Dr. S.K CHATURVEDI Dr. KANUPRIYA CHATURVEDI HIV/AIDS and children with special reference to India’s response for Prevention of Mother to Child Transmission of HIV/AIDS, Treatment & Care Dr. S.K CHATURVEDI Dr. KANUPRIYA CHATURVEDI

OBJECTIVES To have an understanding of the issues problem of HIV in women and children To have an understanding of India’s response to these problems and issues To have knowledge of the scale up strategy for services

Global HIV/AIDS IN 2005 Effect on Children 40.3 million people are living with HIV/AIDS 2.3 million are children under 15 years 700,000 children< 15 years were newly infected with HIV 5,70,000 children died of HIV More than 14 million children <15yrs have lost one or both parents to AIDS

High Prevalence States ADULT HIV PREVALENCE High Prevalence States

Rationale for PPTCT in India 27 million pregnancies per year* 1,89,000 infected pregnancies per year Cohort of 56,700 infected newborns per year

SCALE UP STRATEGY The National Prevention of mother to child transmission of HIV (PPTCT) Programme was launched by Government of India in December 2002 in the country in a phased manner by adopting a multisectoral, decentralized, phased and incremental approach In the first phase of the programme the medical colleges of the six high prevalence states were covered followed by district hospitals Care in high prevalence of these states and medical colleges of the vulnerable and highly vulnerable states In the second phase the programme was scaled up to the district hospitals of the low prevalence states and sub district level in high prevalence states.

PMTCT Policy and Guidelines/Targets National Guidelines on PPTCT were formulated in 2001-2002. These guidelines give directions for establishing a PPTCT centre in ante-natal clinics, capacity building of health care providers, implementation of PPTCT package, M&E of the program etc. National AIDS Control Organisation (NACO) had set the target to reduce HIV prevalence among pregnant women age 15-49 yrs to below 3% in the six high prevalence states and below 1% in the other states by 2007). Government of India has adopted the UNGASS goals for the PPTCT program. i.e. Reduced transmission of Mother To Child Transmission (MTCT) of HIV to <20% by 2005 and <10% by 2010

PPTCT Intervention Package Group Education/ante natal care Pre and Post Test Counseling /partner Counseling Institutional delivery and safe birthing practices Administration Of Nevirapine to Mother & Baby Counseling of mothers on Infant Feeding Options, STIs ,Family Planning Follow up, Care and Support (Linkages with Vats, ART clinics, Community Care Centers and Hospitals for Opportunistic Infections

ARV TREATMENT The free ARV treatment was started in April 2004 in the 8 government hospitals. Currently, 54 government-funded health facilities, 9 state government supported centres, 4 intersectoral partners and 4 NGO’s centres are providing ART in the country. A total of 26,485 patients are taking ART through NACO supported 54 ART centres out of which 8323 are women and 125 are children below 15 years of age group

ARV ( CONTD) 11 ART centres out of above 54 have also been identified under PMTCT programme for providing ART facilities to the beneficiaries referred from PPTCT centres under GFATM Project Round II. 3563 AIDS affected mothers and children are getting ART treatment from these centres till February, 2006. In addition, ART services are also being provided through 3 NGO partners supported under GFATM Round-II project which are ARCONS, Mumbai; YRG Care, Chennai; and Freedom Foundation, Bangalore. These NGOs are providing ART to 4095 AIDS affected mother and children through their 4 identified sites. The National ART scheme plan to scale up free ART services to 100,000 patients by 2007 and 1,80,000 patients till August, 2010.

TREATMENT OF OPPORTUNISTIC INFECTIONS The National AIDS Control Programme is providing facility for treatment of opportunistic infections in all the government medical college hospitals and district hospitals in the country. Free treatment for tuberculosis is provided through DOT centres throughout the country.

COMMUNITY CARE CENTRES A total of 85 community care centres are also supported by the programme across the country for providing services to critically ill AIDS patients and for AIDS patients who do not have anyone to look after them in the family. The beneficiaries also include mother and children. All of these centres are implemented through NGOs.

OTHER MEASURES (a) Prevention of trafficking of women and girl child: UNDP in partnership with NACO and DWCD and with support from DFID has launched a project “Prevention of trafficking, HIV/AIDS in women and girls (TAHA)” in June 2005 for implementation in 11 states. The project aims to reduce vulnerability to trafficking and HIV by addressing underlying causes with participatory right and gender sensitive framework by promoting integrated multisectoral response

CONTD. (b) School AIDS Education Programme and other Interventions with Young People: School AIDS Education Programme has covered 90,000 schools of higher secondary level out of 1.50 lac schools. Besides this 1.5 lac students have been covered through the “University Talk-AID” Programme being run under the aegis of the Ministry of Youth Affairs and Sports. For sensitization of non-school going mostly rural youth, “Village Talks AIDS” Programme has been implemented covering 11,550 villages in 385 districts.

CONTD. (c) Targeted Intervention Projects are being implemented for commercial sex workers, street children, injecting drug users, migrant labour population. These project provides services for STI clinic, condom promotion, counselling for behavioural changes through peer education and are operated by NGOs. Currently 1088 TI projects are functioning d) An intensive awareness campaign was launched on World AIDS Day, 2004 with the theme “Women, Girls & HIV/AIDS”. Subsequently total HIV/AIDS awareness campaign was launched for one month duration during 2005/06which was implemented by 35 States/UTs except Lakshadweep, Meghalaya, Daman & Diu.

CONCLUSIONS HIV/AIDS awareness activities, PPTCT scheme and provision of free ART treatment has been scaled up in India and it has helped in reduction of mother to children transmission of HIV. There is still further scope for improving the coverage and expansion of the programme at the peripheral level, bringing greater awareness about prevention of HIV and increasing demand for PPTCT services and expansion of free ART scheme Government of India is totally committed to prevention of HIV infection in children and for care & support of those already infected. NACP-III is being finalized in the current year for implementation in next 5 years. It is planned to increase the coverage under PPTCT scheme in high prevalence and other states. It is also planned to extend free ART facilities to 1,80,000 patients till August, 2010.