National AIDS Control Programme
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Direct answer
NACP-V, running from 2021 to 2026 under the National AIDS Control Organisation (NACO), is the current phase of a programme that began in 1992, and it aims to end AIDS as a public health threat by 2030 through the UNAIDS 95-95-95 cascade — 95% of people living with HIV knowing their status, 95% of those diagnosed on antiretroviral therapy, and 95% of those on treatment virally suppressed. India's backbone today is test-and-treat (ART for all diagnosed persons regardless of CD4 count), free TLD — tenofovir, lamivudine, dolutegravir — as first-line therapy, an ICTC (integrated counselling and testing) network applying the NACO three-test strategy, early infant diagnosis by DNA PCR at six weeks, and targeted interventions for key populations — female sex workers, men who have sex with men, transgender persons and people who inject drugs. The Human Immunodeficiency Virus (Prevention and Control) Act 2017 adds the rights-based legal frame: non-discrimination, informed consent, and free treatment as an entitlement.
What you must remember
- Phase chronology: NACP-I 1992 (NACO established), NACP-II 1999, NACP-III 2007-12 (halt-and-reverse of the epidemic), NACP-IV 2012 extended, NACP-V 2021-2026.
- Test and treat: since 2017 every HIV-positive person is eligible for ART immediately, discarding the old CD4 threshold — the single biggest programme change of the last decade.
- First-line ART: TLD (tenofovir + lamivudine + dolutegravir), a single daily tablet rolled out from 2020, replacing the older efavirenz-based regimens; second- and third-line regimens are also provided free, with viral load monitoring for failure detection.
- Testing pathway: ICTC centres apply the NACO three-assay strategy in series for diagnosis; the window period (about 2-12 weeks for antibody tests) is a favourite viva number.
- PPTCT: all pregnant women tested; positive mothers receive lifelong triple-drug ART (option B-plus), replacement-feeding guidance, and infants prophylaxis with DNA PCR at six weeks.
- Key-population interventions: peer-led targeted interventions with condom promotion, needle-syringe exchange and opioid substitution therapy for people who inject drugs, and STI/RTI services integrated with HIV care (rebranded as Suraksha clinics in recent years).
- HIV Act 2017: prohibits discrimination in employment, education and healthcare; mandates informed consent with limited exceptions; protects data privacy; and makes free ART an enforceable right — in force since 2018.
- Epidemiology frame: adult HIV prevalence is roughly 0.2% (about 2.5 million people living with HIV), with declining new infections, per NACO estimates.
One patient's journey through the cascade
A pregnant woman registered at an anganwadi is offered ICTC testing under PPTCT; a reactive assay followed by confirmatory assays per the NACO algorithm makes the diagnosis, and her husband is tested the same week. She starts TLD immediately — no CD4 gate exists — delivers in a facility, receives replacement-feeding counselling, and her baby gets prophylaxis with HIV DNA PCR at six weeks, the negative result closing the vertical-transmission question. Her husband, diagnosed positive, is linked to an ART centre, achieves an undetectable viral load at six months (U = U — undetectable equals untransmittable, the counselling sentence that transforms adherence), and his annual viral load continues to confirm suppression. The three 95s appear in miniature: status known, treatment started, virus suppressed. Where the cascade leaks, NACP-V's community-led testing, differentiated ART delivery and viral-load coverage are the patches; where the law shields them from a dismissive employer, the HIV Act 2017 is the answer examiners expect.
How the exam frames it
Chronology anchors most one-liners: 1992 (NACP-I and NACO), 2007 (NACP-III), 2021 (NACP-V), 2017 (test-and-treat and the HIV Act — the same year is deliberate exam machinery). Regimen questions reward currency: TLD as first-line, dolutegravir-based, replacing efavirenz; the older AZT-based answers are now distractors. Paediatric questions centre on the six-week DNA PCR for early infant diagnosis. Prevention questions test PPTCT's option B-plus lifelong triple ART, needle-syringe exchange with opioid substitution therapy, and the window-period logic of testing. Finally, the cascade: identify which "95" a proposed intervention strengthens — the reasoning item that separates understanding from memorised years.
Frequently asked questions
What are the 95-95-95 targets guiding NACP-V?
Ninety-five per cent of people living with HIV knowing their status, 95% of the diagnosed on antiretroviral therapy, and 95% of those on treatment achieving viral suppression — the UNAIDS cascade towards ending AIDS by 2030.
What is India's preferred first-line ART regimen?
TLD — tenofovir, lamivudine and dolutegravir as a single daily tablet — provided free since its 2020 rollout, replacing efavirenz-based first-line therapy.
When is early infant diagnosis performed and by what test?
HIV DNA PCR on a dried blood spot at six weeks of age for HIV-exposed infants, with repeat testing per protocol — because maternal antibodies make serology uninterpretable in infancy.
What does test and treat mean in the Indian programme?
Every person confirmed HIV-positive is started on ART irrespective of CD4 count or clinical stage — policy since 2017 — removing the earlier immunological threshold.
What protections does the HIV Act 2017 provide?
Non-discrimination in employment, education and healthcare, informed consent for testing and treatment, confidentiality of HIV-related information, and free treatment as an enforceable legal right.