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

Intervention package for high risk migrants is outlined below

• Outreach and Communication.
• Peer-led, NGO-supported outreach and behavior change communication (BCC).
• Differentiated outreach based on risk and typology.
• Large-group format activities (e.g. street theatre, games, etc.)
• Interpersonal behavior change communication(IPC)
• Services.
• Promotion of condoms.
• Linkages to STI(sexually transmitted infection) services and other health services (e.g., ICTC, ART, drug/alcohol de-addiction)
• Strong referral and follow-up system.
• Enabling Environment.
• Advocacy With Key  stakeholders/power structures
• Linkages with other programmes and entitlements.
• Community Mobilization.
• Building capacity of migrants group to assume ownership of the programme.
• Prevention is done with the help of migrants programme by one to one and VPL involvements.
• Peer educators involvement.
• The migrants counselor  of various outreach workers distribute pamphlets printed in Telgu, Kannada , Malayalam ,and Tamil with the help of mobile ICTC.
• With the help of self help group follow up and facilities available in district like ICTC linking to ART treatment adherence follow up of MIS and LFU are done with help of M&E, PO & field workers with ART and with DAPCU and it is discussed in monthly review meeting of DAPCU every month.

Experience:

PPTCT services in Coimbatore are done new prophylaxis regimen is started (e. g 1) Name X of Bihar found positive and  then case was referred to ART centre and  CD count done and ART initiated on JULY 19.

 A case Bombay was delivered in CMC  case and ART prophylaxis was  initiated.

 A case Kerala  was delivered in CMC and both the cases PPTCT services were done.

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

Prevention & Early Detection

• In the migration group, it is difficult to detect early because of mobility. But we can try to prevent and detect early e. g. identifying the migrant’s area in the city; district and state then we can start an intervention.
• We try to contact with community leaders and connect and involve them in the programme.
• Develop the IEC and BCC material in their own languages.
• Establish the facility either in or near to their areas.
• We also try to meet owner of their work places, industries; shads to obtain the permission to organize a programme. Also request them to provide the leaves to migrant workers for taking services.
• We also plan our service schedules as per their availability, holiday etc. 

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

• Arrange the meeting with president of association of industries, owner of work place for giving permission and leave for taking treatment.
• Setting ARTC’s time schedule according to migrant’s time & availability.
• Prepare IEC,BCC material in their own languages and as per their social aspects.
• In the cases of MIS’ & LFUs we have tried to contact with their state’s sacs and also particular district’s ARTC; where the first visit of MIS was done.
• Sharing a line list of migrant MIS & LFUs among ARTCs.
• Contact with leaders of communities to track migrants, because many time leader has more authentic information about place of migrations.
• Establish on-line system for transfer out patients.  

PPTCT services

• Develop the peer educator system, specially for migrant ANCs. Because non-awareness of migrant females about services provide by PHCs, CHCs and other healthcare centers.
• She doesn’t know the name and address of ASHA Workers of their areas.
• She feels loneliness in these types of situations.

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

The critical most part of NACP is the ART Linkages amongst Migrant Population.

Kolhapur DAPCU has linked many inter state migrant cases by coordinating among DAPCUs. e.g. – in the month of June, 2013 an ANC case from Karnataka migrated to Kolhapur. Concerned ICTC counselor shared this information with Belgaum DAPCU and with Karnataka SACS. It was further coordinated with MSACS by KSACS. MSACS forwarded details of the client to Kolhapur DAPCU. The DAPCU shared client’s details with the nearby ICTC counselor where she had been migrated. Finally, this client was traced out by collective efforts of DAPCU and PPTCT NGO. And in such a way linked to Kolhapur GMC ART Center.

Kolhapur District’s NGO, Lotus Medical Foundation migrants project played a vital role in giving preventive measures and has taken innovative efforts to create awareness through social activities.

Along with MSPSS NGO for migrants is also taking special efforts with the help of ICTC staff for STI/HIV screening and doing appreciable work in referral and linkages.

A pilot project is going to be held by NACO and MSACS for seasonal Migrant i.e. sugarcane cutters of Kolhapur District’s Sugar Factories. Preliminary meetings has been done under the chairmanship of  Hon. Project Director, MSACS, Mr. Prakash Sabade, on 17^th April, 2013 in the presence of District Collector, Joint Director, Civil Surgeon, DHO & Labour Welfare Officers from sugar factories. The project will be commenced from 1^st Oct, 2013 for next 6 months. It will cover HIV/ STI/ ANC screening along with routine physical check up.

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

Comprehensive HIV/AIDS Service are provided to the HIV Positive Migrants:

East District Delhi is situated in border of Uttar Pardesh (Ghaziabad & Noida).  Patparganj & Jhil Mil industrial areas are also situated in East District, Delhi. The migration pattern is basically due to migration of Industrial workers. 

Services to Migrants Client: 

If any migrated client found positive ART counselor provide him all the services i.e. counseling, Pre-ART registration, CD4 testing etc.

Other District:

If client from other district found positive, that client is linked to ART center for pre ART registration CD4 count and if found eligible then on ART, if client is willing to continue the treatment from his own district then he can be transferred and informed to concerned ART.

Other State:

If positive client from other state found positive, the client is linked to ART center for Pre ART registration CD4 count and if found eligible then on ART, if client is willing to continue the treatment from his own state then he can be transferred and informed to concerned ART. Counselors note the permanent address of the client and provide the same to Concerned SACS.

Prevention and Early Detection:

DAPCU– East arrange IEC activity like Full Site Sensitization Programme, Mega Health Camps, Poster, Nukkad Natak etc. with co-ordination of DSACS, Youth Awareness by Nukkad Natak, Session regarding HIV-AIDS in Delhi Police, lectures on HIV-AIDS in schools, I.T.Is, awareness campaigning at Metro Station, Railway Station & I.S.B.T, Condom promotion activities in Industrial Areas & also maintain the line list of discordant couple and ensure their testing every 3 months.

Linking to ART center, Treatment adherence, follow-up of LFU/MIS and PPTCT Services:

We try our level best to ensure linkages. In ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the client, family counseling is given to the positive client so that he / she should not face any discrimination.

Follow-up of LFU/MIS:

Collecting line list of Clients from ART center and trace out the same through Outreach workers and TI NGOs and after that share with respective ART centre.

 

 

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.

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

Amravati district is having Border of Madhya Pradesh and all the district of Amravati division like, Akola, Yavatmal, Washim and Buldhana also a border of Nagpur and Wardha District. In Amravati the PLHIV migrants from adjoining district are more because the divisional head quarter are in Amravati.

1. For the prevention and early detection the regular medical checkup camp in the migrant area.
2. At the time of medical checkup camp the two addresses of migrant with permanent contact no. should collect.
3. The reactive client link ART center immediately if the client found in medical camp or the PLHIV migrant from other district.
4. The choice available to client where he/she are convenient to take the treatment.
5. In within district the follow-up of LFU/MIS client take through the ORW of NGO/Network and the ICTC staff.
6. In other district the details of the client mail to the concert DAPCU and the Network.
7. In other State the details of the client mail to DAPCU SACS and the concert DAPCU and Network.
8. In PPTCT services the problem of PLHIV migrant are common because the lady are came for delivery in her mother’s home and if found reactive she return her husband’s home after delivery. On this cases we collect the both the address of reactive ANC and transfer the information to concert DAPCU for remaining services.
9. The responsibility of migrant PLHIV should give to concert program NGO like if the client is ANC the responsibility gives to PPTCT NGO, For FSW it gives to TI-FSW.
10. But after all it is very crucial to cover PLHIV migrant.

The coordination of the DAPCU with other NGO, Network, CBO and other DAPCU are playing important role to cover migrant PLHIVs.

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

Angul a centrally located District in the state of Odisha with 12.70 lakhs  population and is a most advanced district due to vast coal mines located in abode and also big industries like NALCO, NTPC, JSPL, MCL, ADANI Monnet, UCL is working in the same district.  Due to vast coal mines and big industries number of migrant population is increasing day by day.

        HIV/AIDS and migration are two of the crucial social issues increasing today’s changing world.  In Angul two TI NGO namely U.S.S. and SARC is working for migrant population since 2008 to till date. SARC working area is Talcher, NTPC, South Balanda, Bhusan site, CPP, Nalco and working  for 12000 target population and presently it covers 16216 migrant population & with the referral of  SARC to ICTC 23  numbers of migrant labourer were detected as HIV positive and their details status are given below:

Pre ART	On ART	Death	Out of State / Migrant
16	09	02	05

           USS working areas is inside the JSPL Plant and working for 10000 target population and presently covered 15176 migrant populations & with the referral of U.S.S. to ICTC 25 numbers of migrant laborer were detected as HIV Positive and their details status are given below:

Pre ART	On ART	Death	Out of State / Migrant
14	08	01	10

            Every month, DAPCU Angul staff closely supervise the work of TI, verified their record, visited the Hotspot, DIC and collected various information from the clients regarding the TI work, attended the meeting/ awareness meeting / Health check up camp organised by TI and both ICTC supervisor and DPM attended the PMC meeting and discuss their problem and their problem was also highlighted in the DAPCC meeting and action was taken accordingly.

           

           It was observed by. DAPCU Angul that generally the HIV/AIDs intervention strategy in Angul district is focussed on following stages of migration.

-          Pre departure

-          Migration

-          Adaptation

-          Settle period

-          Remigration

           
         For providing comprehensive HIV/AIDS service to the HIV positive migrants and for prevention and control of HIV/ AIDS within the district the two TI NGO working for migrants are given emphasis on following points    

-          Group meeting

-          One to one contact

-          Mid media activity / IEC campaign

-          Health Camp

-          Hot spot level  meeting

-          DIC level meeting

-          Condom promotion

-          STI/RTI  Treatment

-          Referral / linkage  to ART centre/ DIC/CCC/DSRC’/ RNTCP

-          Advocating meeting

-          Legal support

-          Linkage with various social benefit scheme  etc

After detection of HIV positive the migrant workers / clients were refer to ART centre for pre ART regd. /CD₄ test / on PRT registration/DMC etc. During follow up of the client,  the TI partner /  DAPCU staff  /ICTC counsellor gave stress on  inadequate adherence to ART treatment is associated with detectable viral land, decreasing CD₄ count , disease progression, episode of OIS and poorer health out come.

           

           Again MIS case and LFU case of Angul ART Centre was divided into ICTC wise and in the monthly HIV-TB.  Meeting the same MIS case / LFU case was distributed to concerned ICTC counsellor for follow up of the same client.

For providing comprehensive PPTCT Services to HIV positive migrant women emphasis was given by TI/ DAPCU/ ICTC counsellor on following point: 

·  Institutionalisation of delivery  of positive women

·  Prevention of unintended pregnancies among the HIV   infected migrant women.

·  Prevention of HIV transmission from HIV infected migrant women to their infants

·  Care and support to HIV infected migrant women, their children, 

     Again in Angul district during Dasahara, Laxmipuja and Kalipuja festival time, most of the outside migrants clients were return back to their native place of Angul District.  So to provide HIV/AIDS services  to their doorstep, health check up- camp/ STI/RII treatment/ HIV / AIDS  counselling  and testing/condom distribution / Exhibition  was  organised by DAPCU Angul  with the  support of NRHM MHU van & with team of doctors/ paramedical staff/ counsellor/ LT of ICTC  in different villages during the same time.

Out of District:

           Out of Angul district migrant clients also tested their blood in Angul CTC and regd. their name in ART centre. In case of LFU and MIS case   of out of district migrant client   their details name / address was given to the concerned counsellor of other District and the concerned counsellor of the same district flow up of the same client.

Outside State:

All sorts of support / linkage / referral services are also provided to migrant clients of outside state. If the client leave the district then their name and address was given to OSAS/ BBSR for further   follow up. 

Over all sort of social / medical / psychological / moral / legal support was provided to HIV positive migrant workers/ clients. 

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

Prevention & Early Detection

Though there is no TI working for migrants, the transit migrant’s intervention is done by TI-NGO at Titilagarh railway station which is major transit point. During intervention counseling (group and one to one) on HIV/AIDS, distribution of free condoms and take home IEC materials are given.

In Balangir district the migrants return during September to October. In that period health camps are conducted in migration prone blocks for free health checkup and HIV / TB / STI etc screening are also done. Suspected clients including their partners are referred to nearest ICTC for HIV testing.

The detected HIV positive client is immediately linked to ART centre for ART registration and in regular interval they are followed up by concerned counselor. During counseling session their destination / duration of stay / cause of migration etc are observed for future tracking and follow up.

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

By making inter district coordination (Ganjam, VSS, Burla-Sambalpur, Angul) the clients are followed up for LFU/Mis cases and ART registration. Out of 108 nos. of detected migrants, out of them 28 nos. of client have registered out of Balangir. Positive clients from other districts have also registered at Balangir ARTC. We have ensured inter ARTC / LAC coordination during our ART coordination meeting.

PPTCT services

If any ANC found positive and his spouse is migrant, it is always followed up by concerned counselor for institutional delivery and the same information is shared with other DAPCUs where they migrate.

Pictures Related to Health Camp for Migrants

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

Profile of the District: 

Mehsana district is located in North Gujarat, about 75 km from Ahmedabad.The district borders with Banaskantha district in the north, Patan and Surendranagar districts in the west, Gandhinagar and Ahmedabad districts in the south and Sabarkantha district in the east.The major crops of Mehsana are Potato, Cotton, Tobacco, Oilseeds, Castor Seeds, Cumin, Psyllium and Anise .Asia’s second largest dairy ‘Dudhsagar Milk Cooperative Dairy’ and largest market yard ‘Unjha’ is located in Mehsana.‘Sun Temple’ at Modhera is an important tourist destination of Mehsana district. High out-migration to Surat and Mumbai for Diamond work, courier services (Angadiya) and for Transport related work from across the District and abroad also.High in-migration from Rajasthan and other parts of Gujarat.

In Mehsana district generally the positive migrant clients are from Banaskantha, Sabarkantha, Patan & other nearest district and also from Rajasthan state & Maharastra state. Within the District migrant positive clients are linked to ART Center nearer to Patan & nearest district at Govt.District Hospital, Patan, Banaskantha & Sabarkantha for Pre-ART registration, CD4 count.  If CD4 count is less than 350 then efforts are made for registering the positive clients on ART at ART Center.

Whenever any client found positive from other district (Patan, Sabarkantha & Banaskantha), counselor provides option to Client for taking ART treatment according to Client choice. If client is willing to continue the treatment from his own district then Client is transfer out to that particular district ART Center for further treatment, if CD4 count is less than 350 we put him on ART. Counselors note down the permanent, current address & Mobile number of respective client for further follow up.

The MIS/LFU line-list share with the LWS, ICTCs, DSRCs, CSC, Jatan Project for tracking the LFU/MIS patient and revert back them to ART. DAPCU plays a major role for taking the follow-up of such activities.

DAPCU track the migrant ANC delivery as per EDD & also confirm the EID Follow up by tracking PPTCT calendar.

DAPCU & ART Center conduct the Monthly meeting with LWS, ICTCs, DSRCs, CSC, Jatan Project for LFU & Linkages.

Example:

In the month of July-13 one Couple HIV positive Diagnosed (1 is ANC & 1 is General Client) in ICTC Unjha from Banaskantha District, who is ART Registration at ARTC Patan.

            ANCs commonly avail services in two districts viz. at her parents’ home and at her marital home. Tracing and follow up between districts becomes difficult for EID/DBS, 6 weeks, 6 months, 12 months, 18 month.

Example:

In the month of March-13 we had one ANC HIV positive Diagnosed (first test) in FICTC Ambaliyasan from Sabarkantha District, than she go to her parents’ home at Sunsar Ta.Bhiloda Di.Sabarkantha. District Supervisor DAPCU Mehsana informed to ICTC Counselor Bhiloda for Confirmation. She reached to ICTC & Confirmatory test done at ICTC Bhiloda & She found HIV Positive & ICTC Counselor Bhiloda counsel her & she agree for delivery at ICTC Bhiloda. 

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

Prevention:

In the Udupi district usually the high number of migrant cases are from Other Dist,Other States. The District has got various number of Industries which attracts other district and state populations to get migrated to the District. A good amount of Kooli is also great opening to the people. When any migrant found positive, that would be counseled,linelisted and referred to ART centre for the further treatment(CD4,Pre ART, Initiation of ART). Suppose a case from other state comes positive, counseling would be done and according to his convenience, he/She will be transferred to their native places for the further treatment.

Early Detection:

Migrants will be identified in Road constructions, Construction areas, Fisheries area and some residential areas.HIV awareness areas and STI/RTI info will be given.

Once a migrant found positive,ORW’s will take them to counselors where counselor will give necessary counseling regarding positive living. A number of health camps will be arranged in the sites and industries. Where all the migrants will get referred and tested.

For prevention and early detection IEC activity like Full Site Sensitization Programme, Mega Health Camps, Poster, Sessions on HIV Awareness, Street play, Congregation will be arranged.

A positive client will be taken to the ART centre through ORW’s and at ART center the patient is counseled for drug adherence, side effects of the ART medicine are explained to the patient, family counseling is given to the patient so that he should not face any discrimination within his family. Sometimes patient will be referred to DLN’s to get the services and follow up will be done.

Follow-up of MIS and LFU:

With the help of stake holder labor contractor and from other sources information’s will be collected. On other hand Follow-up of LFU/MIS is ensured by collecting line list of such patients from ART center and then the same is handed over to Outreach workers and TI NGOs so that they can trace out the positive clients detail and then inform the ART centre.

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

DAPCUs ensure comprehensive HIV/ AIDS services that are provided to the HIV Positive Migrants by following means:

1. Within district:

Comprehensive HIV/AIDS services are being provided to the HIV Positive Migrants within the district by DAPCU with the assistance of TI-NGOs, especially those are being working on the Migrants. IEC & HIV/AIDS Service Demand Generation camps are regularly organized by TI-NGOs on the Migrant’s hot spots within the district. HIV-AIDS services like counseling, HIV Testing, providing condoms, referrals and linkages to the other linked facilities are being provided to the migrants through activities performed by TI-NGOs with the co-operation and co-ordination from DAPCU side. Regular follow-up of clients residing in the district are being done by Counselors of ICTCs and ART Centers to minimize the numbers of LFUs and MIS’. If any HIV Positive client is faced problem in the registration at the HIV-AIDS health facilities due to non-availability of Id-Proof then DAPCU with the help of TI-NGOs and District Administration takes efforts to make sure that concern HIV Positive migrant client can availed the Id-Proof.

2. Out of district:

Since, some of biggest and renowned hospitals are situated in the Central District of Delhi, therefore, huge number of clients, not only from other district of Delhi but also from other state of India are came over here and obtained the facilities concerning to the HIV-AIDS from the HIV-AIDS related facilities in the District. Also HIV Positive Clients are given options to choose ART facility as per their convenience either situated in the district or other districts of Delhi for treatment. According to their choice, they are linked with ART Center chosen by them.  Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS and other concern DAPCUs for proper follow-up of LFUs and MIS and ensuring comprehensive services coverage of Migrant Clients of other districts of Delhi. All DAPCUs in Delhi co-ordinate and help one another for the same.

3. Out of State:

Central Delhi is a gateway of migrants from & to Union Territory of Delhi due to presence of two busiest railway stations of the Country i. e. Delhi and New Delhi Railway Stations and also biggest wholesale markets of India i.e. Sadar Bazar, Paharganj, Chandni Chowk, Karol Bagh etc. There is huge number of migrants come in and gone out every day from Central Delhi to another parts of the country. In addition of the above presence of National Level Big Hospital, the numbers of clients are very huge which are obtaining facilities from HIV-AIDS facilities present in the District. As per cited above Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS for proper follow-up and ensuring comprehensive services coverage of Migrant Clients of other states of India. Follow-up of LFUs and MIS of other states are done with the help of DSACS and concern SACS. Also permanent address of the clients’ native place is obtained & recorded during his/her visit at the ICTCs so that follow-up of the same can become trouble-free.