As per the topic,i.e.,CURRENT STATUS AND

CHALLENGES IN THE TREATMENT OF

AIDS , a project report in the form of a power

point presentation has been presented here.

This presentation deals with all the information

and researches that I have gone through in the

last three weeks according to my topic.

• Adult HIV prevalence: 0.31%

• 10% of the world's HIV/AIDS population live in India

• New annual HIV infections has declined by more than 50 percent during the last decade, 2.7 lakh in 2000 to1.2 lakh in 2009.

• Majority of infected individuals are in 15 – 45 yrs age group, Male-female ratio – 2 : 1

• Every year in India, over 100,000 pregnant women with HIV give birth

HIV estimates for India (2007)

Category Estimation

Total population 1.027 billion

HIV prevalence (15-49 years) 0.34%

HIV prevalence among men (15-49 years) 0.40%

HIV prevalence among women (15-49 years) 0.27%

Number of people living with HIV (adults and

children)2.31 million

Number of Children living with HIV (>15 years) 3.8% of total

Then I studied about the Routes of Transmission of HIV, India, 2010-11

To Prevent the country from felling prey to this Epidemic various steps had to be taken by the Central Government . Since, every country and every government needs to have a solution to deal with such an issue; the Indian Government formulated the National AIDS Control Program.

I have gone through various objectives and functions of the three different phases of NACP and have tried to describe them in brief.

National AIDS Control Programme

Phase-I (1992 - 1999) was implemented across the country with objective to slow the spread of HIV to reduce future morbidity, mortality, and the impact of AIDS by initiating a major effort in the prevention of HIV transmission.

Phase-II (1999 - 2006) was aimed at reducing spread of HIV infection in India and strengthen India's capacity to respond to HIV epidemic on long term basis.

Phase-III (2007-2012)was based on the experiences and lessons drawn from NACP-I and II, and was built upon their strengths.

From my research I have tried to conclude India’s response to the epidemic in such a way

Targeted Interventions projects:

1,385 under various State AIDS Control Societies (SACS)

Access to safe blood:

1,127 Blood Banks & 155 Blood Component Separation Units

Syndromic Case Management

1,038 designated STI/RTI clinics, + 90 new

Laboratory support for CD4

211 CD4 machines

Counselling and testing services:

5,233 stand-alone ICTCs, 1,632 facility integrated ICTCs.

Then I went through the Integrated Counselling And Testing Centers (ICTC) and found that they had

• Voluntary HIV testing with appropriate pre-and post-test counseling

• Confidentiality

• No Test & Treat Approach

9

I have also studied about the Antioretroviral therapy(ART) in India which was as follows

Free ART roll out programme –Dec 2004

Current status [Jun 2011]

ART centers - 313

PLHA receiving ART from Govt -428638 including 25071 children ,

PLHA receiving ART from private sector- approx1,50,000.

COE: providing second line ART : 10 centres of excellence and covers 1929 patients

PLHA registered : 40 % of the estimated 2.39 million pts. have been identified and registered in ART clinics across the country

ART scale up in India

I read about these Antiretroviral drugs available in India (2011)

• NRTIs– Zidovudine

– Stavudine

– Tenofovir

– Lamivudine

– Didanosine

– Abacavir

• NNRTIs– Nevirapine

– Efavirenz

• PIs– Atazanavir

– Lopinavir/Ritonavir

– Darunavir

– Indinavir

– Nelfinavir

• Integrase inhibitors– Raltegravir

These are the Antiretroviral drugs available free through the public health care delivery

• First line antiretroviral therapy (therapy naïve)

– Zidovudine/Lamivudine/Nevirapine

– Stavudine/Lamivudine/Nevirapine

– Zidovudine/Lamivudine/Efavirenz

– Stavudine/Lamivudine/Efavirenz

– Tenfovir/Emtricitabine/NVP or EFV*

• Second line antiretroviral therapy (treatment experienced) :

– Zidovudine/Lamivudine/Tenofovir/Atazanavir/Ritonavir

I found that these are the Challenges faced in treatment

Low Health seeking behavior Stigma Diagnosis of OI

Early diagnosis of PTB & EPTB in HIV Diagnosis of MDR and XDR tuberculosis among PLHA

First line ART Raising cut of for ART initiation to CD4 350 cells cu mm. Need for introduction of viral load, drug resistance and TDM in the ART programme.Resistance to first line ART drugs

PMTCT- Single dose NVP 14

In the end I chalked out the needs and future objectives that must be taken in order to prevent this

STD from spreading..

Continuous surveillanceAwareness programmesIncreased health care allocationsIdentification of high risk groupsAccess to treatment for allRemoval of stigma and discriminationDeveloping appropriate guidelinesCreation of an enabling environment wherein those infected and affected by HIV can lead a life of dignity. This is the cornerstone of all interventions.Provide universal access to HIV prevention, care, support and treatment services.

Creation of an enabling environment wherein those infected and affected by HIV can lead a life of dignity. This is the cornerstone of all interventions.Provide universal access to HIV prevention, care, support and treatment services. For making the implementation mechanism more responsive, proactive and dynamic, the HRD strategy of NACO and SACS is based on qualification, competence, commitment and continuity.