AIDS Control Programme & National Tobacco Control Programme

Social and Preventive Pharmacy | B.Pharm | 10 Marks Each

QUESTION 1: AIDS CONTROL PROGRAMME (National AIDS Control Programme - NACP)

Introduction

• Prevent further transmission of HIV
• Decrease morbidity and mortality associated with HIV infection
• Minimize the socio-economic impact of HIV/AIDS

Historical Milestones

Phases of NACP

• Objective: Slow down the spread of HIV infection to reduce morbidity, mortality and impact of AIDS
• Focus: Awareness generation, setting up surveillance systems, safe blood supply, preventive services for high-risk groups
• Funding: World Bank credit of USD 84 million

• Two key objectives:
  1. To reduce the spread of HIV infection in India
  2. To increase India's capacity to respond to HIV/AIDS on a long-term basis
• Key initiatives:
  • Adoption of National AIDS Prevention and Control Policy (2002)
  • Scaled-up Targeted Interventions (TI) for high-risk groups
  • National Blood Policy adopted
  • Greater Involvement of People with HIV/AIDS (GIPA) strategy
  • National Adolescent Education Programme (NAEP) launched
  • Introduction of counselling, testing, and PPTCT programmes
  • Launch of National ART Programme
  • Establishment of State AIDS Control Societies (SACS)
• Funding: World Bank credit of USD 191 million

• Goal: Halt and reverse the HIV/AIDS epidemic in India
• Based on "Three Ones" principle: one agreed action framework, one national coordinating authority, one monitoring and evaluation system
• Two key pillars: Prevention and Care, Support & Treatment (CST)
• Scaled up prevention among High Risk Groups (HRGs) and general population
• Established Technical Support Units (TSUs) at national and state level
• District AIDS Prevention and Control Units (DAPCUs) strengthened
• Strategic Information Management System (SIMS) established

• Objective: Reduce new HIV infections by 50%
• Consolidating the gains of NACP-III
• Focus on universal access to treatment and services
• Prevention, CST, and institutional strengthening

• Target: End AIDS by 2030
• 95-95-95 target: 95% of PLHIV know their status, 95% on treatment, 95% virally suppressed
• Elimination of Mother-to-Child Transmission (EMTCT)

Key Components of NACP

1. Targeted Interventions (TI): Services for high-risk groups (sex workers, injecting drug users, men who have sex with men, truckers, migrants)
2. Prevention of Parent-to-Child Transmission (PPTCT): Testing and treatment for HIV-positive pregnant women
3. Anti-Retroviral Therapy (ART): Free ART through government ART centres
4. Blood Safety: Ensuring safe blood transfusion via licensed blood banks
5. Condom Promotion: Social marketing and free condom distribution
6. IEC/BCC Activities: Information, Education, Communication and Behaviour Change Communication
7. Counselling and Testing: Integrated Counselling and Testing Centres (ICTCs)
8. Care, Support and Treatment (CST): Link ART Centres, care and support centres
9. Surveillance: Sentinel surveillance to track HIV prevalence
10. Capacity Building: Training healthcare workers, SACS, NGOs

Organizational Structure

• National Level: NACO under Ministry of Health and Family Welfare
• State Level: State AIDS Control Societies (SACS)
• District Level: District AIDS Prevention and Control Units (DAPCUs)
• Community Level: NGOs, community-based organizations, PLHIV networks

Achievements

• Adult HIV prevalence reduced to 0.22% (2020)
• Approximately 23.18 lakh People Living with HIV (PLHIV) in India
• India's AIDS control is globally recognized as a success story
• Free ART available at government centres across the country

QUESTION 2: NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)

Introduction

Aims and Objectives of NTCP

1. Create awareness about the harmful effects of tobacco consumption
2. Reduce production and supply of tobacco products
3. Ensure effective implementation of COTPA 2003 (Cigarettes and Other Tobacco Products Act)
4. Help people quit tobacco use through cessation services
5. Facilitate implementation of WHO Framework Convention on Tobacco Control (FCTC) strategies

Legal Framework: COTPA 2003

• Ban on tobacco advertising, promotion and sponsorship
• Prohibition of smoking in public places
• Mandatory pictorial health warnings on tobacco product packages (covering 85% of pack)
• Prohibition of sale of tobacco to minors (under 18 years)
• Prohibition of sale within 100 metres of educational institutions

WHO Framework Convention on Tobacco Control (WHO-FCTC)

• M - Monitor tobacco use and prevention policies
• P - Protect people from tobacco smoke
• O - Offer help to quit tobacco use
• W - Warn about the dangers of tobacco
• E - Enforce bans on tobacco advertising, promotion, sponsorship
• R - Raise taxes on tobacco

Organizational Structure of NTCP (Three-Tier Structure)

• The NTCC functions under the Joint Secretary of MoHFW
• Technical assistance provided by the Directorate General of Health Services

Key Activities Under NTCP

• Policy formulation and coordination
• IEC campaigns (mass media, print, outdoor)
• Coordination with WHO-FCTC
• Monitoring and evaluation

• Implementation of COTPA
• Training of enforcement officers
• IEC activities specific to the state
• Coordination with STCC

• Awareness campaigns in schools, colleges, communities
• Enforcement of no-smoking zones
• Establishment of Tobacco Cessation Centres (TCCs)
• Capacity building of healthcare workers

Tobacco Cessation Services

• Tobacco Cessation Centres (TCCs): Set up at medical colleges and district hospitals for counselling and pharmacotherapy
• National Tobacco Cessation Helpline (1800-11-2356): Toll-free quitline
• Pharmacotherapy includes Nicotine Replacement Therapy (NRT), Bupropion, Varenicline
• Brief Advice by health workers (ABC approach: Ask, Brief Advice, Cessation support)

CHC Level Services Under NTCP (as per Park's Textbook)

• Health education and IEC activities regarding harmful effects of tobacco use and second-hand smoke
• Promoting quitting of tobacco in the community; offering brief advice to all smokers and tobacco users
• Making the premises of CHC (Community Health Centre) tobacco-free; display of mandatory signages

• Setting up a Tobacco Cessation Clinic by training the counsellor in tobacco cessation

Implementation Progress

• During 11th Five Year Plan: NTCP implemented in 21 states covering 42 districts
• 12th Five Year Plan goal: Reduce prevalence of tobacco use by 5%
• Result: As per GATS-2 (Global Adult Tobacco Survey), tobacco use prevalence reduced from 34.6% (2009-10) to 28.6% (2016-17) - a reduction of 6 percentage points
• Total tobacco users reduced by approximately 81 lakh (8.1 million)
• Currently implemented in all 36 States/Union Territories covering over 600 districts

Target Groups

• General population (especially youth and women)
• School and college students
• Rural communities
• Tobacco farmers (alternative livelihood programmes)

Comparison Summary Table

Sources: Park's Textbook of Preventive and Social Medicine (23rd ed.), NACO official website, National Tobacco Control Programme (MoHFW), WHO-FCTC India report.