DAPCU Kohima Response to DCC for HIV-TB

We apologize the delay in posting this response from Kohima

1. The DAPCU Kohima alongwith all the ICTC Counsellors, Counsellor Blood bank and STI, and the RNTCP staff conduct Monthly meetings where we get to know each other's programs, targets and achievements, issues, grievances, and how to address these problems. These meetings have been found to be extremely fruitful to all as we get to learn and share on a common platform. The counsellors are not scared to speak out and hence we get to know and address their problems.
2.  The DAPCU office Kohima is attached to the District Tuberculosis Centre (DTC) so whenever there is shortage of staffs at DTC, the DAPCU staffs accompany the clients for testing to the nearest ICTC centre.
3. We go for field visits to centres together with the RNTCP staff.
4. We attend Health Melas together with the RNCTP staff.
5. We share IEC materials when there is need.

DAPCU Nalgonda Response to DCC for HIV-TB

The overall objective of the DCC District Coordination Committee for TB/HIV is to ensure the implementation of TB/HIV collaboration activities in the District and review the performance of the same.

In this context Nalgonda DAPCU has been conducted the DCC meeting on 26^th of October 2012 under the chairmanship of District Collector. During this meeting all the line department staff of DM&HO, DTCO, Addl. DM&HO, DCHS, DPM NRHM, ART SMO, and President DLN invited for sharing their views and sort out the complications came while working.

The main agenda of the HIV/TB DCC meeting is

Ø  Performance review ICTC/DMC level

Ø  Line List preparation

Ø  ICTC to RNTCP referrals review Vice-versa

Ø  Discussion on HIV/TB co infected cases pre ART registration

Ø  Discussion on coordination between ICTC to RNTCP

Ø  Sharing of experiences

TB is the most common opportunistic infection in people living with HIV. As HIV breaks down the immune system, HIV- infected people are at greatly increased risk of TB. TB in turn accelerates the progression of HIV to AIDS and shortens the survival of patients with HIV infection. Thus, TB and HIV are closely interlinked

In order to provide HIV testing facilities for individuals diagnosed with TB as well as to understand the TB status of HIV positive individuals it is important promote coordination and information sharing between DMCs and ICTCs. The in referrals from RNTCP to ICTC over the past

It was observed that, there is a gap between cross referral of RNTCP to ICTC vice versa. Hence we noticed these many issues in the DCC meeting, and the DAPCU is planning to take up special drive on HIV/TB intensified case finding in the coming months.

S.no	HIV-TB
	Key Indicators	2009-2010	2010-2011	2011-2012	Up to Dec 2012
1	Total Cross Referrals (ICTC <> RNTCP)	5687	5842	6076	5129
2	Clients referred from ICTC to RNTCP	3417	3894	3885	3074
3	Clients referred from RNTCP to ICTC	2270	1948	2191	1381
4	Co-Infection target	342	307	599	599
5	Co-Infection	307	193	153	106
6	%Achievement                        (HIV-TB Co-Infection)	89.76	62.86	26.9	18.0

Having a holistic campaign by DAPCU and DTO to address the issue of low cross referrals between the HIV and RNTCP facilities by increasing the outreach combined with the simple messages with the support of the line departments

Conducted training to DMC LTs on HIV testing preferably SD screening Test. During this 28 DMC LTs have been trained on whole blood testing & counseling.

DAPCU has taken the line-list of LFU/MIS patients from ART and segregate it geographically to each NGO. The review of this activity conducted in each month in ART/CCC coordination meeting

DAPCU raised a concern about the entry in HIV-TB ART TB treatment should enter correctly on white card.  After testing of TB patient, the HIV status should include in the TB register.

In Intensified TB care finding every facility should develop good rapport with each OPD. Maximum referrals from OPD (Acute respiratory tract infection) Cough with expectation referred for TB Screening.

The District Collector instructed to DM&HO, to address the issues related to HIV/TB co-infectious cases by visiting the field and interact with the patients. According to this, instructed to DTCO and DAPCU to plan it as early as possible. 

Discussed about the X-Ray machine, it is not functioning properly in DTCO Office, in this context the District Collector suggested to DCHS to pursue the issue and submit a report regarding this. Regarding X-Ray machine the DTCO told that, it is an old model machine and not showing the proper result, hence the cases are referring to the district hospital located in the same premises because there is an advanced technology X-Ray machine for accurate result

DAPCU West Godavari Response to DCC for HIV-TB

1.                  What are the advantages of DCC in HIV-TB collaboration activity?

DPM sharing the data to Hon’ble Collector Dr.G.Vani Mohan IAS 

      

• As the District Collector is the Chairman of DCC it is easier to convincing regarding the urgency of HIV-TB collaboration throughout the district to effect the required mainstreaming and convergence both inside the health and other line departments.
• The DCC meeting comprises not only HIV testing service provider unit but all the facilities providing services related to HIV are involved for their performance / achievement review such as ICTC, F-ICTC, TU, DMC, ART, TI, CCC, DIC, DSRC, BB & NGO/CBO under one umbrella i.e. District Collector.
• Helps to take in time decision and in other hand helps to save the time.
• Builds a close coordination between all platforms.
• All the stakeholders from different wings perceive their roles and responsibilities in the HIV-TB collaboration activity.
• Appropriate and strategic plans are taken into decision at the time of gap analysis of target vrs achievement.

Share examples from your districts - How can 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).

• Counseled clients where HIV testing facility is not available. Clients are followed up by concerned counselors for their HIV test at nearest ICTC.
• Even clients are accompanied by ASHA / LW or counselor for the betterment of the client.
• Where the DMCs are not co located with ICTC clients are being referred to nearest ICTC and they are looked after by concerned STS.
• However through the convening of DCC in every quarter, our performance in the field of cross referral, co-infection detection and CPT administration has remarkably increased.

Share examples from your districts - 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.

The consistent increase of referrals from ICTC to RNTCP is maintaining but there is decline of referrals from RNTCP to ICTC and on the same hand we can also elicit that the case detection for co infection is also declining by the below given indicators

Year	RNTCP to ICTC	ICTC to RNTCP	Co-Infection
2009	2723	4169	432
2010	2520	3753	415
2011	2413	3141	346
2012	2000	4787	291

• All RNTCP lab Technicians are trained on SD Bio Line Rapid Test Kit training so that they can do HIV Screening at DMC level.
• ANM’s and ASHAs are sensitized by ICTC counselor in their sector meeting regularly so that they can motivate all symptomatic cases every month.
• All ASHAs are referring and accompanying the suspected TB cases to DMC.
• At regular intervals ANM, staff nurses are sensitized regarding HIV-AIDS specifically on safe injection practices.
• Universal precaution guidelines are always being adhered to for ensuring non transmission through the processes of health care provision at any of the service delivery units of HIV, TB and its CST.

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

• DTCO had taken utmost responsibility in sharing the responsibilities of RNTCP staff in coordination and cooperation with NACP staff structures
• All STS and STLS are linked to ICTC’s and they were given the responsibility of testing all cases for identified TB positives
• We have 3 Community Care Centers and all the 3 CCC’s were equipped as DMC’s, hence the identification, drugs and followup had been more easier than earlier. (DAPCU had made many efforts in setting up of DMC’s and FI ICTC’s in PPP Mode in one place)
• All co-infected cases are being followed by STS, Counselor and ART Centre regularly.
• They are also given medicines at their door steps.
• Positive ANC’s and TB line list positives are also being followed by ILFS and PPTCT ORW’s

Share examples from your districts - What are the strategies DAPCU should opt for 100%   treatment, care and support for TB – HIV co- infection cases?

• Leprosy Dy.Para Medical Officers are also shared the responsibility of tracking the cases for Tuberculosis.           
• Client specific / personified co-infected cases are reviewed (Date of detection, CPT administration, ART adherence etc.) in monthly HIV-TB co-ordination cum review meeting.
• Counselors of ICTC are attending the ASHA sector meeting for more no. of referrals to ICTC for service uptake.
• Responsibility is given to ICTC-Counselor and STS/STLS of respective areas.
• Feed back is taken jointly by DPM and DTO for each client.

DAPCU Vizianagaram Response to DCC for HIV-TB

1.          Advantages of DCC in HIV-TB collaboration activity

        

                     The coordination between two programmes is very essential in HIV/AIDS Control Programme that is National AIDS Control Programme & Revised National TB Control Programme.  The both deceases are going together to increase mortality in People Living with HIV/AIDS.  Until or unless diagnosis of TB and treating TB among HIV patients we can’t improve quality of life and reduce deaths.  Simultaneously the RNTCP also should make all TB patients test for HIV and send them for ART

District Coordination Committee chaired by District Collector and meets once in quarter to discuss the progress of the HIV-TB collaboration activities in the district and identifying gaps, issues and requirements for further improvement.  The members are ADM & HO (A&L), DTCO, DCHS, MOTC, MO- TU, MO-ART, MO/Counsellor – ICTC, MO-CCC, DPM, DIS and representative from ICDS.

·         Improves quality in service delivery both NACP & RNTCP

·         Coordination between both programmes will be improved

·         Address gaps and get the support from DC or Dept. Heads

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).

DAPCU conducts DCC meeting every quarter as per the instructions of APSACS and sharing minutes with all for implementing the recommendations given by the committee.

·         All PHCs integrated with FICTC activities and RNTCP activities

·         All 36 DMCs were covered with HIV testing facility.

·         All DMC LTs were trained on HIV screening.

·         All TB suspects are also being tested for HIV in the District.

·         Line listing and pairing every month for finding missed TB cases for HIV testing through ICTC counsellors Outreach work and MICTC (Mobile ICTC).

·         DOT Plus Supervisor & DIS are jointly visiting ART Centre and ICTC for supportive supervision.

·         All Known HIV infected TB patients should be initiated on CPT and ART at time of registration.

·         Each and every person attending the ICTC with cough of two weeks duration and with cough of one day duration in HIV positive clients are referred to the Designated Microscopy Centre for sputum test.

·         All TB and HIV Positive Cases are getting ART with irrespective of CD4 count as per new guidelines.

·         We are involving with RNTCP staff in monthly review meetings under control of DM & HO to improve coordination between RNTCP and HIV/AIDS Programme

                                           Total TB cases in the District      : 3686

                                           Test for HIV                               : 3439

                                           %                                             : 93%

                                           HIV/TB Co- Infected cases          : 253

                                           in the district 

                                           HIV/TB Co- Infected cases          : 208

                                           put on ART 

                                           %                                              : 82%

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.

            APSACS has supplied IEC material like posters and pamphlets on TB to DAPCU.  The messages on TB Prevention are spreading through IEC material at all facilities in the district.  DAPCU covers one topic on TB in every training, sensitization and review meetings and ASHAs, ANMs, AWWs, and Field level staff is being oriented regularly by NACP and RNTCP programmes. Universal precaution guidelines are always being adhered to for ensuring non transmission through the processes of health care provision at any of the service delivery units of HIV, TB and its CST.

4.    Role of ICTCs, ART, and Care and Support Centres in intensified TB case findings.

·         The testing of TB for all HIV cases before treating with ART is mandatory and strictly followed by ART centre.

·         Each and every person attending the ICTC with cough of two weeks duration and with cough of one day duration in HIV positive clients are referred to the Designated Microscopy Centre for sputum test.

Year	2011-2012(Dec)	2010-2011	2009-2010
ICTC to RNTCP referral	2548	4948	4216
RNTCP to ICTC referral	1429	1955	2321

5. Strategies DAPCU should opt for 100%   treatment, care and support for TB – HIV co- infection cases?

·         Team of NACP & RNTCP have been sensitized and oriented many times on importance of treating HIV-TB co infected cases and giving priority in providing services at ART.

·         Involving NGOs, RNTCP and General Health cadres in tracking of untreated HIV-TB co infected cases by sharing line list every month.

·         Encouraging DOT Plus supervisor to visit ART centre to identify the gaps and involving RNTCP staff for field level support.

·         Involving DTCO in ART Centre coordination meetings, Monthly review meetings.