National AIDS Control Programme (NACP)

NACP is implemented in five-year phases. NACP-I (1992-99) established NACO and the State AIDS Control Societies (SACS). NACP-II (1999-2006) scaled up targeted interventions for high-risk groups. NACP-III (2007-12) introduced the 'Prevention to Care' continuum with free ART. NACP-IV (2014-2017) consolidated gains. NACP-V (2021-2025) aims at HIV elimination by 2030 with a focus on hard-to-reach populations and the '95-95-95' targets (95% of PLHIV know their status, 95% of diagnosed on ART, 95% of those on ART virally suppressed).

NACP works through a vertical structure parallel to the general health system: National AIDS Control Organisation at the centre, State AIDS Control Societies at state level, District AIDS Prevention and Control Units (DAPCUs) at district level, and Integrated Counselling and Testing Centres (ICTCs) and Anti-Retroviral Treatment (ART) centres at facility level.

NACP's testing strategy follows the WHO-recommended 3-test algorithm (replacing the older 2-test strategy in 2020). All testing is voluntary, confidential, with pre- and post-test counselling. Testing sites include:

• ICTC (Integrated Counselling and Testing Centre): Standalone or facility-based; offers voluntary counselling and testing.
• F-ICTC (Facility Integrated ICTC): Co-located in labour rooms, STI clinics, TB treatment centres — provider-initiated testing.
• PPP-ICTC: Public-private partnership sites at private hospitals.
• Daksh: Community-based testing facilities for key populations.

The three tests used in the NACP algorithm (in order): test-1 is a high-sensitivity kit (e.g., Meriscreen HIV 1&2); if positive, test-2 uses a different antigen/kit (e.g., SD Bioline); if positive, test-3 confirms using a third kit (e.g., Comb-AIDS). A sample is reported positive only if all three tests are reactive. If discordant (test 1+ but test 2-), repeat in 2 weeks or use nucleic acid testing.

The Prevention of Parent-to-Child Transmission (PPTCT) programme is one of NACP's flagship interventions. All pregnant women are offered HIV testing under the 'Option B+' strategy since 2015: any pregnant woman found HIV-positive starts lifelong ART immediately, regardless of CD4 count. The baby receives prophylactic Nevirapine (or NVP + AZT for high-risk cases) for 6-12 weeks, and exclusive replacement feeding in the first 6 months is recommended if AFASS (Affordable, Feasible, Acceptable, Sustainable, Safe) criteria are met; otherwise exclusive breastfeeding for 6 months is recommended.

With universal PPTCT coverage, vertical transmission has fallen from 25-40% (untreated) to under 2% (treated). India's goal is elimination of vertical transmission by 2030 — defined as < 2% transmission rate in breastfeeding populations and < 5% in non-breastfeeding populations, alongside < 50 new paediatric HIV infections per 100,000 live births.

India's free ART programme, launched on 1 April 2004, now serves more than 17 lakh PLHIV through over 700 ART centres and 1200+ Link ART centres. The first-line regimen since 2020 is the fixed-dose combination TLE (Tenofovir 300 mg + Lamivudine 300 mg + Efavirenz 600 mg) once daily, or TLD (Tenofovir + Lamivudine + Dolutegravir) which replaced TLE in 2020 as the preferred first-line. Dolutegravir is preferred due to higher viral suppression rates, higher genetic barrier to resistance, and better tolerance.

Second-line regimen after first-line failure (clinical, immunological, or virological): boosted Atazanavir (ATV/r) or Lopinavir/ritonavir (LPV/r) + 2 NRTIs selected on the basis of resistance testing. Third-line regimens include Darunavir/ritonavir, Etravirine, Raltegravir or Dolutegravir. Pre-ART evaluation: CD4 count, HIV viral load, HBsAg, anti-HCV, serum creatinine, CBC, fasting glucose, lipid profile. Viral load monitoring is recommended at 6 months after ART initiation and annually thereafter. Target: undetectable viral load (< 1000 copies/ml).

TIs are NACP's primary strategy for high-risk groups: Female Sex Workers (FSWs), Men who have Sex with Men (MSM), Transgender people (TG), People Who Inject Drugs (PWID), and Hijra community. Each TI project is operated by an NGO or community-based organisation and offers: peer-led outreach; condom distribution; STI management through designated clinics; ICTC referral; ART linkage; and enabling environment activities (legal aid, crisis management). Needle and Syringe Exchange Programmes (NSEP) and Opioid Substitution Therapy (OST) with buprenorphine are the two key interventions for PWID.

Despite criminalisation of certain behaviours under IPC Section 377 (now read down by the Supreme Court in 2018), TIs continue to operate through community-led approaches. Approximately 15 lakh HRG members are currently enrolled in TI projects across India.

India's goal is to achieve the '95-95-95' targets by 2030: 95% of PLHIV know their status (currently ~80%), 95% of diagnosed PLHIV are on ART (currently ~85%), and 95% of those on ART are virally suppressed (currently ~85%). The NACP-V (2021-2025) strategy focuses on:

• HIV Self-Testing (HIVST) kits distributed through community channels
• Index testing (testing family members of confirmed positives)
• Dolutegravir-based regimens as first-line for all
• Viral Load testing scale-up — universal access for all on ART
• Differentiated care models — multi-month refills, community-based distribution
• Stigma reduction through the 'Mission Sampark' and 'Stigma-Free Health Facilities' initiatives

Reference: naco.gov.in and India HIV Estimates 2023.

NACP is among the world's most ambitious public health programmes against a single virus, and India's success in keeping HIV prevalence below 0.25% for over a decade is internationally recognised. For UPSC CMS candidates, PPTCT Option B+, the 3-test algorithm, and the 95-95-95 targets are extremely high-yield PSM topics.