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Delhi Scenario of HIV/AIDS

Delhi Scenario of HIV/AIDS. Dr. A. K. Gupta MD (Pediatrics) Additional Project Director Delhi State AIDS Control Society. DELHI SCENARIO (March 2012). Total population - 18 million, First case- 1988 Estimated PLHAs (2011)- 36,000 Low prevalence state (Prevalence in Gen.

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Delhi Scenario of HIV/AIDS

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  1. Delhi Scenario of HIV/AIDS Dr. A. K. Gupta MD (Pediatrics) Additional Project Director Delhi State AIDS Control Society

  2. DELHI SCENARIO (March 2012) • Total population - 18 million, First case- • 1988 • Estimated PLHAs (2011)- 36,000 • Low prevalence state (Prevalence in Gen. • population- 0.2%) • Highly vulnerable state- (Migrant labour- • 0.88 million, Truckers stationed/day-35000) • Total high risk population ->1.00 Lakh • HIV +VE Regd. In HIV Care At ART Centers : 36452 • Eligible patients actually started on ART- 17997 • No. Currently Alive & on ART-10822 • LFU (7%), Died (8%) or Transferred out to other states(21%)

  3. CATEGORIZATION OF DISTRICTS IN DELHI

  4. PERINATAL OTHERS I.D.Us BLOOD TRANSFUSION SEXUAL

  5. HIV Trend Among Ante Natal Cases, Delhi

  6. Declining HIV Positivity rate in ICTC of Delhi 2007-2011

  7. NACP-III (2007-12) : Goal & Objectives Goal: To halt and reverse the epidemic in India over the next five years Objectives: • Prevent new infections by saturating coverage of HRG through TI and scaled up interventions in the general population. • Provide greater care, support and treatment to larger numbers of PLHIV • Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment programme at district, state and national levels • Strengthen the nationwide SIMS

  8. Prevention Care, Support & Treatment Strategic Information Management Capacity Building Care & support Monitoring and Evaluation Institutional Strengthening High risk populations Low risk populations • Targeted interventions • STI care • Condom promotion • Enabling environment • HIV Sentinel Surveillance • Behavioural Surveillance • Monitoring and evaluation • Operational research • Blood safety • Integrated Counselling and testing including PPTCT • STI Care • IEC and social mobilisation • Mainstreaming • ART • HIV-TB Co-ordination • Treatment of Opportunistic Infections • Community Care Centres • Post-Exposure Prophylaxis • DAPCU • Technical Resource Groups • Enhanced HR at NACO, SACS and districts • Enhanced training activities

  9. Status Of Targeted Intervention (TI) Projects 2011-12

  10. Integrated Counseling & Testing (I.C.T.C) (93 centres)

  11. Testing algorithm

  12. Rationale For PPTCT Services in Delhi • Annual pregnancies - 2.5 lakh • HIV infected pregnancies - 500 35% Transmission rate * • Infected newborns - 175 *Risk of transmission without PMTCT intervention (WHO 2010)

  13. Early Infant Diagnosis Launched in Dec 2010 EID Test Lab for DNA-PCR testing-1 (NCDC, New Delhi) EID sample collection sites- 19 ICTCs Whole Blood Collection for DNA-PCR sites (ART centers)- 7

  14. Procedure for heel prick 5-10kg infants • Warm the area • Wash hands, put on gloves • Position baby with foot down • Clean area, dry 30 sec • Press lancet into foot, prick skin • Wipe away first drop • Allow large drop to collect • Touch blood drop to card • Fill entire circle with drop • Fill at least 3 circles • Clean foot, no bandage <5kg infants Overhead 4-5

  15. Valid DBS specimen Overhead 4-34

  16. TB-HIV Collaborative Activities

  17. TB and HIV in India • Highest TB burden in the world • 1.8 million TB cases per year • 3rd highest HIV burden • 2.3 million PLHA (2007) • Prevalence 0.34% (adult population) • Estimated HIV-TB co-infected: 55,000-65,000

  18. Risk of TB in HIV Patients HIV patients are at an increased risk of: • Acquiring latent TB • Developing active TB once infected with M. tuberculosis • Becoming re-infected with a second strain of TB • Relapsing after stopping treatment Lifetime Risk of TB Source: NACO

  19. Revised guidelines for starting ART for HIV TB co-infected patients • All HIV infected TB patients need to be started on ART • with CD4 count <350 (in case of pulmonary TB) and • irrespective of CD4 count in case of extrapulmonary TB • within 2 weeks of starting ATT • NACO, November 2008

  20. Anti Retroviral Treatment

  21. Goals of ART Clinical goal To prolong life & improve quality of life 2. Virological goal Greatest possible reduction in viral load for as long as possible to halt disease progression and to prevent or delay resistance 3. Immunological goal Immune reconstitution - CD4 within normal range

  22. WHEN TO START? - Initiation of ART in Adults and Adolescents National Guideline Revised National Guideline (April 2009)

  23. National ART regimen First-line ART: First-line ART is the initial regimen prescribed for an ART naïve patient when the patient fulfils national clinical and laboratory criteria to start ART. (Current NACO treatment guidelines for first-line ART recommends two classes of drugs for initial treatment ie 2 NRTI + 1 NNRTI.) Zidovudine / Lamivudine / Nevirapine Or Stavudine / Lamivudine / Nevirapine ( Efavirenz in place of Nevarapine if coinfected with TB or side effects with NVP, Tenofovir for special situations only)

  24. Initiating ART: Patient Education • It is not curative, but prolongs life • Treatment is lifelong, expensive • High level of adherence is critical (>95%) • Short and long term adverse events • Drug interactions • Safer sex still essential • Do not share drugs with friends , family members Start ART when patient is ready

  25. SUCCESSFUL HIV THERAPY REQUIRES RIGOROUS ADHERENCE • >95% adherence necessary to achieve viral load <400 copies/mL in 81% of HIV patients • A 10% reduction in adherence was associated with a doubling of HIV RNA level • 80% adherence may be sufficient to achieve therapeutic goals in other chronic disease states (e.g., hypertension)

  26. Cumulative Outcome of PLHAs on ART, India

  27. Special Achievements of DSACS under NACP III Financial Assistance to Poor PLHAs and Orphan children by Delhi Govt Free Investigations including CT Scan, MRI, blood and other tests of PLHAs in HIV care at ART centers of Delhi Free Blood / Blood products for PLHAs without processing fees and without replacement donations Launch of First Post Exposure Prophylaxis toll free interactive voice response helpline in the country (dial 1097 and select option 6) for prevention of HIV, HBV & HCV in Health care Workers during occupational exposure. Setting up of First Youth Friendly health Centre in Delhi in collaboration with DSHM/NRHM at JamiaMiliaIslamia in August 2010. Mapping of massage parlors for the first time in the country- in New Delhi, Central, North, North- West and South Delhi districts with aim to assess the Knowledge, Behavior, Attitude and practices of the workers, clients and owners of 1050 massage parlours and categorize them by assessment of vulnerability. 18% massage parlours observed to be having risky behavior activities. Training of NRHM Grass-root level functionaries –ASHAs, ANMs etc

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