Lok Sabha Question No. 2760 (UNSTARRED), answered on 2020-03-06
Subject: Epidemics of AIDS, TB and Malaria
Ministry: HEALTH AND FAMILY WELFARE
Asked by: D. M. Kathir Anand, Magunta Sreenivasulu Reddy, Beesetti  Venkata Satyavathi, M V V Satyanarayana, Chandra Sekhar Bellana, Anil Firojiya, Kotagiri Sridhar

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2760 TO BE ANSWERED ON 06 TH MARCH, 2020

## EPIDEMICS OF AIDS, T B AND MALARIA

## 2760. SHRI D.M. KATHIR ANAND:

SHRI MAGUNTA SREENIVASULU REDDY:

DR. BEESETTI VENKATA SATYAVATHI:

SHRI M.V.V. SATYANARAYANA:

SHRI CHANDRA SEKHAR BELLANA:

SHRI ANIL FIROJIYA:

SHRI SRIDHAR KOTAGIRI:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether Sustainable Development Goal (SDG)adopted by member countries of the UN in 2015 has set a target of ending the epidemics of AIDS, TB and Malaria by 2030, if so, the details thereof;
- (b) whether the Indian experience has been more positive but calls for continued vigilance and committedaction, if so, the details thereof and steps taken thereon;
- (c) whether the HIV related deaths have declined in India and if so, the proportionate decline in such deaths, State/UT - wise;
- (d) whether drug treatment of HIV is now wel lfounded with an array of established and new anti - viral drugs, if so, the status of usage of these drugs in India; and
- (e)  the  steps  taken  to  increase  awareness  among  the adolescents  and  particularly  vulnerable groups in States/UTs especially in Andhra Pradesh?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (DR. HARSH VARDHAN)

- (a)& (b): Yes.  Sustainable  Development  Goal  (SDG)  has  set  a  target  of  ending  the epidemics of AIDS, tuberculosis, and malaria by 2030. This is the third target under t ensuring healthy lives and promoting the well - being for all at all ages.

Indian experienc e has been more positive but calls for continued vigilance and committ action. The details for AIDS, TB and Malaria are at Annexure 1.

(c) : Yes.  HIV/AIDS- related  deaths  have  been  declining  in  the  country.  As  per  latest  H Estimations (2017) Report, e stimated AIDS - related deathshave declined nationally by 71% since their peak in 2005 against the global average of 51%. The State/UT -wise detail for estimated HIV/AIDS -related deaths is at Annexure 2.

(d) : Yes. Government of India launched the free anti - r etroviral therapy (ART) programme on 1st April 2004 at eight government hospitals. As on December 2019, 13.66 lakh HIV infec people are availing free lifelong ART from 552 ART centres supported under National AI Control Programme (NACP). The programme has detailed treatment guidelines which keep on evolving  based  on  evidences  and  extant  guidelines,  including  WHO  guidelines,  to  assis prescription of ART by Medical Officers under NACP.

- (e) : Under  NACP,  the  Adolescence  Education  Programme  (AEP)  is  b e ng  implemented through  State  AIDS  Control  Societies  in  coordination  with  State  Council  of  Educati Research and Training using a 16 hours' curriculum - based module developed by The National Council of Educational Research and Training, to impart life s kills to the students of 8th, 9th & 11th standard.

So  far,  AEP  is  being  implemented  in  more  than  55000  schools  across  the  countr including 7932 schools in Andhra Pradesh.

## Details on AIDS, TB and Malaria

## I. AIDS

As per the latest HIV Estimations (2017) Report, India has seen a decline of 80% in estimated  new  infections from the peak  of the epidemic.  Similarly,  estimated  AIDSrelated deathshave also declined by 71% since their peak in 2005. These declines are better  than  global  averages.  Government  of  India  has  launched  the  'Test  and  Test' policy to initiate anti-retroviral treatment (ART) of HIV infected people as soon as they are detected positive. Further, Mission 'Sampark' has been implemented to trace those who are Lost to Follow Up and then bring them back to ART services. Routine viral load testing for HIV infected people who are on ART has also been initiated. HIV testing has been made integral component of essential package of services to the pregnant women under the programme. The HIV/AIDS Prevention Act (2017) addresses the issue related to stigma, discrimination and improvement in the quality of life of the people living with HIV/AIDS. India's response to combating HIV/AIDS is globally seen as a success story.

## II. TB

The SDG targets with regard to TB are:

- 80% reduction in incidence and
- 90% reduction in mortality (base line 2015).

The  Indian  experience  has  been  positive.  As  per  the  Indicators  defined  in  the Sustainable Development Goals -

- Incidence of Tuberculosis per lakh population: Baseline for India was 217 per lakh population for 2015. In the year 2018, 199 Tuberculosis cases per lakh population were estimated to occur in the country (as per Global TB Report 2019).
- Mortality of Tuberculosis per lakh population: Baseline for India was 34.8 cases per lakh population. In the year 2018, 32.7 Tuberculosis deaths per lakh population were estimated to occur in the country (as per Global TB Report 2019).

In  order  to  ensure  continued  vigilance  and  committed  action,  the  Ministry  has developed  and  is  implementing  the  National  Strategic  Plan  (NSP)  for  Tuberculosis (2017-2025) with the goal of ending TB by 2025. The key focus areas are:

1. Early  diagnosis  of  all  the  TB  patients,  prompt  and  appropriate  treatment  with quality assured drugs and treatment regimens along with suitable patient support systems to promote treatment adherence.
3. Prevention strategies including active case finding and contact tracing in high risk / vulnerable population
2. Engaging with the private sector service providers and the patients seeking care in the private sector.
4. Airborne infection control.
5. Multi-sectoral response for addressing social determinants of TB.

The 'TB HaregaDeshJeetega' campaign was launched on 25th September 2019.

## III. Malaria

Indian  experience  has  been  more  positive  but  calls  for  continued  vigilance  and committed  action.  The  malaria  cases/deaths  have  reduced  significantly  in  2019 compared to 2016.

The details of cases and deaths for last four years is given below:

| Year   |   API |   Cases | %Reduction compared to previous year   |   Deaths | %Reduction compared to previous year   |
|--------|-------|---------|----------------------------------------|----------|----------------------------------------|
| 2016   |  0.85 | 1087285 |                                        |      331 |                                        |
| 2017   |  0.64 |  844558 | 22.32                                  |      194 | 41.38                                  |
| 2018   |  0.32 |  429928 | 49.09                                  |       96 | 50.15                                  |
| 2019#  |  0.25 |  334693 | 22.15                                  |       50 | 47.91                                  |

#As on December, 2019 provisional

Annual Parasite Incidence maintained <1 and continuously declining.

To achieve the above goals the following steps have been taken:

1. In order to meet the national target of malaria elimination by 2030, the National Framework  for  Malaria  Elimination  (NFME)  has  been  launched  in  February 2016.The document lays out the vision, mission, broad principles & practices to achieve the target of malaria elimination by 2030.
2. The  National  Strategic  Plan  (NSP)  for  the  period  2017-22  has  also  been launched  in  July  2017  for  guidance  on  district-based  planning,  implementation and  monitoring,  which  includes  surveillance  of  malaria  as  a  core  strategy. Following the launch of NFME & NSP, India has recorded     a significant decline in malaria cases and deaths, recognized by World Malaria Report (WMR) 2018 and 2019 also.
3. To strengthen malaria reporting all the states have been advised to make malaria a  'notifiable  disease'.  Malaria  has  been  made  notifiable  in  27  states  and  the remaining states are in the process of making it notifiable.
5. The increase in cases, if any are captured and reported through the Integrated Disease  Surveillance  Programme  (IDSP)  for  immediate  response  to  prevent further transmission.
4. In  order  to  ensure  early  diagnosis  and  prompt  complete  treatment,  Accredited Social  Health  Activists  (ASHAs)  at  the  village  level  have  been  trained  in diagnosis, treatment and reporting of malaria cases.
6. To  prevent  people  from  malaria,  the  entire  at  risk  population  living  in  areas reporting API>1 (Annual Parasite Incidence of more than one case per thousand population) have been provided with Long Lasting Insecticidal Nets (LLINs).

State/UT-wise AIDS-related deaths in 2005 and 2017

| State/UT                  | 2005     | 2017   |
|---------------------------|----------|--------|
| Andhra Pradesh            | 45367    | 8460   |
| Arunachal Pradesh         | 9        | 19     |
| Assam                     | 253      | 266    |
| Bihar                     | 1841     | 3304   |
| Chhattisgarh              | 2115     | 870    |
| Delhi                     | 561      | 575    |
| Goa                       | 866      | 307    |
| Gujarat                   | 3371     | 2123   |
| Himachal Pradesh          | 134      | 26     |
| Haryana                   | 1052     | 1313   |
| Jharkhand                 | 773      | 1330   |
| Jammu & Kashmir           | 66       | 32     |
| Karnataka                 | 39868    | 8450   |
| Kerala                    | 1567     | 750    |
| Meghalaya                 | 35       | 23     |
| Maharashtra               | 64261    | 10104  |
| Manipur                   | 3167     | 1621   |
| Madhya Pradesh            | 2657     | 1853   |
| Mizoram                   | 623      | 474    |
| Nagaland                  | 1016     | 537    |
| Odisha                    | 1705     | 1389   |
| Punjab                    | 1422     | 757    |
| Rajasthan                 | 1430     | 899    |
| Sikkim                    | 6        | 2      |
| Tamil Nadu                | 17683    | 2801   |
| Telangana                 | 24916    | 10157  |
| Tripura                   | 64       | 65     |
| Uttarakhand               | 149      | 213    |
| Uttar Pradesh             | 5552     | 3819   |
| West Bengal               | 12776    | 6472   |
| Andaman & Nicobar Islands | 6        | 15     |
| Chandigarh                | 23       | 53     |
| Dadra & Nagar Haveli      | 5        | 9      |
| Daman & Diu               | 5        | 8      |
| Puducherry                | 30       | 17     |
| India                     | 2,35,374 | 69,113 |

Source: HIV Estimations 2017