An effort to reduce Lost to follow up cases( LFU’s) & adherence to ART, by DAPCU,North Tripura

Realizing the significance to provide holistic care & support for PLHA’s, there is a need for ART drug initiation & treatment for PLHA’s. Here, DAPCU, North Tripura, has put an emphasis on providing attention to the subject. This has been observed that there are many clients, do not reach ART & FI-ART, every month or on time to take medicine & CD4 tests remains pending to assess their present status. Even, this has been observed that newly detected client doesn’t reach to ICTC & FI-ART to do their confirmation tests & link to ART System. So, this is a chronic issue realizing the care for PLHIV’s & DAPCU, North Tripura has made significance on that. With the increasing number of persons living with the Human Immunodeficiency Virus (HIV), there is a need to have a comprehensive strategy to reduce the number of dropouts from the anti-retroviral (ART) therapy. 

HIV infection is not the end of life. People can lead a healthy life for a long time with appropriate medical care. Anti-retroviral therapy (ART)  effectively suppresses replication, if taken at the right time. Successful viral suppression restores the immune system and halts onset and progression of the disease as well as reduces the chances of getting opportunistic infections – this is how ART is aimed to work. Medication thus enhances both qualities of life and longevity.

Adherence to ART is Critical & LFU’s have been divided into two categories as PRE ART LFU & On-ART LFU’s.

Adherence to the ART regimen is, therefore, very vital in this treatment. Any irregularity in the prescribed regimen can lead to resistance to HIV drugs, and thus can weaken or negate its effect.

As the number of HIV+ve detection keep on rising Tripura State AIDS Control Society established LAC in the undivided North Tripura in the year 2008 and the FI-ART was established at Dharmanagar Dist. Hospital, North Tripura in the April’ 2015. Earlier HIV+ve detected was asked to go to Agartala (State Capital of Tripura) For CD4 testing before starting the ART. As most of the +ve detected were from poor economic background, many were not able to go to Agartala as it was about 190 km with steep hill terrain and poor transport connectivity, so to avail the facility, few strategies have been taken. Intervention by DAPCU:-

Ø   Reason for not attending at  ART:- DAPCU has made various teams & through dividing the team visited at different spots & directly interacted with PLHA’s & family members. I tried to know the reason for not attending. All socio-demographic and clinical factors associated with antiretroviral therapy adherence. Illiteracy & ignorance was common factors for Lost to Follow up. Male drivers were lost to follow-up To a greater extent, male patients were serodiscordant. In a few cases, Migration led to drop patients. Other essential factors leading to loss to follow up were: death in the family, side effects of drugs, and family disturbance. Alcoholism was the cause of male patients. In a few cases, very poor economic condition lies the most importance.  CONCLUSION AND RELEVANCE: Migration, illiteracy, alcoholism, discordant couples, death in family, low socio-economic Status, resorting to alternative therapies, were the prominent factors that directly influenced and aggravated the problem of non-adherence. Targeting these variables will cause a definite reduction in lost to follow-up cases.

Ø     Strategy have been taken through collecting Blood Sample at FI-ART, where clients can easily reach out & Sent To AGMC, ART. With this approach, Since 2016, FI-ART Campaign is going on & On 29^th December at FI-ART, Dharmanagar, 2016 total 57 blood sample have been collected for  CD4 testing with collective approach of AGMC, Agartala,  TSACS, Agartala, ART-Agartala, DAPCU, North Tripura, CMO, North Tripura, MS-DH, Dharmanagar, FI-ART-Dharmanagar, TI & Non-TI. In the year,2019, on 28-29^th  April 2019, CD4  Campaign has been organized at Dharmanagar Dist Hospital & LAC, Kailashahar. A total of 31 Samples collected.

Ø     Few  pockets to be created where at least 15-20 clients can be gathered & collection of Blood Sample for pending & Baseline CD4 clients through Mobile ICTC, as in every month, M-ICTC visits in the district.

Ø  Mobilization &  sensitization for CD4 testing in Capacity Building Workshop with.

Ø  Outreach & Counseling to them as the message can be reached to them & they may be aware regarding the significance of their lives.

Ø  25^th June,2019 ,DPM,DAPCU  & other TI’s etc  conducted Cd4 campaign & Initiation of ART at Damcherra. Total of 15 samples collected & initiated for ART drugs.

Ø  Visits with Community member, ASHA facilitator, MPS, MPW to trace them.

Ø  In the current month, ( September 2019)  DAPCU did drive for FI-ART initiation campaign at Damcherra PHC & Khedacherra PHC. In this team, DIS, DAPCU, MO-FI-ART & Counselor, Lab Tech-Panisagar SA ICTC, visited at PHC’s to make spot initiation with check-up with the help of TI, N-TI’s. On 17^th Sep 2019 visited at Damcherra & there was linked 12 New Cases & 4 LFU.Similarly on 21^st September 2019 at Khedacherra PHC, there was bound 5 New Cases & LFU. There we made a screening campaign too. DIS, DAPCU made a home visit with N-TI & Vihaan to counsel them & we succeeded.

Similarly DPM, DAPCU with the help of N-TI visited  in various places of the district to conduct home visits & those clients back to FI-ART.

Ø  In future planning DAPCU will take integrated camp with HIV Screening & Spot ART Initiation to reduce LFU’s. Thus, many clients have access to ART drugs & reduced LFU’s consequently.

& Similarly, DAPCU will continue the practice considering the  LFU’s in the  Specified Area. Here, this is very much necessary to mention the whole the procedure has been achieved through the extreme effort of Chief Medical Officer, North Tripura, Tripura SACS, FI-ART, TI, N-TI’s, Vihaan & relevant Health institutions.

Photos:

              Fig:ART  drug initiation campaign at Khedacherra  In September,2019.

                                 Fig: Meeting with CMO,North Tripura regarding LFU minimize in June,2019

                         Fig: Home visit by DPM,DAPCU with N-TI at  Kumarghat in August,2019.

Fig:Home visit by DIS,DAPCU at Jalabassa  in August,2019.

Fig: ART  drug initiation campaign at Damcherra  In June,2019.

Fig:Home visit by DIS,DAPCU at Khedacherra in September,2019

FINANCIAL SUPPORT MOTIVATED FROM CHURCH

A joined initiative had been initiated by DAPCU and WNP+(Wokha Network of Positive People) for financial Support from the church. The initiative started in the month of February 2019. The aim to motivate church for financial support was started due to non-availability of Sponsoring project like VIHAAN Helpdesk of NNP+ Kohima under Alliance India HIV/AIDS since December 2017 which resulted in nonpayment of house rent and to support the staff.

There was a set of meeting with the church Mission & evangelism committee of Wokha Town Baptist Church in order to be materialized. The following are proposed to the Church Committee

Sl No	Particulars	Amount	Months
1	House Rent	Rs. 3000/pm	12 months
2	2 Outreach Workers	Rs. 7000*2	12 months
3	Office maintenance	Rs.500	12 months

After much deliberation, the financial support was granted in the month of April 2019 with some deduction/omit. In the meeting, it was also decided that the fund will be drawn on a monthly basis from the accountant office of the church. 

        Details below:

Sl No	Particulars	Description	Period	Amount
1	House  Rent	January 2019-December 2019.Backdated	12 months	Rs.3000*12
2	Honorarium for outreach worker	1 person	12 months	Rs. 7000*12
			Total	Rs. 1,20,000 (One lakh twenty thousand)

      

DAPCU PEREN DISTRICT TEAM INITIATIVES - "EMPOWER"

                                                     ‘Empower’

 Empower was initiated in the year 2013 by DAPCU Peren which aims to provide quality education to the children infected and affected by HIV in the Peren district. So that one day these children will able to bring qualitative changes in their family as well as the PLHIV community and society as a whole. It was observed that most of the PLHIV in the Peren district are from poor Economic background and hardly manage with their daily needs, the Expenditure on their daily needs medical expenses and education comes to a perplex and many a time the education expenses become the least importance, This will adversely affect the future of their family. Keeping those things in mind Empower committee sponsored their educational expenses.

Empower is a district-specific initiative and it is not a fund/support received from any Govt. sector. It is purely a contribution of the individuals who have contributed to the future of Children living with HIV and their families. In order to monitor and ensure proper the utilisation of fund and the activities, a Committee was formed with the approval of Deputy Commissioner Peren (2013)

The committee members consist of.

  1. ADC Peren – Chairman

 2. Dy. CMO /DACO- Member Secretary 

 3. DPM (NRHM)- Member

 4. President DLN- Member

 5. Vice President DLN-Member

 6. Dapcu Staff –Member.

With the support of the officers and the individual the “empower” becomes a very successful activity in building the future of the CLHIV.  Under this initiative 23  CLHIV have received the benefit since 2013. The first beneficiaries are pursuing 11 standards and some will be appearing HSLC exam this year. This report would be incomplete if we fail to acknowledge the donors who selflessly contributed to the cause since 2013 and make this initiative a fruitful one.

                 

Empower 2018-2019

The Empower committee decided:

To link the CLHIV to different schemes in Govt. sector particularly (schemes on education).

Fund drive activities to continue in the district and support the educational of CLHIV whenever required.

Preference to be given to the students who are studying in Govt. school to encourage the children to study in Govt. school.

Activities conducted.

 6 children were supported with the amount received from the donors.

 2 were linked to Pre Matric scholarship

 1 linked to a free basic computer course supported by Nehru Yuva Kendra.

   

Action Plan( 2019-2020)

The committee to link all the CLHIV eligible for Pre Matrict scholarship and to link in the 2019-2020 session.

Booklet for Fund drive distributed and to disburse the collected amount on need basis of the CHILV for 2019-2020 in August 2019.

           

The committee decided to support any CLHIV who are excel in studies and wish to pursue their higher education.

                                                       ‘Poor PLHIV travel cost’

Peren is a district where 80% of the population lived in rural areas, and many villages are hard to reach areas. HIV doesn’t discriminate any Population even to the rural area, many clients were detected positive from a rural area in the district. These populations fully depended on agriculture for their livelihood and from a poor economic background, where their treatment become a Secondary and many clients doesn’t have money for their treatment even though they were tested positive and need to avail the facilities. 

In order to achieve the 90/90/90 goal and encourage HIV positive clients to access ART and Continue their treatment and to make sure that all the positive clients are initiated on ART, DAPCU Peren initiated “Travel Cost for Poor PLHIV” in 2016

Activities carried out under this initiative:

 i). The activity for fundraising was started in August 2016. Dapcu Peren in Coordination with the HIV facilities in the district organized a Fate day in which the total amount of 60,000 was earned, the same amount was invested in a Calendar project in 2017 and in which 96,600 the total amount of earned for the Activity

The initiative was reviewed in all the HIV facilities coordination meetings.

ii). An amount was fixed base on the area to the nearest ART/FIARTC.

 iii). The counselor and the field staff to recommend the clients based on the Counseling of the clients and Dapcu to take the final decision to allot the travel cost.

iv). The preference will be given to the newly detected clients and lost to follow clients  to make sure  that 90/90/90 goal is achieve and as to part of 0 LFU campaign in the district. The benefit will be given in cash and the counselor/field staff to counter Sign the slip.

V). An audit committee was formed with the Program Manager TFA, Counselor ICTC Ahthibung and Data Manager OST Jalukie as members.

As part of this initiative 5 PLHIV request for the travel and recommended by the counselor and Program Manager and 5 PLHIV received the Benefit in the 2018-19. 23 PLHIV received this support in the till date.

Implementation of Mobile ICTC & Strategy development to organize the campaign among General Population by DAPCU,North Tripura

HIV/AIDS screening is very much mandatory throughout all Vulnerable, ANC’s & equally important among the general population considering the elimination of HIV/AIDS. So, thinking the perspective & with the objective of mass screening, DAPCU, North Tripura has taken the initiative of mass screening in different Brickfield workers in the various brickfield, Tea Garden Labourers in various Tea Gardens, slum areas, Jails, village markets, Gaon Panchayats, Motor Vehicle Syndicate points, Indian Oil Depot,   communities where people can’t access the health facility due to distance  &  targeted population are not covered through Targeted Intervention projects etc.  Here, concept & implementation of Mobile ICTC is the prime aspect to get it done.

The sub-populations that are more vulnerable or practice high-risk behavior or have higher HIV prevalence levels are the target group for counseling and testing services in the country. In last year’s, clients accessed counseling and testing services in the ICTC throughout the country.

HIV counseling and testing service is a key entry point to the prevention of HIV infection and to treatment and care for people who are infected with HIV. When availing counseling and testing services, people can access accurate information about HIV prevention and care and undergo an HIV test in a supportive and confidential environment. People who are found HIV negative are supported with information and counseling to reduce risks and remain HIV negative. People who are found HIV positive are provided psycho-social support and linked to treatment and care.

So, in those identified places, DAPCU has made the effort to intervene as these populations are also equally important to get screened for HIV/AIDS. They always don’t avail the facility of ICTC’s & F-ICTC’s & they don’t have consciousness on HIV/AIDS too.  DPM & DIS, DAPCU has visited in Labour Welfare Department & Met with District Labour officer regarding the significance of HIV/AIDS screening & lesson of consciousness on HIV/AIDS of Brickfield, Tea Garden laborers. In this way, DAPCU has communicated & made liaisoning with various Gaon Panchayats, Market committee, community & tried to convince them to gather mass population for organizing M-ICTC Campaign. Sometimes we got helped from Panchayat Raj Training Institute & local PRI bodies, respective PHC. Thus, the mass population has been screened who sometimes can’t access the facility of General Health System & don’t visit ICTC. So, those untouched populations have been screened for HIV/AIDS.

Thus, Mobile ICTC has been organized for mass screening. In these M-ICTC campaigns, with the screening of HIV/AIDS, the general population has been aware of HIV/AIDS & received various necessary information on health.

DAPCU North Tripura conducted the campaign as following dates in last 2018-19 FY & April,19  to August 2019:-

Ø  In last 2018-19 FY, total of 1805 clients have been screened. 6 clients got re-active & confirmed as HIV Positive. These campaigns  were  organized at Manuvalley Tea Estate, Shova Bagan, Jagannathpur Tea Estate (Unakoti Dist), Damcherra Bazar, Jalabassa Bazar, Brajendranagar, Sanicherra (North Tripura), etc.

Ø  Since April 2019 to September 2019 total of 496 clients have been screened through M-ICTC & No positive detected. These campaigns were held at Dharmanagr Brickfield, Chinibagan Brickfield,  Ganganagar Tea Garden, Huplongcherra Tea Garden in North Tripura. In M-ICTC maintained a complete methodology of HCTS.

Ø  This is most well observed that after conducting & sensitization through M-ICTC , health consciousness behavior & approach have been developed  among people  & with  self motive attend ICTC’s & F-ICTC’s at different health institutions.

Ø  DAPCU has collaborated with existing health facility & NHM to leverage & reach the service to hard to reach areas. Mobilized General population, pregnant women & other vulnerable population through networking with the local community members, field-level Government health institutions, Self-help Groups & NGO’s etc.

Thus, this has been observed that, in several places, through several means, M-ICTC have been organized & General population have been covered.

Here, this is very much necessary to mention the whole procedure has been achieved through the integrated effort of DAPCU. In each sphere, DAPCU staff have managed. Such as DPM & DIS communicated to organize & on the spot facilitated to do. M&E reported & helped to maintain records. Dist. The accountant helped to organize the said programs. Here, a team of M-ICTC Van was involved & AD-ICTC leads to make successful the campaign. .Here, TI, N-TI, ICTC’s also helped a lot. Obviously, local authority & various Govt. Departments helped to organize & conduct the campaign.

Photos:

                                           Fig1: MICTC at Churaibari Brickfield

                                             Fig2: M&E, DAPCU in M-ICTC at Ranirbari Tea Estate

                                         Fig3: DIS, DAPCU at M-ICTC campaign at Indian Oil Depot,                                                                         Dharmanagar, North Tripura with Transport workers

Fig4: DPM, DAPCU at M-ICTC Campaign at Indian Oil Depot, Dharmanagar, North Tripura & message to workers.

Fig5: AD-ICTC, TSACS in M-ICTC campaign at Indian Oil Depot, Dharmanagar, North Tripura & message to  Transport drivers

Note on HIV Screening in Jail (North Tripura,DAPCU)

Initiatives  on HIV Screening, counseling of Jail Inmates  & Other Prisoners by DAPCU, North Tripura

This is very much urgency of the hour to screen HIV/AIDS among Jail inmates, Juveniles in correctional homes & other prisoners, who have been involved in criminal activity & as a consequence going through confinement. They are also vulnerable & require counseling & a lesson of consciousness among them regarding HIV/AIDS, STD & other related diseases. Prisoners are at special risk for infection with human immunodeficiency virus (HIV) because of overcrowded prisons, unprotected sex, and sexual assault, the occurrence of sexual practices that are risky to health, unsafe injecting practices, and inadequate HIV prevention, care, and support services.

Globally, many studies on human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS) have been undertaken by various government and non-governmental organizations among the general public. There are certain high-risk groups in well-defined but restricted settings who are usually left out from the interventions they deserve especially in developing countries. Inmates of prisons are an example of this left out of the population. Prisoners worldwide have a significantly higher prevalence of HIV than in the community. Prisoners are at special risk for HIV infection because of overcrowded prisons, unprotected sex and sexual assault, the occurrence of sexual practices that are risky to health, unsafe injecting practices, and inadequate HIV prevention, care, and support services.

Considering & observing the above situation, DAPCU, North Tripura has already started the programs & planned to conduct & organize the Campaign in all District Jails since April 2018 & yet well the practice is going on. DAPCU also took the same initiative as per the direction from NACO & through collaborating with TSACS.

The intervention of DAPCU, North Tripura:-  In order to organize the camp at first DPM & DIS, DAPCU met with all Jail authorities  in North & Unakoti District of Tripura & also communicated through the letter. At dist.level, Sub Divisional Magistrate (SDM) is the superintendent of Jail & his concern is necessary to deal with the system & we communicated with SDM & at next we also met with Deputy Jailer. We, fixed date & consequently through the collaboration of TSACS & AD-ICTC. We mobilized Mobile ICTC VAN from SACS on the specific date & venue, that it may also be conducive for inmates & jail authority also.

·         At first, we did a counseling session  with  all jail inmates regarding awareness of HIV/AIDS, Significance of HIV/AIDS screening, etc.As, The knowledge about HIV/AIDS among inmates was high, but misconceptions about HIV/AIDS are still rife among the prisoners and educational programs would be required to correct this. Most of the inmates still display negative attitudes that are likely to encourage stigmatization and discrimination against the PLWHA. This will militate against voluntary counseling and testing as fear of isolation will prevent individuals from being tested. So, DAPCU, North Tripura intervene in this context to remove misconception & to get them tested. At last, everyone got tested after our counseling session & few staffs of jail screened them.

·         Then, one by one came for screening following all the formal procedure ( Such as filling consent form, etc)  & test was done.

·         Handed over the reports to the jail authority & two known reactive found. Consequently, positives did verify & found already existed. However, we again counsel them for medical adherence & to be in touch with a regular medical check-up.

DAPCU North Tripura conducted the campaign as following dates:-

Ø  7^th April 2018:- Dharmanagar Sub  Jail- 61 Screened.

Ø  7^th May 2018:- Kailashahar Dist.Jail-54 Screened.

Ø  6^th September 2018:- Kanchanpur Sub Jail:-24 Screened & 1 Known Positive.

Ø  30th January 2019:-Dharmanagar Sub Jail:-58 screened & 1 known Positive found.

Apart from that, ICTC staffs reach in Jail  on need to screen inmates & whoever found Positive, linkage with FI-ART/ART for medical adherence.

Here, this is very much necessary to mention the whole procedure has been achieved through the integrated effort of DAPCU. In each sphere, DAPCU staffs have managed. Such as, DPM & DIS communicated to organize & on the spot facilitated to do. M&E reported & helped to maintain records. Dist. Accountant helped to organize the said programs. Here, the team of M-ICTC Van were involved & AD-ICTC lead. Here, TI, N-TI, AHANA, respective ICTC’s also helped a lot. Obviously, the Authority of Jails & SDM did co-operate with us to do so.

All HIV-positive inmates have special needs, ART Guidelines for HIV-infected Adults and Adolescents, released by NACO in May 2018, strongly recommend establishing effective linkages between ART and harm-reduction programs. It also states that ART should be given as part of a comprehensive package of prevention (including harm reduction), care and support and treatment. So, in this year also DAPCU will drive for the same practice in September 2019  to do the programs across all jails at Dist. There are 2 Sub-jail at North Tripura & One Dist Jail at kailashahar, Unakoti.  DAPCU has covered all the jails & we have also planned to involve One Juvenile Home in North Tripura under Child Welfare Committee. We may also communicate with the Inspector of Jail Prisons at Agartala.

Photos:-  

Dharmanagar SUB JAIL, North Tripura on 7^th April 2018 during the campaign

Awareness camp cum HIV Screening at Sub District Jail Dharmanagar & Dist Jail,Kailashahar among on trial/convicted Prisoner on 30^th January 2019.