The ART Therapy of India’s HIV/AIDS Response

Context

Twenty years ago, on April 1, 2004, the Indian government launched Free Antiretroviral Therapy (ART) for Persons living with HIV (PLHIV).

• The  Success free ART Therapy and subsequent steps under the NACP can potentially guide other public health programmes in the country.

About ART Therapy: Antiretroviral Therapy (ART)

• ART Therapy is the treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs. 
• The standard treatment consists of a combination of drugs (often called “highly active antiretroviral therapy” or HAART) that suppress HIV replication.
• Benefits: 
  • ART reduces mortality and morbidity rates among HIV-infected people and improves their quality of life. 
  • The benefits of ART also include the prevention of HIV transmission by suppressing HIV replication in persons living with the virus. 
    • This benefit of ART is also defined as “undetectable equal untransmittable” , or U=U.

Impact of Free ART Therapy

• Reduction in Prevalence: In 2023, the prevalence of HIV in 15-49 years has come down to 0.20 (confidence interval 0.17%-0.25%) and the burden of disease in terms of estimated PLHIV has been coming down to 2.4 million.
• India’s share in PLHIV globally had come down to 6.3% (from around 10% two decades ago). 
• Status: As of the end of 2023, of all PLHIV, an estimated 82% knew their HIV status, 72% were on ART and 68% were virally suppressed.
• Decline in New Infections: The annual new HIV infections in India have declined by 48% against the global average of 31% (the baseline year of 2010). 
• Decline in Mortalities: The annual AIDS-related mortalities have declined by 82% against the global average of 47% (the baseline year of 2010).

National AIDS Control Programme (NACP)

• The NACP, launched in 1992, is being implemented as a comprehensive programme for the prevention and control of HIV/ AIDS in India.
• Thirty-five years since then, NACP has evolved as one of the world’s largest programmes through
• five distinct phases.
• Currently, NACP-V (extension) is under implementation for 2021-2026.

NACP Phase-V:

• It is a Central Sector Scheme, fully funded by the Government of India, with an outlay of Rs 15471.94 crore. 
• Aim: To reduce annual new HIV infections and AIDS-related mortalities by 80% by 2025-26 from the baseline value of 2010.
  • It also aims to attain dual elimination of vertical transmission and elimination of HIV/AIDS-related stigma while promoting universal access to quality STI/RTI services to at-risk and vulnerable populations.
• Goal:  In alignment with global targets agreed by the UNAIDS. NACP Phase-V calls for the attainment of ambitious targets of 95-95-95 by 2025. 
  • where 95% of all people living with HIV know their HIV status;
  •  95% of all people diagnosed with HIV infection receive sustained antiretroviral therapy (ART), and 
  • 95% of all people receiving antiretroviral therapy achieve viral suppression by 2025. 

Challenges in Achievements of Target:

1. The delayed enrolment to the ART facilities.
2. Non-adherence to ART Treatment and lack of follow-up.
3. Sustained supply and availability of ART drugs.
4. Low Private Sector Engagement
5. Constant Training and Capacity Building of Staff
6. Focus on strengthening integration with other programmes 
   1. such as hepatitis, non-communicable diseases (diabetes and hypertension) and mental health.
7. Focus on reducing preventable mortality.

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