Voluntary counseling and Testing in Pakistan

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Voluntary counseling and Testing in Pakistan

• Mr. (Dr.) Nadeem Ikram
• MBBS, DCP, FCPS (IMMUNOLOGY)
• National HIV/STI Referral Lab
• NACP, NIH, Chak Shahzad
• Islamabad, Pakistan

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Country Profile

• Population (2005) 159,196,336
• Provinces 4
• Area 2 , AJK
• Languages - Urdu
• Area 796,095 sq km
• Currency Pak Rupee
• Capital - Islamabad
• Ethnic composition - Muslims 97

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Location Southern Asia, India on the east, Iran
and Afghanistan on the west, China in the north
and the Arabian sea in the south.
PAKISTAN - socio-political context
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Epidemiological Profile

• Estimated Prevalence 0.1
• NACP/MOH (using WHO/UNAIDS EPI Forecast Model)
• estimates the number to be approximately
• 80,000

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Current epidemiological trends

• Shift from low prevalence into concentrated stage
  HIV prevalence among IDUs and MSWs more than 5
• In 2004, 2005 2006 predominant mode of
  transmission is I/V drug use (IBBS data)
• Increasing number of individuals being reported
  with HIV men who have sex with men, hijras,
  female sex workers
• Increasing numbers of individuals having signs
  and symptoms related to early HIV infection are
  being reported to health care facilities

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Round One Surveillance Results
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Implications of the change

• HIV transmission through injecting drug use is
  highly dynamic explosive spread
• Drug user population is highly mobile
• Drug user population is not isolated and has
  links with other vulnerable populations in
  addition to general population (are married)
• Donate blood for money (paid donors)
• Burden on health systems
• Poor infection control practices
• High risk groups to general population
• Youth vulnerability- high

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Key Risk Factors in Pakistani Scenario

• Low literacy rates
• Silence and denial
• High Poverty levels
• Low spending on health and education
• High prevalence of risky behaviors
• Large number of internal and external migrants
• A high proportion of adolescents and young
  adults
• Gender inequalities

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Laboratory networks

• Central level National Referral Laboratory
• Secondary level Provincial Laboratories
• Primary level VCT, ANC,TB, STI clinics
• Strengthen communication and collaboration
  between all levels in the network

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STRATEGIES

• STRATEGY I Single assay
• Screening
• STRATEGY II 2 different assays
• Surveillance
• STRATEGY III 3 different assays
• Diagnosis

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Strategy III Pre-requisites

• Informed consent Mandatory
• Testing is optional voluntary
• Pre- and post-test counseling
• Prepare for possible emotional trauma
• Complete confidentiality
• of the test as well as of the individual

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Achievements to date

• Establishment of 16 VCT centres (both community
  based and hospital based) for general population
• VCT is an integral component of service delivery
  package( SDP) of 20 projects currently being
  implemented for most at risk population IDUs,
  FSWs, MSW/Hijra, truckers, jail inmates.
• 46 surveillance Centers for general population
• Quarterly reports from surveillance centers
  and blood banks data.

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Achievements to date

• Operationalisation of nine ARV treatment centers.
• Strengthening of blood transfusion services.
  Guidelines for QC in blood banking
• Human resource development - doctors and nurses
  in management of STIs and AIDS patients
• Procurement of drugs for STIs, OIs and ARV
• Service delivery to HRGs - scaling up still
  remains a challenge
• Advocacy/sensitization sessions for
  parliamentarians, political influentials,
  religious leaders, district government and policy
  makers

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CHALLENGES

• Varying level of political commitment at
  provincial district level
• Limited non health sector involvement
• Limited private sector involvement
• General lack of access to information and
  resources on HIV/AIDS
• Difficult accessibility of high risk groups
• Local data on specific behavioural
  vulnerabilities of HRGs
• Access to youth both in-school out-of-school
• Large un-regulated private sector catering to 60
  of population needs
• Strengthening of BTS infrastructure

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CHALLENGES

• Epidemiological modeling based on available data
• Stigma related to STIs and myths and
  misconceptions related to STIs
• pilot projects focusing on sexual and
  reproductive health for youth
• Further need for multisectoral involvement in
  HIV/AIDS prevention activities
• Stigma and discrimination of PLWHA
• Strengthening of ME plans for Programme
  implementation
• Availability of all regimens of ARV and their
  regular supplies
• High cost of treatment, diagnostics and treatment
  monitoring.

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Thanks