Industries of Public and Private Sectors,
the target groups and service providers, a Workshop employer organizations, chamber of commerce, trade
to Review Existing IEC Prototype & Development of union, network of positive people, civil societies and
Communication Strategy for Counselling and Testing officials from ILO, NACO and State AIDS Control
Services and STI was held in New Delhi on 2nd & 3rd Societies had participated in the workshop. Team of
August, 2017 with the collaboration of Plan India. This NACO and SACS’ had visited Mormugao Port Trust
review helped in identifying the gaps & challenges in to understand the activities initiated by major port at
the existing material. the workplace and nearby communities. Meeting held
National and Regional Workshops on Strengthening with senior management, medical team and concerned
World of Work Response to HIV officials engaged in HIV/AIDS prevention activities.

The World of Work response to HIV is one of the

strategic priorities of NACP IV in order to strengthen
HIV and AIDS prevention among workforce engaged
in formal and informal sector. A National level
workshop on ‘Strengthening World of Work and
Private Sector Response’ was organized by NACO in
collaboration with International Labour Organization
(ILO) on 16th - 17th February, 2017 in Delhi. As per
the recommendation, a two-day regional workshop on
‘Strengthening Public and Private Sector Response
in NACP IV’ was successfully organized by NACO
in collaboration with ILO and West Bengal State
AIDS Control Society on 11th & 12th July, 2017 in Workshop on Strengthening World of Work Response to
Kolkata. Sharing of good practice on implementation HIV
of HIV/AIDS programme by industries, State specific
representations on ICTC data analysis indicating HIV Consultations on Ideation of Strategies for
positivity trends in different occupations, workplace reduction of stigma and discrimination in health
and experience on reaching worker engage in informal and non-health settings
economy, reducing stigma and discrimination against
PLHIV at workplace were the highlights of the Two consultations on ideation of strategies for
workshop. Team of NACO and SACS had visited the prevention, management and redressal of stigma
head office of Coal India Limited (CIL) to understand in health and non-health setting were organized
the work initiated by Coal India and their nine on 14th and 28th March, 2017 respectively. During
subsidiaries units (Public Sector Units) on HIV/AIDS the consultations, the framework of guidelines for
prevention. Second two-day regional workshop on prevention and management of stigma associated
‘Strengthening Public and Private Sector Response with HIV/AIDS (stigma guidelines) was discussed.
in NACP IV’ was successfully organized by NACO The first consultation was attended by officials from
in collaboration with ILO and Madhya Pradesh State NACO; representatives from various communities
AIDS Control Society on 21st & 22nd July, 2017 in like Female Sex Worker, Injecting Drug Users and
Bhopal. Team of NACO and SACS’ had visited Men have Sex with Men, Transgender, representative
Anant Spinning Mill to understand initiative taken on from civil societies and HIV/AIDS Alliance. The
workplace intervention and bringing awareness among second consultation was attended by representative
youth and nearby communities. In the series, the third from various non-health ministries like Ministry of
regional workshop on ‘Strengthening Public and Empowerment of Person with Disability, Defence,
Road Transport & Highways, Human Resource

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Development, Rural Development, Housing and playing a vital role in creating a new culture of
Urban Poverty Alleviation, Shipping, officials from ‘learning something new’ and ‘broadening our
NACO, consultants from UNDP and ILO. perspective’ through sharing of knowledge and
experiences over informal gatherings.
24.10 RESEARCH AND EVALUATION
• Aligned with the mandate to build capacities
Research & Evaluation is a vital component of in evidence generation, the Research &
Strategic Information Management. Evaluation Division organised a ‘Capacity
• During the FY 2017-18, 12 research studies Building Workshop on Operational Research,
were initiated to generate evidence through Ethics & Data Analysis in HIV/AIDS Research’
operational research on critical gaps in in collaboration with CDC and WHO from
programme implementation. These areas 30 January – 2 February, 2017 at New Delhi.
vary from survival analysis among adult and The workshop focused on priority research
paediatric, EID, HIV-HCV burden among areas identified for evidence generation under
transgenders, vulnerability assessment study the national programme. Participants from
among select female migrant populations, AIIMS, NARI, NICED, STM, NIE, PGIMER,
hard to reach MSM, changing trends in sex Population Council, programme managers
work dynamics and use of new technology, from NACO and SACS attended the Workshop.
understanding sero-discordant settings etc. The participants worked under the guidance of
Mentors, experts in the field of public health
• There are eight studies currently ongoing on and HIV/AIDS research. During the workshop,
priority areas identified by the programme viz. six protocols were developed on key gaps
functional convergence of services among RCH in programme implementation–LFU, issues
and NACP for Key Population and for attendees of adherence, Tenofovir toxicities, strategies
at public health care facilities, biomarkers to to increase detection, congenital syphilis. A
identify immunological and virologic failure, follow-up workshop on Operational Research
service linkages between HIV and family in HIV/AIDS was organised during 16-17
planning to improve use of dual protection October, 2017 to review the status of the studies.
among HIV positive people, prevalence of
WHO recommended TB Symptom Screening • Another capacity building initiative was the
complex among patients attending ART centres, fifth round of NACO Research Fellowship
feasibility of operationalization of immediate Scheme (NRFS). NACO has formulated
ART and testing of counselling intervention, the NACO Research Fellowship Scheme to
dose related pharmacokinetics of Rifabutin promote young scientists enrolled in MD/
during concomitant ritonavir administration in MPhil/PhD in relevant discipline from any
HIV infected TB patients. recognized Indian University. In the 5th round of
NRFS, three fellowships were awarded–2 from
• The Section started a new initiative in the form National AIDS Research Institute, Pune and 1
of Brown Bag Seminar Series with the aim to from Government Medical College, Amritsar.
inform as well as build capacities and knowledge A call for applications was issued followed
of programme managers at NACO and SACS, by selection through a Technical Evaluation
civil society and community, academicians and Committee. Selected candidates have been
scientists, development partners and other key provided financial support from NACO.
stakeholders. The seminar series serves as a
gateway for knowledge sharing, open dialogue • Three Expert Committee meetings were
of information, resulting into cross-learning on organised this year – 16th & 17th meetings of
new developments, programme management the Technical Resource Group on Research
and strengthening NACO’s research agenda. (TRG on R&D) and the 13th Meeting of the
The ‘Brown Bag Seminar Series’ has been NACO-Ethics Committee. The TRG reviewed

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15 research protocols and 5 progress reports capacity building through the PhD and
for technical review; while the NACO-Ethics training initiatives and stakeholder from the
Committee reviewed 5 research protocols for perspective of implementing policies based
ethical review. on programme output;
• Review meetings – This year four review ¾¾ India-Africa (and India-SA MRC) platform
meetings – North Eastern region, Western through partnership in scientific areas
region, Review involving 13 States and one at of common interest, initiating policy
NARI, Pune was undertaken by the Research integration and research knowledge
& Evaluation Division. The team reviewed all exchange across regions; and
the research related activities completed and
ongoing in the States. ¾¾ Indo-US Joint Working Group for technical
collaboration on HIV research.
• Promoting Operational Research at local
levels - This year, there was a consolidated • Exposure visits
effort to promote Operational Research at State ¾¾ To build advocacy for HIV/AIDS
AIDS Control Societies (SACS) and involving research and orient young post graduate
the States in programme formulation, data medical students on the National AIDS
generation, evidence, and planning processes. Control Programme, the Division
Programme Managers from SACS were facilitated exposure-cum-training visits by
involved in operational research studies for Vivekananda College of Nursing, Lucknow
finding localised solutions to programmatic in February, 2017 and by Armed Forces
gaps at State and district levels. Medical College, Pune in September, 2017.
• Synergies with other Key Stakeholders – Interactive discussions and presentation on
all components (incl. research) of NACP
¾¾ Technical coordination with National were held with the visiting students/faculty
Surveys e.g. National Family Health and NACO officers.
Survey (NFHS) and National Sample
Survey (NSS); ¾¾ A key area of focus in the India-Africa
steered South-South collaboration is geared
¾¾ Technical collaboration on Indo-foreign
toward creation of a suitable consortium
collaborative research proposals referred
between Indian and African clinical
by Health Ministry’s Screening Committee,
research centres (CRCs), key population
and intra-mural research projects under
communities and other institutes and
Project Review Committee on STI & HIV,
organizations of regional importance.
Indian Council of Medical Research;
Taking this initiative forward, a nine-
¾¾ Technical collaboration on DBT-ICMR member team consisting of community
programme for integrating the treatment representatives from Kenya and Rwanda
cohorts through NACO and initiating and officials of International AIDS Vaccine
activities for integrating with the proposed Initiative (IAVI) visited India during 13-
national bio-repository in this programme 17 March, 2017 and during 24-28 July,
and enabling storage of treatment samples; 2017. The main objectives of the visits
towards the same initiating policy and were to work towards developing a joint
funding integration; and exploration of joint population based community engagement
studies towards common goals in socio- study protocol between India and Africa
behavioural and epidemiological research key populations with a focus on early HIV
through the platform; detection and social media engagement.
¾¾ Indo-Dutch Collaborative programme The delegation visited NACO on 27th July,
under which NACO is a scientific partner; 2017 to interact and share experiences with

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senior officials of NACO. The teams also national AIDS response. As country moved towards
visited Mumbai District AIDS Control fast track targets and aims to “End of AIDS by 2030”,
Society, TI sites of Ekta Foundation and the system is crucial to assess the progress towards
Humsafar Trust in Mumbai; SPACE an stated targets and goals. There are various information
MSM and TG intervention and YRG CARE management systems at place to manage and monitor
Sites in New Delhi. the patient records and data. Major information
systems of NACO are SIMS (Strategic Information
24.11 DATA ANALYSIS & DISSEMINATION Management System), PALS (PLHIV ART Linkage
UNIT (DADU) System), IMS (Inventory Management System),
Data Analysis & Dissemination Unit (DADU), a key MSDS (Migrant Service Delivery System) & Excel
component of Strategic Information, NACO focuses Based Analytical Tool for Core Group at NGO-TI
on strengthening data quality, use and management, level.
systematic analysis, synthesis, developing Among all, Strategic Information Management
standardized approaches, methods and tools for System (SIMS) is backbone of the programme
quality monitoring, validation and analysis of different monitoring and currently hosted on the MeghRaj
datasets etc. It is mandated to support and supervise Cloud of GoI. The reporting is mostly 80% or more
SACS to strengthen the capacity of staff at various across the components.
levels particularly in analyzing data and making better
use of it in decision making, performing on-site data ladyd (Sankalak), a bulletin of Monitoring, Evaluation
validations and data verification for informing policy and Surveillance division, aims to report progress
making and programme management at all levels of national AIDS response on select key indictors
including field units to SACS upto Central level. including those from the 2020 fast track targets. It
summarizes the data, at national and State level, on
DADU also lays emphasis on knowledge translation as
epidemic and shows progress made under prevention,
an important element of policy making and programme
detection and treatment components for FY 2016-17.
management at all levels. With this in view, DADU
Sankalak will contribute to regular and systematic
has initiated Round 2 of National Data Analysis
analysis and dissemination of the progress on critical
Plan (NDAP) to analyze the huge amount of data
indicators to policy-makers, programme managers
generated under the programme, to develop analytic
and technical staff as well as to other stakeholders in
documents, scientific papers, journal articles, etc. for
the NACP.
publication and wider dissemination and to provide
scientific evidence for programme management by Epidemic Surveillance
strengthening and scaling up appropriate strategies.
HIV Sentinel Surveillance (HSS) and HIV estimates
Second Surveillance Audit of ISO 9001:2008 provide key evidences on the level of the HIV
Certification epidemic and its trends across population groups and
locations. 15th Round of HIV Sentinel Surveillance
An external surveillance audit of implementation of
was implemented between February, 2017 to August,
Quality Management System of ISO 9001:2008 in
2017. It was implemented at 1317 sentinel sites-829
NACO was carried out by STQC auditors during 4-6
sites among ANC clinic attendees and 488 sites among
October, 2017. It was completed successfully without
the high-risk group & bridge population: Female Sex
any Non-Compliance. It just gives indication how
Workers (FSW), Men having Sex with Men (MSM),
NACO professionally work. This can be role model
Injecting Drug Users (IDU), Hijra/Transgender People
for other National disease control programme in the
(H/TG), Single Male Migrants (SMM) & Long-
country.
Distance Truckers (LDT). A brief technical report has
24.12 Monitoring, Evaluation and been prepared from the 15th round summarizing the
Surveillance key findings on HIV level and trends.

Programme monitoring is vital to evidence-based National AIDS Control Organization (NACO),

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Ministry of Health & Family Welfare, Government of Surveillance is information for action and
India periodically undertakes HIV estimation process dissemination of epidemiological investigations.
to provide the updated information on the status of District categorization for decentralized and focused
HIV epidemic in India. The first HIV estimation in response was done as early as 2006. As the programme
India was done in 1998, while the last round was done matured, HSS sites were scaled up across the country;
in 2015. India HIV Estimates 2017 is under progress HRG size estimates were implemented and initiatives
and will provide the most recent evidences on the like use of facility-based data and triangulating them
HIV epidemic in the country and the States/Union with epidemiological data were initiated. All this
Territories on key parameters of HIV prevalence, helped in better understanding of the epidemic and
number of people living with HIV (PLHIV), new subsequent fine tuning of the responses upto the
HIV infections, AIDS-related mortality and treatment district level. In continuation, State epidemiological
needs. fact sheets were published during 2017-18 for
disseminating most recent epidemiological evidences
Under HIV Estimations 2017, “Expert Consultation- up to the district level.
Cum-Capacity Building Workshop” was organized
by Surveillance division from 16-19 August, 2017 at 24.13 PROCUREMENT
Dr. Ramalingaswami Board Room, AIIMS, New
Delhi. The workshop was inaugurated by Shri Procurement are done using funds under the GFATM.
Sanjeeva Kumar, Additional Secretary & Director The World Bank and Domestic Fund, through
General, National AIDS Control Organization Procurement Agent i.e M/s RITES Limited, M/s
(NACO). The workshop was also honoured with Strategic Alliance Management Services Private
presence of Padma Shri Dr Randeep Guleria, Director, Limited and Central Medical Services Society
AIIMS. Representatives from UNAIDS, CDC-DGHT (CMSS). M/s RITES Limited continued to provide
India, WHO India, USAID India and FHI360 also services to the NACO as Procurement Agent in
attended the workshop. terms of the contract signed between National AIDS
Control Organization and M/s RITES Limited on
8th October, 2015 and valid for 2 years. The renewal
of contract in under process. M/s Strategic Alliance
Management Services Private Limited is appointed as
Procurement Agent in the FY 2015-16 and a contract
is signed between NACO and M/s Strategic Alliance
Management Services Private Limited on 14th October,
2015 for 2 years. NACO had also appointed CMSS as
a procurement Agent in the Year 2016.
24.14 ADMINISTRATION
NACO is headed by the Additional Secretary & DG
to the Government of India, who is assisted by the
Joint Secretary, four Deputy Director General, one
Assistant Director General, one Director, one Deputy
Secretary and two Under Secretaries.
Shri Sanjeeva Kumar has taken charge as Additional
Secretary & DG, NACO. Besides the regular staff
(33 Nos.) of the Organization in Group “A”, “B”,
“C” and “D”, there are contractual staff to assist the
Organization in discharging its assigned functions.
The work allocated to the National AIDS Control
Expert Consultation-Cum-Capacity Building Workshop Organization as per the existing Allocation of Business

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Rules, as under: 24.15 FINANCIAL MANAGEMENT

Financial management deals with the review of
¾¾ Inter-Sectoral, Inter-Organisational and
annual plans and budgets, fund flow mechanisms and
Inter-Institutional Coordination, both
accounting and internal control systems. It focuses on
under the Central and State Governments,
financial analysis for programmatic and management
in areas related to HIV/AIDS Control and
use that forms basis for better decisions, reducing
prevention
delays and bottlenecks. This provides reasonable
¾¾ Providing institutional framework for high- assurance that:
end research for control, prevention, cure • Operations are being conducted effectively and
and management of HIV/AIDS and all efficiently in accordance with NACP norms;
coordination in this regard. • Financial and operational reporting are reliable;
¾¾ Dissemination of accurate, complete and • Laws and regulations are being complied with
timely information about HIV/AIDS to NACO, which was co-terminous with 12th Five
motivate, equip and empower people year Plan has been proposed for continuation from
and promotion of measures for effective April, 2017 to March, 2020 with outlay of another
protection against the spread of the disease. Rs. 7300.00 crores by Expenditure Finance Committee.
¾¾ International Co-operation, exchange Key functions:
programme and advanced training in HIV/
•• Budgeting
AIDS Management and Research.
 Preparation of Demands for Grant
¾¾ Promoting research studies in the field of
HIV/AIDS prevention and control.  Preparation for Budget Estimate/Revised
Estimate in consultation with the
¾¾ National Blood Transfusion Council, an
Programme Divisions
Autonomous Body.
•• Accounting functions
¾¾ Matter relating to collection processing and
supply of safe blood. Management of Blood  Annual Action Plan (AAP) Processing
Transfusion Service. and conveying approval
 Releases to State Government for onward
¾¾ All policy matters relating to National
transmissions to the corresponding
AIDS Control Programme, Prevention and
SACS
Control of HIV/AIDS.
 Expenditure accounting of NACO and
The information on the Organization and its various SACS
activities are provided on the NACO website of the  Monitoring of Utilization Certificates
([Link] and is updated from time-
•• Audit Functions
to-time. The website is linked to the Centralized
Public Grievance Redress and Monitoring System  Coordination for statutory as well as
(CPGRAMS) of Department of Administrative internal audit of SACS
Reforms and Public Grievance and Pensions, Ministry  Submission of audit reports to Ministry,
of Personnel, Public Grievances and Pensions. Donor agencies etc.
 Facilitate audit at NACO level
Table-24.15.1: Year-wise Expenditure during the NACP-IV (Rs. in crore)
2014-15 2015-16 2016-17 2017-18
RE Expenditure RE Expenditure RE Expenditure BE Expenditure *
1397.00 1287.39 1615.00 1605.72 1753.00 1749.12 2000.00 1169.26
* Booked Figure up to 13 October, 2017
th

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