North Delhi DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

This table of problems and solutions of their district was shared by the North Delhi DAPCU.

ICTCs Problems found & Solutions made
1. Most of HIV positive clients are from outside of the district and outside state.  They became migrant or LFU due to this reason. 2. Poor counselling of Positive client at ART Center.	1. Counsellors were told to give special attention towards counselling of HIV positive clients and make possible that they should be linked to ART as soon as possible. It was emphasized to do Home visits to follow positive clients. For Verification of Address of positive clients. 2. Advised Counsellor (ICTC/PPTCT) to go with the ANC positive client to ART center for providing better services at ART Center and co-ordinating with Counsellor of ART Center.  3. To improve counselling skills.
TI NGOs Problems found & Solutions made
1. It was found in some TI NGOs that they do not have data of total line list of HIV positive people. Counsellor was unable to tell about CD4, ART Regn. No. or anything about positive people found / tested by NGO) Even though Counsellor was not aware about Pre ART Regn. and ART Regn.		Clarified the difference between pre- ART regn. & ART Regn. And told about CD4 count. Counsellor was briefed that they should make separate register for HIV positive where all details of HIV positive clients should be made e.g. ID, AGE & permanent Address with current hot spot address, Peer Educator name, ORW Name, timings of contact, HIV Test Done – ICTC Name with Date,  Pre-ART Regn. No., CD4 Count (<350 > 350), ART Regn. No., Remarks besides how many times contacted by Peer Educator. Clarity on ‘shared confidentiality’ will be useful.

Central Delhi DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

Strategies which DAPCU-Central has used in our district to ensure people diagnosed HIV positive from ICTCs reach the ART Centre for Pre - ART registration are as follows

Supporting counselors in ensuring quality counselling

1. Importance of continuity of medication is stressed on by counselors
2. Assessment tests in ICTC Review Meetings on different topics eg. Pre-test & Post-test counselling etc.
3. Taking feedbacks in ICTC Review Meeting on today’s learning and suggestions for next meetings. 

Coordination between ICTC and ART

1. Improving rapport between ICTC / PPTCT counsellors and Counsellor of ART centres.
2. Better sharing of responsibilities through handing and taking over of Clients in person by the counsellor of both the ends. (Client is accompanied by counsellor to ART –Centre for Pre ART registration)

Coordination with other facilities and programmes

1. HIV-TB Co-ordination. For example detected positive in Regarpura ICTC (referred in from RNTCP ) who was not getting himself registered with ART, had been handled by counsellor ICTC and was prepared for being registered in the RML hospital with the help of Counsellors RML(ICTC & ART) and STS of concerned DOT centres.  
2. Joint Review of ICTC counsellor with staff of ART, CCC, TI- NGOs.
3. Discussion in Review meetings. Example: A dicussion on methods to ensure address verification of clients undergoing Pre ART registration took place in the review meeting.  The DPM, DAPCU-Central facilitated discussions and few of these were implemented 

Follow up of positive individuals 

1. The TI community members who were found positive are followed up through the TI team
2. Joint visit with ICTC counselors when required 

East Delhi, DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

In DAPCU East, there is no ARTc, DAPCU East utilized the services from link ARTC (North-East District, Delhi). Registration time of client is 9 AM to 11 AM, which is very less and after registration there are so many test, which takes 2 or 3 days and only two days in a week (Morning/Thursday) are vailable for CD4 test.

For improving the linkage between ARTC & ICTC, month wise data is shared between facilities. For Example – ARTc will share CD4 status & TB status of PLHIV with ICTC/PPTCT/STI counselor.

Some initiatives taken by DAPCU-East

1. ICTC Counselor will refer the client with proper guidance about ARTc
2. For time saving the client is linked with the staff of CCC and ORW.
3. For ANC client counselor linked the patient personally.
4. DPM also visit the link ARTC and make a good linkage, referral system & collect the line list of PLHIV twice in a month to follow the LFU cases

Rajkot DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

In January 2012, 70 people were tested positive and 59 Pre-ART registrations took place. The following practices are in place in Rajkot to ensure Pre-ART registration

• ICTC-ART CO-ORD sheet is used at ICTC & ART level
• Discuss the number found positive and number of Pre ART registration in the DAPCU Monthly Review Meeting . The discussion also focuses on why clients fail to reach ART Center and we try our best to ensure that all HIV positive reach to ARTc.
• The quarterly meetings by ART center to discuss LFU, MIS & and planning for those found positive but not reaching the ART centre.
• After phone calls to LFUs  the list of LFU patients who have not return back to ART center, is sorted out  by ART center in three categories and followed up.

             * List of LFU of Rajkot City (local) (CCC & RDNP)

             * List of LFU of Rajkot Mandal (tehsil) (DAPCU)

             * List of LFU patients out of rajkot district (GSACS)

Churachandpur, DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

STRATEGIES ADOPTED BY DAPCU,CHURACHANDPUR DISTRICT  IN ENSURING ALL HIV +VE CLIENTS DETECTED FOR PRE-ART REGISTRATION AT ARTC:-

1.Ensuring best quality Post-test Counseling for mitigation of fear/stigma psychosis in accessing ARTc for Pre-ART registration: Even if ARTc is sharing the same roof, if quality of post test counseling fails, the Positive Client might not get registered.

2.Accompanied Referral for the Hub Facility(ICTC) nearer to the ARTc: Most of the time, distance speaks, especially for a hilly district like Churachandpur where road/transport communication is always a problem. The best strategy is to accompany the Positive Client directly to the Counselor of the ARTc for Pre ART Registration (not to send nor refer alone,).The role of Community Care Coordinator,ARTc is highly eminent here but in some ARTcs,like ARTc,CCPur the post of Com. Care Coordinator is not filled thereby causing a big gap in service delivery(No one to coordinate accompanied referral to ensure Pre-ART Registration)

3. Individual Tracking & Feedback to the Referring NGO/Provider:For every Positive Client detected at ICTC, the details of the Client’s address(+Name of TD Block), contact N0.,Reference Person in the town where ARTc is located etc and the  referring NGO/Provider are well noted.

4. Tactful Scanning of ICTC Clients in Pre-test Counseling: Many a times, the counselors are dismayed  when the Positive Clients detected in ICTC disclosed that they were on ART already after the test result is out ,and they had come for the test again. This is one of the main factor's responsible for shortage of Pre-ART registration in ARTc against the total Positive detected in ICTCs.

5. Maintaining consistency at ICTCs in following up of Positive Clients till they get registered:-The major reasons for not registering/delayed registration are:i)Family Members simply refuse to declare the test result. ii) Non acceptance of his/her status,   iii) Fear of  Social Stigma, etc.etc.The +ve Client has to overcome all those factors before registration in ARTc.It takes time ,maybe in terms of months or even years. But the Counselor/ICTC team are instructed to maintain consistency in continual counseling/advocacy of the amily Members/Close relatives and the +ve   Client. Female HIV Positive Clients are harder to tackle with all stratified layers of advocacy required. Nevertheless we have to keep on tracking till ..that time.

Coimbatore DAPCU – Response to Question of the Month February 2012 - Facilitating ICTC to Pre ART Registration

This post was in response to the February 2012 theme

The following were the strategies  followed by DAPCU, Coimbatore to ensure that people diagnosed HIV positive from ICTCs reach the ART Centre for Pre -ART registration.

1. If positive identified then the details of the positive cases to be mailed to ART centre with a copy to DAPCU.
2. If the identified positive person is pregnant, in addition with the above process, the information is to be communicated to PPTCT NGO. From PPTCT NGO, ORWs are asked to undergo home visit at the earliest for the client registration in ART and further followup.
3. If the patient registered in ART, then the details of ART registration is communicated to all ICTCs on weekly basis with a copy to DAPCU.
4. In Coimbatore district the gap in ART registration has decreased when compared to the situation that was there when the DAPCU had just started functioning.
5. Also maximum all the positives are registered in ART during the month itself.
6. If any positive belongs to other district, the concern ICTC centre is asked to send a mail to other district and ensure the same for ART registration.

The DAPCU monitors these processes on a weekly basis.

Erode DAPCU – Response to Question of the Month February 2012 - Facilitating ICTC to Pre ART Registration

This post was in response to the February 2012 theme

1. PLHIV once identified in ICTC is referred to the ART on the day of identification itself. This follow-up will be done within 7 days to ensure Pre ART registration of the client.
2. If the client does not turn up to the ART center, follow up of the same will be done by the counsellors of the centre in the very next outreach activity.
3. In ANC cases the assistants of the out reach worker of the PPTCT NGO is obtained. In few cases guidance and supportive counselling will be provided by the corresponding ICTC Medical Officer.
4. Rs. 50 supplied by the PACT programme (DIC) is given to the poor ANC positive mothers.
5. HIV positives who are outside of the border of the district Thalavady (This is also the Tamil Nadu, Karnataka, Border) are referred to the Chamrajnagar, Karnataka for their easy accessibility for ART.
6. Other District positive cases are immediately referred to the corresponding district via Phones & Emails to the concerned DAPCU after consent of the PLHIV.

Satara DAPCU – Response to Question of the Month February 2012 - Facilitating ICTC to Pre ART Registration

1. Accompanied Referral:Accompanied referral by Counselors, Lab Technician, ORW of PPTCT NGO or DIC can do the major roll in effective linkages from ICTC and ART.
2. Effective counseling of ART importance:If the client found positive the counselor should do the effective counseling on importance of ART in post test or follow up counseling.
3. Home visits: Home visit is an important tool for developing the linkages from ICTC to ART. Counselor, ORW, Peer educators, coordinator,  should do  home visits and DAPCU should monitor it.
4. Effective coordination with DIC & PPTCT NGOs:When the client is  LFU then DIC & PPTCT NGOs can play a vital role to link them at ART
5. Perfect documentation of address and contact numbers:Various times the clients are not giving proper address or contact no. Hence the counselor should motivate the client for sharing the right address and contact numbers.

This post was in response to the February 2012 theme

Amravati DAPCU – Response to Question of the Month February 2012 - Facilitating ICTC to Pre ART Registration

This post was in response to the February 2012 theme

We used these strategies for the linkage of reactive client to ART centre.

1. The line list of reactive client is maintained on weekly basis at the ICTC centre and cross check of this with ART centre on weekend telephonic-ally.
2. The prepared line list is shared with the DLN, DIC.
3. One day is fixed by ICTC level for providing the travelling facility to those clients those are not reach at ART centre. 
4. The line list of Pre-ART registered client shared by ART centre with all the ICTC.
5. The Civil Surgeon certificate issue after the Pre-ART registration of the client.

 The above strategies are followed in the day to day work in my district. Our email id is dpoamravati@mahasacs.org

Central Delhi DAPCU's Efforts for TI Programme Sakhi Milan- Appreciation from Delhi TSU

Excerpts from Delhi TSU report of Sakhi Milan

"The Joint TI -Project, GB Road organized a community event in Dec 2011 titled ‘Sakhi Milan’ creating platform for many sex workers to come out of their brothels and be part of cultural events. This event stands out since it attracted many brothel owners and madams who were not open to participating in organization initiatives till six months ago. Efforts made by TI project in last 6 months brought many unseen faces to participate and endorse the event.The success of this event lies in the fact that there was good coordination between the various facilities in the district.

The day started with a solidarity march led by Peer Educators and Outreach Workers working with GB Road Project which was joined by brothel owners and FSWs from brothels. During the march, the participants raised slogans “Ek Do Teen Char Condom se Karen HIV Pai War." The event included many activities like a play performed by team from PSI, Introduction to female condoms by Ms Seema Sharma from HLFPPT, a quiz organized by ICTC counselor on HIV/STI. The highlight of the event was a ‘Fancy Dress Competition’ for  Peer Educators. One feature that was common among all participants was the message on HIV with every performance (though not planned so). For example, the first prize winner acted as Gabbar of Sholay and she tweaked the dialogues to say – ‘Arey O Sambha – Kitne Virus the’."

What was Central Delhi DAPCU’s Contribution?

The DAPCU was able to get the support of the Additional CDMO in providing health services during this event. The report developed by TSU especially acknowledges the contributions of the DPM “Dr. Rani, DAPCU DPM Central District worked throughout the preparation phase to make this event a success. Her efforts to invite the chief guest, coordinating with CDMOs office to procure general medicines for the Health Camp and working closely with the TI team are highly appreciated.”

Shalabh Mittal, Team Leader (Overall & Strategic Planning) Delhi, (managed by Raman Development Consultants Pvt Ltd) says -‘The spirit of the programme was to work together to achieve desirable results. This event was a success because the efforts of TI project, DAPCU, DSACS and TSU were  in synergy and this has laid a foundation to transform individual commitment into team effort. I especially salute this spirit and encourage all DAPCUs across the country to find synergy in working with TIs and other facilities and not for a moment get into fault finding mission. Together we can bring BIG change.” 

Central Delhi DAPCU can be contacted on dapcucentral@gmail.com

Dr Rajan Khobragade , Team Leader , National Technical Support Unit, - Shares an inspirational experience

We thank, Mr Arvind Kumar the author of the note  and also Mr  Dharmendra Parmar for sharing this piece with us.  This piece was originally posted at http://tpanand.blogspot.in/2012/01/meeting-project-objectives-differently.html. 

Meeting Project Objectives Differently

"Blind people work together and make parts of Boilers at Trichy for IOCL’s Paradip Refinery project …..… An experience sharing.

21st December 2011 has etched an unforgettable memory in my mind. I was at Tiruchirapalli on a mission to expedite supplies of Boilers at BHEL’s works for Power plant of IOCL’s ongoing Paradip Refinery Project. BHEL has outsourced non-pressure parts of these boilers to certain vendors nearby Trichy. ‘ORBIT’ is among such outsourced vendors, who is making Pins & Clamps of these boilers for our project. We decided to visit ORBIT also for review and expediting balance supplies. When we reached ORBIT works, we were greeted by their President Mr. P.R. Pandi, who himself is a blind person. To my utter surprise, the whole ORBIT workshop is run by blind persons. Though I was aware of certain special schools and institutions for blind persons but never heard about any manufacturing industry run completely by such persons. What I saw next inside the workshop is quite difficult to believe. I had never witnessed such well coordinated and coherent working by blind persons. People were segregating the raw material, feeding the raw material on cutting, shearing and punching machines with the help of their fellow blind friends, collecting the final products and bagging them after quality checks. The whole manufacturing process was efficiently done and finished product was meeting the quality standards. I was lost in deep admiration seeing their untiring efforts for making vital parts for my project and emotionally touched. Their interpersonal understanding and collective effort was exemplary and far better as compared to normal workers engaged in other industrial units. Below photos depict it completely but silently…

People were working with no ego and communication was being made not with vital sensory organs like eyes, but with their hearts. I was thrilled and compelled to think that dedicated and sincere working by these special people is a great example towards values of humanity which defies all laws of Project management. Calm and peace prevail here in their coordinated rhythm of working against any feeling of industrial acrimony. What came next was even more surprising. A physically handicapped welder was doing welding on the job and was assisted by a blind helper. We saw his blind helper almost running and going to store room next door to fetch the electrodes quickly. When enquired how he could do such job with much ease, my fellow companion from BHEL, Mr. Jai Ram told me that every worker working here is fully conversant with the layout of workshop and does the job with calculated steps – concepts of time and motion study, well grasped by them by heart. I was overwhelmed by their indomitable spirit, everlasting zeal and working in perfect harmony.

At the end, ORBIT president Mr. Pandi requested me ‘Sir, if you come across any blind person, please direct him to me, we will make him our team member here’. I controlled my emotions, advised them to maintain timelines and quickly moved out with mixed feelings, thinking and admiring effort and passion of ORBIT in this endeavour and with firm conviction that Paradip Refinery Project will soon be a realised dream.

Arvind Kumar

Chief Project Manager-PDRP

Indian Oil Corporation Ltd.

Refineries Head Quarters, New Delhi

Mobile: 9582262166

Email: kumarar@iocl.co.in

PS:I would like to thank IOCL Management & BHEL team for giving me an opportunity to

have such wonderful experience with a noble cause during project expediting at BHEL,Trichy."

HIV Replication Animation - video

An interesting animation on how the HIV virus replicates.

Amma - a touching video

We will be sharing some interesting videos related to our work on HIV. We can use these in our presentations/trainings/workshops and even see these as a team during monthly meetings.

If there are some videos you would like to share with other DAPCUs please email the link to us at dapcuspeak@gmail.com.