NACP IV

BY
Dr. HARSIMRAN
Associate Professor

12/16/2025 1
 HIV/AIDS refers to…
➢ “Acquired Immuno Deficiency Syndrome” (AIDS) or a set of
symptoms and infections resulting from the damage to the human
immune system caused by the Human Immunodeficiency Virus
(HIV).

➢ This condition progressively reduces the effectiveness of the immune

system and leaves individuals susceptible to opportunistic infections
and tumors.

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 GLOBAL SCENARIO
➢ In 2016, There were estimation of 36.7 million population living
with HIV, out of these, 2.1 million were children below 15 years of
age.

➢ Worldwide 1.8 million people became newly infected with HIV & 1
million people were died of AIDS related illness in 2016.

➢ Since 2010, new HIV infections have declines by 47 % among

children and 11% among adults.

➢ The world has committed to ending the AIDS epidemic by 2030.

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 INDIAN SCENARIO
➢ In 2005, There were 5.2 million people in the country having
infection with an adult prevalence 0.91%.

➢ As per status of National AIDS Response in December 2016,

National adult (15-49 years) HIV prevalence in India is estimated at
0.25%.

➢ Prevalence among males was 0.30% and 0.22% among females in

2016.

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➢ The epidemic is greater in

1. Urban area as compared to Rural area.

2. Males as compared to females

3. Those women whose spouses are in transport industry.

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➢ Transmission of HIV infection through

1. Sexual

2. Blood and Blood products

3. Sharing of Syringes and Needles among drug users.

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 HISTORICAL PERSPECTIVE
➢ In 1986 Government set up an AIDS Task Force under ICMR and
established a National AIDS Committee (NAC) chaired by
Secretary, Department of Health and Family Welfare.

➢ In 1987, National AIDS Control Programme was initiated, with

help from the World Bank.

➢ In 1989, a Medium Term Plan for AIDS Control was developed

with the support of the WHO.

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➢ NACP- I:- Launched in 1992-99, focused on national HIV
surveillance system, prevention activities among High Risk groups
and Blood Safety Programme.

➢ NACP- II:- Launched in 1999-2002, focused on scale up of targeted

interventions for HRGs greater involvement of People living with
HIV (PLHIV), community networking and treatment programme.

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➢NACP- III:- Launched in 2007-2012, focused on rapid expansion of
prevention, care and support and treatment efforts across the country
with a focus on increasing services through institutional scale up and
out reach.

❖The two year gap has been attributed to shortage of funds due to
unavailability of donors. This brought the programme to a pause of
nearly 18 months.

➢NACP- IV:- Launched in 2012-2017, aims to accelerate the process of

reversal and to further strengthen the epidemic response in India
through cautious and well defined integration process.

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 NACP-IV Preparatory Process
➢ The strategy and plan for NACP-IV (2012-2017) has been
developed through an elaborate and extensive process.

➢ The process has adopted an inclusive, participatory and widely

consultative approach with 15 Working Groups and 30 sub-groups
covering all thematic areas involving 624 representatives from
central and state governments representatives

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 NACP-IV
➢ Goal:- To accelerate the process of reversal and further
strengthen the epidemic response in India through a well defined,
Integration process.

➢ Objectives:-
1. Reduce new infections by 50% (2007 Baseline of NACP III)

2. Provide Comprehensive care and support to all persons living

with HIV/AIDS and treatment services for all those who require
it.

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 KEY Priorities of NACP IV
1. Preventing new infections.

2. Preventing Parent to child transmission.

3. Focusing on IEC strategies for behaviour change.

4. Providing comprehensive care, support and treatment to eligible

PLHIV.

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5. Decentralising roll out of services including technical support.

6. Building capacities of NGO and Civil society partners especially in

emerging epidemics.

7. Integration HIV services with the health system in a phased manner.

8. Mainstreaming of HIV/AIDS activities with all key central and state

level ministries.

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 Key Strategies
1. Intensifying and consolidating prevention services, with a focus on
HRGs and vulnerable population.

2. Increasing access and promoting comprehensive care, support and

treatment.

3. Expanding IEC services for general population & high risk groups
with a focus on behaviour change and demand generation.

4. Building capacities at national, state, district and facility levels.

5. Strengthening Strategic Information Management Systems.

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 MID TERM APPRAISAL of NACP- IV
➢ Launched in February to August 2016.

➢ It was launched with the objectives as following:-

1. Reviewing the achievements.

2. Documentation of the achievements.

3. Identifying the opportunities.

4. Bridging the critical gaps and the challenges of the programme.

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➢ The partners of MTA of NACP-IV was
1. NACO

2. Technical Experts

3. Representatives of Community and Civil Society

4. Key stakeholders

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• Recommendations from MTA:-
1. Roll out new strategy like Community based testing, Population,
Geo prioritisation.

2. Strengthen STI programme and Prevention of Mother to Child

Transmission of Syphilis.

3. Strengthen the National Blood Transfusion Council (NBTC) and

State Blood Transfusion Council (SBTC).

4. Strengthen SIMS (Strategic Information Management System) *.

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5. Focus on Institutional Strengthening.

6. Streamline financial management.

➢ MTA suggested some thrust area for the remaining period. Based on
these, NSP- 2017-2024 have been formulated in the last year of
NACP-IV.

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 NSP for HIV/AIDS AND STI
(2017-2024)
➢ In 2014, UNAIDS released new ambitious but achievable targets for
HIV treatment scale up from 2015 to be achieve by 2030.

➢ These were set of three targets known as the 90-90-90 as follows:-

1. 90% of all people living with HIV will know their HIV status.

2. 90% of all people with diagnosed HIV infection will receive

sustained anti retroviral therapy.

3. 90% of all people anti retroviral therapy will have viral suppression.

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➢ VISION:- Paving the way for AIDS free India.

➢ Mission:- Attain Universal Coverage, Treatment & Care that are

effective and Equitable needs.

➢ Goal:- Zero New Infections, Zero Deaths and Zero discrimination.

(0-0-0)

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➢ Targets:-
1. Reduction of 75% New infection.

2. 90-90-90 target:- 90% of all people living with HIV must know
their status, 90% of People living with HIV will receive sustained
Anti Retroviral Therapy and 90% of HIV Patients receiving Anti
Retroviral therapy should experience Viral Suppression.

3. Elimination of Mother to Child Transmission of HIV & Syphilis.

4. Elimination of Stigma & Social Discrimination.

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 Package of Services Provided Under
NACP-IV
➢ Targeted Interventions for High Risk Groups and Bridge Population.

➢ Needle-Syringe Exchange Programme (NSEP) and Opioid

Substitution Therapy (OST) for IDUs.

➢ Link Worker Scheme (LWS) for HRGs and vulnerable population in

rural areas.

➢ Prevention & Control STI/RTI

➢ Blood Safety

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➢ HIV Counselling & Testing Services.

➢ PPTCT

➢ Condom promotion

➢ IEC/BCC

➢ Social Mobilization, Youth Interventions and Adolescent Education

Programme

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➢ Laboratory services for CD4 Testing and other investigations.

➢ Free First line & second line ART through ART centres and Link
ART Centres (LACs), Centres of Excellence (COE) & ART plus
Centres.

➢ Paediatric ART for children.

➢ Early Infant Diagnosis for HIV exposed infants.

➢ HIV-TB Coordination.

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➢ Treatment of Opportunistic Infections.

➢ Helpline at the National/State level.

➢ Capacity Building like Establishment support and Capacity

Strengthening, Training, Mainstreaming/Private Sector Partnership.

➢ SIMS through Training and Implementation of SIMS, Monitoring

and Evaluation, Surveillance, Research.

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 HIV Care in General Health System
Public Health Three-Tier Model of HIV Treatment Service
Infrastructure
Selected CoE 10
Medical PCoE 7
CoE &
Colleges ART plus 37
ART +
Centre 54
Medical
colleges and ART Centres
District Level (448)
Hospitals
Sub-District
level Hospitals Link ART Centres and LAC Plus Centres
& CHC (987)

Total CST Facilities:( 1435)

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 New Initiatives under NACP-IV
➢ Establishment and scale up of interventions for Trans genders.

➢ Female Condom Programme.

➢ Scale up of Multi-Drug Regimen for Prevention of Parent to Child

Transmission (PPTCT).

➢ Establishment of Metro Blood Banks and Plasma Fractionation

Centre.

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➢ Launch of Third Line ART and scale up of first and second Line
ART

➢ Demand promotion strategies specially using mid-media e.g.,

National Folk Media Campaign & Red Ribbon Express and buses.

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 National AIDS Control Organisation
(NACO)
➢ Established in 1992 as a separate wing under the Department of
Health, Ministry of Health & Family Welfare.

➢ National AIDS Control Programme is a fully funded Central Sector

Scheme implemented through State/ UT AIDS Control Societies
(SACS) in States/Union Territories (UTs) and closely monitored
through District AIDS prevention and control unit (DAPCU) in 188
high priority districts.

➢ Currently, National AIDS Control Programme (NACP)-IV

(extension) is under implementation for the period 2017-20.

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 Budgets of NACP IV

Prevention 8,495.80 Cr

Care, Support and Treatment 3,961.15 Cr

Institutional Strengthening & 569.70 Cr

Project Management

SIMS 388.40 Cr

Total Budget 13,415.05 Cr

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PREVENTION AND CONTROL
1. INFORMATION, EDUCATION, AND COMMUNICATION (IEC):
2. PREVENTION OF BLOOD BORNE AND PARENTERAL HIV
TRANSMISSION.
3. PRE ART CARE
4. ADMINISTRATION OF ANTI-RETROVIRAL THERAPY (ART)
5. PREVENTION OF PARENT-TO-CHILD TRANSMISSION
(PPTCT)
6. PROTECTION OF THE HEALTHCARE WORKERS
7. Suraksha clinic -are a chain of STI/RTI clinics. These
clinics are established by national AIDS control
organisation for the better health services and for the
prevention of HIV/AIDS in India.
8. HIV with TB: in patients with HIV-related TB, the
priority is to treat TB, especially smear-positive
pulmonary TB.
However, patients with HIV-related TB can have ART and
anti-tb treatment at the same time, if managed carefully.
[Link] of HIV-infected children: the
immunization schedule of HIV infected children is
more or less similar to that for other children,
except that BCG should not be given to
symptomatic HIV positive children but it can be
given to the new-born child, even if the mother is
HIV positive.
[Link] sentinel surveillance. HSS is done on
antenatal cases and high-risk groups.
ESTABLISHMENT OF ANTI-RETROVIRAL
THERAPY (ART)
• Board of governors in super-session of medical council of
India has issued an amended gazette notification, dated
25th June 2019, wherein establishment of ART center
is mandatory for all medical colleges, which are
functional for more than 4 years
• Around 30 government and 198 private medical
colleges are functional for more than 4 years and do
not have an ART centre.
• For medical college (government or private) which do not
have an ART center, NACO to provide drugs and technical
support while HR and infrastructure is supported by
institutes
• For medical colleges (government) where ART center is
already functional with NACO support, medical colleges may
take over the HR and recurring cost component of ART
centers in phased manner
• For medical colleges (private) where ART center is already
functional in PPP mode, it is proposed to continue to same
approach .
 BLOOD TRANSFUSION
SERVICES
• Promoting voluntary blood donation; screening for
HIV and other transfusion transmissible infection;
• Strengthening quality management systems and
capacity building
• Around 12 million blood units collected in 2018-19.
 SURAKSHA CLINIC

• PRE-PACKED STI/RTI COLOUR CODED

KITS : pre- packed colour coded STI/RTI kits have
been provided for free supply to all designated
STI/RTI clinics. These kits are being procured
centrally and supplied to all state AIDS control
societies.
KIT 1 GREY FOR URETHRAL DISCHARGE,ANO-RECTAL
DISCHARGE AND CERVICITIS
KIT 2 FOR VAGINITIS
GREEN
KIT 3 FOR GENITAL ULCERS
WHITE
KIT 4 BLUE FOR GENITAL ULCERS
KIT 5 RED FOR GENITAL ULCERS
KIT 6 LOWER ABDOMINAL PAIN
YELLOW
KIT 7 FOR INGUINAL BUBO.
BLACK
 Information, education and
communication
• To increase knowledge among general population (especially youth
and women) on safe sexual behaviour
• To sustain behaviour change in high risk groups and bridge
populations;
• To generate demand for care, support and treatment services; and
• To make appropriate changes in societal norms that reinforce positive
attitude, beliefs and practices to reduce stigma and discrimination.
• Adolescence education programme: this
programme runs in secondary and senior secondary
schools to built up life skills of adolescents to cope with
the physical and psychological changes associated with
growing up.
• Under the programme, 16 hour sessions are scheduled
during the academic terms of class IX and XI.
• State AIDS control society have further adapted the
modules after state level consultations with NGOs
academicians, psychologists and parent-teacher bodies.
• This programme is being Implemented in 23 states and
by march 2014, 49,000 schools have been covered.
• RED RIBBON CLUBS: The purpose of red
ribbon club formation in colleges is to encourage peer-
to-peer messaging on HIV prevention and to provide a
safe space for young people to seek clarifications of
their doubts and myths surrounding HIV/AIDS.
• It also promote voluntary blood donation among
youth.
 THANK YOU
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