Evaluation of the population-level impact of HIV prevention interventions in India

Abstract

BACKGROUND: Established in 1992, the National AIDS Control Programme (NACP) aims to combat HIV in India. The majority of NACP budget has been allocated to prevention activities rather than treatment. The effort to tackle HIV through preventive measures was further reinforced by the launch of the India AIDS Initiative (Avahan) in 2003, sponsored by the Bill & Melinda Gates Foundation. The effectiveness of controlling HIV via prevention has long been a subject of debate. Few studies have provided substantive evidence on this issue. The objective of this study was to examine the impact of NACP and the Avahan initiative on population level HIV prevalence in India. METHODS: We evaluated the population level impact of NACP and Avahan by examining the association between HIV prevalence trend and the intensity of intervention programmes between 2003 and 2008. Population prevalence was estimated on the basis of the national HIV sentinel surveillance data obtained annually at antenatal clinics. The intensity of interventions was estimated with the annual cumulative grants and services provided by both programmes at the district level. A mixed effects regression model was used to estimate the association between the intervention intensity and the population HIV prevalence trends, taking into account differences in the underlying epidemic trends across states. FINDINGS: In general, the preventive efforts through NACP and Avahan appeared to be associated with a decline in HIV prevalence in the general population. Specifically, in the high HIV-burden states of Andhra Pradesh and Karnataka, higher intervention intensity was associated with significant decline in HIV prevalence between 2003 and 2008. This association was less pronounced in Maharashtra and Tamil Nadu states during this period. INTERPRETATION: This study is the first to demonstrate a beneficial impact of a nationwide HIV prevention programme. The findings suggest that HIV prevention is effective in containment of the spread of HIV. It provides support for India’s strategy, which emphasises comprehensive prevention programmes for the control of HIV.