The surveillance system is continuously evolving under the National AIDS and STD Control program (NACP) since its inception in 1992. Given the contour of Sustainable Development Goal (SDG) and global recommendations for comprehensive surveillance systems, NACO has formulated a framework for an Integrated and Enhanced Surveillance and Epidemiology (IESE) of HIV, STIs and related comorbidities providing high-quality epidemiological data in a cohesive manner maximizing the opportunities available in the existing NACP systems while adhering to the highest ethical standards.

The IESE framework covers various population group in view of the concentrated nature of the epidemic in the country. It includes low-risk, bridge (truckers, migrants, etc) as well as high-risk groups including people in prisons and other close settings. Within the given framework, more population groups are being covered depending upon the epidemiological needs as informed through programmatic and research data. The population group is being covered in both the community and facility settings the Programmatic Case-based Surveillance as well as cross-sectional bio-behavioural surveys (BBS). BBS adopts a combination of consecutive, random and respondent-driven sampling (RDS) approaches depending upon the objectives and the population group under consideration. The bio-behavioural data is being collected to meet both the epidemiological as well as programmatic needs. Given the contours of SDG 3.3 targets, HIV biomarkers pertaining to the prevalence, VL and CD4 are the key considerations and mainstay of the IESE under NACP. For the STIs, biomarkers for Syphilis, NG and CT are the key considerations. Based on the programmatic, epidemiological and reporting needs, biomarkers of related Co-Morbidities like Hepatitis B, Hepatitis C and any other feasible biomarkers are also being considered. The data forms collect information across the domains of socioeconomic-demographic profile, HIV/AIDS-related risk behaviours, knowledge and practices, interventions related knowledge and services uptake, stigma and discrimination and co-morbidities related risk behaviour.

Estimation of HIV burden has been formulated as one of the key activities within the IESE framework under NACP-V. It became an integral part of the S&E activities under NACP since 1998 when the HIV Sentinel Surveillance (HSS) was launched. It is being carried out periodically to provide latest evidence on the status of HIV epidemic at national State/UT level. The HIV estimation has been carried out annually since the 2019 round of estimation. As the NACP activities are tailored to focus on the ‘End of AIDS’, monitoring the epidemiological indicators at district-level became critical for programme plan planning and tracking progress at more granular level. For the first time in India, HIV estimation was carried out at district-level during 2017 round, when district-wise estimates were derived for five high prevalence States in India. In 2019, district-level HIV estimates were generated for all the States/UTs providing comprehensive epidemiological understanding of the epidemic in 735 districts across the country.

The IESE activity is implemented using robust scientific methods following a rigorous consultative process under the oversight of NACO’s institutional arrangements.