Objectives of Session: • Key Components under NACPIII • Care, Support and Treatment programmes under NACPIII • To understand linkages between different services |
Chapter outline:
1. Introduction
2. Goals & oOjectives of NACP III
3. Components of NACP III
3.1Targetted Intervenetion for High Risk Groups
3.2 Link Worker Scheme
3.3 STI treatment
3.4 IEC with focus on BCC
3.5 Blood Safety
3.6 Integrated Counselling & Testing Centres
3.7 Care Support & Treatment
3.8 Care Support & Treatment
4. Overview of Care Support & Treatment
National AIDS Control Programme Phase III (NACP III) 2007 – 2012
- Introduction
Based on the lessons learnt and achievements made in Phase I and II, India developed the Third National AIDS Programme Implementation Plan (2007-2012). This has evolved through a year-long preparatory process that included wide-ranging consultations through 14 working groups, e-forums, civil society organisations, PLHA networks, NGOs/CBOs, national expert groups, development partners and the World Bank led pre-appraisal team. It has also incorporated inputs from various assessments and studies. All this has led to a consensus about the goals, objectives and overall framework of the NACP–III.
- Goal and Objectives
The overall goal of NACP-III is to halt and reverse the epidemic in India over the next 5 years by integrating programmes for prevention, care, support and treatment. This will be achieved through a four-pronged strategy:
- Prevention of new infections in high risk groups and general population through:
- Saturation of coverage of high risk groups with targeted interventions (TIs)
- Scaled up interventions in the general population
- Providing greater care, support and treatment to larger number of PLHA.
- Strengthening the infrastructure, systems and human resources in prevention, care, support and treatment programmes at the district, state and national level.
- Strengthening the nationwide Strategic Information Management System.
The specific objective is to reduce new infection as estimated in the first year of the programme by:
· Sixty per cent (60%) in high prevalence states so as to obtain the reversal of the epidemic; and
· Forty per cent (40%) in the vulnerable states so as to stabilize the epidemic.
Prevention is the core strategy of India Response to HIV/AIDS
- Components of NACP III
The major programmatic components of NACP III are as follows:
• Prevention
• Targetted Intervenetion for High Risk Groups
• Link Worker Scheme
• STI treatment
• Promoting Condom Use
• IEC with focus on BCC
• Blood Safety
• Integrated Counselling & testing services ( including PPTCT )
• Care, Support and Treatment
The functions of each of the components are discussed below :
3.1 Targetted Interventions (TI)
Implemented by NGOs and focuses on saturating the high risk groups (FSW, IDUs & MSM) and bridge population (migrants and truckers)
Services offered under TI include :
• Behaviour change communication
• Condom promotion
• Management of: Sexually transmitted infections
• Needle Exchange Programme/oral substation therapy (for injecting drug users)
• Creating and enabling Environment
• Referral services for counseling and HIV testing and treatment
3.2 Link Workers Scheme
• Aims at saturating the reach of HIV related services to the high risk groups based in rural areas.
• The key services delivery areas are:
– Capacitating the rural community and equipping them with HIV related knowledge to combat the epidemic.
– Linking the HRG and vulnerable population to the public health services, STI , ICTC, ART and then their follow up that to communities.
– Addressing issues regarding counselling, condoms and behaviour change among youth and de-stigmatizing the environment.
3.3 Sexually Transmitted Infections (STI Clinics)
Provision of STI/RTI case services is an important strategy to prevent HIV transmission and promote sexual and reproductive health under NACP-III and RCH-II. These include:
• Training of preferred private practitioners for syndromic management.
• Diagnosis and treatment of sexually transmitted infections through syndromic cases management by providing color coded packs.
• Linkages with HRGs
• Referral services from STI clinics to Integrated Counseling and Training Centres
3.4 Blood Safety
• The objective is to ensure blood safety
• Increase accessibility to blood banks
• Adequate supply of safe and quality blood
• Screening of donated blood for HIV, syphilis, hepatitis B & C and malaria before transfusion.
• Promote voluntary blood donations by organizing camps
• Establishment of blood components separation units.
• Increasing access to blood in rural areas through blood storage units
3.5 Information Education and Communication (IEC)
• Behavior Change Communication and public awareness through mass media, mid media and interpersonal communication
• Create an enabling environment free of stigma and discrimination
• Awareness about services available under the programme to improve utilization.
3.5 Integrated Counseling & Testing Centres
Single window service for:
– Pre-test counseling before HIV testing
– HIV testing and providing results of the test
– Post test counseling to both positive and negative persons
– Condom promotion and distribution
– Identification for HIV+ pregnant women
– Providing prophylaxis (nevirapine tablet and syrup and mother and new born) for prevention of transmission from mother to child
– Prophylactic (co-trimoxozole) to exposed children
– Education regarding infant feeding
– Referral to ART Centre for investigation and treatment
– Cross referral between RNTCP and ICTCs
3.6 Care Support & Treatment : The Services provided under Care Support & Tretament programme are as follows:
• Treatment and Patient Management
o Diagnostic services, Anti Retroviral Treatment, Treatment of OI
• Counseling Service
o Family Counseling, Nutritional Counseling, Treatment literacy, Psychosocial support
• Referral and Outreach
o Adherence monitoring, Default retrieval
• Social Support
o Link with NGOs, Support for PLHA
- An overview of Care Support & Treatment :
ART programme started on 1st April 2004 at 8 institutions. Currently 292 ART Centres are functioning with nearly 3.7 lakh adults and 22,000 children alive and on treatment. 540 Link ART Centres are providing services to nearly 20,000 PLHIV. In addition, 359 Community Care Centres are functioning
4.1 Service Delivery Points under Care Support & Treatment
• ART Centres
• Link ART Centres (LAC)
• LAC Plus Centres
• Centres of Excellence (CoE)
• ART Plus Centres
• Regional Pediatric Centres (RPC)
• Community Care Centres (CCC)
4.2 ART centres:
Main Objective of Anti-retroviral Therapy Centers (ART) is to provide comprehensive services to eligible persons with HIV/AIDS including ART. ART centres are located in the Medicine department of Medical colleges & District Hospitals.
Services available at ART Centres.
• First line ARV drugs
• Free Diagnostic services (CD4 count)
• Regular supply of ARV drugs procured centrally and supplied directly to ART Centres
• Free Treatment of Opportunistic Infections
Functions of ART centres
• Registration of HIV+ persons identified at ICTCs for ART
• Conduct CD4 Count and other laboratory investigations to assess eligibility for ART
• Follow-up of pre-ART and ART patients
• Provide free ARV drugs to eligible persons on a monthly basis
• Provide counselling services before and during treatment for ensuring regular intake with >95% drug adherence, nutrition, use of condom, hygiene etc.
• Diagnose and treat Opportunistic Infections
• Montor patient on ART in terms of OIs, side effects , adherence and treatment failure
• Referral for specialized services or in-patient care
4.3 Link ART Centres :
The concept of LINK ART CENTRES was initiated in 2008 , to minimize the travelling needs for the patients stable on ART and improve drug adherence .
Site for setting up LAC
Integrated Counselling and Testing Centres in Government Hospitals including Rural/Taluka Hospitals and CHCs
It is a low cost facility and expenditure is only on facility development, training and operational costs
Functions of Link ART centres
• Adherence counseling and monitoring.
• Provide ART drugs to stable patients on ART linked out by Nodal ART Centre.
• Identification of the critical side effects of ART / OI medication,
• Identify symptoms suggestive of OI, side effects of drugs.
• Referral to the main ART centre at the earliest.
Link ART center shall not initiate ART in any patient.
4.4 LAC Plus :
Rationale:
• Gaps between those detected at ICTC & enrolled at ART
• The study on factors affecting enrolment of PLHA in India revealed that long distances and travel are the main constraints in accessing ART services.
• Nearly 20% patients reach the ART Centres at a very late stage (CD4 count <50) when the risk of mortality is 3 times higher.
Objectives:
• The roll out of the revised scheme shall be initiated at existing Link ART Centres with a patient load of more than 100 PLHIV on ART and will be expanded in a phased manner after getting prior approval from NACO.
• To integrate HIV services with the Primary / Secondary Health Care system.
• To build capacity of human resources at Primary Health Care Level in follow-up of ART services
• To increase access of ART services to the PLHA.
• To bridge HIV testing & treatment services
• To improve ARV drug adherence
Functions
Existing Functions | Revised Functions |
• ARV Drug dispensing • Monitoring of PLHIV on ART • counseling on adherence, nutritional & positive prevention • Identification of side –effects • Treatment of Minor OIs | • Enrolment of PLHIV into HIV care and treatment ART Care • Pre-ART management inc. baseline investigations and sample collection for CD4 count. • Follow up of pre-ART patients not eligible for ART. • Referral of eligible patients to Nodal ART Centre for ART initiation. • Screening of HIV-TB co infection • Monitoring of PLHIV on ART and Drug dispensing • Treatment of Minor OIs • Identification of side –effects • Counseling on adherence, nutritional & positive prevention • Tracing of LFU and MIS |
— The roll out of the revised scheme shall be initiated at existing Link ART Centres with a patient load of more than 70 PLHIV on ART and will be expanded in a phased manner after getting prior approval from NACO.
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4.5 Centres for Excellence:
Rationale for Centers of Excellence
§ Requirement of a shift to chronic patient management approach.
§ Issues surrounding long term adherence and HIV drug resistance require constant training and upgrading of knowledge and skills among providers.
§ To address the need for capacity building of good quality, skilled and knowledgeable healthcare providers.
§ Serve as models in HIV/AIDS care and support.
Functions of Centres of Excellence:
List of CoEs
1 | Government Gandhi General Hospital , Hyderabad, Andhra Pradesh |
2 | PGIMER , Chandigarh |
3 | MAMC, New Delhi |
4 | BJMC, Ahmedabad, Gujarat |
5 | Bowring and Lady Curzon Hospital, Bangalore, Karnataka, |
6 | STM, Kolkata, West Bengal |
7 | Sir J.J. Hospital, Mumbai, Maharashtra |
8 | GHTM, Tambaram Chennai, Tamil Nadu |
9 | BHU, Uttar Pradesh |
10 | RIMS, Imphal, Manipur |
4.6 ART Plus
• Patients experiencing treatment failure with 1st Line ART are referred to the Centres of Excellence for further evaluation and 2nd Line treatment, if required.
• Many patients are reportedly facing problems due to long distance, travel, time and costs.
• Based on the existing number of patients on Second Line ART & distance from COE, it has been decided to expand the network of ART centres that would be capacitated to start 2nd Line treatment following the same referral procedure as adopted for the Centres of Excellence.
List of ART plus Centres
1. Govt. Medical College, Aurangabad
2. Byramjee Jejeebhoy Medical College & Sasoon Hospital, Pune
3. Govt. Medical College, Nagpur
4. Govt. Medical College, Salem
5. Govt. MedicalCollege, Surat
6. KIMS, Hubli, Karnataka
7. GGH, Vijayawada, Andhra Pradesh
4.7 Regional Paediatric ART Centres
Regional Paediatric ART Centres serve as Centres of Excellence for Paediatric care including management of complicated OIs, training and research activities. These centers will have varying roles and responsibilities for delivery of care and support to infected children
- Providing a child-friendly one-stop service for comprehensive care which provide
· Specialized laboratory Services including Early Infant Diagnosis
· ART to children infected with HIV
· treatment for opportunistic infections as well as inpatient care
· Counseling on adherence , nutrition and adolescent issues
- Technical Support :These centres will provide the necessary technical support to the up scaling of pediatric AIDS care. They will focus on developing the capacity of the staff in pediatric HIV clinical management and diagnosis, management of OIs, pediatric ARVs, comprehensive care, improving referrals and linkages, as well as research activities.
- Model Centres: These centre shall be a centre of excellence in diagnosis, treatment, and continuing care of HIV/AIDS, and opportunistic infections and other HIV/AIDS-related conditions.
4.8 Community care Centres:
Under the national programme, a Community Care Centre (CCC) is a place with facilities for
out-patient and inpatient treatment where a PLHA receives the following services. Psycho-social support to PLHA
• Drug Adherence and nutritional counseling
• Support to new patients on ART
• Follow-up of PLHA including tracing missed cases and those lost to follow-up
• Home-based care and services
• Treatment of minor OI (Out-patient/Inpatient Care)
• Palliative treatment to terminal cases
The CCC are located in community settings.
4.9 Referral & Linkages:
Flow of Patients under Care Support & Treatment Programme;
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