How Project Accelerate Is Helping India In Its Intense Battle Against AIDS

While the government of India is keeping its efforts and hopes alive to check the spread of AIDS, particularly among the youths, there are certain initiatives that are focussed on particular groups that are most vulnerable to the infectious and an incurable disease. Program ACCELERATE, funded by USAID/PEPFAR, has been working with the National AIDS Control Organisation (NACO) since 2019 to advance progress towards the UNAIDS 95-95-95 goals to achieve epidemic control in India. In an email interview to Indiatimes, Dr Jalpa Thakker, Director - Programs, ACCELERATE, Johns Hopkins University School of Medicine spoke about this initiative.

John Hopkins University

Q. Considering that the government wants to eliminate the AIDS epidemic by 2030, what is the status of the AIDS epidemic in India?

Although India has the third highest number of people living with HIV (PLHIV) globally, the epidemic is largely concentrated among key populations (i.e., men who have sex with men, female sex workers, hijras/transgender individuals, people who inject drugs). The Indian Government, through the National AIDS Control Organisation (NACO), focuses much of its efforts on reaching these groups, providing access to HIV testing, expanding HIV treatment for PLHIV, and curbing the spread of HIV within and outside of these communities.

The NACO program has been reaching the vulnerable populations since 1992 and has been able to achieve significant control on the epidemic. India has inched closer to achieving UNAIDS 95-95-95 goals. As per the 2019-2020 Sankalak report published by NACO 76% of PLHIV know their status, 84% of PLHIV who know their HIV status are on treatment and 84% PLHIV on ART are virally suppressed. Programs like ACCELERATE assist NACO in addressing gaps in programming and outreach among at-risk populations, including key populations and PLHIV.

Q. What is program ACCELERATE's role in helping arrest the spread of the epidemic, particularly among vulnerable groups like Indian youth?

Reuters

ACCELERATE works predominantly across 33 high-burden districts and 6 states across India. In addition, ACCELERATE provides support to online clients across the country through its virtual platform, Safe Zindagi. ACCELEATE focuses on reaching PLHIV and four key population groups ¡ª female sex workers, men who have sex with men, transgender persons, and people who inject drugs ¡ª as there is a disproportionate burden of HIV in these key populations and an unmet need for services.

The program strives to provide services to those previously unreached through innovative approaches such as virtual outreach, and integrated platforms offering HIV and non-HIV services. ACCELERATE is leading efforts to make pre exposure prophylaxis (PrEP) and HIV self-testing available in India. Through the Safe Zindagi platform,

ACCELERATE has reached Indian youth by linking more than 6,000 at-risk individuals with HIV testing, among whom 7% tested HIV positive (which is 8 times higher than the positivity rate seen in the public sector). The program helped clients who tested positive start treatment for HIV as soon as possible. ACCELERATE has played a significant role in innovating models and platforms to reach hidden populations with HIV services, especially online youth, through Safe Zindagi and social media outreach.

Q. What is the role testing can play in slowing the spread of AIDS? How can the youth test themselves?

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In order to prevent the spread of HIV, it is imperative to make HIV testing services easily accessible. This can ensure that PLHIV know their status and start treatment as soon as possible. They can also take preventative measures (condoms and safe sex practices) to prevent onward transmission to others.

Treatment is the most effective prevention tool since it reduces the HIV viral load in the body of someone living with HIV. Taking treatment regularly minimizes the chances of HIV transmission through sex, needle sharing, childbirth or breastfeeding. The Government of India through NACO has been delivering HIV testing services through physical venues such as integrated counselling and testing centres spread across 33,220 sites in India.

These centres provide testing, counselling and linkage support to PLHIV. However, many at-risk, young individuals do not prefer in-person venues due to long lines, stigma, and confidentiality concerns. Therefore, offering more options for HIV testing which are accessible and flexible, such as online outreach and HIV self-testing, can facilitate more PLHIV getting on treatment. Only an estimated 79% of people living with HIV in India know their status, meaning there are a significant number of individuals who do not know their HIV status and may be unknowingly transmitting the infection to others. One of the newest and effective ways to offer services to unreached populations is through online platforms.

Through the internet, programs can connect people to HIV testing options where an individual does not have to visit a physical site and can get tested in private at a convenient location and time. HIV self-testing provides a way to get tested at a flexible location and time with or without assistance. ACCELERATE is distributing HIV self-testing kits which include easy to understand instructions that come along with the kit and is also available in digital format for easy access. The program¡¯s online platform, Safe Zindagi, provides additional resources through audio-visuals explaining how to complete and interpret HIV self-testing kits. ACCELERATE has distributed HIV self-testing kits to more than 1,000 individuals.

90% of those who completed HIV self-testing reported their result and were supported by counsellors for follow-up steps. The HIV self-testing model on Safe Zindagi has proven to be effective in reaching and testing at-risk, young individuals who would not otherwise seek HIV services from traditional physical sites. HIV self-testing should be expanded and included under India¡¯s National ADIS Control Program policy.

Q. What can people living with HIV do so they can remain healthy and live longer?

Reuters

People living with HIV should start antiretroviral treatment (ART) at the earliest to remain healthy, live longer, and prevent HIV transmission. ART stops the HIV virus from replicating in the blood, and if taken regularly, reduces the count of HIV virus to almost an undetectable level (Undetectable=Untransmittable).

To keep the viral load to undetectable levels and avoid health complications, it is crucial to continue taking ART every day for the rest of one¡¯s life. Further, it is important to maintain a healthy lifestyle through a nutritious diet and exercise. ART is available free of cost through India¡¯s public ART centers spread across 670 sites in India. With the advancements in treatment technology, PLHIV can live a full and healthy life by maintaining lifelong adherence to ART.

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