Care Support & Treatment (CST)

Comprehensive HIV Care:

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

The Care, support and treatment services include management of opportunistic infections including control of TB in PLHA, anti-retroviral treatment (ART), safety measures, positive prevention and impact mitigation.

Service delivery:

In Gujarat, ART centres are established in Medical Colleges, District hospitals, Sub district Hospitals of the state and in PPP Model. There is a dedicated team for routine work at ART Centres. Following services are delivered through ART Centres to ensure complete and quality services:

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

What is Anti-Retroviral Therapy (A.R.T.)?

The Anti-Retroviral Therapy (A.R.T.) prevents multiplication of HIV virus and reduces their number. This prevents further damage to body's defense (Immune) system thus improves quality of life and prolongs it. These ARV medicines are required to be taken for sustainability of life. Therefore, it is necessary to take ART medicines regularly under proper guidance and follow-up of Medical Officer of ART Centre.

Objectives of ART Centre:

The main objective of ART Centre is to provide comprehensive package of Care, Support & Treatment services to Persons Living with HIV/AIDS (PLHIV)

The specific objectives of an ART centre are to:

• • Register and provide Care, Support & Treatment services to all PLHIV & monitor patients in HIV care (Pre-ART) regularly
  • Identify eligible PLHIV requiring ART and initiate them on ART in a timely manner as per the NACO guidelines
  • Provide ARV & OI drugs to eligible PLHIV
  • Provide treatment adherence and counseling services before and during treatment to ensure high levels of drug adherence
  • Provide Anti TB Treatment and IPT for prevention of TB in PLHIV patients

Scaling up of CST

Over the years, scale up of Anti-Retroviral Therapy (ART) in the state has posed many challenges, particularly with reference to infrastructure, regular supply of drugs, quality of care, adherence to treatment etc. Reaching to ‘Lost to Follow-up’ cases and convincing them to re-initiate the treatment has been very challenging. With the objective of linking prevention with access to prophylaxis, management of opportunistic infections and ART to achieve ‘continuum of care’, the state had tried and achieved such linkages at many places.

Second line ART :

• Patients experiencing treatment failure with First Line ART are referred to the Centre of Excellence (COE) or ART Plus centres for further evaluation and decision of Second Line treatment.

• 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 Centre of Excellence.

• Many patients are reportedly facing problems due to long distance, travel, time and costs for visiting the COE or ART Plus centres for II-line ART, hence the second line ART is made available from all ART Centres of Country, after being recommended by State AIDS Clinical Expert Panel (SACEP) at COE or ART Plus centres.

Third line ART:

• With the expansion of Programme and improved life span on ART, it is observed that many patients failed on II-line ART and are in need of III-line ART.

• NACO have introduced III-line ART under Programme in the month of May 2016 through all Centre of Excellence in the country.

   

CST Services : Referral & Linkages 

Capacity building:

• • Centre of Excellence: ART Centre, BJMC, Ahmedabad is recognized as Centre of Excellence and ‘’Training Institute” for staff under Care Support and Treatment division of GSACS, to carry out training of staff of ARTCs/FI ARTC/LACs of Gujarat.
  • Operational Research and scientific publications are being conducted through Centre of Excellence.
  • Fellowship Programmes for doctors is being organized through Centre of Excellence in collaboration with IGNOU and NACO.
  • Distance Education / consultation: Telemedicine, NDLS, RDLS is being organized through Centre of Excellence in collaboration with NACO and I Tech.
  • SGRC & SOC meetings organized every quarter at State level for discussions of CST activities and for resolving grievances (if any) of ART Centre related services.

Care & Support centres

Under NACP IV, Care & Support Centres (CSCs) are established and linked to the nearby ART centres across the country.  The CSCs serve as a comprehensive unit for treatment support, positive living and strengthening the enabling environment for PLHIV. This is a 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 are 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 National AIDS Control Organization.

These guidelines focus on the objectives, criteria for selection, required infrastructure, human resources, MIS tools and financial guidelines for CSCs. The guidelines provide directions for setting up new CSCs and guide the existing ones on effective implementation of the programme. The CSCs are working under the name of Vihaan Project. These CSCs are functional in Gujarat under Vihaan Project with Global Fund support while others are made functional with the support from NHM in the districts not covered through global fund.

Vihaan objectives

 Specific objectives of the programme include:

• • Early linkages of PLHIV to Care, Support and Treatment services:  The CSC is supporting PLHIV who are 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 the State Health budget “Jatan” project was initiated by the Government of Gujarat for all HIV positive People (PLHIV) registered at ART centres for the travel reimbursement of their visit at ART Centre for monthly checkup and ARV pickup.

Programme specially designed for improving adherence of all PLHIV for their ART Treatment. Project is managed since the year 2008-09 by the Gujarat State Network of People Living with HIV/AIDS (GSNP+) with the support of District Level Network of People Living with HIV/AIDS. The Care Taker of the HIV positive Children may also get traveling reimbursement for their loss of wages for the encouragement of taking treatment of Children. Additionally, if a mother visits an ICTC for the DBS testing of her child, then also she will get travel reimbursement for this visit.

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. 

Supportive supervision:

To supplement the existing monitoring system, identify strengths/weakness of ART centres and give recommendations a Score-Card was developed in spreadsheet format on monthly base from March’2014 onwards. Over the time, with the feedback received from ART Centres and experts from National and State level, the score card is evolved and currently there are total 24 indicators covered under Score-Card, where 12 of them are scoring and other 12 are non-scoring indicators but indirectly affecting performance of scoring indicators.

In view of 90:90:90 targets, the centres are classified in three color-zones: Green (Score>=90%), Yellow (Score<90% &>=75%) and Red (Score<75%). Visits were prioritized at centres with more indicators in yellow/red zone. Score card provides a simple and important tool of monitoring and helps in improving quality of monitoring by maximizing output in less time by pin pointing poor performing indicators and giving more emphasis on them. This proves a cost effective way of monitoring the important indicators of the program. This score card was included as best practices document by National AIDS Control Organization (NACO) and the regional progress report of WHO SEARO. The GSACS now uses this score card regularly for distance monitoring through tele medicine/RDLS sessions also. The same score card is adopted by NACO for the performance monitoring of all ART centres at national level.

Recognition:

Gujarat State AIDS Control Society (GSACS) received the National Best Performance Award for HIV Care, Support & Treatment (CST) for excellent performance in all the indicators during the national review of all the states and Union Territories organized by National AIDS Control Organization (NACO). The award was given away by Dr R S Gupta, Deputy Director General, CST, NACO, to Dr Rajesh Gopal, Additional Project Director, GSACS, on behalf of Dr Jayanti Ravi, Project Director, GSACS, Health Commissioner and Principal Secretary (Health & Family Welfare). The performances of all the states were reviewed on various indicators, viz. Quality of care, support and treatment services for HIV/AIDS and innovative practices adopted by respective states for the same.