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How do DAPCUs facilitate Pre ART registration of all found positive)? A few emerging themes based on DAPCU responses on this blog (please click on the name of the district to view their detailed response)

Coordination between ICTC and ART Centres

• Through monthly coordination meetings - Ganjam shares that they collate the information available with them prior to the meeting and review gaps during their meetings.
• Through tools like ICTC -ART coordination sheet (Rajkot)
• Exchange phone numbers and stay in touch is what some DAPCUs have to say.  Phone calls and SMSs are sent between counsellors of ICTC and ART to inform that a client might be visiting or to inform that referred clients have reached. (Surat). This supports daily tracking between facilities.
•  Through email - In Coimbatore the ICTC informs DAPCU and ART centres via email about the found positives and referrals. ART Centre sends a similar communication to them when the clients register for Pre ART. For pregnant women (ANC) the PPTCT NGOs are informed via email. This is a weekly process in Coimbatore.

Accompanied referrals

• In Central Delhi counsellors often accompany positive clients for Pre Art registration. (They have also provided the trend of Pre ART registration in their district from April 11-Dec 11, please visit Central Delhi’s post for details.)
• For East Delhi accompanied referral is especially useful if as they share that the ART centre is distant and not in their district
• Outreach teams of the PPTCT and DLN accompany positive clients to the ART centre – share Satara, Surat

Field Follow Up

• In Bangalore Urban , the team first mapped the outreach teams available in the district and then deputed them to follow up on positive individuals for Pre Art registration. They have also shared the ANC trends CD4 and ART please visit Bangalore Urban’s post for details.
• In Amravati the grassroots team is provided a list of identified positive individuals who have not undergone Pre ART registration and home visits and follow up is ensured by them. Similar processes are followed at Balangir and additionally they share that there are block wise point persons from the DLN who support this activity. (They have share data for the period of 2010-2011 on Found Positive vs. Pre ART registrations please visit Balangir’s post for details.)
• Coordination with other programmes like RNTCP. In Central Delhi , RNTCP counsellors help TB clients who are HIV positive get registered at ART
• In Tirupur Counsellor Outreach is a special focus and they have tracked and shared examples of their success. Tirupur has provided specific examples on counsellor outreach visit resulting in pre ART registration please visit Tirupur’s post for details.
• TI counsellors maintain positive line list in North Delhi and ensure follow up through PEs
• In Churachandpur , NGO partners are informed regarding the clients in their region testing positive and they are expected to follow up
• In Nanded the DAPCU shares that they meet with PHC MO and Sub-center ANM, ASHA to encourage follow up and also brief them on confidentiality. They have shared cumulative achievements for 2011-12 please visit Nanded’s post for details.

Inter District Coordination

• Dahod recommends that informing other districts about clients from their districts testing positive or registering for ART centre is equally important. Erode and Coimbatore  also share that they send this information to other districts.

A few other strategies 

• No user charges – free tests prior to ART registration (Balangir)
• Provision of transport facilities through the Rogi Kalyan Samiti in Dahod . They have provided details from April 2011-Dec 2011 on Pre ART registration along with the reasons found for individuals who have not undergone Pre ART registration. Please visit Dahod’s posts for details.

Reducing LFUs - DAPCUs brainstorm strategies

Pleased to share with you a compilation of responses received on our question to DAPCUs on reducing LFUs (Dec 2011). We received responses from 55 DAPCUs covering a very wide range of strategies. While some DAPCUs have suggested strategies in preventing LFUs others have provided their suggestions on tracing and re-entering them. 


Here is a glimpse at what DAPCUs have to say 

Knowing the cause can help you find solutions.  Talk to counselors, doctors, PLHIV networks and try to understand why people do not reach the ART centre. You will find multiple reasons – inability to tolerate side effects, travel, migration, death etc. Understand the causes in your district - and then look for solutions.

Do you know how/where to contact PLHIV on ART? understand how details of contacts are maintained at the ART centre.  Ensure that complete contact information is recorded. If you don't know where they live or how to get in touch with them, how can you support them in getting back on ART? 

Provide support for travel - Travel concessions are available for PLHIV on ART and they should be informed about them.  Provide concessions to those in need it and are eligible. 
No travel schemes in your district? Talk to the District Collector and Health Department about creating local provisions . There will be solutions, let’s look for them.

Send reminders: Some counselors in ART centres send messages or make phone calls prior to the date of  visit to remind them of the same. Some DAPCUs share that special attention must be devoted to PLHIV who miss appointments. Lets be in touch with those due for an ART visit prior to their dates. Today’s MIS could be tomorrow’s LFUs.

Map the LFUs - Pool the grass root team: Mobilizing grassroots teams for follow up can be a good strategy for re entering LFUs.  Compile a list of all the grass root workers  (ORWs , PEs, Link Workers etc, PLHIV networks) and LFUs. Map both LFUs and the grassroot teams blockwise and assign responsibilities to the team. 
There will be enough people to support LFU re-entry. Mobilise them, use review meetings to discuss this strategy and tune it to the needs of your district.  

LACs can help: based on guidelines and willingness of the PLHIV  transfer out PLHIV to LACs convenient to them. This will not only make it easier for the PLHIV but also help in reducing the load at the ART centre. The ART centre will then be able to focus on PLHIV with adherence issues and LFUs etc more closely. If your district needs more LACs, speak to SACS.

Think beyond your district : It is possible that PLHIV receiving ART from your district are residents from other districts/states. In such a case find out whether they would like to be transferred to their District/State . If the PLHIV is already LFU and cannot be traced in your district contact the district where he/she comes from, ask them to help you trace this PLHIV. All DAPCU and ART centre contact details are provided on the NACO website. http://www.nacoonline.org/ListofARTCenter/. The problems in the neighbouring district/state might be similar. Support them too.

Other suggestions received include, provision of social benefit schemes, ensuring filling up of all vacancies in the district so that uninterrupted and quality services may be provided; spreading awareness about faulty promises of HIV cure; family counselling etc.

Thanks to all DAPCUs who contributed to this discussion.  We are sure that we will all be able to learn from each other. 

If you have something more to say or want add more about the success of your district, please click on comments and type in your information. Or you can write to dapcuspeak@gmail.com