DAPCU East Delhi Response to DCC for HIV-TB

o   District Coordination Committee for TB-HIV ensures the implementation of TB-HIV collaborative activities in the District and review the performance.

o   To strengthen the collaborative activities between the RNTCP and NACP in the District.

o   All stakeholders from different components share their view to strengthen the HIV-TB activities in the District.

o   Data sharing and minimize the gaps.

o   Monitoring and supervision to both DMC and ICTC by DAPCU Staff for increasing the cross referrals.

o   Regularly attend the Monthly DTO meeting by DAPCU staff with concerned counselor to strengthen the referral and also identify the issues and try to fill the gaps.

o   If no ART in district, the counselor of Link ART center is referring the on ART TB symptomatic cases to ART & DMCs for sputum examination and further treatment.

o   Using IEC material on HIV-AIDS in the ICTC centers.

o   In the outreach activities, counselor regularly does home visit with the coordination of DOTS service provider.

  

Year	From RNTCP to           ICTC	From ICTC to RNTCP	Co-infected
April-11 to March-12	5142	434	62
April-12 to Dec 12	4720	375	42

o Regular follow up the co-infection cases by the counselor.

o   Improve the cross referral (ICTC – RNTCP & RNTCP-ICTC).

o   ASHA worker sensitized by DPM & Counselor on HIV-TB, in regular intervals.

o   All ASHAs are referring the suspected TB cases to centers.

o   All co-infected cases are being followed by STS & Counselor regularly.

o   Strong coordination between STS & Counselor.

o   Share the data and line list.

o   DPM visit the center and meet the DTO to find out the issues.

o   Monthly meeting with STS, Counselor and DAPCU Staff to improve the TB-HIV activities in District.

DAPCU Bangalor Urban Response to DCC for HIV-TB

1. District co-ordination committee is in place in the district (Bangalore Urban)
2. Meet regularly once in 3 months under the chairmanship of D C
3. Discuses about the programme implementation, performance and challenges
4. Major challenge of Bangalore Urban is non-co-location of ICTC and DMC. To address this    issue, regular outreach activities are being planned and implemented.
5. To resolve this issue permanently, all the DMC lab-technicians are trained for HIV testing and 22 DMC’s are being planned to run as F – ICTC subject to the availability of the HIV testing kits.
6. All these issues are being regularly reviewed by the DC.
7. In addition to this, HIV-TB collaborative activities are being regularly reviewed every month by the DC in the district mission meeting and Z P, C E O at the district health society meeting.
8. Also HIV-TB cross referral performance is reviewed for the ICTC counselors and STS by the DAPCU and DTO

DAPCU Balangir Response to DCC for HIV-TB

1.            What are the advantages of DCC in HIV-TB collaboration activity?

      a)      As the District Collector is the Chairman of DCC it is easier to convincing regarding the urgency of HIV-TB collaboration throughout the district to effect the required mainstreaming and convergence both inside the health and other line departments.

  b)      The DCC meeting comprises not only HIV testing service provider unit but all the facilities providing services related to HIV are involved for their performance / achievement review such as ICTC, F-ICTC, TU, DMC, ART, TI, CCC, DIC, DSRC, BB & NGO/CBO under one umbrella i.e. District Collector.

c)      Helps to take in time decision and in other hand helps to save the time.

d)     Builds a close coordination between all platforms.

e)    All the stakeholders from different wings perceive their roles and responsibilities in the HIV-TB collaboration activity.

f)    Appropriate and strategic plans are taken into decision at the time of gap analysis of target vrs achievement.

2.      Share examples from your districts - How can DCC for TB – HIV strengthen the cross referrals between the ICTC and RNTCP (diagnostic and treatment services, and ART and DOTS services, and overall implementation of the National framework for TB – HIV Collaborative activities).

a)   Counseled clients where HIV testing facility is not available. Clients are followed up by concerned counselors for their HIV test at nearest ICTC.

b)   Even clients are accompanied by ASHA / LW or counselor for the betterment of the client.

c)  Where the DMCs are not co located with ICTC clients are being referred to nearest ICTC and they are looked after by concerned STS.

d)  However through the convening of DCC in every quarter, our performance in the field of cross referral, co-infection detection and CPT administration has remarkably increased.

Year	From RNTCP to ICTC	From ICTC to RNTCP	Co-Infection
2009	65	189	0
2010	243	697	6
2011	567	1057	11
2012	898	1269	10

3.      Share examples from your districts - Appropriate measures are taken to prevent the spread of TB infection in facilities caring for HIV – AIDS and spread of HIV infection through safe injection practices in the facilities providing RNTCP treatment services.

a)      ASHAs are sensitized by ICTC counselor in their ASHA sector meeting regularly.

b)     All ASHAs are referring and accompanying the suspected TB cases to DMC.

c)   At regular intervals ANM, staff nurses are sensitized regarding HIV-AIDS specifically on safe injection practices.

d)    Universal precaution guidelines are always being adhered to for ensuring non transmission through the processes of health care provision at any of the service delivery units of HIV, TB and its CST.

4.      Share examples from your districts - Role of ICTCs, ART, and Care and Support Centres in intensified TB case findings.

a)    All co-infected cases are being followed by STS, Counselor and ART Centre regularly.

b)    They are also given medicines at their door steps.

c)     STS and counselors are making joint visit to the co-infected clients.

d)    Gradual improvement in HIV-TB collaborative activity is shown in the above table.

5.      Share examples from your districts - What are the strategies DAPCU should opt for 100%   treatment, care and support for TB – HIV co- infection cases?

a) Client specific / personified co-infected cases are reviewed (Date of detection, CPT administration, ART adherence etc.) in monthly HIV-TB co-ordination cum review meeting.

e)    Counselors of ICTC are attending the ASHA sector meeting for more no. of referrals to ICTC for service uptake.

b)     Responsibility is given to ICTC-Counselor and STS/STLS of respective areas.

c)      Feed back is taken jointly by DPM and DTO for each client.

DAPCU Bhadrak Response to DCC for HIV-TB

 1.      Advantages of DCC in HIV-TB collaboration activity 

10th DCC for HIV-TB meeting Chaired by Collector & DM on 27th Dec-12

• It is a gateway to review the HIV-TB activities on quarterly basis and to sort out the issues and analysis the gaps.
• It ensures the Target vs Achievement of cross referral of all ICTCs and DMCs.
• By conducting regular DCC meeting, it brings the importance among the DCC members to focus on TB-HIV activities.
• It also points out the gap of the TB-HIV activity and accordingly DAPCU makes the strategic planning for the better implementation.
• It creates a interpersonal relationship, well coordination among the members.
• It facilitates the members to take decision for the proper implementation of the TB-HIV activities in the District.

2.      Implementation of the National framework for TB – HIV Collaborative activities

            There are many instances that DAPCU through DCC has exercised its role for  
        strengthening the cross referrals and implementation of the National frame work for 
        TB-HIV collaborative activities. 

• Ensuring the referral by the support of Counsellors of ICTCs/LAC/STD Clinic/TI/DIC.
• Regular monitoring and supervision to both DMC & ICTC by DAPCU and Nodal Officer, AIDS and DTO also minimize the gaps.
• Regular monthly review cum co-ordination meeting on HIV-TB among the Counsellors- STS/STLS/nodal officers and other referral units in the district also strengthen the coordination and makes a platform to discuss various issues and gaps.
• Ensuring the increase of referrals in ICTC and DMCs by the DOTS Provider and ASHAs through discussions in the ASHA sector meeting by our ICTC counsellors.

   We expect the following results from our above approach and its happening also.

1. It will strengthen the referral system of on ART cases having TB symptoms in the LAC+.
2. It will ensure about the priority of TB treatment of PLHIV and any other opportunistic infections and need of CPT prophylaxis.
3. It will streamline the timely reporting system of TB-HIV and line listing.
4. It will reduce the TB prevalence in HIV and increase the rate of cure in TB treatment. 

3.      Measures to prevent TB & HIV 

• For prevention of TB in paediatric cases, INH tablet of 10 mg per Kg. Body weight is being provided.
• Monteux test is being provided to all suspected children having TB symptoms in all DMCs.
• The single use of disproven syringes and needles in DMC for Monteux test of the paediatric cases.
• To prevent the infection of TB accurate and exact algorithm of sputum container disposal is maintained through waste management system.
• Counselling to the symptomatic and diagnosed TB cases by using  the 10 point tools in ICTCs.
• Referral to all HIV +ve clients and suspected TB symptomatic cases to the DMCs from ICTC for sputum examination.
• Referral to DMC/ART Centre from LAC/ICTC the on ART TB symptomatic cases for further treatment.
• Priority on TB treatment first among on ART cases.
• Regular follow up to the co infection cases and MDR TB cases by the counsellor and ensuring the hygienic condition in ICTC for infection control of TB and other opportunistic infections.

4.      Role of ICTCs, ART, and Care & Support Centres in intensified TB case findings 

• Information/knowledge provided on TB/HIV and its impact on the community through counselling process to find out the TB suspected cases.
• Referral of suspected TB symptomatic cases to DMCs for Sputum examination.
• Referring of all HIV positive cases/co-infection cases for administration of CPT prophylaxis.
• Regular home visit to co-infection cases and consulting to the DOTS Provider to refer the contact persons of TB affected cases to ICTC and DMCs through outreach.
• Attending the TB-HIV co-ordination meeting.
• Providing the IEC materials on HIV-TB to the clients visiting to the ICTC.
• Using the cross referral signage board in both ICTC and DMC and OPD.
• Co-ordinating with TI/IDIC/STD Clinic/LAC for referral of suspected TB cases to ICTC and DMCs.
• As there is no ART, the Counsellor of LAC is referring the On ART TB symptomatic cases to ART & DMCs for  sputum examination and further treatment .
• Motivating the ASHAs and DP by the counsellor to refer the TB suspected cases to ICTC and DMC.

5.      Strategies for 100% treatment, care and support for TB– HIV co- infection cases

      On the above services provided in different facilities the DAPCU, Bhadrak is having the 
      following strategic planning for the implementation of TB-HIV activities in the Bhadrak 
      district.    

1. Regular monthly HIV-TB co-ordination meeting.
2. Regular quarterly DCC meeting on HIV-TB activities.
3. Monitoring and supportive supervision to different ICTCs to DMCs by DAPCU team/DACO/DTO in every month.
4. Maintaining a separate register for co-infection cases for better follow-up and treatment services.
5. Validation of HIV-TB line listing report and send the HIV-TB monthly compilation report to OSACS.
6. Ensuring the HIV-TB activities through convergence with other line departments in the District.
7. Lastly ensuring the 100% follow up to the all TB and HIV cases and ensuring the 100% pre ART registration of all HIV +ve cases through outreach activity.

DAPCU Solapur Response to DCC for HIV-TB

District Coordination Committee for TB – HIV ensures the implementation of TB – HIV collaboration activities in the District and review the performance of the same.

In Solapur district the HIV-TB DCC meeting held regularly under the chairmanship of DACO. All the ground level staff, DTO, CTO, DPM NRHM, DHO, DPO, DS, ART SMO invited for sharing their views and sort out the complications came while working. District experienced the various advantages of HIV-TB DCC meeting.

     1.    Advantages of DCC in HIV-TB Collaboration activity –

·         Data Sharing / Exchange

·         Line List HIV-TB Update

·         Experience Sharing

·         ICTC – RNTCP referral improvement & Vice-versa. 

·         Initiation of F-ICTC at DMC level.

·       Conducted hands on training of ICTC LT for ZN strain & sputum examination while scheduled the training of DMC – LT for HIV testing preferably SD screening Test.

·       To enhance the HIV testing of TB patients used the NRHM machinery. Provided to & fro charges to TB clients with one of his relative up to Rs. 400.

·         Notification of each TB patient could possible with proper format.

·         Implemented the TB screening of Close family members of TB patients as TB is a communicable disease.

·   Allied with School Health Activity (NRHM) Program. Medical Officer Look for Pediatrics TB Suspect’s and Co-ordinate with DMC and then these Children referred to the nearest DMC for TB Screening. If Pediatric TB cases diagnosed ( Mainly Lymphadonopaty ) family screening for TB conducted.

·   DAPCU has taken the line-list of LFU/MIS patients from ART and segregate it geographically to each NGO. The review of this activity conducted in each month.

      2.    DAPCU has analyzed the fact that there should be 100% coordination from both the national    program. In the first Quarter meeting the basic fact has identified by verifying the line-list from DMC and concern ICTC.

      3.    Also a DAPCU raised a serious concern about the entry in HIV-TB ART White Card, details about the TB treatment should enter correctly on white card.  After testing of TB patient, the HIV status should include in the TB register.

      4.    To Prevent Spread of TB in Care- Facility level DAPCU puts IEC material with the help of TB department. Provided mask to the ICTC staff.

     5.   DAPCU stressed the qualitative referral from OPD.  In Intensified TB care finding every facility should develop good repo with each OPD. Maximum referrals from OPD (Acute respiratory tract infection) Cough with expectation referred for TB Screening. There should be close watch Over Pediatric TB as well as sputum Negative and extra pulmonary TB suspicion should be screened. DAPCU instructed ART Facility for close watch on Borderline CD4 Pt. In due cause development of TB should be diagnosed promptly and further management should be done very promptly.

      6.    To avoid TB Death cases in Co-infection (TB Meningitis look carefully).

      7.    MDR TB Should be properly Managed.

      8.    The performance of the Solapur district can be analyzed in 2012 against 2011.

Sr. No.	Quarterly	Total ICTC Clients	ICTC to RNTCP	% of Referral	RNTCP to ICTC	HIV-TB Co- infected	DOTS Initiated
1	Jan11 to March-11	7919	851	10.74%	457	84	81
2	April 11 to June 11	9374	906	9.66%	437	66	64
3	July11to   Sept 11	9707	932	9.60%	346	55	54
4	Oct 11 to  Dec 11	11690	1048	8.96%	385	57	57
	Total	38690	3737	9.65%	1625	262	256

Sr. No.	Quarterly	Total ICTC Clients	ICTC to RNTCP	% of Referral.	RNTCP to ICTC	HIV-TB Co- infected	DOTS Initiated
1	Jan12 to     March-12	11810	1195	10.11%	367	61	60
2	April 12 to June 12	6865	858	12.49%	306	70	64
3	July 12 to     Sept 12	12868	1190	9.24%	411	63	59
4	Oct 12 to  Nov 12	6596	637	9.65%	192	28	28
	Total	38139	3880	10.17%	1276	222	211