The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that globally almost 40 million adults and children are living with HIV/AIDS (December 2003). Despite advances in the prevention and control strategies with respect to HIV/AIDS, it is estimated that 1500 new infections of HIV occur each day. Over the next few years, it is anticipates that Asia will face the highest burden of new HIV infections, India being particularly vulnerable. HIV/AIDS is known to adversely impact development, but more research is needed, also in India, to identify and quantify the exact impact of HIV.

National AIDS Control Organization (NACO), Ministry of Health & Family Welfare, Government of India needs reliable estimates of both the burden of disease and the socioeconomic impact of HIV/AIDS within the country. Such information would be helpful in formulating future strategies for reduction and mitigation of the impact of HIV/AIDS epidemic. In collaboration with UNDP, ICMR, NCAER and IHS, NACO seeks to initiate and implement these studies.

1. The UNDP is committed to promoting sustainable human development and has vast experience in preparation of Human Development Reports globally, nationally and at the state levels also building on its strong networks as well as the civil society. The Human Development Resource Centre (HDRC), at the UNDP country office has a strong commitment to mainstreaming HIV/AIDS as a development issue.

2. The Indian Council of Medical Research (ICMR), New Delhi is an apex body that provides stewardship and supports biomedical research in India, is an autonomous body funded by Ministry of Health & Family Welfare. It has a network of 26 institutes and nearly 100 field stations across the country. While several of institutes are engaged in HIV/AIDS related research, its National AIDS Research Institute (NARI) at Pun, spearheads research on HIV/AIDS within the country. NARI brings together a multidisciplinary team of scientists spanning the basic sciences, applied and operations research and behavioral science. ICMR's National Institute of Epidemiology (NIE), Chennai provides consultancy in epidemiology, and design of vaccine efficacy and clinical studies. Other major institutes of ICMR involved HIV/AIDS research includes the Tuberculosis Research Centre (TRC), Chennai (HIV/TB co-infection), National Institute of Cholera and Enteric Disease, Kolkata (opportunistic infections ofd Gut in the HIV infected, Injecting Drug Users (IDUs) and HIV), and provides support to ICMR activities on HIV/AIDS in the North- East states. Trough its institutes the ICMR would help in development of study protocol and take up studies related to burden of disease in Maharastra, Tamil Nadu and States of Northeast.

3. The National Council for Applied Economic Research (NCAER), New Delhi is an autonomous apex body with vast expertise in undertaking large scale macro economic research studies. In this collaboration NCAER will conduct the appropriate socioeconomic impact studies related to HIV/AIDS epidemic.

4. The Institute of Health Systems (IHS), Hyderabad is an autonomous research and training institution, sponsored by Government of India programmes of the Department of Family Welfare, Ministry of Health and Family Welfare. The IHS specializes in Burden of Disease Estimation and related research methodologies and serves as a base for an extensive array of burden of disease study and training initiatives in the country. The Andhra Pradesh Burden of Disease study of IHS has been noted as a rigorous study of state level burden of disease and is one of the first national burden of disease studies in the world. Reliable estimates of disease burden facilitate agenda setting and readjustment of priorities within the health sector and also within related sector like nutrition, drinking water etc. In this collaboration, the IHS will conduct research in estimating burden of disease in respect of HIV/AIDS, by involving in all the stages of the study.

The above parties will fully cooperate in accordance with the terms of this Memorandum of Understanding and hereby aggress to participate in conducting studies and respect of the burden of disease and the socioeconomic impact of HIV/AIDS in high prevalence states as per the roles and objectives outlined in this memorandum

Burden of Disease:- ICMR and IHS will develop and finalize the design of a study protocol on disease burden in the known six high prevalence States 1 on the basis of available data and will undertake such additional studies as essential to estimate the burden of disease. This would include, inter-alia

1. Analysis of Surveillance Data: The current data collection systems will be analyzed and evaluated for consistency of data elements, completeness and accuracy.

2. Estimation of incidence of HIV/AIDS: A close study of the epidemiological profile will facilitate systematic estimation of the incidence of HIV/AIDS district-wise, group-wise, gender-wise, rural/urban, age group and vulnerability ti HIV/AIDS by using "Dismod", a software used for internal validation of estimated incidence of disease from prevalence data, in the selected states and provide future scenarios.
3. Estimation of morbidity and mortality on account of HIV/AIDS in the select states including future scenarios (Estimation of Burden of Disease on account of HIV/AIDS in the study areas).
4. All of the above research will provide inputs into the socioeconomic impact studies undertaken by NCEAR, ICMR & IHS will also provide technical assistance in interpreting of prevalence and burden of disease.
5. The study design to be developed by ICMR and IHS will clearly identify specific technical and geographical responsibilities (ICMR- Tamil Nadu, Maharashtra, Manipur and Nagaland; IHS- Andhra Pradesh and Karnataka) between the two implementing agencies and the level of support that each will provide to NCEAR. The Steering Committee (See article 10) will facilitate smooth functioning of the partnership and also enable sharing information. Assist in mobilizing additional technical assistance and manage peer review , where appropriate , of the design and findings.

Socioeconomic Impact:- The impact studies will be undertaken by NCEAR in all six states; viz Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu, Manipur and Nagaland. NCAER will use the prevalence and incidence rates and other relevant estimates computed by ICMR and IHS undertaking socioeconomic studies. More specifically the NCEAR will focus its research on the following:

1. Analyze the nature and type of the economic impact of HIV/AIDS on households: This segment of research will help to find out state specific strategies that are needed to alleviate the problems faced by HIV/AIDS affected households. The focus will be investigate the relationship between HIV/AIDS and distribution on income and wealth, changes in structure of employment and social security.

2. Assess sectoral impact: State Specific measurement of the current and potential impact of HIV/AIDS on different sectors of the economy including (but not limited to) agriculture, tourism and health care industry will be undertaken.

3. Assess net impact of HIV/AIDS on the State and national level economic performance: An integrated model incorporating specific sectors, associated labour force participation and effects on productivity will be developed to evaluate and estimate the impact of HIV/AIDS on the respective state Net State Domestic Product (NSDP).

1. Burden of Diseases: Institutes of ICMR and IHS
2. Socioeconomic Impact : NCAER
3. Providing available information/material and state level facilitation and cooperation of state level authorities: NACO
4. Financial and Technical Resources (as per Article 10.4): UNDP

Research Ethics: The participating agencies here by agree to follow the general research ethics guidelines as laid down by ICMR for carrying out biomedical research in human subjects and other relevant institutional guidelines. It is the responsibility of the implementing agencies to get required clearances through their appropriate ethical committees or institutional review boards as required for carrying out biomedical research in human subjects.

NACO through Ministry of Health and Family Welfare would facilitate, in accordance with the existing rules and regulations and guidelines, the granting of appropriate terms and permissions to work on this initiative in a transparent manner and will facilitate and coordinate functioning amongst the participating agencies.

Article 8

The agencies undertaking the study will be responsible for the management of the study component agreed upon and will be responsible for the conduct of their investigators. NACO is indemnified from the effects of the action of the agencies or their representatives in the field and NACO will not be held responsible for legal issues arising out of the same.

Publication: Participating institutions will have limited publications in respect of work done by them, and subject to approval in writing from NACO. The agencies desirous of publishing their work will write to the Project Director , NACO for approval and if NACO does not respond with in 45 days from the receipt of the request, it shall be deemed as approved.

Upon signing of the agreement , NACO will constitute a Steering committee with the following members- NACO, ICMR, NCAER, IHS, UNDP, UNAIDS, three SACS representatives and one PLHA representative with the Additional Secretary (H) and Project Director NACO as Chair. The Steering Committee will meet on a quarterly basis and the implementing agencies will represent progress reports at these meetings. The Steering Committee will also responsible for overall monitoring of the study, facilitation of smooth functioning between the partners, facilitate timely flow of technical and financial resources and will undertake advocacy and appropriate dissemination of the study findings.

The Steering Committee may set up a technical monitoring group with specific terms of reference for regular monitoring of the progress of the study.

NACO will be responsible for obtaining the necessary clearances and for providing available information from the national and state level organization/institutions on the epidemic. NACO will also facilitate engagement and activate cooperation of the state level authorities in the conduct of the study. NACO will also facilitate (through IHS) a two day meeting of experts to further detail the methodology of the study with in 15 days of the signing of MOU, and this methodology will bind the partners, until such time as they are further adjusted the Steering Committee as per Article 10.1

Each of the implementing agencies will be provided with a block start-up grant as per budget given by the resource institutes (Annexure -I) with in seven days of signing of MOU. Based on the study protocol developed and approved by the Steering Committee, UNDP release additional installments for the completion of the study, as per request of the Chair of the Steering Committee. UNDP will also facilitate peer review of the study findings and recommendations and also engage ( within the availability of the budget- Annex 1), any additional technical expert that may be required in the effective conduct of the study.

ICMR , NCAER and IHS will ensure that the study is conducted maintaining highest quality standards. The total duration of the study including final reports will be 12 months from the signing the MOU. A work plan is attached as Annexure-II.

Total

1. Review the existing literature in the field especially as it applies to India

2. Develop a study protocol by which impact of the HIV/AIDS epidemic on the sectors and areas outlined above can be studied

3. Collect data and estimate the results of the study

4. Analyze the national response to the epidemic in the light of the study findings and recommend changes in strategy, if any

5. Dissemination of the findings of the workshop.

6. Finalization of report

 Agenda

Home