DAPCU Amravati Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Has DAPCU faced any problems after closing CCC in the District? 

• DAPCU Amravati has CCC since beginning.
• CCC Amravati doing excellent Job and the almost all the clients with the funding and monitoring agency are very happy so the after closing CCC the major problem are found in the gap of eligible on ART.
• The client came after pre art he/she should stay there for OI management and the palliated treatment and in this period the CD4 done and client put on ART.

What measures have been taken by DAPCU to replace the services given by CCC?

• DAPCU doing advocacy with the District Civil Surgeon and Dean of Private medical collage to please give the services of IPD those are in OI Management or Bed ridden clients.
• Also discuss with CSC to if the clients are suffer from some IPD problem communicate to DAPCU and DACO. 

How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health    facilities?

• All OPD clients are first entered in to the ART center we have the DSRC (STI/RTI) in the same floor of the ART so the maximum OI and Skin problem are solve in the one place. In other OPD clients they are refer to the general OPD in civil hospital and in medical college.
• In IPD client the case paper and IPD registration form are available with ART center the SMO or MO can direct admit the client.

What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

• The DAPCU Amravati are doing advocacy with all the Govt. health facilities and private medical collage for give services to the PLHIV.
• The DAPCU Amravati are giving facility to all the PLHIV who needs the facilities like FNAC which are not available in the Govt. facilities are free in the private medical college.
• The DAPCU Amravati is also give facility to CLHIV in special day with the pediatrics availability in medical college in every Thursday.
• The DAPCU Amravati also gives facility of Pepsmere testing in woman hospital for PLHIV women and HRG without any charge.

DAPCU Khordha Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Has DAPCU faced any problems after closing CCC in the District?

Yes DAPCU facing problems after closing CCC from the Program. CCC has been intensive care unit for the PLHA.CCC has also been treated as FRU for the PLHA for OI management and drug adherence.

DAPCU has been facing following challenges after closing of CCC:

• There is no monitoring of Drug adherence and follow up of clients who start ART.
• No address verification of the clients there is no home visits happening to know and follow up clients after initiation of ART.
• No address verification challenged to trace out cases if found LFU and MIS cases.
• New life skill and positive living of the PLHA( after initiation of ART) is not been provided to the clients.
• Increased rate of LFU and MIS case has been a major challenge for DAPCU to re enrollment of LFU and MIS cases  in case the clients address is not been verified.
• No follow up of cases through home visits after closing of CCC.
• Intensive health care is not been provided where as earlier client could reach CCC at any point of time with their problems. Whenever any OI occurs they hesitate to come to the medical as they get harassed, and feel likes stop taking ART in future.

What measures have been taken by DAPCU to replace the services given by CCC?

Tracing of LFU and MIS case- ORW and PCs of TI / LWS are assigned to tracking of LFU and MIS cases they have been assigned areas where they will follow up the cases:

Address Verification – During the positive detection in the ICTC the counselors are instructed to obtain valid address. After detection of positive one to one cases are being followed up for ART registration. The concerned Counselors are instructed to follow up the case with ART counselor to ensure 100% ART registration.

Psychosocial support -  Instructed to all the counselor of ICTC and Counselor of ART Center to counsel about the life style, intake of life long drug to the PLHA including the positive life style CD4 Count and Pre ART registration. Apart from this the clients are referred to DLN for psychosocial support and counseling. The ORWs are present at the ART centre to counsel the client who came for ART registration.

Home Visit- All the counselors are asked to have home visit to the clients who are LFU and MIS. Along with the ORWs of TI, Non TI NGOS and LWS are also asked to have home visits. Various areas has been assigned with the TI, Non TI and LWS to tracking of cases. DAPCU is directly involved in the process to coordination with NGOs, ART center, LWS and SACS.

Management of Co infection cases- The list of co infection cases obtained from ART center in every month and shared with the RNTCP to follow up of cases and track of each is being obtained by ART center and RNTCP.

How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health facilities?

Followings are some of the areas integrated for in and outpatient services in the Govt. Health facilities:

• The Head of the institution of the Hospital near to ARTC is directly involved in the ART coordination meeting who also facilitated to provide services to the PLHA in the existing health facility.
• All pathological tests, Blood transfusion are performed free of cost for the PLHA in the Hospital
• For intensive medical requirement like surgery etc of any PLHA DLN used to coordinate with the department in coordination with ARTC and DAPCU. The SMO ARTC also have greater role to facilitate health services for the PLHA in the government health facility.
• Sensitization programmes are conducted in the Hospitals in support of non TI NGOs to reduce stigma and discrimination against the PLHA.
• For institutional delivery of Positive ANC a coordination mechanism has been developed with one of the Non TI NGO. The positive (ANC) is being shared to the NGO and their ORWs are asked to monitor and follow up the ANC by home visit. Their work is also been reviewed in the DAPCU level. The ORWs are facilitates for delivery of positive mother in coordination with ICTC under PPTCT programme.    

DAPCU Bhadrak Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

• Has DAPCU Faced any Problems after Closing CCC in the District?

It is mentioned here that there is no CCC established in the district, rather previously there is a CCC in nearby district Balasore. The PLHIVs of Bhadrak district depends upon the Balasore CCC and same centre takes all sorts of care, support and treatment to the clients. Though the CCC has the provision of Outreach Worker and the workers are very much committed to their work and follow-up the clients at the time of field work. No doubt, the DAPCU, Bhadrak has faced problem due to there is neither CCC nor a DIC for looking after the PLHIV.

• What measures have been taken by DAPCU to replace the service given by CCC?

The District has no CCC, DIC and ART centre, but there is a LAC+ in the district. The MOI/C of the LAC+ has provided time for the PLHIV for all sorts of Care, Support and treatment.  The CDMO of this district takes all sorts provisions of care to the PLHIV.

• How did DAPCU integrate the Inpatient and Outpatient services in the existing Govt. health Facility?

Most of the Outpatient are cared by the MOI/C, LAC+ and MOI/C of STD Clinic. In case of any difficulty the concerned doctor refer the clients to the concerned head/specialist of the departments for better treatment. If necessary the client may admitted in the hospital for better care and treatment or any difficulty the clients refer to the higher institution for treatment.

• What are the good Practices or approaches adopted to Provide Medical care to PLHIV within the district?

1. At the time of need the Blood bank provided blood to the PLHIV in free of cost and the RKS provide the cost for the blood sample.
2. Travel expenses  of the PLHIV met from the Red-Cross fund and it was manage by the DAPCU ( till date Rs-30,000/ has already been sanctioned from the red-cross)
3. The RKS also provided free Ambulance services to the PLHIV at the time of need.
4. All Pathological tests for the PLHIV are conducted free of cost.
5. All ANC Positive delivery was conducted in the DHH as well as the CHC level. The labour room in charge provides necessary delivery kits and Nevirapine tablet and syrup to the client which was supplied by NACO/OSACS.
6. Any types of operations need for PLHIV are conducted in the district.
7. At the time of treatments all necessary medicines are provided to the PLHIV from available fund. 

DAPCU Ganjam Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

DAPCU has faced problems after closing of CCC. After closing of CCC the referral and linkages has been stopped.

No specific measures has been started to replace the services given by CCC.

ON ART PLHA linked to 4 link ART Centre of Ganjam district.  DAPCU has coordinated with the 4 link ART Centre Medical officer Incharge to provide the general medical service along with the ART.

DAPCU - East Delhi response on the Theme: Care and Support Services for PLHIVs in the Absence of CCC

1. Has DAPCU faced any problems after closing CCC in the District? 

• CCCs were established by NACO for providing care, support & treatment to PLHIV.
• DAPCU East doesn’t have CCC & ART centre since beginning. So DAPCU-East didn’t face any problems after closing the CCC.

2. What measures have been taken by DAPCU to replace the services given by CCC?

• As we already mentioned that we didn’t have CCC & ART since beginning therefore we need not to take any measures for replacing the services given by ccc. 

3.How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health    facilities?

• Positive clients were referred to Link ART Centre.  In Link ART centre the counsellor provided proper counselling to PLHIV clients and after that they will get treatment from Link ART centre. In case PLHIVs face any problem in getting in Patient & out Patient services in the existing Govt. Health facilities, DAPCU - East coordinates with Govt. Health facilities with the help of CDMO office & District Administration.

4. What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

• Time to time Sensitization programs on HIV-AIDS and PLHIV’s Stigma & Discrimination related issues are organized by DAPCU - East in  Government Health Facilities of the east District.
• DAPCU –East organized Workshop, Mega Camp, Health Camp & IEC activities in regular time frame.
• Linked PLHIV’s to available facilities to provide care & support services, as per their requirement.
• Linked PLHIV’s to Social Beneficiaries Schemes with the help of Local District Administration.
• In case of any problem to provide medical care to PLHIV within the district the matter was discussed in the DAPCC meeting.

DAPCU Balangir response on the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

1. Has DAPCU faced any problems after closing CCC in the District?

• Yes. The PLHIVs were deprived of getting medical treatment like OI, drug reaction etc. through CCC.
• When CCC was there in this district, the PLHIVs were coming with a confidence and without any hesitation of getting care, support and treatment.

2. What measures have been taken by DAPCU to replace the services given by CCC?

• DAPCU has coordinated with DLN for providing support to PLHIVs, those are coming from remote places to ARTC, Balangir for their shelter and treatment at DSRC.
• LFU tracking is being made through DLN and other networks like USS. ICTC counselors are suggested for follow up even the client is not detected at their ICTCs.

3. How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health facilities?

• Any medical treatment / test is required which is not available at ARTC, through district health administration, the PLHIVs are included to get the benefits from the Govt. health facilities.
• Most of the times the health care providers like doctors, Staff nurses are sensitized on HIV/AIDS which in turn the PLHIVs are get benefited from the health facilities.

4. What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

• DAPCU has coordinated / organized various sensitization programmes on HIV/AIDS to make aware the Health Care Providers on the same.
• Free clinical tests are being done at SDH levels.
• Now it become a general that HIV positive deliveries are being conducted at DHH and SDH level through constant sensitization to the Health Care Providers (from top to bottom) through various sensitization programme, during field visits etc.

DAPCU Angul Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Has DAPCU faced any problems after closing CCC in the District?

CCC is an innovative idea implemented by NACO for providing care support treatment to PLHIV and its also provided psychological support to PLHIV clients. Presently although the PLHIV were admitted in Govt. Hospital and getting all sort of care & treatment but still  they are  in tension condition -- that their status may be disclosed to the community member.

DAPCU Angul was established in Nov-2008 and from the beginning of establishment of DAPCU Angul there is no CCC in Angul. The ART centre was established in Angul district in the year 2010. So from the beginning the PLHIV clients were getting care and treatment service from Govt. Hospital. Two HIV positive networks were working in Angul district i.e. Network of Angul positive people (NAP+) & Angul District Network of Positive People (ADNP+) and they provided  psychological support to PLHIV clients. The CCC was established in Angul in the year 2012 and before starting its work in a proper manner the centre was closed due to legal problems. So DAPCU Angul has not faced any problem after closing of CCC in the District.

What measures have been taken by DAPCU to replace the services given by CCC?

Angul PLHIV client has not received any services from CCC Angul as it is closed before its functioning in a proper manner due to some legal problem.

How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health facilities?

After detection of Positive in ICTCs all clients were referred to ART Centre.  In ART centre the counselor provided proper counseling to all PLHIV clients. The PLHIV clients received all sorts of treatment in ART centre. In case of any complication  the SMO ART Centre refer the clients to concerned specialist and in outdoor timings all sorts of treatment was provided  to PLHIV and in case of any emergency the clients were admitted in the Hospital and without any hesitation all sorts of care, treatment was provided by Para medical staff / Doctors /  etc.

What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

1. All pathological tests were provided to PLHIV in free of cost.
2. Blood was provided to PLHIV in free of cost.
3. In case of referral the Ambulance service was provided to PLHIV in free of cost.
4. In all CHC/SDH/DHH the positive delivery was conducted.
5. Presently it was decided in  the last HIV-TB monthly review cum co-ordination meeting held on 08.11.13 that the PLHIV can utilized the service of 108 Ambulance for coming to ART Centre in case of any financial problem.
6. Again it was also decided in the HIV-TB monthly meeting held on 08.11.13 that the fund from GKS can be utilized for needy PLHIV for referring the PLHIV to ART Centre.
7. In case of any problem to provide medical care to PLHIV within the district the matter was discussed in the DHH monthly review meeting and DAPCC meeting and decision was taken accordingly to provide proper care, support service to PLHIV.

DAPCU North Delhi Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Integrating Care and Support Services to PLHIV in the Existing Government Health Facilities" in the Absence of CCCs in the District.

1. In our North district there is no ART Center and CCC from the beginning and now also. So, we did not face any problem or difficulty after closing the CCC in the districts.
2. As there is no ART Center and CCC from the beginning and now also, we did not take any measures to replace the services given by CCC.
3. If any problem is occurred to get in Patient & out Patient services in the existing Govt. Health facilities by PLHIV, DAPCU staff take appropriate action by coordinating with ICTC Counselor, ART Counselor, Doctors in the hospital so that the PLHIV would get in Patient & out Patient services in the existing Govt. Health facilities.
4. Discussed with CDMO, DACO and other medical officers about the OIs infection when the PLHAs need admission in the hospital. We have sent a Circular through Deputy Commissioner, North District to all the Medical Superintendent of Hospitals and Medical Officer In-chage of Maternity Home of North District for:  (a) providing all available health services in the facility to people infected and affected by HIV / AIDS, (b) ANC who is detected to be HIV positive in the district should be delivered within district hospital, sub hospital and maternity homes. (c) Prophylaxis should be provided to both mother and baby. 

DAPCU Central Delhi Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Problems faced after closing of CCCs

• No exclusive In-patient care is now available for PLHIVs.
• Difficulties in verification of addresses of clients to be registered in ARTCs and addresses of those couldn’t be verified by the ARTCs.
• Scarcity in Couple Counseling, Nutritional Counseling etc. those were provided by CCCs.
• Lack in Psychological, Social & Legal support necessary after community rejection.
• Non-availability of Home Based Care for PLHIVs.

Measures have been taken to replace the services given by CCCs

• Necessary in-patient care is being provided through Government Health Facilities those having staff sensitized on HIV-AIDS.
• Staff of ARTCs is supported by TI-NGOs, ICTCs and DAPCU in the verification of addresses of PLHIVs.
• All type of necessary counseling is provided by the staff of ARTCs and ICTCs to PLHIVs.
•  Psychological, Social & Legal supports are provided DLN of PLHIVs, TI-NGOs and coordinated by DAPCU.

Integration of In-Patient and Out-Patient Services in the existing Government Health Facilities

• Authorities and Medical Officers of the Existing Government Health Facilities are requested with the support of IDHS-Central & District Administration to provide all necessary In-Patient and Out-Patient Services to PLHIVs with extra care.

Practices & Approaches adopted to provide medical care to PHIV within the district

• Medical, Para-Medical & Non-Medical Staff of the Government Health Facilities are being regularly sensitized on HIV-AIDS and PLHIV’s related issues.
• Stigma & Discrimination towards PLHIVs are being diminished in the Society through Advocacy Meetings, Mainstreaming Workshops, IEC activities in Mega Camps, Health Camps & School Health Melas.
• PLHIVs are being educated about Social & Financial Benefit Schemes available for them. Details of the schemes are collected & compiled by DAPCU from different departments & institutions and shared with ARTCs and TI-NGOs for further sharing with PLHIVs.

DAPCU Bhavnagar Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Has DAPCU faced any problems after closing CCC in the District?

• Yes, we have the faced the problem when PLHIV pt. come from interfere villages for taken a health services. We have no any places where there pt. is stay for night.

• Also problem occurs for minor OI treatment.

• Sometime pt. receives the treatment but not get a psycho-socio support from health facility.

• Major problem in outreach activity specially tracking of MISS & LFU cases.

• Not specific system for tracking of MISS & LFU cases by staff.

What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

• There is a one option for provide medical care to PLHIV sensitize the all health worker about care and support to PLHIV. 

• Give the training about care and support ( ART regimen, OI treatment, eligibility criteria for ART, CD4 importance)to PHC and CHC medical officer. Also training give to private practitioner for ARTC. And inform them for what type of services given from ARTC to PLHIV. 

• Establish the LINK ART CENTER   at the  each and every ICTC and PPTCT. Because all medical and paramedical staff will involve the CST Programme. And also PLHIV will taken a ART for long time regularly. Therefore reduce the work burden from Nodal  ARTC.  Also benefit for partner testing. 

DAPCU North Tripura Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

District AIDS Prevention & Control Unit of North Tripura (DAPCU) is working since 2009 & providing services to the peripheral units in keeping liaising & Co-ordination with other line Departments in order to improve the programme.

DAPCU is covering two districts, North & Unakoti. Eastern part of North Tripura is connected with Assam and northern part of Mizoram, West side of North Tripura is connected with Dhalai District, North Tripura is connected with Bangladesh and South part of North Tripura is connected with Bangladesh and a part of Mizoram. The economy of the District is primarily agrarian. Majority of the people is below poverty line. Economic factor is the derivation of the problem.

North Tripura is having 2469.90 square Kilo Meter of Geographical area & near about 10 lacs population.

The Care, support & treatment needs of HIV positive people in the stage of infection, needs holistic care & support. Under the national program, a Community Care Centre (CCC) is a place with facilities for outpatient and inpatient treatment. Basically DAPCU, North Tripura is not having CCC in the district but the patient was referred to CCC.

• Integrating Care & Support services is being provided to PLHA in existing Govt. health facility & Services.

DAPCU faced problem after closing of CCC, because patients were coming from ICTC, F-ICTC, TI & other units at DAPCU to take services, as earlier they used to get services but now they are not able to access the service. So now where they will go? This is the major concern of DAPCU to facilitate the patient. PLHA used to get following services:

Medical Services.

Psycho-Social Support.

Nursing Care.

Counseling.

Free medicine & Services on Opportunistic Infection.

Providing Anti natal & Post natal care.

Free Accommodation to the In-patient.

Now, they are deprived of these above mentioned services & came at DAPCU to facilitate them, so now this is a major concern for DAPCU. They felt that CCC is “A home away from home”.

• DAPCU faced problem & took some initiatives on this issue:

1. During Meetings, Visits & discussion, discussed with MO/IC, MO, MS, SDMO & other officers to admit PLHA’s in case of OI’s & when they need admission. The matter was also discussed with CMO, DM & other line departments. So, now they are getting the care, support services from these peripheral units.
2. DAPCU also facilitated PLHA’s through PHC, CHC & IL & FS, and LWS to refer them at ART Centre.
3. Mobilized through different funds through discussion with MO/IC.

• DAPCU integrated & facilitated the In-patient & outpatient services through following measures:

1. During visits, meetings & discussion with MO & MO/IC discussed with MO & MO/IC to admit PLHA in case of OI’s & also provide care & support services. Now, they are getting the services.
2. Providing medicine intake to the patients as per doctor’s prescription.
3. Linkages & referral services as per problem concerned.
4. Mobilize pregnant women for PPTCT services & liaison with other health functionaries such as ANM, ASHA and Anganwadi workers.

• DAPCU is doing some good practices, those are as follows:

1. Linking with needed resources & centers, through concerned facilities to enhance their functional capacity & also provide care & support services.
2. Undertake field visits to verify the address of the person who has been enrolled on ART and sent to ART for counseling support.
3. Providing training to Doctors & Staff Nurses.
4. Mobilizing through outreach worker.

Staff Meeting at DAPCU on PLHA Issue Conducted by DAPCU

Meeting with line Departments on PLHA issue

DAPCU Kanyakumari Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

Problems Faced after the closing of CCCs:

For minor OIs we find very difficult to get admissions in Medical College hospital. And patients who are new and need to do basic investigations had have to come long way for two to three days to ARTC. CCC was a good place where only PLHAs can share there problems with out any hesitations as all the patients are PLHAs and the bystanders also know about them.They could talk to everybody in CCC openly.But in hospitals even the staff know about the HIV status the patient in the near by bed is not aware and the PLHA is always in a fear that whether anybody tell them about the HIV satus.Until they are discharged from the hospital they under the fear that the HIV status will be disclosed to others by any of the staff.

Measures have been taken by DAPCU to replace the services given by CCC:

Discussed with DACO and other medical officers about the minor Ois when the PLHAs need admission in the hospital.Now all the MOs of peripheral centres are willing to admit the PLHAs and to give  care to them and also trying to give any other support needed for the PLHAs. Previously when one PLHA come to peripheral centre usually the MO refer them to ARTC. Now the descrimination has come down and most of them are treating the PLHAs in Govt hospitals.