DAPCU Kodagu Response for-World AIDS Day-2013

WORLD AIDS DAY -2013, KODAGU, KARNATAKA

Date: 02-12-13
Place: Kaveri Kalakshethra (Town Hall), Madikeri
Jaatha  (Procession)Programme:                                                       

• Jatha programme started from Govt PU College, Madikeri at 9.30am
• Jatha ingurated by the District Judge M.V. Jadar and Mrs. Shobha Civil Judge  and Dr. V. Parvathy  were Chief Guest .
• During the Jatha Street play performed by Raga Ranjini Kalatanda, Mandya          
• 
• Students (RRC Members) of Govt P.U College, ANM Traning Centre and MET Nursing school, Madikeri, Members of ODP, NGO’s participate.
• Jatha programme concluded at town hall, Madikeri.

Stage Programme:

• Programme started at 11.00 am
• The programme chaired by Mrs. Mani Nanjappa – President Distyrict Education and Standing Committee – Jilla Panchayath, Kodagu
• The programme inaguarated by Mr. Usha Devamma – Vice president, Jilla Panchayath, Kodagu.
• Mrs. Shrividhya – CEO- Jilla Panchayath, Kodagu was the chief guest of the programme.

During the Programme :

• Experience shared by the president – Sarvodhaya Network for people living with HIV- AIDS.

Oath programme:

• Oath taken by all the participants by lighting the candle in the form of Red Ribbon Club. 
• On behalf of World AIDS Day-13 Radio programme on HIV/AIDS in Local channel has been done.

Media Programme :  by the District Supervisor

• Radio Programme conducted on HIV/AIDS, Women & HIV & Youth & HIV
• Live Programme (Phone in) on HIV-AIDS in the Local Channal

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

1.        Prevention & Early Detection:

In Karnataka is Kodagu District is a rural region with most of the economy based on agriculture, plantations and forestry. Coffee processing is a major economic contributor. Most of the people are engaged in coffee plantation work, which is the backbone of this economy. The major industries are Coffee Curing industries, Spices, Honey and Wax products. In recent years, tourism has begun to play a role in the economy, which has let to mushrooming of hotels and hence has attracted significant number of migrants from across the state and country.As Kodagu  is largely a coffee growing district, it attracts large number of estate workers from across the state and sometime from other states. 

• In the present situation, there are lots of Migrant population in the District. Most of them come as labourers to work in plantation and construction sites. from Orissa, West Bengal, Assam, U.P, Chathisgad, Rajasthan, Delhi, Andhra Pradesh, Tamil Nadu, Kerala  & Bellary, Chamarajnagar & other  parts of Karnataka.
• Most of them come to work, leaving their family in their own native, where there may be a chance of High Risk Behavior.
• HIV positive cases are found in the ICTC Centre’s & most of them are illiterates & lack Health education including HIV-AIDS & STI.
• In order to prevent further infection & also to provide care, treatment & services to the infected, the need of HIV-AIDS awareness along with the services were felt in the Kodagu District.
• Asha KiranaTI-NGO is working for migrant workers at the construction sites & in the Plantation Sector.
• In this regard  In co-ordination with DAPCU, Asha Kiran TI-NGO & Concerned heads of the site,  Special Health Check-up camps were held with awareness on HIV-AIDS, STI , Dental Check-up & General Health were held in different Estates  & Migrant Sites. So that we can create awareness on HIV-AIDS among the migrant workers and also we reduce the risk of transmission. Those who are found positive can be identified at the earliest to provide proper treatment, care & support.

2.        Linking  to ART, Treatment Adherence, Follow-up of MIS & LFU:

• Those found Positive are linked to the ART Centre at the earliest with proper counselling by the ICTC & ART Counsellor.
• Continuous follow-up is done through the outreach workers of TI-NGO, when the leave the District on work they will be transferred out to the nearest ART Centre. 

3.        PPTCT services:

• As per the PPTCT Guideline all the Registered ANC’s are referred for HIV Counselling & Testing services. And the Positive Clients are  linked to the ART at the earliest & will be given necessary PPTCT services
• In Kodagu sometimes we get clients from out of Districts (either Parents House or Husband’s House or the native of those Districts) like Mysore, Dakshina Kannada, Mandya etc. Such cases will be informed to the concerned District, for follow-up for delivery, treatment & MB Pair follow-up.
• Some time we get cases from other District for Delivery & further follow-up , such cases will be provide proper care, treatment & Support. 

4.        Challenges in Providing HIV/AIDS services to the Migrant Clients:

• It is difficult to link them to ART, especially if their stay in the Place is for a short period
• Language barrier if the client is from North Eastern States where they will not knowing any other language other than their mother tongue.
• Poor Adherence & Follow-up for treatment & more chances of MIS & LFU of out of state Clients. 
• Difficulty in tracing the clients from out of state as they are migrants they will not going back to their native instead they will go to different site on work.

Kodagu response on Coordination among 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.

There is a need for Co-ordination among DAPCUs to share the information, Strategies towards the implementation of the programme.

DAPCUs support each other and how is this coordination achieved

• Follow-up of PLHA for Treatment, Care & Support
• Follow-up of ANC Clients for Treatment, Delivery, MB Pair follow-up etc.
• Follow-up of LFU & MIS
• For reallocation of consumables, KITS, Drugs etc.
• Exchange of ideas & strategies for the success of the programme.
• What role do the SACS play in enhancing this co-ordination?
• To organize inter District Meetings to share the issues
• To share the issues in the state level review meeting

Support of other DAPCU’s

• ANC Clients detected in our District has been delivered in Mysore (Parents House) District has been followed for treatment & MB pair follow-up
• ANC client detected at Dakshina Kannada has been followed in Kodagu for ART & DBS
• Migrant clients detected Positive in Kodagu are followed for treatment at Mysore & Chamrajnagara
• Clients detected positive in the District are on treatment in the neighboring Districts like Mysore, Dakshina Kanna, Hassan, Chamrajnagara, Mandya etc
• Shortage of KITS & NVP Drugs are relocated to Mysore & Dakshina Kannada
• Consumables like Syringes & test Tubes were given to Mysore District
• Out of District Cases are sent to the concerned DAPCU’s for follow-up. If the follow-up is done in our District same will be informed.

Kodagu's Response to Theme- DAPCUs and F-ICTCs

1.Role of DAPCUs in locating a suitable health facility to establish F-ICTCs:

As per the guideline from SACS DAPCU’s have to identify the F-ICTC’s in the District. While identifying the F-ICTC DAPCU’s will look into the following indicators:

• Number of case load at the OPD
• No  of deliveries per month
• DMC’s
• Need for ICTC depending the key population, like Tribal Area, More no of positivity identified, High Risk Area, Migrant Population etc
• If it is PPP number of Deliveries & Number HIV test conducted will be taken for consideration

2.Capacity building of FICTCs:

• List of identified F-ICTC’s will be sent to SAC
• Induction Training on Counseling for the Staff Nurse will be conducted through SACS at the regional level
• Induction Training for the Lab-Technicians will be conducted through SACS at SRL’s
• At District level Staff Nurse & Lab-Technicians are oriented on ICTC Service, Follow-up and Documentation & Reporting
• Importance of ICTC services will be briefed during the orientation

3.Strengthening linkage b/n FICTC & designated ICTCs:

• Strengthening of F-ICTC through regular Monitoring & Supervision by DPO, DIS & concerned ICTC Staff
• Each F-ICTC will be linked to One Stand Alone ICTC, wherein they have guide the concerned
• F-ICTC staff proper Counselling & Testing service at F-ICTC
• As per the need Review meeting for F-ICTC Staff
• To ensure regular supply of TEST KITS
• Follow-up of clients found reactive for 1st test at F-ICTC & immediate referral to Stand alone ICTC

4.Monitoring  & Evaluation  of F-ICTCs:

• Monitoring & Evaluation of F-ICTC through timely submission of Complete & correct Reports, Proper documentation of clients counseled & tested in the Register
• Review meeting for F-ICTC staff to review the progress, & gaps in the programme & issues related to F-ICTC will be discussed in the Taluka Meeting & also in the District level Medical Officers Meeting
• IEC promotion & condom supply
• To ensure daily testing & ensure the same is well documented

5.Achievements to share:

• There is 10 F-ICTC & 2 PPP ICTC’s in the District and doing well related counseling, testing,documentation & reporting
• From July-2013  07 more F-ICTC’s in the District are going to function

DAPCU KODAGU Response for Supportive Supervision

1.  Supervision is a key role of DAPCUs.

Supervision is recognized as critical part of human resource management for the delivery of quality health care services. It is especially important for HIV and AIDS related health services. Supervision and mentoring are complementary activities, that are both necessary to build a continuum of care and support

Supervision is a process that promotes quality at all levels of the health system by strengthening relationships within the system, focusing on the identification and resolution of problems, optimizing the allocation of resources, promoting high standards, team work and better two-way communication.

Supervision as an intervention deserves special attention, it can improve performance and it could be a mechanism for providing professional development, improving health workers' job satisfaction, and increasing motivation

2. How do you plan and implement your visits for supportive supervision?

The HIV and AIDS health service areas will be covered with all services comes under NACO & KSAPS. That is , ICTC,PPTCT, ART, STI, Blood Safety, IEC , TB-HIV, Recording & Reporting.  

Planning  & Implementation

• On priority basis the facilities visits are planned to monitor the following aspects.
• Based on the performance of the Facility, Supervision visits are done.
• During the visit all the aspects are supervised, that is Counselling, Treatment, Follow-up, Cross referral etc.
• Monthly Reports are cross verified with the Registers
• The gaps are identified during the visit and the same has to be corrected
• Before visit a checklist of supervision is prepared

• On the whole programme is monitored according to the NACO Guideline

3. What should DAPCUs keep in mind while undertaking supervision? 

• In supervision we should strengthen & improve the skills & knowledge of the staff for   effective implementation of the programme, where the supervision should not make the staff demotivated.

4. Do’s in Supervision:

•   Monitoring of the Programme according to the guideline
•   Make the staff understand the gap and to take corrective action for the same
•   Improve the Skill and Knowledge of the staff for effective implementation of the programme
•   Proper documentation of the work done should be supervised
•   Activity at the facility should be client oriented
•   Feedback of the visit to the staff & Officers for further improvement.

5. Don’ts in Supervision:

• Should not be demotivate
• Should not discourage the staff

DAPCU Kodagu Response to Role of DAPCUs to Support TI

1.    Strategies  used in Kodagu  District for

Ø  Coverage of HRGs registration:

HRG Registration is done through the CBO-Ashodaya Samithi which is a Core Composite TI working in the District. The Registration is done through Social Network Basis through Peer Educators, ORW’s & CBO staff.

Ø Strategies to improve ICTC service to the HRG’s (twice a year):                       

By Conducting Special Health Camps & Outreach activities. And also maintaining individual Health Record system and insisting them to undergo HIV Test & STI Check up once in 6 & 3 months respectively.

 Ø  Pre ART Registration and Testing for CD4 Count of HRGs found HIV Positive:

Through Effective Counselling Positive Clients are referred to ART & continuous follow-up is done for CD4 & treatment by TI, ICTC & ART staff.

 Ø  Measures to improve the STI service to the HRG’s and ensure RMCs:   Regular STI Clinic services are held in three Talukas twice a month and HRG’s are motivated by Peer Educators & ORW’s to avail the services.

Ø Distribution of condoms, to all HRGs:

Distribution is done by CBO staff & outlets as per the requirement.

2.    How do DAPCUs and TSUs coordinate to support TIs. Please give examples

Ø  Monthly achievement of ICTC  & STI services by the TI are reviewed in the Monthly meeting

Ø  Outreach camps & Special camps are planned in co-ordination with ICTC, TI & DAPCU. And the same are discussed during the Monthly Review Meeting.

3.    DAPCU support TIs in accessing the district administration

Ø  The District level DAPCC & DCC meeting under the Chairmanship of D.C held every Quarter. The TI issues are discussed in the meeting.

  Ø  A meeting with the HRG’s was held along with WCD Department. The HRG’s opined that they are not willing to identify themselves in the society; therefore, they are not willing to access the social benefit schemes.

    

4.     Challenges

Ø  It is difficult to give continuous service to the HRG’s who are nomadic

Ø Though the many people in the District are involved in High Risk activities, it is difficult to bring them under TI service.

Ø There are many social Benefit schemes available, but the HRG’s are not availing them because of stigma & discrimination.

DAPCU Kodagu Response to DCC For TB-HIV

1.      Advantages of DCC in HIV-TB collaboration activity

v  DCC for HIV-TB will help us in understanding the HIV-TB activity in the District Quarterly

v  DCC will  strengthen supervision, monitoring and review of TB/HIV collaborative activities

v  As TB is the commonest co-infection among HIV Patients, by detecting TB at the earliest stage of AIDS , we can treat the person and improve his health & diminish the mortality & morbidity.

v  Co-ordination between two programme, RNCTC & HIV is benefited mutually for the benefit of the client.

v  As DC is the chairmen the District administration will understand the programme & help us in solving the constraints & challenges faced in the implementation of the programme.

v  We can have holistic approach in managing a co-infection patient & implement both the ATT & ART effectively

v  It will help in tracking the MIS & LFU co-infection clients

v  Intensified case finding at the facility will be reviewed

v  Monitoring & supervision by the DC

2.      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)

v  Less cross referral facilities are  focused during the in the meeting

v  To follow the 10 point TB tool at ICTC & to refer all TB suspects to ICTC from RNTCP

v  Details of TB registered clients , HIV test among the them , Co-infection & linkages to ART will be reviewed in the meeting

v  The gaps & the strategies to improve the cross referral has been discussed.

v  Representation & suggestion  from DLN, DIC & NGO for betterment of the HIV-TB programme

3.      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.

           
                      Monthly Facility Review:

·         ICTC centre wise   & ART review of TB-HIV activities

·         Discussion on TB diagnosed cases & co-infection clients

·         ATT & ART treatment for the co-infection clients

                  Monthly ART, ICTC & RNTCP Review:

·     Client wise HIV-TB activities are reviewed at the monthly ICTC,ART & RNTCP meeting at the ART on every 4^th Saturday. Where all the ART staff, ICTC Counsellors, RNTCP staff & DIC Staff will participate & the review done by the DACO, DIS & ART MO

·         PITC activity ( All TB suspects at the DMC  & ICTC are tested for HIV)are reviewed

·    Gaps in the above activity & gaps in treatment (ATT & ART) should be filled by adopting appropriate measures.

·         Follow-up of MIS & LFU co-infection clients by the ICTC, ART RNTCP & DIC staff.

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

                                     Role of ICTC :

·         Counselling on TB for all the clients attending ICTC  for  early detection

·         Referring symptomatic clients to RNTCP

·         Linking  co-infection clients for ATT & ART at the earliest, in order to reduce HIV-TB deaths 

·          Follow-up of co-infection clients

Role of ART :

·         Intensified case finding by all the ART staff

·         ART & ATT & initiation of CPT  for the co-infection clients

·         Adherence to the treatment

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?

v  Early Detection through cross referral from ICTC , ART & RNTCP

v  Line listing of the clients

v  Client wise review at the ART centre

v  Ensuring Adherence to ATT & ART

“MY HEALTH" CAMPAIGN FOR THE ESTATE WORKERS IN KODAGU

Kodagu is a rural region with most of the economy based on agriculture, plantations and forestry. Coffee processing is a major economic contributor. Most of the people are engaged in coffee plantation work, which is the backbone of this economy. The major industries are Coffee Curing industries, Spices, Honey and Wax products. In recent years, tourism has begun to play a role in the economy, which has let to mushrooming of hotels and hence has attracted significant number of migrants from across the state and country. The population in rural area is about 86.38 % and population in urban areas is 14.61 %. The reason being the rural areas are wider when compared to urban areas. It is one the five tribal belts of Karnataka. According to the 2011 census of India, Kodagu has a population of 5,54,762.  This ranks it 539 out of 640 districts in India in terms of population. The district has a population density of 135 inhabitants per square kilometre (350 /sq mi).  Its population growth rate over the decade 2001–2011 was 1.13% and has a sex ratio of 1019 females for every 1000 males, and a literacy rate of 82.52%.

•      The epidemic in Kodagu shows a decreasing trend since the last three year. 

•     The drivers of the epidemic in the district are thought to be the daily wageworkers, which include tribal and other backward class population.  

•      As coorg is largely a coffee growing district, it attracts large number of estate workers from across the state and sometime from other states. 

•      There are 10,725 labourers registered in Labour Department (These are the labours working above 5 acres of land). There is more number of labours, if we include below 5 acres estates. And 46115 tribal estimated in the district. 

•      It is observed that due to factors such as accessibility to health care facilities, illiteracy, dependence on the estate owners (tribal’s are not the decision makers) the health seeking behaviour specifically HIV testing and condom use among the tribal population is relatively lower.   

•      As on date, information collected from the DAPCUs around 43 tribals have been identified positives. However, the denominator is not known, as the ICTC data does not capture cast wise details, hence the positivity among the tribal population is not known. 

It is largely felt that specific tribal groups (such as the yeravas, kurabs) have a high risk of acquiring HIV due to their high-risk behaviour and cultural practises.

In order to develop a comprehensive plan of action, detailed understanding of the HIV scenario in the district and to design this campaign for ICTC demand generation, the following steps were undertaken.

OBJECTIVES:

•       Health seeking behaviour among the estate workers including tribes

•      Motivating the estate workers to avail the services available in the    District

•      Increase in HIV Testing & Counselling service in the District

PRE-LAUNCH PROGRAMME:

•      Under the Chairmanship of Deputy commissioner  Kodagu , Preliminary Meeting with the Stakeholder-Department & NGO has been conducted on 09-10-12. On the same day Core-Committee has been formed.

•  Training for ANM & ASHA Worker has been completed in the District in November-12, with the support of DHO & Taluk Health Officers of Virajpet & Somwarpet

•      Training for Anganwadi Worker has been completed in the District in November-12, with the support of DD & CDPO women & Child Welfare.

•       3 sensitization programmes for the estate owners has been done in the month of November-12.

•      Campaign Details were briefed to the Medical Officers during meeting

•       Explained in detail about the Campaign & the roles & responsibilities of the ICTC staff  to all the ICTC staff during the monthly meeting 

•      Date : 12-12-2012

•      Place : Virajpet

•   Procession(Jaatha) : at 9.30 a.m from Raja Rajeshwari Theatre, Virajpet, through the main Town  till Town Hall Virajpet, by the RRC students of Govt First Grade College & Kavery college Virajpet.

     

     During the Procession a Street Play by the Folk Team Karwar, has been played in the mid of the Town (Near Clock Tower)

     •     Stage Programme inaugurated by Mrs. Usha Devamma, Vice President, Zilla Panchayath.

  • Folk Programme-Street Play by Karwar Team

Continuation of the Programme :

Sensitisation & HIV-AIDS Counselling in all the PHC’s of Virajpet & Somwarpet Taluk, for the Estate workers.