HIV Specialist - June 2021 - 46

DR. MATIN AHMAD KHAN
Structural and resource barriers
There has been supply chain bottlenecks more so during the COVID-19
pandemic. It is unfortunate that HIV care staff make very meager
salaries.
Funding
The funding for HIV has been reduced globally. With declining funding
from external donors, any change in policies may have major financial
implications in India considering the fact that we have a large number of
people living with HIV/AIDS..
Covid
Provision of ART during the pandemic restrictions and lock downs,
particularly to HIV key populations, sex workers and LBGTIQ+
communities, has been very challenging. Naturally experts treating
HIV/AIDS are worried that the COVID-19 pandemic has delayed the
World Health Organisation's target to improve the life of people with
HIV (PWH).
What is the government of India doing to help
combat HIV/AIDS?
India is committed to achieving Sustainable Development Goal (SDG)
3.3 for ending the AIDS epidemic as a public health threat by 2030.
We have a national initiative to combat HIV and reach this goal. The
National AIDS Control Programme (NACP) was launched in 1992
and is implemented by the National AIDS Control Organization
(NACO) under the Ministry of Health and Family Welfare. There are
several programs and initiatives the NACP oversees.
One government initiative focuses on Opioid Substitution Therapy
(OST). This program is being implemented as a critical component of
harm reduction programme under NACP through 226 OST centers.
Around 20 percent of the IDUs are on OST as of March 2020 in comparison
to 15 percent coverage in 2017-18
The Government of India launched free ART on 1st April, 2004
at 8 centers under the second phase of the NACP. Since then, the
program has evolved into a robust three-tier system. ART centers
(n=553) across the country, mostly located at medical colleges
and district hospitals, are fundamental to this service delivery
mechanism. The decentralization of services has been achieved
through the establishment of Link ART Centres (LAC) and LAC
plus (1327). 310 Care & Support Centres (CSCs) facilitate access
to essential services, thereby increasing treatment adherence and
reducing stigma and discrimination. The ART centers are mapped
to Centres of Excellence (CoE): Adult (11) and pediatric (7) and ART
Plus centers (93) at select teaching institutions for timely initiation of
the second and third line of ART.
The Government of India launched " Test and Treat " model on
28th April, 2017 to put PWH on ART as soon as they are detected
HIV positive, irrespective of their CD4 count. The objective was to
improve the survival rate and quality of life of HIV infected persons
at the individual level. In 2019-20, for every 100 HIV infected people
identified at HIV counselling and testing centers, 88 PWH were
initiated on ART.
46 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
Dr. Matin delivering a Guest lecture on ART at
Department of Pharmacology, Yenepoya Medical
College, Mangalore Karnataka India.
India is a signatory to the Joint United
Nations Programme on HIV and AIDS
(UNAIDS) goal of Elimination of Mother
to Child Transmission (EMTCT) of HIV
by 2020. The Prevention of Parent to Child
Transmission (PPTCT) programme is being
implemented under NACP to achieve the
EMTCT goal. Almost 2.45 crore HIV tests
among pregnant women were conducted
in 2019-20. This translates into 82 tests
for every 100 estimated pregnant women
against the target of 95 tests by 2020. Bihar,
Nagaland, Odisha and Uttarakhand are
critical States with around 67 HIV tests done
for every 100 estimated pregnant women.
Uttar Pradesh is another high burden State
recording less than 75 tests for every 100
estimated pregnant women.
Among the total HIV-positive pregnant
women covered under the programme, the
proportion of ART has hovered around 90 to
91 percent since 2017-18. This is a significant
challenge to the programme because of the
committed ART coverage target of ≥95 percent
under the program to achieve EMTCT.
The challenge is specifically in the States
of Arunachal Pradesh, Haryana, Himachal
Pradesh, Jharkhand, Nagaland, Puducherry
and Sikkim where less than 70 percent of
HIV-positive pregnant women were initiated
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HIV Specialist - June 2021

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