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1.HIV Background and Epidemiology - Copy (2).ppt

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Hem Gautam
Hem Gautam

The global HIV epidemic affected 36.7 million people in 2017, including 5.1 million in Asia and the Pacific region. In Nepal, there were an estimated 31,020 people living with HIV in 2017. While HIV prevalence in the general adult population remains below 1%, the epidemic in Nepal is considered concentrated among key populations such as people who inject drugs, female sex workers, and men who have sex with men. The government of Nepal has set targets to identify 90% of estimated HIV cases, treat 90% of identified cases, and retain 90% of people on antiretroviral therapy by 2020 in order to end the AIDS epidemic in the country by 2030.

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National Centre for AIDS and STD Control HIV AND AIDS BACKGROUND AND EPIDEMIOLOGY
National Centre for AIDS and STD Control Global Scenario of HIV-2017 Global Asia and pacific Region Nepal People living with HIV 36.7 million 5.1 million 31,020 New HIV Infections (total) 1.8 million 300,000 835 AIDS-related deaths 1. million 180,000 1,306
National Centre for AIDS and STD Control About 5,700 new HIV infections (adults and children) a day in 2015 ? About 66% are in Sub Saharan Africa ? About 400 are among children under 15 years of age ? About 5,300 are among adults aged 15 years and older, of whom: -almost 47% are among women -about 35% are among young people (15-24) Source UNAIDS 2016 Global Statistics
National Centre for AIDS and STD Control Regional Situation
National Centre for AIDS and STD Control Global estimation for HIV (UNAIDS, 2017) Adults and children living with HIV Adults and children newly infected with HIV Adult & child deaths due to AIDS Eastern and southern Africa 19.4 million [17.8 millionC21.1 million] 790 000 [710 000C870 000] 420 000 [350 000C510 000] Western and central Africa 6.1 million [4.9 millionC7.6 million 370 000 [270 000C490 000] 310 000 [220 00C400 000] Middle East and North Africa 230 000 [160 000C380 000] 18 000 [11 000C39 000] 11 000 [7700C19 000] Asia and the Pacific 5.1 million [3.9 millionC7.2 million] 270 000 [190 000C370 000] 170 000 [130 000C220 000] Latin America 1.8 million [1.4 millionC2.1 million] 97 000 [79 000C120 000] 36 000 [28 000C45 000] Caribbean 310 000 [280 000C350 000] 18 000 [15 000C22 000] 9400 [7300C12 000] Eastern Europe and central Asia 1.6 million [1.4 millionC1.7 million] 190 000 [160 000C220 000] 40 000 [32 000C49 000] Western and central Europe and North America 2.1 million [2.0 millionC2.3 million] 73 000 [68 000C78 000] 18 000 [15 000C20 000] TOTAL 36.7 million [30.8 millionC42.9 million] 1.8 million [1.6 millionC2.1 million] 1.0 million [830 000C1.2 million]
National Centre for AIDS and STD Control Country Situation
National Centre for AIDS and STD Control Current Situation of HIV and AIDS in Nepal (NCASC, 2016) ? The first HIV infection was detected in 1988 in Nepal. ? Since then HIV epidemic has evolve from low- to concentrated among Key affected populations C People with Injecting drugs (PWID) C Female sex workers (FSW) C Clients of female sex workers C Men who have sex with men (MSM) C Labor migrants ? Heterosexual transmission is dominant ? HIV prevalence in general population is <1%.
National Centre for AIDS and STD Control State of HIV Epidemics 1) Low Level Epidemics ? HIV <5% in all sub population with high risk behaviour 2) Concentrated Epidemics ? HIV >5% among in any subpopulation with high risk behaviour and < 1% among women attending antenatal clinic 3) Generalized Epidemics ? HIV > 1% among women attending antenatal clinic (in general population)
National Centre for AIDS and STD Control Concentrated Epidemic ? HIV prevalence >5% among in any sub population with high risk behaviour & <1% among women attending antenatal clinic Current HIV Situation in Nepal
National Centre for AIDS and STD Control Situation of HIV Epidemic in Nepal 2017 Total Estimated PLHIV 31,020 HIV Prevalence (15-49) 0.15 Male living with HIV 19,020 (61.3%) Female living with HIV 12,000 (38.7%) Children living with HIV (out of total infections) 1,192 (3.8%) HIV Prevalence (15-24) 0.02 New HIV infections 835 Mother Needing eVT services 304 AIDS-related Deaths 1,306
National Centre for AIDS and STD Control HIV prevalence among adult aged 15-49 years 0.18 0.12 0.15 0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Percent Male Female Total
National Centre for AIDS and STD Control Trends of Estimated Prevalence, New Infection and Deaths (1985 C 2020) 1,306 835 0 1000 2000 3000 4000 5000 6000 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Number of new infection and deaths Estimated deaths Estimated new infections
National Centre for AIDS and STD Control ARV Services in all districts 15,260 on ARV By Dec, 2017)
National Centre for AIDS and STD Control PMTCT(eVT) services in all districts 382,827 pregnant women testedfor HIV (July 15, 2016 to July 15, 2017)
National Centre for AIDS and STD Control Provincial Situation Province HIV Testing and Counseling PMTCT On ART Tested Positive Tested Positive Province 1 31780 207 53646 27 1197 Province 2 14245 273 32724 17 1428 Province 3 39043 630 100340 45 4082 Province 4 4530 108 45189 20 1807 Province 5 45104 346 81521 13 2772 Province 6 682 9 16899 0 434 Province 7 40844 208 52568 6 2824 Nepal 176228 1781 382,827 128 14544 Source: NCASC, 2017
National Centre for AIDS and STD Control 31020 19720 15260 15260 7998 7184 0 5000 10000 15000 20000 25000 30000 35000 Estimated Number of PLHIV Number of alive PLHIV and know their status PLHIV Received ART Retension on ART (12 months) Viral Load Test Viral Load Suppression # of PLHIVs Treatment Cascade of HIV in Nepal 2017 Source: National Center for AIDS and STD Control (NCASC), 2017 Expansion of viral load services/access 36% Need for expanding ART enrollment Retention on ART program for 12 month and more 51% PLHIVs are yet to initiate ART Need for expanding HIV Testing Coverage PLHIVs are yet to have viral load test and suppressed 90% 90% HIVision 2020 64% 49% 23% PLHIVs are yet to be identified to reach 90 percent 77 % 90%
National Centre for AIDS and STD Control Services Package Target Populations Comprehensive HIV prevention package for key populations at higher risk and general population: ? Targeted interventions: IEC, BCC, Condom programming, Harm reduction (NSE, OST) ? HIV testing and counseling ? STI diagnosis and treatment ? PWIDs ? SWs and their clients ? MSM/TG ? Labour migrants and spouses ? TB patients (high risk) ? General population PMTCT ANC attendees ART , management of OIs, including TB-HIV co- infection, and infection control PLHIV Care and Support (CHBC, CCC, social protection) Infected and affected by HIV Stigma and discrimination reduction All Capacity development Health care providers (public & private) Social protection, human rights, impact mitigation All (specifically among key populations at higher risk and PLHIV)
National Centre for AIDS and STD Control 26 DBS sample collecting sites for EID Services 30 CD4 Machines in 28 sites 15 OST sites in 10 Districts 3 Viral Load testing sites in 3 sites (NPHL, Seti Zonal Hospital and Bir Hospital) TB/HIV service through 68 ART sites in 59 districts Other Services 25 ART Dispensing Centers to support in treatment adherence
National Centre for AIDS and STD Control Incidence Meter: Towards End of HIV Epidemic Source UNAIDS 2016
National Centre for AIDS and STD Control National HIV Strategic Plan 2016-2021 ? Ending the AIDS epidemic, as a public health threat in Nepal, by 2030 Vision ? Identify, recommend and test 90% of estimated population ? Treat 90% of those diagnosed as HIV positive ? Retain 90% of those on ART ? Eliminate vertical transmission of HIV and keep mothers alive and well ? Eliminate congenital syphilis ? Reduce 75% of new HIV infections Targets
National Centre for AIDS and STD Control Key Priority Actions for Ending AIDS in Nepal ? Strengthen IRRTTR (Identify, Reach, Recommend, Test, Treat and Retain) ? Scale up HIV testing and treatment for key populations (TTR and TaSP) C Community Based Testing approach ? Focus on major sources of new infection ? Scale up evidence-based prevention interventions for key affected populations ? Integrate and decentralise HIV service delivery systems ? 90-90-90 by 2020
National Centre for AIDS and STD Control Key Priority Actions for Ending AIDS in Nepal ? Massive scale up of HIV testing among pregnant women (reached at least up to birthing center) ? Early DNA-PCR test among exposed baby for early detection of HIV among infant ? Early enrollment in treatment both mother and born baby ? Scale up treatment centers and ? Easy access for the EID test ? Elimination of vertical transmission of HIV by 2021
National Centre for AIDS and STD Control Thank You

More Related Content

1.HIV Background and Epidemiology - Copy (2).ppt

  • 1. National Centre for AIDS and STD Control HIV AND AIDS BACKGROUND AND EPIDEMIOLOGY
  • 2. National Centre for AIDS and STD Control Global Scenario of HIV-2017 Global Asia and pacific Region Nepal People living with HIV 36.7 million 5.1 million 31,020 New HIV Infections (total) 1.8 million 300,000 835 AIDS-related deaths 1. million 180,000 1,306
  • 3. National Centre for AIDS and STD Control About 5,700 new HIV infections (adults and children) a day in 2015 ? About 66% are in Sub Saharan Africa ? About 400 are among children under 15 years of age ? About 5,300 are among adults aged 15 years and older, of whom: -almost 47% are among women -about 35% are among young people (15-24) Source UNAIDS 2016 Global Statistics
  • 4. National Centre for AIDS and STD Control Regional Situation
  • 5. National Centre for AIDS and STD Control Global estimation for HIV (UNAIDS, 2017) Adults and children living with HIV Adults and children newly infected with HIV Adult & child deaths due to AIDS Eastern and southern Africa 19.4 million [17.8 millionC21.1 million] 790 000 [710 000C870 000] 420 000 [350 000C510 000] Western and central Africa 6.1 million [4.9 millionC7.6 million 370 000 [270 000C490 000] 310 000 [220 00C400 000] Middle East and North Africa 230 000 [160 000C380 000] 18 000 [11 000C39 000] 11 000 [7700C19 000] Asia and the Pacific 5.1 million [3.9 millionC7.2 million] 270 000 [190 000C370 000] 170 000 [130 000C220 000] Latin America 1.8 million [1.4 millionC2.1 million] 97 000 [79 000C120 000] 36 000 [28 000C45 000] Caribbean 310 000 [280 000C350 000] 18 000 [15 000C22 000] 9400 [7300C12 000] Eastern Europe and central Asia 1.6 million [1.4 millionC1.7 million] 190 000 [160 000C220 000] 40 000 [32 000C49 000] Western and central Europe and North America 2.1 million [2.0 millionC2.3 million] 73 000 [68 000C78 000] 18 000 [15 000C20 000] TOTAL 36.7 million [30.8 millionC42.9 million] 1.8 million [1.6 millionC2.1 million] 1.0 million [830 000C1.2 million]
  • 6. National Centre for AIDS and STD Control Country Situation
  • 7. National Centre for AIDS and STD Control Current Situation of HIV and AIDS in Nepal (NCASC, 2016) ? The first HIV infection was detected in 1988 in Nepal. ? Since then HIV epidemic has evolve from low- to concentrated among Key affected populations C People with Injecting drugs (PWID) C Female sex workers (FSW) C Clients of female sex workers C Men who have sex with men (MSM) C Labor migrants ? Heterosexual transmission is dominant ? HIV prevalence in general population is <1%.
  • 8. National Centre for AIDS and STD Control State of HIV Epidemics 1) Low Level Epidemics ? HIV <5% in all sub population with high risk behaviour 2) Concentrated Epidemics ? HIV >5% among in any subpopulation with high risk behaviour and < 1% among women attending antenatal clinic 3) Generalized Epidemics ? HIV > 1% among women attending antenatal clinic (in general population)
  • 9. National Centre for AIDS and STD Control Concentrated Epidemic ? HIV prevalence >5% among in any sub population with high risk behaviour & <1% among women attending antenatal clinic Current HIV Situation in Nepal
  • 10. National Centre for AIDS and STD Control Situation of HIV Epidemic in Nepal 2017 Total Estimated PLHIV 31,020 HIV Prevalence (15-49) 0.15 Male living with HIV 19,020 (61.3%) Female living with HIV 12,000 (38.7%) Children living with HIV (out of total infections) 1,192 (3.8%) HIV Prevalence (15-24) 0.02 New HIV infections 835 Mother Needing eVT services 304 AIDS-related Deaths 1,306
  • 11. National Centre for AIDS and STD Control HIV prevalence among adult aged 15-49 years 0.18 0.12 0.15 0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Percent Male Female Total
  • 12. National Centre for AIDS and STD Control Trends of Estimated Prevalence, New Infection and Deaths (1985 C 2020) 1,306 835 0 1000 2000 3000 4000 5000 6000 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Number of new infection and deaths Estimated deaths Estimated new infections
  • 13. National Centre for AIDS and STD Control ARV Services in all districts 15,260 on ARV By Dec, 2017)
  • 14. National Centre for AIDS and STD Control PMTCT(eVT) services in all districts 382,827 pregnant women testedfor HIV (July 15, 2016 to July 15, 2017)
  • 15. National Centre for AIDS and STD Control Provincial Situation Province HIV Testing and Counseling PMTCT On ART Tested Positive Tested Positive Province 1 31780 207 53646 27 1197 Province 2 14245 273 32724 17 1428 Province 3 39043 630 100340 45 4082 Province 4 4530 108 45189 20 1807 Province 5 45104 346 81521 13 2772 Province 6 682 9 16899 0 434 Province 7 40844 208 52568 6 2824 Nepal 176228 1781 382,827 128 14544 Source: NCASC, 2017
  • 16. National Centre for AIDS and STD Control 31020 19720 15260 15260 7998 7184 0 5000 10000 15000 20000 25000 30000 35000 Estimated Number of PLHIV Number of alive PLHIV and know their status PLHIV Received ART Retension on ART (12 months) Viral Load Test Viral Load Suppression # of PLHIVs Treatment Cascade of HIV in Nepal 2017 Source: National Center for AIDS and STD Control (NCASC), 2017 Expansion of viral load services/access 36% Need for expanding ART enrollment Retention on ART program for 12 month and more 51% PLHIVs are yet to initiate ART Need for expanding HIV Testing Coverage PLHIVs are yet to have viral load test and suppressed 90% 90% HIVision 2020 64% 49% 23% PLHIVs are yet to be identified to reach 90 percent 77 % 90%
  • 17. National Centre for AIDS and STD Control Services Package Target Populations Comprehensive HIV prevention package for key populations at higher risk and general population: ? Targeted interventions: IEC, BCC, Condom programming, Harm reduction (NSE, OST) ? HIV testing and counseling ? STI diagnosis and treatment ? PWIDs ? SWs and their clients ? MSM/TG ? Labour migrants and spouses ? TB patients (high risk) ? General population PMTCT ANC attendees ART , management of OIs, including TB-HIV co- infection, and infection control PLHIV Care and Support (CHBC, CCC, social protection) Infected and affected by HIV Stigma and discrimination reduction All Capacity development Health care providers (public & private) Social protection, human rights, impact mitigation All (specifically among key populations at higher risk and PLHIV)
  • 18. National Centre for AIDS and STD Control 26 DBS sample collecting sites for EID Services 30 CD4 Machines in 28 sites 15 OST sites in 10 Districts 3 Viral Load testing sites in 3 sites (NPHL, Seti Zonal Hospital and Bir Hospital) TB/HIV service through 68 ART sites in 59 districts Other Services 25 ART Dispensing Centers to support in treatment adherence
  • 19. National Centre for AIDS and STD Control Incidence Meter: Towards End of HIV Epidemic Source UNAIDS 2016
  • 20. National Centre for AIDS and STD Control National HIV Strategic Plan 2016-2021 ? Ending the AIDS epidemic, as a public health threat in Nepal, by 2030 Vision ? Identify, recommend and test 90% of estimated population ? Treat 90% of those diagnosed as HIV positive ? Retain 90% of those on ART ? Eliminate vertical transmission of HIV and keep mothers alive and well ? Eliminate congenital syphilis ? Reduce 75% of new HIV infections Targets
  • 21. National Centre for AIDS and STD Control Key Priority Actions for Ending AIDS in Nepal ? Strengthen IRRTTR (Identify, Reach, Recommend, Test, Treat and Retain) ? Scale up HIV testing and treatment for key populations (TTR and TaSP) C Community Based Testing approach ? Focus on major sources of new infection ? Scale up evidence-based prevention interventions for key affected populations ? Integrate and decentralise HIV service delivery systems ? 90-90-90 by 2020
  • 22. National Centre for AIDS and STD Control Key Priority Actions for Ending AIDS in Nepal ? Massive scale up of HIV testing among pregnant women (reached at least up to birthing center) ? Early DNA-PCR test among exposed baby for early detection of HIV among infant ? Early enrollment in treatment both mother and born baby ? Scale up treatment centers and ? Easy access for the EID test ? Elimination of vertical transmission of HIV by 2021
  • 23. National Centre for AIDS and STD Control Thank You