HIV Prevention, Care and Treatment

Decentralisation of HIV care and treatment services – ART initiation at testing centres

In order to decentralize and mainstream HIV care and treatment services with the health system, an innovative approach of providing HIV treatment (ART initiation) at peripheral health centers was implemented. Decentralisation of HIV services with the general health system helps to increase access to ART services and decongest the ART centers. It is also envisaged that this model aids in reduction of linkage loss between HIV diagnosis and ART initiations and enhance retention of PLHIV on ART.

The intervention was undertaken at LAC-plus centres located at Area Hospitals of Nuziveedu, Bapatla and Ramachandrapuram located in Krishna, Guntur and East Godavari districts respectively. Feasibility assessment was undertaken in the three sites to ascertain the possibility of ART initiation where availability of resources and specialist medical officers was a criterion. Nominated staff was trained. Recording tools were modified to suit the intervention and updating the patient’s details in Inventory Management System (IMS) was initiated at Link ART Centre plus sites.

Decentralising HIV treatment substantially increased access to care and treatment to people living with HIV, where about 40 % of eligible PLHIV were initiated on ART.

Integration of HIV/AIDS services in Tribal Health

Tribal health was one of the areas of concern where the tribal population faces burden of diseases exacerbated by the low access to healthcare especially for HIV/AIDS. Improved access to health services will result in patients undergoing treatment adhering to it, resulting in healthier and longer lives.

Integrating HIV/AIDS-related services into the tribal health plan, provide the opportunity to enhance the quality of care provided to PLHIV in the hard-to-reach tribal areas of East Godavari district and has demonstrated positive outcomes in providing access to ART treatment services and engaging them on care. To integrate HIV/AIDS care, support and treatment services in tribal health facilities, two Link ART centers at Area Hospital, Chintoor and Community Health Center, Kunavaram, tribal areas of East Godavari district.

A special drive was conducted to track PLHIV who had missed doses (MIS)/Lost to Follow up (LFU) and initiate them on ART, and about 102 LFUs were successfully tracked and retained on care. Seven out of 18 PLHIV who are on Pre ART and LFU and 13 On ART and LFUs reported at the LAC centre and got initiated on ART. About 70 % of LFUs and MIS cases were linked to Link ART Centres for re-engagement in care.

Prison intervention

Prisoners have been identified as one of the special groups under NACP, and NACO aims to address all high-risk populations living in prisons and other closed settings in the country.

Enhancing access to ART dispensation within the central prison hospitals ensured access to comprehensive care and treatment to the prison inmates. To provide access to ART treatment and improve adherence to treatment to the prison inmates, Link ART Centre were established within central prison hospital located at Rajahmundry, Visakhapatnam, Kadapa and Nellore districts. Prison Hospitals are adequately staffed, where in medical doctors, staff nurses, laboratory technicians, pharmacists and other paramedical staff, were oriented on HIV care and treatment guidelines.

With this initiative, it is envisaged that there will be considerable reduction of lost to follow Up cases , increase in adherence levels among Prison inmates on ART, as the ART drugs are available within the prison hospital, which will also in-turn reduce the burden on state government.

Center of Excellence

To provide comprehensive care and treatment services to the PLHIV, Center of Excellence (CoE) was established and operationalised on 1st December 2018, at Siddhartha Medical College, New Government General Hospital, Vijayawada, in the state of Andhra Pradesh.

SHARE INDIA has provided necessary support to train and orient the service providers and members of the State AIDS Expert Clinical Panel (SACEP) to make the newly established CoE fully functional. CoE staff were trained on functioning of CoE and provided hands on support for conducting SACEP.

Strengthened SACEPs among the ten ART plus centres in the state by building capacities of the staff and through distinct mentoring and monitoring . With introduction of e-SACEP mechanism, there was reduction in time to review patients and recommend for switch to appropriate alternate regimen. Patients eligible for second line ART and alternate first line as recommended by SACEP are being initiated on second line ART at respective ART centres.

Over a period of six months a total of 621 patients were reviewed with suspected treatment failure, among those 156 patients were recommended for 2nd line and 33 patients for 3rd line.

Strengthening capacities of health staff

With an intent to orient and equip ART center staff to implement the guidelines on prevention and management of TB in PLHIV, trained about 956 ART staff including Medical Officers and Staff Nurses from 510 ART centers across the country .

A comprehensive training package covering all the key components of single window services – TB screening, early referral for CBNAAT and daily TB treatment for PLHIV was developed to orient ART center staff. Taking these efforts further, all the ART centre’s staff in Andhra Pradesh and Maharashtra have been trained on the revised guidelines.
(find more: Training on daily Anti TB treatment and 3Is, National Report)

SHARE INDIA also supported in capacity building of District AIDS Prevention Control Unit and Revised National Tuberculosis Control Program staff, which led to strengthened coordination and implementation of collaborative TB/HIV activities. It has significantly contributed for improvement in number of PLHIV screened and tested for TB and has ensured 99% initiation of TB treatment among TB co-infected PLHIV and reduced referral loss.

Assessment of Airborne Infection Control measures at 31 ART centres in Pune, Thane and Mumbai was conducted (FY 2017 – 2018).

Engaging with Communities

Evidences suggest that engaging communities is essential in advocating for a robust response to the epidemic and delivering services that can reach everyone in need and tackling HIV-related stigma and discrimination. Communities are engaged to identify HIV –positive individuals, link them to HIV treatment and services and ensure that they achieve viral load suppression and long term retention in care.

Collaborations with networks: SHARE INDIA partnered with community networks (district level) to re-engage patients in care. Engaged community as peer navigators to reach those PLHIV who are not accessing treatment, educate and mobilise them to access treatment.

Retention on care: To improve retention on care, involved communities to track lost to follow up cases and engage them in care.

SHARE INDIA, in collaboration with India’s National Institute of Tuberculosis and Respiratory Disease (NITRD), Project ECHO (Extension for Community Healthcare Outcomes), U.S Centers for Disease Control and Prevention (CDC) and the National AIDS Control Organization (NACO) launched virtual e-NISCHIT (National Initiative to Strengthen Collaboration between HIV-TB through e-Learning) program. This initiative aims to build capacities of healthcare providers from ART centres on HIV-TB co-management, by providing a platform for live interaction with subject experts. This model is based on the hub-and-spoke knowledge-sharing networks, led by expert teams for case based learning and discussions. Within a span of one year from its inception, 40 interactive live sessions were conducted, where experts in HIV-TB arena from Government of India, World Health Organization and premier private healthcare institutions provided their inputs on 30 live cases presented from the field during the sessions. The initiative has successfully reached to approximately 1500 health care providers in 115 ART centres from Northern and Southern states of the country.

Virtual Monitoring

In addition to the regular site level technical assistance and continuous quality improvement measures, SHARE INDIA has provided technical assistance to APSACS for monitoring of process and implementation of newer initiatives like multi month dispensation at the ART centers.

Using ZOOM technology (video conferencing) structured virtual review meetings were held once in every month with all the staff of ART centers in the state of Andhra Pradesh, to inform and improve the service delivery of the centers.

The project staff had provided centre wise written feedback on a monthly basis with identified gaps and probable solutions. Post written feedback, phone follow-up was made to enquire action taken status, based on the feedback.

Regular virtual review meetings with ART centres staff resulted in improved program outcomes viz.,, improved screenings vs initiations on 3MD, decreased errors in recording and reporting and Monthly Progress Report. Virtual review helped the ART centres to initiate the more number of PLHIVs on ART. Apart from reducing travel cost and time of program staff, it also helped in real time monitoring of program implementation. It has served as a platform for cross learnings and experience sharing between ART centres and also for strengthening capacities of health staff. Virtual monitoring proved to be a cost effective monitoring tool that has demonstrated positive outcomes.