Lecture done for MSc Medical Admin Students

1. National STD/AIDS Control Programme
Dr. Ajith Karawita MBBS, PGDV, MD
National STD/AIDS Control Programme

2. Contributing to a healthier nation through
sexual health promotion, emphasizing the
prevention, control and provision of quality
care for STIs including HIV and AIDS
2
Mission
Vision
Quality sexual health services
for a healthier nation.

3. 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

4. HMP
Health Master
Plan
(has 5 strategic
areas) (10 year)
1. Health service
delivery
2. Community
empowerment
3. Human resource
development
4. Financing ,
Resource allocation
& Utilization
5. Stewardship &
management of the
health sector
Programme
areas of Health
service delivery
1.1 Programme for
organizational
development
1.2 Medical supplies
1.3 National quality
assurance
1.4 Disease control
programmes
1.5 Programme for
vulnerable populations
1.6 National Nutrition
programme
1.7 Health promotion
programme
1.4. Disease
control
programmes
(has 28
areas)
STD/AIDS
CONTROL
National
STD/AIDS Control
Programme

6. 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

7. 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)

8. STRENGTHS FOR ACTION:
POLICY AND LEGAL FRAMEWORK

9. 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

10. STRENGTHS FOR ACTION:
INTERNATIONAL POLITICAL TOOLS AND
COMMITMENTS

11. 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 aspects
2002: The rights of the child
2004: Follow-up - Declaration of Commitment on HIV/AIDS
2004: Access to medication in pandemics - HIV/AIDS, TB & M
2004: Rights of the child
2004: Regional call for capacity-building in public health
2004: Scaling up treatment and care

12. 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

13. 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

14. 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)

16. 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

17. ORGANOGRAM, National STD/AIDS Control Programmes
17

18. 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)

19. 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

20. National Strategic Plan (NSP)
2007-2011

21. 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 HIV
The strategic objectives
1. Increase coverage and effectiveness of prevention
interventions
2. Increase coverage and effectiveness of care, support and
treatment interventions

22. Strategic Approach in the
National STD/AIDS Control Programme
Strategy 1: Prevention
Strategy 2: Treatment, care, and support
Strategy 3: Generating and using strategic information
Strategy 4 Multisectoral involvement and decentralization
Strategy 5 Policy development and legislation
Strategy 6: Strengthening national coordination and management
capacity

23. Strategy 1:
Prevention

24. 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

25. 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)

26. 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 29
Branch clinics, Yellow 21
STI clinics with ART facility,
(Blue pins)
4
Non STI units with ART facility
(IDH)
1

27. 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.

28. 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)

29. 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

30. Strategy 2:
Care, treatment and support

31. 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.

32. 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.

33. 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

34. Strategy 3:
Generating and using strategic
information

35. • 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.

36. Strategy 4:
Multisectoral involvement and
decentralization

37. 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.

38. 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

39. Strategy 5:
Policy development and legislation

40. 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

41. Strategy 6:
Strengthening national coordination and
management capacity

42. ORGANOGRAM, National STD/AIDS Control Programmes
42

43. 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.
• OneNational AIDS
Coordinating Authority, with a
broad-based multisectoral mandate.
• Oneagreed country-level
Monitoring and Evaluation
System.

44. One agreed HIV/AIDS Action
Framework that provides the basis for coordinating the
work of all partners.
National Strategic plan

45. One National AIDS Coordinating
Authority, with a broad-based multisectoral mandate.
National AIDS
Council
National AIDS
Committee
Sub
committees

46. One agreed country-level
Monitoring and Evaluation
System.
National AIDS
Council
National AIDS
Committee
Surveillance, M&E
subcommittee

47. GFATM and other Project Frameworks

48. PROJECT OR PROGRAMME AREAS
Progress 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 programmes
Police awareness programme under UNFPA funds in the Colombo and Gampaha
Districts
Development of National HIV/AIDS policy
National World AIDS day programme
Programme for the Elimination of congenital syphilis by 2015 (WHO funded
project)

49. PROJECT OR PROGRAMME AREAS
Major 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

50. What next and future?

51. 2011 Political Declaration: Targets and
elimination commitments
• Achieve universal access to HIV prevention, treatment,
care and support by 2015
• Targets and commitments