Building Institutional Capacity to Improve HIV-TB Care and Treatment Service Quality in India under the President's Emergency Plan for AIDS Relief (PEPFAR)

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India is home to the third largest number of people living with HIV/AIDS (PLWH) in the world. There are an estimated 2.09 million people living with HIV. The Government of India (GoI) has undertaken a robust scale up of its antiretroviral treatment (ART) program, starting from eight ART centers in 2004 to over 420 centers now in 2014. Currently, over 750,000 PLWH are on ART out of 1.1 million eligible for treatment. Despite scale up success, several challenges remain for the ART program to achieve the expansion it envisages over the next five years. These include human capacity issues, loss of patients from detection to enrollment in HIV care, and late HIV detection and retention. At every stage, over 200,000 patients are lost from testing to enrollment in care, to retention in care and then to treatment. Although progress has been made in the implementation of the HIV-TB program, there are several gaps that need to be addressed. The linkages between HIV/AIDS and the Revised National Tuberculosis Control Program (RNTCP) are suboptimal, particularly in northern states due to limited capacity and infrastructure. Only 61% (2014) of TB patients were screened for HIV and knew their HIV status in the last one year. Of those identified as HIV positive, 85% were linked to ART. However, the concern is that the referral from HIV testing and care facilities to RNTCP is quite low.

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