Monday, 25 November 2013

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.    

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