DAPCU Khordha (Orissa) Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

Linkages and referrals to the positive people are one of the major responsibility of the counselor at ICTCs. However, it is not ended with linkages only but to make proper follow up hence forth and to ensure partner notification for further test. In most of the DAPCU Districts it is being followed up and monitored to ensure 100% ART linkages. It may not be easy for the ICTCs which are far from the ART centre.

Although we have achieved good results in ART linkages, still the scenario was not so convenient in earlier days. There are some of the issues which are still could not be addressed. However, the percentage (%) of ART linkages under DAPCU Khordha was 94% during the period of 2012 and there was no such effort was made to ensure 100% ART linkages and also there is no system initiated to linkages the pending cases. And later these issues have been observed seriously and various efforts were made to ensure 100% ART linkages in the District. Now we have achieved 97% in ART linkages.

Efforts made:

It is viewed that number of testing were increased and number of positives too. So, it was challenge for us to link them with ART Centre. So, following efforts were made to reduce the linkage gaps between ICTC and ART.

1. Discussions and review in the monthly TB- HIV cum coordination meeting with data, showing number of positive detection in the ICTC in the month and ART enrollment. Along with highlighting the no of cases (from the ICTC) are not yet enrolled at ART Center.
2. Sharing of detected positive cases (source SIMS) of all ICTCs for the current month with the ART centre providing data in line listing format containing address, age, occupation, mode of transmission, ICTC where positive detected, date of detection etc to get filled Pre –ART number, Base line CD4, and ON ART Number if he/she eligible for ART.
3. Cross verification of these data with the concerned ICTCs through meetings and through telephonic discussion and feed backs.
4. All Counselors are suggested to ensure that the referred client has visited/reached to the ART center or not, through telephonic discussion / in a written format
5. ART linkages is also been discussed in the monthly ART coordination meeting where DPM is attending in a regular basis.
6. The drop out cases that are not visited to ART centre after detected positive, are the major challenge for us. Although we have no separate mechanism, but the concerned counselor is advised to visit her / his house with CSC / Link Worker/ ORW ( if it falls LWS/TI  area)  to convince them in each Saturday during the outreach activity.
7. Simultaneously the line list of the PLHA who is denying for ART registration after given consent at ICTC are to be shared with the CSC for tracking and in this effort, the concerned counselors are also going with the CSC.
8. Some long pending cases are also shared with CSC for tracking and the action taken report of those cases are submitted to DNO, DAPCU.
9. The cases who are belong to other district are ensured that they are linked with their nearest ART centre if he/she is not enrolled at our ART center. This is facilitated through telephonic discussion with the concerned DAPCU/ ART. (recently 3 cases are linked through this process)
10. Responsible also given concern TI NGO & LWS (for those cases referred by LWS/ TI and detected positive in ICTCs) to follow and ensure to ART registration.

10. DIS and other DAPCU staffs are joint visit with CSC and Concerned counselor to the PLHA who are not agreed to visit ART center.
11. CDMO & ADMO (PH) apprised concern counselors who are achieved 100% ART linkages in monthly meeting. So, that all counselors are taking initiate for achieved 100% ART linkages.

Constrains:

Difficulties to enrolled denying those cases who were agreed initially. Whereas the list of those cases could not be removed from the list.

100% enrollment is not happening due to death after detection and even for denying and absconded cases. 

Not achieving 100% in case of repeat cases.