At a glance
For over 50 years, CDC has engaged in highly successful technical collaboration with the Government of India (GOI) and Ministry of Health and Family Welfare (MoHFW) while addressing India’s public health priorities. As new health threats emerge, CDC and national partners are well-placed to leverage past successful initiatives to strengthen global health security capabilities and rapidly respond to new public health challenges.
Overview
For over 50 years, CDC has engaged in highly successful technical collaboration with GOI and MoHFW. The collaboration addresses India’s public health priorities:
- Global health security
- HIV
- Tuberculosis (TB)
- Vaccine-preventable diseases (VPDs)
- Antimicrobial resistance (AMR)
As new health threats emerge, CDC and national partners are well-placed to leverage past successful initiatives. Together they work to strengthen global health security capabilities and rapidly respond to new public health challenges.
Public health systems
CDC provides technical expertise in strengthening public health systems to prevent, detect, and respond to emerging infectious diseases. This work helps advance global health security priorities. CDC focuses on real-time disease surveillance, laboratory systems and diagnostics. The work also focuses on workforce development and emergency management.
CDC supports GOI in the conceptualization, development, and implementation of Integrated Public Health Laboratory (IPHL). CDC now supports the scale-up of IPHL across all 730 districts in India. IPHLs have streamlined district- and block-level laboratory practices and increased laboratory diagnostic capacity. CDC supports training in the application of evidence-based techniques. This work helps strengthen infectious diseases diagnostic capacity and assure quality in sub-district, district, and state referral laboratories.
CDC's ongoing efforts to strengthen molecular detection capabilities increase the capacity of district laboratories to detect emerging pathogens. CDC also improves infection prevention and control at 50 hospitals led by the All-India Institute for Medical Sciences.
CDC has supported training for over 10,000 workers in:
- epidemiology and disease surveillance
- public health emergency management
- laboratory diagnostic testing
- biosafety and quality management
Field Epidemiology Training Program (FETP)
FETP strengthens the public health workforce’s abilities to detect, respond, and control disease outbreaks at the source. CDC supports FETPs across India through mentorship for outbreak investigations, surveillance evaluations, COVID-19 activities, and regular training.
Since 2012, India FETP officers investigated over 550 outbreaks and conducted over 300 surveillance evaluations. FETP officers have responded to the COVID-19 pandemic in 22 states and union territories and support measles and rubella elimination efforts.
Emergency management
CDC collaborates with GOI and partners to enhance India’s emergency management capabilities and resilience. CDC supports the establishment, operation, and management of national and sub-national EOCs. EOCs can coordinate and direct response to disease outbreaks, natural or humanmade disasters, and other public health emergencies. CDC also supports creation, development, and maintenance of a comprehensive five-tiered Public Health Emergency and Disaster Management Professional Development Program.
CDC also aims to:
- Increase emergency management human resource capacity.
- Strengthen national and sub-national emergency operations centers (EOCs).
- Develop and update emergency response plans, protocols, and procedures.
- Build and sustain crisis and risk communication capacity.
- Enhance points of entry preparedness and response capabilities.
- Train and equip rapid response teams in management and operations.
- Offer real-time support for multiple EOC activations and outbreak response systems.
HIV
Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC works to implement prevention, testing, and treatment, programs. CDC closely collaborates with partners such as the National AIDS Control Organization (NACO) and State AIDS Control Societies.
CDC uses an equity lens while striving to close access gaps among key populations. CDC implements strategies to improve prevention, testing, and treatment options for people in Manipur, Mizoram, and Nagaland. These are states where HIV prevalence is highest.
CDC supports strategies to improve medication delivery and services in community and health system settings. NACO has adopted these strategies across a network of 712 ART centers.
CDC uses diagnostic network optimization and workforce development to strengthen viral load testing capacity and increase access to services.
Key achievements
- Support nationwide HIV behavioral sentinel surveillance—the largest in the world.
- Implement the HIV Advanced Disease Management for early screening of tuberculosis and cryptococcus .
- Establish partnerships to integrate strategies to address non-communicable diseases for people living with HIV.
- This includes screening and management of cervical cancer, hypertension, and diabetes, into HIV care to ensure treatment continuity.
- This includes screening and management of cervical cancer, hypertension, and diabetes, into HIV care to ensure treatment continuity.
- Draft and disseminate the national operational guidelines for ART services and HIV care and treatment.
- These guidelines were disseminated to 712 ART centers and 29 state AIDS Control Societies.
- These guidelines were disseminated to 712 ART centers and 29 state AIDS Control Societies.
- Provide expanded evidence-based case finding strategies.
- This has included index testing services and social network strategy, which now have been included in the revised national HIV counseling and testing guidelines.
- This has included index testing services and social network strategy, which now have been included in the revised national HIV counseling and testing guidelines.
- Establish community one stop centers in Manipur and Andhra Pradesh for HIV testing and treatment services.
- Enhance laboratory quality towards ISO accreditation for 130 HIV reference labs and over 5,000 HIV testing sites.
- This has lead to early and accurate diagnosis of HIV and other STIs.
- This has lead to early and accurate diagnosis of HIV and other STIs.
TB
CDC supports the National Tuberculosis Elimination Program to end TB by supporting four strategic pillars: detect, treat, prevent, and strengthen capacity.
CDC successfully implemented ‘Strengthening TB Action and Response (STAR)’ project in Mumbai. STAR provides public sector drug susceptibility testing to support initiation of individualized drug-resistant TB (DR TB) treatment and improve treatment adherence. STAR also focuses on strengthening infection prevention and control (IPC) practices to reduce TB transmission at 144 healthcare facilities in Mumbai.
This model of TB IPC in Mumbai is based on CDC’s ‘Building and Strengthening Infection Control Strategies (BASICS)’. This model was successfully scaled up in ten states as the ‘TB Mukt Bharat IPC’ project. CDC and partners trained 953 health staff, including hospital infection committee members (HICC) on TB IPC guidelines. HICC members completed baseline assessments in 131 health facilities across the 10 states. CDC is supporting TB IPC among healthcare workers at Mahatma Gandhi Institute of Medical Sciences and Kasturba hospital in Maharashtra.
During the COVID-19 pandemic, CDC helped improved treatment outcomes among patients with DR TB in Mumbai’s informal urban settlements. The results of this project has been published in CDC's MMWR report.
CDC successfully implemented early TB preventive treatment programs in India which included diagnosing and treating latent TB. CDC used patient-friendly diagnostic tests and treatment regimens. CDC helped increase capacity for next generation sequencing at the National Institute of Research in Chennai. This effort identified common and new TB mutations and led to the first Indian TB catalogue of mutations. CDC works with the National Tuberculosis Elimination Program to strengthen state- and district-level capacity to accelerate TB control and elimination efforts.
Vaccine-preventable diseases (VPDs)
CDC supports efforts to eradicate or control VPDs through the Universal Immunization Program.
Since the mid 1990's, CDC has helped strengthen:
- Epidemiology and laboratory methods.
- Routine immunization services.
- Training methods.
- Data systems.
- Case-based disease surveillance.
- Outbreak preparedness and response.
CDC's support of the National Public Health Surveillance Project strengthened:
Antimicrobial resistance (AMR)
CDC works to increase AMR and healthcare-associated infections (HAIs) surveillance and institutionalize IPC capacity nationally and sub-nationally.
CDC supported GOI to establish the National Antimicrobial Surveillance Network. This increased the country's network from 10 laboratories in 2013 to 40 laboratories across 29 states and union territories.
CDC, the Indian Council of Medical Research and All India Institute of Medical Sciences implemented a HAIs surveillance and prevention network. These networks were used to quickly disseminate COVID-19 information to hospitals.
Key achievements
- CDC supported GOI to strengthen and expand AMR and HAI surveillance across 29 states.
- CDC contributed to technical advisory and core working groups on AMR, IPC, and AMSP committees of MoHFW, Government of India, that guide policy and implementation of AMR surveillance and response activities.
- CDC has developed AMR focused tools, guidelines, SOPs, and training materials for MoHFW.
Influenza
CDC's influenza program focuses on strengthening three main areas: the surveillance network, public health research, and pandemic preparedness. Influenza viruses change constantly and require continued vigilance.
CDC supports India prepare for pandemics in alignment with India's Pandemic Influenza Preparedness and Response Plan. CDC helps by strengthening laboratories and training clinicians on effective case management and infection control. Many of these activities were developed during the 2009 influenza A/H1N1 pandemic and leveraged during the COVID-19 pandemic.
CDC supports strengthening India's influenza surveillance network by building lab capacity. Lab strengthening is achieved by building capacity for molecular diagnostics and providing critical laboratory supplies. Strong influenza surveillance enabled India to detect seasonal peaks during monsoons, understand seasonality in tropical countries, and guide influenza vaccination timing.
Key achievements
- In collaboration with the All India Institute of Medical Sciences, CDC helps determine the disease and economic burdens of influenza and other respiratory viruses in priority groups, evaluates effectiveness of influenza vaccines, and identifies optimal timing for influenza vaccination.
- CDC fosters collaboration for influenza prevention and control across government bodies, healthcare professionals, researchers, and professional organizations in India through multiple stakeholder meetings during 2022-23 period involving representatives from more than 15 states.
- CDC helped advance molecular diagnostic capacity developed during CDC's collaborations with National Institute of Virology.
- CDC supported trainings on Flu-COVID-19 RT-PCR and next-generation sequencing for participants from medical colleges across India and neighboring countries to strengthen laboratory capacity for rapid detection of viruses and other emerging pathogens for disease prevention and control.
Featured success story
Empowering community leaders among female sex workers for HIV service equity and addressing stigma
CDC India, in collaboration with the Society for Health Allied Research and Education INDIA (SHARE INDIA) and the Andhra Pradesh State AIDS Control Society (APSACS) worked to enhance HIV service delivery for female sex workers at NARI SAKSHAM, a community led organization in Rajahmundry, Andhra Pradesh. This organization reaches 2,700 female sex workers across the district through 100 community-based groups.
Female sex workers have historically faced barriers in health care settings such as social exclusion, stigma, and discrimination. Additionally, a complex public health system with limited accessibility has led to poor patient outcomes, including irregular pick up of antiretroviral treatment (ART), lack of follow up, and lower adherence to treatment.
To improve access to HIV treatment among female sex workers living with HIV, CDC provided on-site technical assistance to NARI SAKSHAM for establishing decentralized ART clinical services to ensure consistent treatment and durable viral load suppression. CDC rained community leaders on how to administer ART, regularly check on people living with HIV, collect samples for viral load tests, and report data. Through the Undetectable = Untransmittable (U=U) campaign, community leaders also promoted positive HIV treatment adherence and reducing stigma.
G. Vijaya Rani, coordinator at NARI SAKSHAM, noted significant improvements: 981 people living with HIV, including 412 female sex workers received regular ART. "Earlier we didn't know if members were taking medicines regularly and if their health was okay. Now I can observe that they come regularly and take ART. I am also able to follow up on their VL test due dates and refer them for tests on time".
From 2020 to 2022, the initiative achieved a 98% treatment retention rate for female sex workers with HIV, increased viral load testing access from 21% to 92%, and improved viral suppression from 77% to 94%. This model's success led to its adoption by 29 community-based organizations across Andhra Pradesh, setting a national benchmark for empowering communities and achieving HIV service equity.
