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Care Support & Treatment (CST)

 

Scaling up of CST

Total number of Districts in Gujarat is 26. These 26 districts has been categorized as 7 Category ‘A’ districts, 4  Category ‘B’ districts, 9 category ‘C’ and 6 category ‘D’ districts with an estimated no. of 1,37,000 PLHIV in the state. 7 new districts are made in Gujarat recently, so total number of districts will be 33 in Gujarat.

The state has scaled up the CST services to 27 ART centers (HIV / AIDS Management & Treatment Centers).  Out of these centers 12 are in Government Medical Colleges, 14 in District Hospital and 1 as a collaborative project with a corporate organization. Gujarat has 1 more ART Center at Gotri Medical College, Vadodara and 2 more facility integrated ART Centre at Petlad and PKB Hospital, Rajkot to be made functional in current financial year which is under process.

Comprehensive HIV Care:

The overall goal is to improve the survival and quality of life of PLHIV with Comprehensive HIV care package of services including condoms and prevention education

ART Policy Package:

    • Free Universal Access to ART
    • Free Diagnostic services
    • Standardized combination ARV therapy
    • Regular and secure supply of ARV drugs
    • Robust Monitoring & Evaluation system

Care Support and Treatment under NACP IV

The overall goal of CST component under NACP IV is to provide universal access to comprehensive, equitable, stigma-free, quality care, support and treatment services to all people living with HIV (PLHIV) using an integrated approach.

To achieve the goal, the strategy will be:

    • To scale up access to anti-retroviral treatment (ART), and opportunistic infections (OI) prophylaxis & treatment for children, adolescents and adults, free of stigma and discrimination;
    • To strengthen linkages between ART and other HIV related services under National AIDS Control Programme (NACP)
    • To strengthen the capacity of the existing health system for effective delivery of CST related services;  
    • To integrate and mainstream CST related services within the health system, other departments/ministries and private sector; and
    • To strengthen systems for quality assurance, monitoring and evaluation of CST services.

The Three Tier Structure

  

 CST Services : Referral & Linkages

  

  

Center of Excellence for HIV care & treatment, BJMC Ahmedabad 

    • BJMC, Ahmedabad is one of the 10 COEs.
    • It is national training institute for ART MOs & faculties.
    • Mentoring other ART Centers for quality services in Care, Support & Treatment for PLHIV.
    • Providing treatment of Alternate first line and second line
    • Capacity building of good quality, skilled and knowledgeable healthcare providers in chronic patient management, including treatment failures
    • Training HIV Care personnel (Training centre)
    • Operational Research and scientific publications
    • Fellowship Programmes for doctors
    • Distance Education/consultation: Telemedicine
    • Repository of information related to HIV/AIDS

ART+ center, New civil Hospital - Surat and PDU Hospital - Rajkot 

    • 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 Second Line treatment following the same referral procedure as adopted for the Centres of Excellence.
    • New Civil Hospital - Surat and PDU Hospital – Rajkot are currently functional as ART Plus Centers.
    • Providing treatment of Alternate first line and second line

LINK ART CENTERS

Gujarat is the pioneer of LAC.

Concept

    • The patients who are on ART with poor economical condition and reside far away from ART centre has to come for treatment every month due to lifelong therapy which leads to increase LFU or Miss of the patients who are stable on treatment.
    • For those patients, the best option to minimize the travel and patients also get ARV. For the same LAC was started in Gujarat
    • By this way it is integrated with the health care system of the state.

The staff at LACs is from the existing institute where these LACs are operationalized. So it is not only cost effective but also one part of Main streaming. Till the end of March 2014, 55 LACs are functioning in Gujarat. Gujarat has 9 more LACs to be made functional in current financial year which are under process. The main benefit to start LACs is to reduce the travel cost of patient and to reduce LFU rate. 

LINK ART Plus CENTERS

Concept

    • LAC Plus scheme is being implemented in the existing LACs, as and when the patient load (PLHIV on ART) crosses 70  

Manpower

    • Currently, the LACs are utilizing the existing human resources of the ICTC and the institution
    • However, for LAC Plus, a contractual nurse is being recruited to handle the additional functions and work load.

Care & Support centers

Under NACP IV, Care & Support Centers (CSCs) will be established and linked to high-burden ART centres across the country in a phased manner.  The CSCs will serve as a comprehensive unit for treatment support, positive living and strengthening the enabling environment for PLHIV. This will be part of the national response to meet the needs of PLHIV, especially those from the high risk groups and women and children infected and affected by HIV. CSCs will be run by civil society partners including District Level Networks (DLN) and non-government organizations (NGOs). These partners have been selected primarily on the basis of their track record of working successfully with local PLHIV community and few other assessment criteria decided in consultation with the Department of AIDS Control.

These guidelines focus on the objectives, criteria for selection, required infrastructure, human resources, MIS tools and financial guidelines for CSCs. The guidelines will provide directions for setting up new CSCs and guide the existing ones on effective implementation of the programme. The CSCs will be started under Vihaan Project. 

Vihaan objectives

Specific objectives of the programme include:

    • Early linkages of PLHIV to Care, Support and Treatment services: The CSC will support PLHIV who have newly tested positive to enrol into the ART programme.
    • Improved treatment adherence and education for PLHIV:Adherence education and support can help the PLHIV sustain and manage their treatment regimes. It is essential that all three elements of successful treatment are supported: the client, the provider, and the process.
    • Expanded positive prevention activities: Improved positive prevention will contribute to the national efforts to prevent HIV transmission and reduce overall burden of disease.
    • Improved social protection and wellbeing of PLHIV: Social and economic well-being is an important component of care and support. The CSC will facilitate access to the existing social welfare and protection schemes under different line departments, Corporate Sector, Public Sector Undertakings, Faith Based Organisations and civil society organization.
    • Strengthened community systems and reduced stigma and discrimination:  To ensure a robust system that supports the program goal and ensures stigma and discrimination free access to quality services, it is important that skills of the community members to advocate are strengthened. Establishing community systems like community advisory board (CAB) and discrimination response team (DRT) will bring in sustainable response.

JATAN Project

    • Under NACP III special focus has been given to Pediatric HIV/AIDS as most of the Children Living with HIV/AIDS (CLHAs) die within first 5 years of life which add to under-5 mortality data also.
    • These cases are either late diagnosed or not diagnosed at all, so they are unable to reach ART centers in time for treatment. Timely institution of treatment and its adherence which are critical factors for the successful implementation of program.
    • Government of Gujarat under the State Health budget Project “Jatan” was taken initiative for all HIV+ve PLHIV registered under ART programme will be eligible for traveling reimbursement from “Jatan Project”.
    • Programme specially design for reducing the Stigma & Discrimination at grass route level due to all PLHIV submit the Government Bus or Railway Ticket through Jatan Link worker (Who is HIV+ve) which is situated at ARTCs/LACs. Programme is implemented in year 2008-09 by Gujarat State Network of People Living with HIV/AIDS (GSNP+) with the support of District Level Network of People Living with HIV/AIDS. Under this programme more than 18000 PLHAs including CLHAs were taking benefit for this scheme. Special Care Taker of the HIV+ve Children was got traveling reimbursement and Rs.100 for their loss of wages for the encouragement of taking treatment of Children. 

Goal of the “Jatan Project

Ensure high quality services and optimum utilization of resources so that maximum number of PLHAs gets benefitted from the project – ART Adherence.

 

Objectives of the Project

    • Enhancing the enrolment of people living with HIV in ART center.
    • Reduceloss to follow up cases of ART and pre ART and improve the ART adherence of PLHIV.
    • To improve the health of HIV positive people by providing free transportation facility.
    • Decrease economical burden by providing free traveling to access ART.
    • To improve the quality of life of people living with HIV. 

JATAN Traveling Mechanism

Traveling Guideline for Beneficiaries

    • To get the reimbursement of the traveling, they have to fill one format with the help of Link Workers and other staff, and the Link Worker of that ART center will reimburse traveling on next visit  of that person ( next month).
    • Every beneficiary has to produce one time GSRTC/IR/City bus ticket to get traveling reimbursement on next month. Persons would be disqualified if they don’t have GSRTC/IR/City bus ticket.
    • All the eligible person would get traveling as “home town (district will be considered as their home) to ART Center”, if they travel somewhere to ART center as per the guideline pay; whichever is less.
    • Children enrolled at ART center and LACs for ART or Pre ART registration, get traveling as per actual and guardian would get Rs.100 /- as a compensation of wage lose.
    • Adult (Male- Female) person get traveling benefits as per actual basis. 

Click Here for Score Card- Tool to monitor ART center Performance