Nai Zindagi Trust

1. Organization Description
Nai Zindagi Trust (NZT) is a non-profit organization founded in 1989 to serve people marginalized by drug use and HIV/AIDS across Pakistan. NZT currently implements Pakistan’s Global Fund HIV grant through a comprehensive harm reduction approach. Operating in 63 districts, NZT reaches over 8,000 people who inject drugs (PWID) daily through its Needle Syringe Exchange Program (NSEP), HIV prevention, testing, and linkage services. NZT also supports spouses of HIV+ PWID through prevention and care programs.
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2. Work in Viral Hepatitis
Nai Zindagi Trust integrates HCV prevention, screening, diagnosis, and treatment into its harm reduction and HIV care services. This includes screening PWID, their spouses, and prison inmates, facilitating confirmatory PCR testing, initiating treatment, and monitoring post-treatment outcomes. HCV services are coordinated in partnership with Agha Khan University Hospital and local treatment centers.
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3. Screening and Testing Activities
• Total HCV screenings in 2024: 26,880
• Total HCV-positive cases: 10,540
• Distinct individuals screened: 23,475
o Clients: 14,476 screened | 9,611 positive
o Spouses: 3,758 screened | 396 positive
o Prison inmates: 5,241 screened | 533 positive
• Overall positivity rate: 45%
Screening is conducted through mobile outreach teams and fixed CoPC+ centers, with services extended to prisons and spouses of clients.
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4. Treatment and Care Services
Out of 1,474 referred individuals:
• PCR Positive: 1,064
• PCR Negative: 410
• Treatment Initiated: 900
• Post-Treatment PCR Done: 362
o Cured (PCR Negative): 274
o Still positive: 88
Among spouses:
• 396 tested positive
• 20 began treatment
• 6 completed post-treatment PCR
o 5 were cured
o 1 remained positive
Treatment support includes counseling, transportation assistance, and continuous follow-up through case management.
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5. Advocacy and Community Engagement
Nai Zindagi actively participates in District AIDS Councils (DACs), engages communities via social mobilizers, and counsels both clients and families. HCV awareness and stigma reduction are addressed in outreach sessions, spouse meetings, and through trained outreach staff.
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6. Significance of Managing HIV & HCV Co-infection
Co-infection with HCV significantly worsens health outcomes for people living with HIV. Studies show that co-infected individuals progress to cirrhosis 12–16 years earlier, with HCV responsible for up to 90% of liver-related deaths in HIV-positive populations. NZT’s data shows 90% of HIV+ PWID are co-infected with HCV, highlighting the critical need for integrated diagnosis and treatment. However, lack of free PCR testing, distant treatment centers, and economic barriers restrict access to HCV care. NZT’s integrated model addresses these challenges through in-house linkage and support.
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7. Key Partnerships and Innovations
• Partner: Agha Khan University & Hospital
• Innovations:
o Mobile outreach screening
o Real-time data tracking with UIDs
o Integration of HIV and HCV care
o In-prison HCV services