Knowing your HIV/AIDS epidemic and tailoring an effective response: how did India do it?

Tremendous global efforts have been made to collect data on the HIV/AIDS epidemic. Yet, significant challenges remain for generating and analysing evidence to allocate resources efficiently and implement an effective AIDS response. India offers important lessons and a model for intelligent and integrated use of data on HIV/AIDS for an evidence-based response. Over the past 15 years, the number of data sources has expanded and the geographical unit of data generation, analysis and use for planning has shifted from the national to the state, district and now subdistrict level. The authors describe and critically analyse the evolution of data sets in India and how they have been utilised to better understand the epidemic, advance policy, and plan and implement an increasingly effective, well-targeted and decentralised national response to HIV and AIDS. The authors argue that India is an example of how ‘know your epidemic, know your response ’ message can effectively be implemented at scale and presents important lessons to help other countries design their evidence generation systems. BACKGROUND The HIV epidemic was discovered almost 30 years and we still have 2.7 (range 2.4e2.8) million new infections per year.1 Evidence-based resource allo-cation to increase the efficiency and effectiveness of national programmes has become a global focus.2 While data collection efforts have been extensive globally, too few have been able to embody the Know your epidemic, Know your response message advocated by the HIV/AIDS community at large.3 Two questions remain critical: what data should be collected and how should it be used to help design and implement an effective national response? In India, best viewed as a ‘subcontinent ’ with a population of 1.2 billion people and with 35 states and union territories, 640 districts and 5924 subdistricts,4 the response to HIV has been led by the National AIDS Control Organization (NACO), established in 1986. It has evolved and intensifie