LATUR DAPCU Response to the Comprehensive HIV/AIDS Services to the HIV Positive Migrants

In Latur district generally the positive migrant clients are from Osmanabad, Nanded & other nearest district and also from Karnataka state (10%). Within the District migrant positive clients are linked to ART Center nearer to Osmanabad & nearest district at Govt. Medical College & Hospital, Latur for Pre-ART registration, CD4 count.  If CD4 count is less than 350 then efforts are made for registering the positive clients in ART Center.

Whenever any client found positive from other district (Nanded), counselor provides option to Client for taking ART treatment according to Client choice. If client is willing to continue the treatment from his own district then Client is transfer out to that particular district ART Center for further treatment, if CD4 count is less than 350 we put him on ART. Counselors note down the permanent, current address & Mobile number of respective client for further follow up.

Due to stigma issue some client take the ART services from neighboring district, after some period/month clients reflect LFU in the parent ART. In such situation client not communicate to the ART center. From last six month neighboring ART centers shares the pre ART line list to Latur ART Center to avoid the LFU.

The MIS/LFU line-list share with the NGO’s for tracking the LFU/MIS patient and revert back them to ART. DAPCU plays a major role for taking the follow-up of such activites.

For the prevention DAPCU arrange the health camp at Village level with the coordination of NRHM. STI camps for HRG migrant, Follow up test for HRG & Discordant couple counseling etc. DAPCU track the migrant ANC delivery as per EDD & also confirm the EID Follow up by tracking PPTCT calendar.

DAPCU & ART Center conduct the weekly/fortnightly meeting with all NGO for LFU & Linkages.

Ex- In the month of Jun 13 we had one positive patient from Panjab Battalion, who is transferred out to the punjab after all necessary documents and linkage confirmed by  ARTC Latur in coordination with DAPCU at Punjab.

Jalna District Response to the Theme Comprehensive HIV/AIDS Services to the HIV Positive Migrants:

District Profile of Jalna:
     Jalna district located in the Marathwada,Maharashtra. District has high migration from Buldhana,Aurangabad and Jalgao. The major source of income of the district is from industrial set up i.e.  Rajuri Steel Industries,Pollad Industries,NRB Baring Industries. Rajuri Steel Industries has the big set up in Jalna District. The workers are from Uttar Pradesh, Bihar which are highly involve in the manufacturing of Steel.

Services to the Migrant Client:
     If any Migrant Client found Positive then ART Counselor provide him a effective counseling, give him a moral support, provide him a Pre-ART services, completes his CD4 testing and other testing (LFT/KFT) and if require immediately put him on ART. if the migrant client wishes to take ART treatment at his native place then SMO transfer him for further treatment and DAPCU coordinate with the concern DAPCU for further convenient.

Tracing of LFU/MIS Migrant Client:
     DAPCU Tack the LFU/MIS migrant by tracking the residential permanent address of the client and with the coordination of concern DAPCU. In Case of ANC,DAPCU Jalna coordination with the other DAPCU for migrant ANC delivery, hence coordination among DAPCU is very essential.

 

Akola DAPCU Proposed Strategies for MIS & LFU Reduction

Introduction

DAPCUsare responsible for coordinating NACP activities at the district level. Across the country many DAPCUs have contributed significantly to the gains of the programme. DAPCU Akola observed a few common problems faced during service delivery. These problems were faced not just by Akola but across the state. The team especially Akola M&E designed the innovative strategy and conveyed to the MSACS which was very appreciated and included in AAP 2013-14. A very brief description of these processes is presented below

Problem

Each ART in the district faces the problem of LFU/MIS. A few common reasons observed by us were

•  If client found positive in one district sometimes she/he prefers to take the ART services from neighboring districtdue to stigma issue. In such situation the status of such client reflect LFU in parent ART centeri i.e.  If the client has not communicated to them or a proper transfer out process has not been followed
• ANC cases:  ANCscommonly avail services in two districts viz. at her parents’ home and at her marital home. Tracing and follow up between districts becomes difficult for \EID/DBS, 6 weeks, 6 months, 12 months, 18 months
• Positive HRG especially Migrants/Truckers/FSW travelling from one district to the other also leads to them being reflected as LFU MIS
• Clients test at multiple ICTC centers for confirmation of their HIV status. In such situation client’s pre-ART status shows failure.

The Akola team especially the M&E Assistant has been looking for solutions to these concerns. The data from the district was analyzed, different strategies were discussed. One of the strategies explored by the team was a software based solution. An innovative system was designed called “Electro Unique Profiling System(EUPS)”.A concept note for this was designed by the initiative of the Akola team

What is EUPS and how it supports to the District level activities?In the EUPS system each ICTC and ART center are connect through electronic system. In ART/ICTC counselor has to take the thumb impression of particular client and upload client’s data to the online server. The data of the client will become accessible for each ICTC/ART in the state.

The programme already has basic infrastructure required to develop and implement this system. Only the programme and biometric machines will be required additionally. 

Possible Advantages

• Due to implementation of this system we could avoid the problem of repeat registration/repeat testing as the profile of the client can be accessible to any facility through his thumb impression.
• Auto-updation of all the data of client at its parent ART center if the client came in Migrants/Trafficking FSW/Truckers  group.
• This system could strengthen the referral and linkages services for the client e.g. the client could identified for the social benefit scheme by analyzing his profile.
• Current regimen, status of CD4, OI history etc can be viewed by scanning clients thumb impression in any ART center.
• State could generate the line-list of any client at just single click.
• There will be no need to maintain separate line-listing of any positive client at any ICTC/ART because data could be generate in excel base format.
• SACS could avoid the major problems of data duplication by accepting this system.
• This system could give the exact epicenter of HIV infection and one could analyze the accurate prevalence of specific territory.
• As system providing auto-updation data so there is no need to cross communication barriers with other district.
• Gap in EID/DBS program could be avoided by testing infant to the other EID center. We could provide EID/DBS services to the any neighboring district.

MSACS has been appreciative of this idea and has included it in its 2013-14 AAP. We will update you on any significant progress through this blog.

Buldana Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

Profile of the District: 

     Buldhana District is situated in border of Marathwada and Vidarbha region of Maharashtra.  Buldhana district facing a very high migration rate of PLHIV from Jalna, Aurangabad, Akola, Jalgao and Washim. The major source of income of the district is agriculture and district constructed by very small villages. The migration pattern is basically due to migration of agricultural workers. 

Services to the Migrant Client:

      If any migrated client found positive ART counselor provide him all the services i.e. counseling, Pre-ART registration, CD4 testing etc. and if the patient is eligible for the ART we put him On ART. If the patient is found co-infected then we specially mention the TB treatment and CPT treatment because clients history is important for further follow-up. If the migrant client wishes to take treatment at his parent town then we transfer out migrant client to his town for further treatment.

Tracking of LFU/MIS Migrant client:

DAPCU track the LFU/MIS migrant by tracking the address of the migrant and with the coordination of concern DAPCU. Many a times DAPCU Buldhana need to contact the other state also for tracking LFU/MIS migrant. In the case of ANC, DAPCU Buldhana coordinates with the other DAPCU for Migrant ANC delivery, EID/DBS follow-up.

To provide NACP services to the migrants, coordination among DAPCU is very important. To trace MIS/LFU migrant, to link them to the services, to provide them social benefit schemes etc.  

North Delhi Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

Within District: 

In North Delhi district generally the positive migrant clients are from other district and outside state. In Delhi there are nine ART Centers but there is no ART Center in North Delhi District. Within District migrant positive clients are linked to ART Center near to North District which are lies in other districts such as North West, Central and North East District i.e. Dr. B.S.A. Hospital, LNJP Hospital and G.T.B. Hospital for Pre-ART registration, CD4 count and if CD4 count is less than 350 then efforts are made for registering the positive clients in ART Center.

Other District: 

Whenever any client found positive from other district, counselor provides option to him / her for taking ART treatment according to his / her choice. If client is willing to continue the treatment from his own district then he / she is referred to that particular district ART Center for Pre-Art Registration, CD4 Count if eligible he is taken on ART.

Other State: 

If any client found positive we have suggested our district counselors to note down permanent address as well as current address so that if they become migrants we provide their permanent address to SACS so that they can be traced and ART treatment could be provided to them.

Prevention and Early Detection:

For prevention and early detection we arrange IEC activity like Full Site Sensitization Programme, Mega Health Camps, Poster, Nukkad Natak etc. with co-ordination of DSACS, Youth Awareness by Nukkad Natak in University, Session regarding HIV-AIDS in CRPF and Delhi Police, lectures on HIV-AIDS in schools, maintain the line list of discordant couple and ensure their testing every 3 months.

Linking to ART center, Treatment adherence, follow-up of LFU/MIS and PPTCT Services:

Linking the positive clients to ART center is key indicator of the program and we try our level best to ensure linkages by taking special efforts with the help of counselor. If any problem persists then DIS and DPM took action for registering the positive clients in ART Center.  At ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the client, family counseling is given to the positive client so that he / she should not face any discrimination within his / her family and also society.

Follow-up of LFU/MIS is ensured by collecting line list of such patients from ART center and then the same is handed over to Outreach workers and TI NGOs so that they can trace out the positive clients detail and then inform the ART centre.

DAPCU Bhandara Response to Comprehensive HIV/AIDS Service provided to the HIV Positive Migrants

In Bhandara district generally the positive migrant patients are from Gondia, Nagpur districts and very rarely the other state positive patients are from Madhya Pradesh. within district positive patients are provided comprehensive services by linking them with nodal ART center for PreART  registration ,CD4 count, counseling for drug adherence , psychosocial support etc. if the patient found stable on ART for six months then he can be shifted to the link ART center nearer to his residence.

Other District; whenever there is patient from other district found positive, that patient is linked to nodal ART center for pre ART registration CD4 count and if found eligible then taken ON ART, if patient is willing to continue the treatment from his own district then he can be transferred out to that particular district and the same is communicated to the concerned district.

Other State; whenever there is positive migrant from other state the patient is linked to nodal ART center for PreART registration CD4 count and if found eligible then taken ON ART, if patient is willing to continue the treatment from his own state then he can be transferred out to that particular district of the state and the same is communicated to the concerned district. 

Example- In the month of July 13 we had three positive patients from Hyderabad district state of Andhra Pradesh who were transferred out there after all necessary requirements and their linkage is confirmed. In this way the comprehensive HIV AIDS services are provided to the positive patients belonging to other districts and states.

Prevention and Early Detection

For prevention and early detection we arrange IEC activity like awareness camps, wall painting,  street play etc, in coordination with the NGOs working with DAPCU, provide counseling to college going students on every Saturday, maintain the line list of discordant couple and ensure their testing every 3 months

Linking to ART center, Treatment adherence, follow -up of LFU/MIS and PPTCT Services

Linking the positive patient to ART center is key indicator of the program and we ensure 100% linkage by taking special efforts with the help of counselor by taking the patient personally to ART centre for pre ART registration. At ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the patient, family counseling is given to the patient so that he should not face any discrimination within his family. The patient is also linked to District level network of positive people so that he can get psychosocial support from them and should be free from any stigma. Follow-up of LFU/MIS is ensured by collecting line list of such patients from ART center and then the same is handover to Link workers, DLN network people and PPTCT NGO outreach workers so that they can trace out the patient detail and can inform the ART centre in return. 

DAPCU Akola Response to Comprehensive HIV/AIDS Service are provided to the HIV Positive Migrants

Providing services to the Migrant is supposed to be the tough challenge in front of DAPCU. DAPCU plays a vital role in this segment which is as follows.
i) Identification of gray area for tracking HRG activities in migrants in the district.
ii) Sensitization of industries/corporate sector for covering migrant group.
iii) Linking positive migrant client to the services.
iv) Tracking of LFU/MIS migrant client by coordinating with the neighboring district/state.
v) Transfer out of the migrant client to the native place for further follow-up.
     For early detection, DAPCU Akola coordinates with the industrial sector/corporate industries in the district. Arrange sensitization workshop for the workers in the industries. Arrange health camp for the workers. 
     Brick industry has the big set up in the Akola district.  The workers from Chhattisgarh and MP highly involve in the manufacturing of bricks. ICTC counselor arranges the health camp with the coordination of brick industry owner and provides the health services. The referral of this group to the ICTC is very high. If the positive migrant identified then ICTC counselor provide strong counseling to them and link them to the ART. If client willing to move to his residence then ART coordinate with the other DAPCU and transfer him to his native place ART.

Bhavanagar response to theme - Coordination between DAPCUs

• In LFU tracking DAPCU co ordinate with other DAPCU through SACS. E.G. We are sending LFU tracking list district wise to SACS, SACS send tracking the data other DAPCU and others send reply  to us .
• ART Linkages with other district ART through DAPCU. We are sharing ART linkage data to other ART center AND mark c.c DAPCU. So, DAPCU Monitor the ART linkages activity.
• We teach about spaital map, different type of presentation to other DAPCU when they ask to us.
• Sharing the strategies to achieve the goal and target of HIV testing each other.
• Sharing the success story to each other during quarterly DAPCU review meeting at the SACS.

Angul Response to theme - Coordination between DAPCUs

Co-ordination among staff of a DAPCU and among DAPCUs is essential to achieve the desired goals i.e.  Getting to zero (Zero HIV transmission, Zero Stigma –discrimination & Zero AIDS related death).

There are 7  DAPCU functioning in Odisha. Coordination among DAPCUs of different district is carried out from the beginning of the establishment of DAPCU i.e. from- November 2008 onward. In the  beginning each staff of one  DAPCU  District  co-ordinates with counterparts of other  District DAPCU Staff for the establishment DAPCU, Specially regarding number of files, maintenance/ organizing DAPCC meeting/ DCC meeting/ Data compilation etc.

What are the issues on which DAPCUs support each other and how is the co-ordination achieved?

• In case of one DAPCU district misses any letter/ or communication from OSACS/NACO etc., the other DAPCU districts forwards/ informs the same letter/ communication through Email/Phone etc.
• In case of any form provided by OSACS BBSR to DAPCU district is missed the other DAPCU district forwards the scan copy of the same to the concerned DAPCU district.

What role do the SACS play in enhancing this coordination?

In time intervals the OSACS, organizes DAPCU review meetings/ trainings etc in which all DAPCUs staffs share their feeling/ achievements problems etc by which we get a lesson and accordingly we prepare/ modify our plans/ activities etc.

Recently OSACS, had organized one exposure visit to Bangalore and DPM Ganjam and Angul visited Bangalore on 28th to 29th January 2013. In _ Mysore they met the DAPCU Staff of Mysore and collected various information about their activities.

 Share a few examples on which you have taken the support of other DAPCU and how it has helped you?

• DAPCU Bhadrak mobilized one ILR (Ice Line Refrigerator) from FAKKOR Company. DPM DAPCU Bhadrak was able to mobilize the same ILR, as he discussed the “HIV  Kits”  preservation problems in DAPCC meeting and Collector and District Magistrate  of Bhadrak instructed  FAKKER Company to provide the same to DAPCU Bhadrak.  Accordingly DPM DAPCU Angul also discussed the same kits preservation problem in DAPCC meeting and Collector and District Magistrate instructed to  Executive Director of JSPL to provide the same to DAPCU, Angul and it is under process. 

Show a few examples of the results achieved by inter DAPCU Co-ordination?

• Recently OSACS BBSR organized one inter DAPCU District co ordination   visit and experience sharing among   DAPCU District staff in Angul District.  DPM and M&E Assistant of Khurda and Bhadrak visited the DAPCU, Angul on 3rd July, 2013.  In the same day one meeting was held under the Chairmanship of Joint Director Basic services OSACS BBSR.   In the same meeting DNRT member  was also present & in their presence   each District briefly presented their two major achievements report The DAPCU staff of Khurda and Bhadrak also verified the various files / records of DAPCU Angul and also gave a feedback to Angul DAPCU for better management of work.

Example:
In letter received register the staff of DAPCU Angul are not writing any comments in remark column.  But DAPCU Khurda emphasize to mention “what are the action taken against each letter” received by OSACS /  NACO / various line Deptt and after that , DAPCU Angul is also writing the action taken  issues against  each   received   letter in remark column.

The DAPCU staff of Khurda and Bhadrak also visited the ICTC  II of Angul district and verified their  record. DAPCU, Angul staff also learned many lesson from their supervision style and were able to know that- what are the various issues on which one can minutely observe the activities of the counselor and LT of different ICTC.

In the afternoon session of the same day DNRT member  gave direction to three  DAPCU district staff i.e. Bhadrak, Angul, Khurda for preparation of District Annual  work plan and accordingly the three DAPCU district prepare the AWP and submitted the same to OSACS, BBSR.  Again on 5th July these three DAPCU district staffs guide the other four DAPCU district staff for preparation of District AWP.

Lastly for the first time in Odisha DAPCU history the inter DAPCU coordination visit was organized under the leadership of Joint Director, Basic services OSACS, and DNRT member .  The same programme was highly appreciated by the Collector and District Magistrate of Angul / CDMO Angul/ ADMO (PH)/ DPM, NRHM, Angul and by the DAPCC, Members.  

Banda Response to theme- Coordination between DAPCUs

Yes, it is obviously needed for DAPCUs to work in coordination each other because every state, even district has a different work culture, format, environment, language, structure and so on etc.  If DAPCUs between inter district or state will share their work with other DAPCU whatever district or state, One DAPCU can learn with initiatives, way of work-performance, reporting  and many more thing.  In our District Banda, DAPCU team members share thoughts/ideas, working ways of different task e.g. reporting, through email sharing as well as by telephonic discussion.

• What are the issues on which DAPCUs support each other and how is this coordination achieved?

Issue are discussed with other DAPCUs e.g. reporting matter, preparing maps, social benefit scheme, district level meetings, monthly meetings issue are discussed. We share emails regarding particular subjects/issues, contact telephonic with other DAPCUs staff whenever needed. 

• What role do the SACS play in enhancing this co-ordination? 

Our UPSACS play pivotal role in enhancing this co-ordination, SACS share initiative, working format, technique, strategy of one DAPCU with other DAPCUs to learn and advise to do the same. Initiatives of DAPCU discussed with other DAPCUs at the time of review by SACS and promote to learn by these strategies. In this way UPSACS enhance co-ordination between DAPCUs. 

• Share a few examples in which you have taken the support of other DAPCUs and how it has helped you.

DAPCU BANDA takes support of other DAPCUs in U.P. as well as other than U.P. for many of issues as social benefit scheme, spatial map preparing, ART linkages strategies, IEC activities etc. DAPCU BANDA - IEC activities among rickshaw puller is a best example after learning from initiative of other DAPCUs.  Co-ordination with District Administration learned by Banda DAPCU by DAPCU Series shared by NACO. 

• Share a few examples of the results achieved by inter DAPCUs coordination.

We think that many of initiatives are learn by inter coordination among DAPCUs e.g. DAPCU Kit decentralization system by DAPCU Banda adopted by other DAPCUs in U.P. DAPCU Banda also learned many things by other DAPCUs as linking to HRGs with social welfare scheme and PLHIVs with social benefit scheme. 

Khordha Response to Theme- Coordination between DAPCUs

Is there a need for DAPCUs to work in coordination with each other? If so share how are DAPCUs in your state are doing this.

Yes there is requirement of Coordination in between DAPCUs to share experience and strategies in between them. It is known that since establishment of DAPCUs in the Districts many changes has been occurred and various activities has been initiated it is due to various exposures, sharing and discussions among each other during the district and state review meetings. Sharing of best practices of DAPCUs by NACO and DNRT also contributing to learn from each other. In conclusion there is need and requirement of DAPCUs to work in coordination.

 What are the issues on which DAPCUs support each other and how is this coordination achieved?

Followings are some of the important issues where DAPCU can support each other.

Availing Social benefit schemes: In this context DAPCU required coordination to know about various social benefit schemes of Government and non government agencies availed by other DAPCUs .Through sharing of the process other DAPCUs can adopt the strategy and can avail the same scheme. In this aspect the implemented DAPCU can also share documents like sanction letters, necessary orders of Government for example Order to include PLHIVs in BPL category, Nutrition / ration for CLHIVs from ICDS and sanction of household land for PLHA etc.

District specific programmes/campaigning : DAPCU needs coordination to know about the process and strategy adopted for designing and implementation of District specific programme like DAPCU Bolangir of ODISA has implemented Migrant programme so that can be implemented in other DAPCU districts through coordination and sharing.  

Component wise achievements: Through DAPCU coordination component wise achievements can be shared for example DAPCU Khordha of Odisha shared with DAPCU Angul and DAPCU Bhadrak regarding improvement of Cross referrals from RNTCP to ICTC which has been increased more than 90% so the strategies has been shared in the DAPCU coordination which was held at Angul (with 3 DAPCUs) and like vice versa DAPCU Angul and DAPCU Bhadrak has shared their remarkable achievements which DAPCU Khordha learned. DAPCU Khordha replicating some of the major activities carried by those DAPCU learned from them.

Issues redress by the DAPCU: Through coordination some of the issues like enhance client load to DSRC , enhance in and out referrals regular checkups of HRGs to DSRC and ICTC etc The strategies can be replicated as it is adopted by DAPCUs

Tracking of LFU and MIS cases: DAPCU required coordination for tracking of MIS and LFU cases in two ways one is to track those cases that are falling in the jurisdiction of the neighboring DAPCU District and second the procedure / strategy adopted by the same or other DAPCUs can be replicated through Coordination. However for instant  the strategy adopted by DAPCU Khordha to ensure 100% ART linkages has been shared with DAPCU Bhadrak and DAPCU Angul ( in DAPCU Khordha the A RT linkage was less than 85% which has been increased 95 to 100% since last 6 months.

Sharing of IEC material of different language: IEC materials of different language can be shared through DAPCU Coordination. For instant DAPCU Koraput has received IEC materials in Telugu language from DAPCU Vizianagaram, AP. Not only Telugu language but IEC from other languages can be generated through DAPCU coordination and in this aspect DAPCU coordination required. 

What role do the SACS play in enhancing this co-ordination?

• Followings are some of the aspects where SACS need to play role
• Facilitate relation between DAPCUs sharing of best practices of DAPCUs
• Initiate inter DAPCU coordination like two to three DAPCU can visit one nearest DAPCU ( which has already started through OSACS and  DNRT)
• Organizing meetings in regular intervals.
• Hand holding support to DAPCUs and facilitate to identify issues and strategy planning.

Share a few examples in which you have taken the support of other DAPCUs and how it has helped you. 

During last month Odisha SACS and NDRT has arranged DAPCU coordination meeting at ANGUL DAPCU where DAPCU Khordha and DAPCU Bhadrak have participated. This visit pioneered the scope to work in different areas. We came to know many things from DAPCU wise presentations.

During the visit to DAPCU Angul, we came to know that both the DAPCUs have generated resources from different corporate and companies. The strategies and process has been shared in the meeting and DAPCU Khordha after the visit has initiated to tap resources from o ne of the corporate which is at Khordha. The event is under process. Justification of presenting the event is that this action has been implemented after DAPCU Coordination.  

Response on Coordination between DAPCUs -DAPCU Davangere

DAPCUs really need to coordinate with each other for the smooth implementation of the programme.  DAPCU Davangere coordinated with neighboring DAPCUs: Chitradurga, Shivamogga, Haveri, Bellary, Gadag and far off districts like Kodagu, Mysore, Chikkamangalur, and Bangalore Urban for the issues related to HIV test kits, drugs, IEC, printed forms, reporting, monitoring & trainings.  DAPCU team got full hand support during HIV kits scarcity, chitradurga non-DAPCU unit has issued test kits and shown their concern to run the programme to provide service to people in dire need.  They also extended their support by providing printed formats, they are our first preferential choice for issues related to HIV test kits. DAPCU Haveri and Shivamogga have shown similar concern.

Our team takes inputs to clarify queries on understanding the e-mails some time.  Reporting and monitoring, which is helpful to work effectively through the coordination with DAPCUs: Chikkamangalur and Kodagu.

In creating mass awareness and sensitization on HIV/AIDS messages, we discuss with neighboring DAPCUs: Bellary, Shivamogga, Gadag and Chikkamangalore who provide additional information which is helpful to implement IEC programme in the district.

Coming to trainings DAPCUs: Davngere is considered as regional place and has to coordinate with 5-6 districts. DAPCU: Bellary, Chitradurga, Haveri, Shivamogga, & Koppal, they mail their participants’ list, depute and ensure trainees take-Part in trainings

DAPCUs:Shivamogga & Tumkur have provided inputs and clarified our doubts, queries and shared  opinion on issues concerned with finance.

Far off districts like Bangalore urban too coordinated very well during the shortage of NVP(S), through SACS intervention the shortage was met in short span of time.

With regard to out of district positive cases, Pre-ART, On-ART dues & LFUs of Chitradurga, Haveri & Bellary, there is gap in receiving feedback and this gap need to be bridged. 

SACS play very important role in enhancing  the coordination between DAPCUs.  SACS can readjust/relocate kits, printed formats, IEC materials, drugs in time of shortage/excess in DAPCUs.  SACS need to ensure on priority about out of district cases’ feedback to be exchanged between DAPCUs & to share exceptional achievements and successful implementation of the programme of one district with all other districts, so that it will form a strong base to build and strengthen coordination between DAPCUs, which in turn helps to indentify gaps and to achieve goals of the programme successfully in all districts.

           Our team heartily thanks all the DAPCUs who helped during our need & expecting the same in forth coming days.

Response on Coordination between DAPCUs - MEHABUBNAGAR District - AP

Is there a need for DAPCUs to work in coordination with each other?

• Yes there is a need for DAPCUs to work in co-ordination with each other, which gives platform for Experiences sharing & review among them to become strengthened and in turn pave a way to effective implementation HIV/AIDS Program
• Regarding DAPCU – Mahabubnagar, Andhra Pradesh, highly Backward District, falls between Hyderabad, Kurnool Districts and surrounded by  Range Reddy District.
• Since Highly draught prone are, General and seasonal  migration  to Hyderabad, Other parts of Andra Pradesh and even parts of  India is very high
• Since non availability of specialized Medical Services at District, people are referred to Hyderabad and Kurnool districts 

If so share how are DAPCUs in your state are doing this.

• Coordination meetings at every quarter between DAPCU Hyderabad, DAPCU Rangareddy, DAPCU Medak, DAPCU Mahabubnagar Districts held at conference hall, APSACS, Hyderabad.

What are the issues on which DAPCUs support each other and how is this coordination achieved?

Tracing LFUs, MIS cases and evidence of Death cases

• Reduce the Gap at cases found Positive at ICTCs  & Registered  at ART centre and  LFUs, MIS cases among  Pre  and On ART Registrations
• It is found in context of DAPCU - Mahabubnagar, the district near to Capital City and general & as well seasonal migration is high. Most of the people getting tested at ICTCS centres Mahabubnagar but they are getting registered at ART Centres,  Hyderabad and some cases they are getting both, tested at ICTC Centres Hyderabad  and Registered at ART Centres Hyderabad. And now most of them become MIS/LFUs, they need to be followed up, traced effectively with evidence by DAPCUs – Mahabubnagar, Hyderabad & Rangareddy Districts.

Strengthen Effective Referrals &Linkages mechanisms between above Districts

• Strengthen Effective Referrals &Linkages mechanisms between ART Centres and DAPCUs above said Districts to Tracing LFUs, MIS cases and evidence of Death cases

Sharing & Strengthening of Outreach Activities by data sharing between DAPCUs

• Sharing & Strengthening of Outreach Activities at far way Mandals from Mahbaubnagar ART center, which close to          Rangareddy & Hyderabad Districts. Utilize the Outreach Mechanism to trace LFUs/ MIS & Death cases
• Prepare & sharing the list of cases referred for specialised medical services for follow ups

Stock & Materials Management

• Stock outs situations, Proper & acceptable mechanisms to share stock & material  between DAPCU

What role do the SACS play in enhancing this co-ordination?

• Already regional wise review initiated by APSACS, and instructed all DAPCUs  to have zonal wise reviews ( 4 to 5 DAPCUs fall under each Zonal)  

Examples in which you have taken the support of other DAPCUs

• DAPCUs, Hyderabad & Rangareddy helped us in a follow-up & tracking of LFU, MIS and Death cases.

Examples of the results achieved by inter DAPCU coordination.

• Able to trace 27 LFUs and 3 critical Positive deliveries at Nay pool Hospital, Hyderabad

DAPCU Koppal Response: Coordination Among DAPCUs

 Issues on which DAPCUs support each other:

 a)KITS Collection b)Linkages to ART
a)    Kits Collection: DAPCU Koppal communicate with DAPCO and DS (Gulbarga & Bellary) over telephone and through emails. We collect the kits from Gulbarga and Bellary when they collect it.
We communicate with DACO & DS of Bagalkot and send the excess kits of near expiry to Bagalkot district.
b)    Linkage with ART:
An ANC positive case from Davanagere district got delivered in GH Kushtagi of Koppal district and we communicated this information to DACO and DS of Davanagere district.

Coordination with other DAPCUs
    One ANC positive case detected in our Koppal district but she was resident of Sindhanuru of Raichur district. She went to Sindhanur & Lingasur ART centers of Raichur district but they were not responded properly. Then we called to DACO Raichur & linked to Lingasur ART center.

Another ANC positive case detected in Hanumasagar ICTC of Koppal district but she was the resident of Bagalkot district. This case went for delivery to Ilkal CHC of Bagalkot district and not responded over there. Then we called and communicate to DAPCO and DS Bagalkot, and then this case shifted to DH Bagalkot and ANC delivered over there.

GADAG Response to the Theme: Coordination Among DAPCU.

Need for DAPCU Coordination: 

There is need for coordination among DAPCU’s is very essential for the Implementation of programme in the District.

DAPCU need support for the fallowing issues:
1)    Follow up of LFU/MIS, Pre ART and On ART Cases.
2)    Follow up of ANC cases, Follow up of PLHA treatment, Care and support.
3)    Exchange of Ideas for the successes of Programme
4)    Kit’s Storage and re allocation issues
5)    During preparation of AAP, AWP, DMR Report in sharing experience and knowledge. 

Co Ordination Activities with Neighboring DAPCUs :
We have taken Help from DAPCU Officer of Belgaum during IEC Programme like Red Ribbon Express, World AIDS Day and regarding arrangement of Campaign in the District
When the Kits stock out position (Kit-1) occurs in Bagalakot district They Collect kits from our District.
We have taken help from DAPCU Officer Koppal to bring the kits through their vehicle from Bangalore.
We have taken help ART Medical Officer KIMS Hubli as a resource Person while conducting training for medical officer of new PPTCT Guidelines implementation.
We Discuss that activities with Bagalakot and Dharawad DAPCU’s regarding district level Meetings and reporting methods, also preparation of DAPCU Monthly report with Kodagu DAPCU.
We send MIS/LFU line list to our neighboring district for the fallow up.

DAPCU Bangalore Rural Response to the Theme Co-ordination among DAPCU's

We need Inter District coordination to work with each other.

I.  Issues on  DAPCUs Support each other and Coordination achievement  

1. PLHIVs referrals to neighboring district or Nearest ART Center:   Getting  feedback of Pre-ART, ON ART, MISS/LFU and Death details to fallow up and re-enter to ART Center.

2. Positive ANCs Transfer out & Follow up: In case ANC Positives going to mother house for  delivery to other District and we have transfer out and intimation give to  RCH and DAPCU of the respective District to fallow up the ANC for the further PPTCT Services( Safe delivery, NVP Administration as per new guideline) 

3. TB Cases Transfer out to other District or TUs: Out of District TB Cases referred to his/her native place to initiate the DOTs and ART. To intimate to the DTO and DAPCU of the respective District and get the feedback of out come of the  TB treatment.

4. Share the innovative Ideas and Strategy : Any programmatic and preventive innovative ideas and strategy discussion & share each other in State level review meeting 

5. Training Coordination:  SACS conduct Induction, Refresher and other trainings trough Training institutions at the Mangalore, Darwad, Bangalore etc. The Respective District DAPCU arranges the training and accommodation then coordinate with other DAPCU to depute the training participants.

II. Role of SACS plays in enhancing this co-ordination 

1) SACS Created Official email ID to all DAPCUs in the state: All the information from NACO and others are sent to all DAPCUs

2) Given CUG Sim card to DPO, DS, and ART SMO & MO: Any issues clarification can easily sort out through phone calls.

3) State level DAPCUs Review meeting: DAPCUs give the feedback to their DAPCU & SACS give suggestion to strengthening the Program  

4) Reallocation of HIV Kits, STD Drugs & DBS Cards: SACS Directs to reallocate the excess of drugs or Kits to needed Centers of other District.

5) Quarterly Co-Ordination Meeting with neigh boring district ART center it is good. More to issues at the art center presently.

III. Support of other DAPCUs 

We have transferred out one ANC Positive Case to Shimoga, Megan Hospital to Safe Delivery and Baby fallow up. Now the Baby is on Fallow up.

1. We have received SD–Bioline kits from Tumkur district warehouse as directed by SACS.

2. We reallocated   Excess 30 DBS Cards to Yadgiri District and HIV Kit-1, 30 Kits to  Mangalore District. STD Drugs Kit-5 40 Kits to Shivamogga.

IV. Examples of the results achieved by their DAPCU Coordination.

1. Our district ANC positive went Shimoga District for delivery, she get NVP for MB pair DBS and provide CPT by Shimoga District. 

V. Give examples from your experience

1. Inter DAPCU coordination is were help full in achieving target without missing any case of ANC Positive follow up of DBS, WBS because ANC will be keep moving one place to another place. 

2. Miss LFU cases in a ART and deaths can be easily traced with the help of neighboring/other District.

3. Any innovate method adopted by any DAPCU will share their knowledge   so that other DAPCU can implement the same to the improve the program.

DAPCU Central Delhi Response to the Theme Co-ordination among DAPCU's

Co-ordination among DAPCUs

• Need of co-ordination among DAPCUs:

DAPCUs can enhance their performances through co-ordination among them. They can learn from experiences of other DAPCUs. They can decide that what sort of approach they should adopt in their work, by learning from the successes of other DAPCUs. Similarly, bad experiences of any DAPCU can intimate other DAPCUs to what & how they should not do their work. Consequently, speed and efficiency of DAPCU’s work are improved.

• Co-ordination among DAPCUs in Delhi:

Four DAPCUs are working in Delhi. All of them are working with good co-ordination among them. Experiences are shared through 

Regular formal and informal communications at all levels in DAPCUs. DAPCU review meeting is one example of the formal communication among DAPCUs. Exposure visits to another DAPCUs as & when needed are being done.

• Issues on which DAPCUs are supporting each other:

Maintenance of records & data, format for presentation of performance at DSACS & NACO, monitoring & supervision of HIV-AIDS related facilities, relocation of staff, test kits, equipment s etc. (as & when required), preparation of different line lists, tracking & follow-up of LFUs and any other issue that need help from other DAPCUs.

• Role that is being played by DSACS for enhancement of co-ordination among DAPCUs:

Co-ordination among DAPCUs are fully supported and enhanced by Delhi State AIDS Control Society (DSACS) in Delhi. Any exceptional work done by any DAPCU is appreciated and shared with other DAPCUs by DAPCU Nodal Officer, DSACS. Co-ordination among all four DAPCUs in Delhi is also strengthened by Regular Review Meetings at DSACS. 

• Examples of taking support from other DAPCUs:

Support from other DAPCUs has been taken in making presentation to show performance of the DAPCU in the review meetings. Gaps in different line list are being filled with the help of other DAPCUs. 

• Examples of achievements by inter DAPCU co-ordination: 

Various line lists of HIV Positive Clients have been prepared and are being updated without any gap. Standard formats are followed by all four DAPCUs for presentations of performances in the meetings at DSACS and NACO. 

  
  

DAPCU Yavatmal Response to the Theme Co-ordination among DAPCU's

Introduction:
Yavatmal District is supposed to be the high prevalence district in the Maharashtra state. In Yavatmal the factors contributing in the enhancement of HRG are as follows:
i) A huge migration from coordinating district/state.
ii) FSW trafficking from coordinating district.
iii) Majority of tribal population living with ill traditions.
iv) Hidden brothel in the district.

Without coordination of other District (Amravati, Akola, Hingoli, Chandrapur, Nanded), we can’t trace out the HRG. We have a very strong coordination with the neighboring DAPCUs. FSWs, Migrants and Tribal population we cover with the help of neighboring DAPCUs. 

 DAPCU's Contribution to the  program.
I. For kit storage and kit transportation we take the help of Akola DAPCU.
II. For LFU/MIS tracing DAPCU Yavatmal takes the help of all coordinating District.
III. For arranging workshop and training we take the help of Amravati and Nagpur DAPCU.
In any difficult situation or any obstacles we (DAPCU) coordinate with each other and sort out the problem. Many a times we coordinate with the other state also e.g.
A migrant from Punjab was working in the Yavatmal at garment factory. The person get identified HIV positive in the health camp and moreover his condition was very worst. We admitted him in the district hospital and when he was in a good condition we transferred out him to Bhatinda (home town) and coordinated with the Punjab SACS for further treatment.
Our (DAPCUs) coordination gives us strength to provide the best services to the PLHIV.

DAPCU LATUR response for Co-ordination among DAPCU's

DAPCU Coordination:

The DAPCUs in Maharashtra state are coordinating with each other in a very well manner to achieve NACP goal. DAPCU Latur majorly coordinating with the other DAPCUs in kits transportation, stock-out conditions of kits and consumables, sharing best practices, conducting seminars and trainings to the regional district, tracking MIS/LFU etc.

How DAPCU Latur coordinate with other DAPCU’s.

     In kit shortage at July 13 DAPCU Latur provided kits to the Solapur and Nanded district. We had near expiry vaccute tubes, needles and consumables so we coordinated with the other district through mail and relocate these consumables to the other districts. 

     In crisis we took the help of other district expertise. To solve the stigma & discrimination issue we took the expertise suggestion of other senior DAPCU. To provide social benefit schemes and other judicial rights to the PLHIV DAPCU Latur always coordinated with the neighboring district. At the time of DAPCC meeting we coordinate with the other district and implement the best practices of other district in front of Hon. DC.

SACS role in DAPCU Coordination.

     Visits of Nodal officer from SACS are also providing the expertise to our activities. Nodal officer share the successful strategies of other DAPCUs, which directly gives the value addition to our program. Nodal Officer elaborates the campaigns/activities/plans in front of Hon. District authorities.

DAPCU Chandrapur Response to Co-ordination among DAPCU's

We are happy to send the response on this theme. Coordination among DAPCUs is very useful for us & all DAPCUs. For a smooth working & a good atmosphere it’s really a need a good coordination among DAPCUs. We give only two to three examples of it as below 

1. Relocation of consumables & Kits
    a. We communicate with DPO, DAPCU Dist. Gadchiroli to  relocation STI drugs kit to us.
    b. We request to relocate excess consumable to us from DAPCU, Dist. Thane by email & also on telephonic conversation.

 2. To improve DAPCU performance
    a. We are communicate with other DAPCU & other DAPCU also          communicate with us for Programmatically improvement. For ex. DAPCU Wardha for sharing training loads.
    b. We share information regarding LFU patients with help of   ART center, Chandrapur from DPO,  DAPCU Dist. Yawatmal to reduce number of LFU patients

Chikmagalur Response to coordination among DAPCUs

All the work can not be completed by any one, we need cooperation & coordination to give the compete services. Our SACS has supported in that by providing the CUG mobile sims to all the District AIDS Control Officers & the District ICTC Supervisors in the state. We are also communicating through the e-mails. 

Every district has the issues in receiving the clients from the neighboring districts for delivery, ART, etc. during those times we need some  basic information like testing details, blood report, family history, earlier treatment history,etc.,all those times we have good support & coordination form the other DAPCUs.

Example 1. From our districts some of the HIV+ve ANCs are going to Shimoga district for their parental home for delivery. Recently one HIV+ve ANC was referred to Shimoga District Hospital in the night with the complaint of IUD. She went there without any reports & they were very poor. In the night we have contacted the DAPCU & explained the situation. They immediately contacted the Medical Superintendent of the hospital & admitted, get done scan & the surgery in time.

Example 2. We regularly follow up our babies born to HIV+ve mothers for all the required services. In our EID program also many babies were tested at the age of 6 weeks in other districts with the coordination of DAPCUs. 

Example 3. We used to share the PLHA linelists with the concerned DAPCUs from where they actually belong to & those DAPCUs also given feedback after tracing the person & giving the service.

Example 4. During few months back we have excess stock of HIV test kits which are of near expiry, with the coordination of Mysore DAPCU team we make use of all those within the expiry date. Five months back we were facing shortage of HIV test kits in our district, during that time we have received test kits from Shimoga district which helped us continuing the services at our ICTCs.

Example 5. During the training programs were organised, concerned DAPCUs taken the lead & helped us in deputing our staffs, reaching the venue, arranging the accommodation etc.In the month of July SIMS refresher training was organised in Udupi district for our Counsellors. They have coordinated with us & the training as successfully completed.

There are many examples from which we have learnt from other DAPCUs & implemented in our districts. Some of the DAPCUs creatively made some formats/pppts/profiles in Understanding/reviewing the program which are helped us also. In public service profession coordination play a
important role. 

So Work With Coordination.

Buldana response to DAPCU Coordination

Coordination among DAPCU’s: Buldhana Response.
 Buldhana district located in the end part of Vidarbha,Maharashtra. District has a 80% population from the rural part. District has a 17 stand-alone ICTC’s and 56 PHC’s where the HIV testing has facilitated.
Challenges in the district 

 i)  Migration of HRG.
ii)  FSW trafficking.
iii)  Linking positive client to ART due to geographically difficulty.
iv) Transportation and storage of Kits as facilities located in a very rural part.

To overcome  these challenges  Buldhana DAPCU always takes the help of Coordinating DAPCU, which are follows.
1) FSW from the Buldana district was tested in the Akola  and now is linked  in the Buldhana district for further follow-up.
2) District has a limitation in storage of Kits, so  kits store in the walk in cooler at Akola.
3) For technical expertise we  always take the help of SRL situated at Aurangabad.
4) To coordinate services especially LFU/MIS, ART linkages and ANC follow-up we work with -Aurangabad, Jalna, Akola and Washim
5) For IEC activities and conducting workshop we coordinate  with Aurangabad and Akola.

These coordination activities give the better result to provide best services to the PLHIV and HRG. The linkages and HRG coverage of the district is increasing day by day.