“Scale up of HIV/AIDS Services based on Indicators of Epidemiological Significance in Gujarat, Western India

INTRODUCTION : —In India, Decentralization was a key strategy during National AIDS Control Programme- Phase III (2007-2012) where focus was shifted from state to ‘District’ as a unit of intervention. —Heterogeneity of HIV is a unique characteristic of HIV epidemic in India as well in Gujarat state where transmission pattern vary in different age groups, and geographical areas. —Availability of rich programme data sets, formation of District AIDS Prevention and Control Units and decentralized strategy clicked to develop an innovative methodology of using epidemiological programme indicators for programme scale up strategy and prioritisation.

METHODS : The core epidemiological indicators (programme data) considered for data triangulation were 1. Cumulative PLHIV detected since 2002 2. HIV positivity of attendees at ICTC 3. HIV positivity of ANC attendees at ICTC 4-7. Two sources size estimates of High Risk Groups mainly FSW & MSM. Information on this epidemic relevant —Indicators collected compiled and analysed on a scale at district and sub-district levels. —Indicators selected were relevant to capture any stage of HIV epidemic burden and potential vulnerability. Districts and taluks identified by scoring were plotted using GIS maps.

RESULTS : —Using this methodology, identified 19 (A: 5 and B: 14) districts out of 25 and 56 (A: 27 and B: 29) taluks out of 226 as top priority high burden & vulnerable areas for scale up of services and focused monitoring. Evidence helped in strategic scale up (78-90%) of HIV/AIDS control services including TI-NGOs (70/95), HTC (281/309) and ART services scaled up (19/24) in these identified areas only. It’s an attempt on synergistic effect of both epidemiological & program data analysis. It also emphasized “Know your epidemic, know your response' of UNAIDS theme.

CONCLUSIONS : Data triangulation helped State AIDS Control Society to scale up services for HRGs, PLHIVs and counselling, testing facilities across the state strategically in identified high HIV burden and high vulnerability districts and taluks of utmost priority towards halting and reversing the HIV epidemic. It identified vulnerable, highly vulnerable & high burden districts/ taluks to strengthen program interventions. Identified districts were monitored and supervised by responsible health system district officer periodically. State Health Commissioner issued a circular to District Collectors and Chief District Health Officers, emphasizing on the need for the effective implementation of different components of the National AIDS Control Programme (NACP) in these high-risk districts & taluks.