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.

Nanded DAPCU's Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

	Total Found Positive (2011-12)		Total ART Linkages (2011-12)
	Gen	ANC	Gen	%	ANC	%
Total	1248	70	1036	83%	59	84%

1. For the last 6 months client wise ICTC wise  review in monthly meeting
2. Weekly Review From August-11 - cross checking the ART line list with ICTC +ve line list
3. Meeting with ART SMO for tracking missed clients
4. Line List is given to NGOs for tracking clients and  meeting them
5. Meetings with MS of RH for availability of RH vehicle for +ve client to Reach ART Center Nanded
6. Outreach by counsellor to meet missed clients
7. Meeting with PHC MO and Sub center ANM, ASHA to track missed clients while ensuring confidentiality
8. Co-Ordination meeting with ICTC Counsellor , ART Counsellor, NGO Workers and ASHA
9. E-mails to other districts for tracking migrant clients

Ganjam , Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

Every month we prepare ICTC-wise PLHA line list, along with  details of  Pre ART, On ART registration and CD4 count etc from ART centre. This is collated prior to the monthly monthly meeting.  In the monthly meeting we discuss  gaps and share the data .  (Ganjam had provided a detailed ICTC wise list of found positives vs pre ART registration data for the month of Jan 2012, however we are presenting only the summary on their behalf) 

• HIV+ve detected (Jan 2012)  - 93
• Pre ART Reg (Jan 2012)  -  69 (74.2%) 

Surat DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

1. For facilitating linkage between ICTC and ART we use ICTC –ART referral form. Quarter portion of this form mentioning name of ART center, patient name, Pre ART number & CD4 count is given to ICTC counselors in our monthly meet of ICTC by ART counselor who also attends this meeting.
2. We have also given mobile numbers of all ICTC counselors to ART centers so sometimes ART staff  also inform through SMS to concern ICTC counselor.
3. PPTCT centers  located near ART centers like Civil hospital & SMIMER hospital send their ORWs along with clients to ART  centers so that LFU chances be minimized.
4. We also have around 14 PMTCT ORWs who take list of LFUs from ICTC centers and follow up HIV positives for referral to ART center. These ORWs are posted at various ICTC centers and they have been assigned duty of LFUs follow up, ANC referral and DBS referral.

Dahod DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

Dahod is a tribal district of Gujarat. Migration is one of the major problems to provide continuous health services to people in the district. It was difficult to reach ARTC for PLWHA after diagnosed being tested positive. In the year 2010-11, Pre ART registration was very low (64%). DAPCU has tried to strengthen linkages between ICTC and ARTC for Pre ART registration of individuals diagnosed as HIV positive. DAPCU adopted some strategies for ICTCs to fill the gap of Pre ART registration.

• Proper referral mechanism.
• Co-ordination with ARTC Baroda and Godhara.
• Provision of transportation to reach ARTC. (Use vehicle of hospital under RKS-Rogi kalian Samiti)
• PLHA follow up for pre ART registration.
• Gradually started LAC and ARTC. (Now CD4 testing facility available in district.)
• Monthly review for ICTC- ARTC coordination.

Month2011	PLHA	Pri ART Registration	Remarks
April’11	22	22
May’11	20	17	1 -Not Cooperated - ICTC Dahod 2 -Follow up Awaited -ICTC Dhanpur
June’11	5	5
July’11	9	8	1- Death  - ICTC Sukhsar
August’11	9	7	1- Death - ICTC Dahod 1 - Not Cooperated - FICTC Dudhiya( Limkheda)
September’11	11	10	1- Death- ICTC Dahod
October’11	17	15	1- Follow up Awaited- ICTC Dahod 1- Death - ICTC Dahod
November’11	21	17	1- Follow up Awaited - FICTC -Jesawada( Garbada) 3- Death - ICTC Dahod
December’11	16	16
Total	130	117

Due to regular follow up and proper referral mechanism ICTC-ARTC referrals increased up to 90%.

Bangalore Urban , DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

Period	ANC positive	CD4	Eligible for ART	Put on ART
April 2010 to March 2011	226	106(47%)	23	12 (52%)
October 2011 - December 2011	48	40(83.3%)	10	10(100%)

Strategies in Bangalore Urban district to ensure people diagnosed HIV positive from ICTCs to reach the ART Centre for Pre - ART registration are as follows

1. We held NGO Co-ordination meeting at the DAPCU Office and discussed in detail about the situation of the gap between positives detected and the ART reached status in Bangalore Urban. 
2. The number of outreach workers was assessed and each ORW was allocated one or two ICTCs according to their concerned area of work. After this meeting the ORWs visited to their respected ICTCs once or twice in a month and took the list of positives not reached to ART centres and followed them up mainly through home visits and gave the feedback to the ICTC counsellors. This aspect was strictly reviewed during the monthly meetings.
3. The help of ORWs of DLN was also used in the same manner.
4. All the MOs of PHCs were instructed to utilise the help of ASHA workers for the follow up of HIV positives. Thanks to the NRHM for the incentives given to the ASHA workers for this work.
5. The Saturday outreach activity of ICTC counsellors is mandatorily reviewed in our monthly meetings.
6. The list of Non ART reached cases is being collected from the ICTC counsellor in the monthly meeting and shared with the RCHO, MOs for the follow-up using their field staff.

Balangir DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

The situation / problem / gap

1.   Non-cooperation and non-receipt of ART registration data from other ART centres.

2.   Inadequate Outreach and follow up by counselors and DLN

3.   Irregularity in Madhu Babu Pension Yojana (MBPY) and other State Govt. Social benefit schemes for PLHIV

Action initiated

1.   Encouraged effective post-test counseling by counselor and follow up.

2.   Follow up by self and through ORW by counselor.

3.   Through different ORW like TI / DIC (Positive Network) / PPTCT NGO (Utkal Sevak Samaj-USS) with block wise point person from positive network.

4.   Encouragement in the form of payment of travel cost (To and from). (In DAPCC meeting on 23-09-2011)

5.   Free of cost medical tests before ART registration. (In DAPCC meeting on 23-09-2011)

6.   Free distribution of mosquito net. (In District Coordination meeting of Positive Network on 14-12-2011- by CDMO)

7.   During monthly review meeting, the gap analysis is made between the HIV +ve detection and ART registration.

8.   Establishment of coordination with DLN, with ICTC.

Status 2010 and 2011

Year	Detection	Cumulative detection	Cumulative Pre -ART Regn.
2010	103	385	53 (14%)
2011	121	506	268 (53%)

Status August - September 2011

Month	Detection	Pre ART Regn.
Aug-11	13	10
Sep-11	9	7
Oct-11	9	4
Nov-11	9	5
Dec-11	5	2
Total	45	28 (62%)

Tirupur DAPCU – Response to Question of the Month February 2012 - Facilitating Pre ART Registration

This post was in response to the February 2012 theme

In Tirupur the ICTC Counselor conducts outreach visits and meets positive individuals every Saturday. This is found to be helpful and in GHQH Tirupur , GH Dharapuram and GPHC, Perumanallur  the outreach visits of 3  counselors were able to ensure Pre ART registration of clients within 10 days of their outreach/home visit.

S.No	Name of the ICTC	Name of the Counselor	Client's test date	Counselor Saturday Visit date	Client Pre ART Register date
1	GHQH, Tirupur	Mr.Kannan	30.11.11	10-12-11	15-12-11
2	GH, Dharapuram	Mr.Thangaraj	07.09.11	10.09.2011	14.09.2011
3	GPHC, Perumanallur	Mr.Vijai Prakash	13.01.2012	21.01.2012	28.01.2012