National STD/AIDS Control Programme
Dr. Ajith Karawita MBBS, PGDV, MD
National STD/AIDS Control Programme
Contributing to a healthier nation throughsexual health promotion, emphasizing the prevention, control and provision of quality
care for STIs including HIV and AIDS
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Mission
VisionQuality sexual health services
for a healthier nation.
STI service delivery points
Service delivery points
No
1 Full time STD clinics 29
2 Branch clinics 21
3 IDH 1
ART centers
1 Central clinic, Colombo
2 STD clinic, Kalubovila
3 STD clinic, Ragama
4 STD clinic, Kandy
5 IDH
PROGRAMME AREAS (includes clinical and preventive components)
1 Administration
2 Counselling and testing
3 Epidemiology
4 Financial management
5 HIV treatment, care and support
6 IEC and condom promotion
7 Multisectoral programme
8 Planning and coordination
9 Laboratory services & infection control
10 PMTCT
11 STD care
12 Strategic information management
13 Training and capacity building
HMPHealth Master
Plan (has 5 strategic
areas) (10 year)1. Health service delivery2. Community empowerment3. Human resource development4. Financing , Resource allocation & Utilization5. Stewardship & management of the health sector
Programme areas of Health service delivery1.1 Programme for organizational development1.2 Medical supplies1.3 National quality assurance1.4 Disease control programmes1.5 Programme for vulnerable populations1.6 National Nutrition programme1.7 Health promotion programme
1.4. Disease control
programmes (has 28 areas)
STD/AIDS CONTROLNational STD/AIDS Control Programme
National STD/AIDS Control Programme, Sri Lanka
National STD/AIDS Control Programme and the Central Clinic
Strategic Information Management Unit of the National STD/AIDS Control Programme
Partners in the STD/AIDS Control• Government
– National STD/AIDS Control Programme, NBTS, NDDCB, Epid unit, FHB, HEB
• Private sector partners (Business coalition)• Civil society organizations (NGOs, CBOs, FBOs)
– E.g. Sarvodaya, CSDF, COJ, Alliance Lanka, MMM– Family planning association
• Development partners (UN agencies, Other INGOs)
STRENGTHS FOR ACTION: POLICY AND LEGAL FRAMEWORK
National Policy Framework for HIV Prevention Interventions
• Constitution• National Health Policy• National AIDS Policy• National Policy on
HIV/AIDS in the world of work
• Draft MCH policy• Draft National Blood Policy• Health Promotion Policy
STRENGTHS FOR ACTION: INTERNATIONAL POLITICAL TOOLS AND
COMMITMENTS
Resolution adopted by the General Assembly related to HIV/AIDS
1989: Convention on the Rights of the Child (CRC) 2000: UN security council resolution 1308 2000: United Nations Millennium Declaration 2000: Review of the problem of HIV/AIDS in all its aspects2002: The rights of the child 2004: Follow-up - Declaration of Commitment on HIV/AIDS 2004: Access to medication in pandemics - HIV/AIDS, TB & M2004: Rights of the child 2004: Regional call for capacity-building in public health 2004: Scaling up treatment and care
Resolution adopted by the General Assembly related to HIV/AIDS
2005: International cooperation against the world drug problem 2005: 2005 World Summit Outcome 2006: Political Declaration on HIV/AIDS 2007: Trafficking in women and girls 2007: Rights of the child 2008: Towards global partnerships 2009: The protection of human rights in the context of HIV/AIDS 2010: Policies and programmes involving youth 2010: Achieving universal access for DU, PLHIV/affected by HIV 2010: WHO HIV strategy 2011-2015 2010: UNAIDS HIV strategy 2011-2015
The Millennium Development Goals (MDGs)
Eradicate Extreme Poverty and Hunger
Improve Maternal Health
Achieve Universal Primary Education
Combat HIV/AIDS, Malaria and other Diseases
Promote Gender Equality and Empower Women
Ensure Environmental Sustainability
Reduce Child Mortality
Develop a Global Partnership for Development
National Guidance of the Programme/Commitments
• Health Master Plan (10 year)– Supported by Mid-term
plan (3 year)– Annual Health Plan
• National Strategic Plan (NSP) based on external reviews
• GFATM performance frameworks (R6, R9)
National STD/AIDS Control Programme, Sri Lanka
National STD/AIDS Control Programme and the Central Clinic
Strategic Information Management Unit of the National STD/AIDS Control Programme
ORGANOGRAM, National STD/AIDS Control Programmes
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Committees
• National AIDS Council• National AIDS committee with subcommittees for each
programme components– Prevention sub committee– HIV clinical care and counseling sub committee– Laboratory and surveillance sub committee– Strategic Information Management (SIM)– IEC subcommittee– NGO sub committee– Legal and ethics sub committee
• Provincial AIDS Committees• Programme director and the senior management team (SMT)
PROGRAMME AREAS (includes clinical and preventive components)
1 Planning and coordination unit
2 Capacity building and training unit
3 STD unit
4 PMTCT unit
5 HIV Care and treatment unit
6 Multisectoral coordination unit
7 Counselling and testing unit
8 IEC and condom promotion unit
9 Laboratory services unit
10 Strategic information management (SIM) unit (M&E, Surveillance, Research)
11 Financial management unit
12 Administration unit
National Strategic Plan (NSP)2007-2011
Goals and Strategic Objectives in the National Strategic Plan
The goals of the National STD/AIDS Control Programme Maintain current low prevalence of HIV among most-at-risk-
populations (MARP) and the general population Improve the quality of life of people infected with, or affected
by HIVThe strategic objectives
1. Increase coverage and effectiveness of prevention interventions
2. Increase coverage and effectiveness of care, support and treatment interventions
Strategic Approach in the National STD/AIDS Control Programme
Strategy 1: PreventionStrategy 2: Treatment, care, and supportStrategy 3: Generating and using strategic informationStrategy 4 Multisectoral involvement and decentralizationStrategy 5 Policy development and legislationStrategy 6: Strengthening national coordination and management
capacity
Strategy 1: Prevention
Increased scale and quality of comprehensive interventions for MARPs:
FSW & clients, MSM, IDU/DU and prisoners.
• Routine interventions for MARPs by the network of National STD/AIDS Control Programme clinics through staff of the 28 fulltime STD clinics and 21 branch clinics.
• Mapping of MARPs as a pilot project and implementation of micro-planning
• Under GFATM R9 – Provision of sexual health services for MARPs including beach boys.
• Routine provision of services for prisoners through prison hospital network in Sri Lanka include management of SRH issues, referrals for STI care, HIV care and HIV counselling and testing services.
• Under GFATM R9-Provision of sexual health services for prisoners• Under GFATM R9-Social mapping of these populations for TIs
Increased scale and coverage of HIV communication interventions for general population and lesser risk populations
(youth, migrant workers, etc.)
• Routine IEC programmes through network of service delivery points in the NSACP
• Mainstreaming of SRH and STI and HIV issues to Education sector, inclusion of HIV/AIDS in to school curriculum through National Institute of Education (NIE)
• Under GFATM R6-education of school children in sabaragamuwa province
• Under GFATM R6-awarness programmes for plantation sector workers (60 estates in 5 districts)
• Mass media campaigns• World AIDS Day campaigns (public, private and civil society
organizations)
Increased quality and coverage of STI services.
• Provision of STI services through delivery points of NSACP and private practitioners
STI service delivery points
Total number of STI clinics 29Branch clinics, Yellow 21STI clinics with ART facility, (Blue pins) 4
Non STI units with ART facility (IDH) 1
Increased quality and coverage of PPTCT services
• Four prong approach is used– Prong 1: Primary prevention of HIV, especially among pregnant
women and young people;– Prong 2: Prevention of unintended pregnancies among HIV-infected
women;– Prong 3: Prevention of HIV transmission from HIV-infected women to
their children;– Prong 4: Treatment, care and support to HIV-infected women and
their families
• Opt out HIV screening among urban antenatal mothers (Colombo district hospitals, DMH, CSHW, Gampaha, Kalutara)
• Provision of prophylaxis through STD clinic delivery points (onsite and referred basis)
• Training of HCWs on PPTCT, Breast feeding options etc.
Increased quality of blood transfusion services.
• HIV screening commenced in 1987. (Now using 11 days window period ELISA for screening)
• No Blood transfusion related HIV infection reported since year 2000
• So far 3 cases of transfusion related HIV infections reported (0.4% of all HIV cases)
Reduced transmission in the health services
• Implementation of standard precautions for HCWs through infection control units
• Provision of post exposure prophylaxis• Developed SOPs for STI care services• Prevention of biohazards – use of safety
precautions e.g. Safety cabinets• Safe waste disposal systems• Training of STD clinic staff and infection control
unit staffs for PEP
Strategy 2: Care, treatment and support
Increased quality and use of counselling and testing services.
• Counselling and testing services are integrated to the service delivery points of the NSACP.
• Under GFATM R6-Counselling and testing model introduced to plantation sector workers (26 centres)
• Training on HIV counselling and testing for HCWs – International and national level.
Increased quality and coverage of HIV and AIDS treatment services
• ART is provided through 28 STD clinics (4 centres are on site drug dispensing units, others are referral and follow up centres)
• ART is also provided through one identified Base Hospital (former infectious disease hospital) in Angoda
• Slandered treatment protocols are use for treatments and M&E. E.g. WHO guidelines, BASHH guidelines etc
• All eligible patients are given ART.
Increased quality and coverage of home and community based care for PLHIV
• Low prevalent country – Not a huge issue• Home and community-based care is provided
through some NGOs• Training of family members for provision of
care• Home visits are done form Gov. STI service
providers if necessary
Strategy 3: Generating and using strategic
information
• National integrated behavioural and biological surveillance (IBBS) implemented, documented and disseminated
• Formative and operational research implemented, documented and disseminated
• HIV/AIDS related services monitored, documented and disseminated through national progress reports.
Strategy 4: Multisectoral involvement and
decentralization
Increased engagement and capacity of NGOs in prevention, care and policy development.
• Provision of training and capacity building for NGOs
• NGOs represent in the National AIDS Committees, sub committees, provincial AIDS committees.
Increased engagement and capacity of key ministries/departments.
• Mainstreaming of HIV/AIDS concerns in to the relevant wok plans of the ministries and other departments – Department of Education and National Institute of
Education (NIE)– Foreign employment bureau– Department of fisheries and aquatic resources
Strategy 5: Policy development and legislation
Policy development and legislation
• Supportive National HIV/AIDS policy passed• Sectoral HIV/AIDS policies developed in
accordance with the NAP• Compassionate and supportive attitudes
improved among lawmakers, advocates, law enforcers etc
Strategy 6: Strengthening national coordination and
management capacity
ORGANOGRAM, National STD/AIDS Control Programmes
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The “Three Ones” principles
• The "Three Ones" are a set of principles for the coordination of national AIDS responses
• These principles were endorsed at a high-level meeting held on 25 April 2004 and co-hosted by UNAIDS, the United Kingdom and the United States.
The “Three Ones” principles are:
• One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners.
• One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.
• One agreed country-level Monitoring and Evaluation System.
One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners.
National Strategic plan
One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.
National AIDS Council
National AIDS Committee
Sub committees
One agreed country-level Monitoring and Evaluation
System. National AIDS
Council
National AIDS Committee
Surveillance, M&E subcommittee
GFATM and other Project Frameworks
PROJECT OR PROGRAMME AREASProgress of GFATM R6 activities in GFATM R9.con R6 proposal (HIV component)School sector project (GFATM R9.con R6), Sabaragamuwa Province
Plantation sector project
Treatment, care and support for people living with HIV/AIDS under GFATM R6
Other projects and programmesPolice awareness programme under UNFPA funds in the Colombo and Gampaha DistrictsDevelopment of National HIV/AIDS policyNational World AIDS day programmeProgramme for the Elimination of congenital syphilis by 2015 (WHO funded project)
PROJECT OR PROGRAMME AREASMajor activity areas under GFATM R9 (HIV component)
1. Provision of Sexual health services for FSWs
2. Provision of Sexual health services for MSM
3. Training of STD clinic staff
4. Provision of Sexual health services for BB
5. Provision of harm reduction Sexual health services for BB
6. Provision Sexual health services for prisoners
7. Procurement of health products
8. Increase quality of VCT services
9. Increase quality and coverage of HIV/AIDS treatment services
10. Formative and operational research
11. Planning and administration on M&E
12. National size estimation of MARPs
What next and future?
2011 Political Declaration: Targets and elimination commitments
• Achieve universal access to HIV prevention, treatment, care and support by 2015
• Targets and commitments
Thank you