DAPCU Khordha (Orissa) Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

Linkages and referrals to the positive people are one of the major responsibility of the counselor at ICTCs. However, it is not ended with linkages only but to make proper follow up hence forth and to ensure partner notification for further test. In most of the DAPCU Districts it is being followed up and monitored to ensure 100% ART linkages. It may not be easy for the ICTCs which are far from the ART centre.

Although we have achieved good results in ART linkages, still the scenario was not so convenient in earlier days. There are some of the issues which are still could not be addressed. However, the percentage (%) of ART linkages under DAPCU Khordha was 94% during the period of 2012 and there was no such effort was made to ensure 100% ART linkages and also there is no system initiated to linkages the pending cases. And later these issues have been observed seriously and various efforts were made to ensure 100% ART linkages in the District. Now we have achieved 97% in ART linkages.

Efforts made:

It is viewed that number of testing were increased and number of positives too. So, it was challenge for us to link them with ART Centre. So, following efforts were made to reduce the linkage gaps between ICTC and ART.

1. Discussions and review in the monthly TB- HIV cum coordination meeting with data, showing number of positive detection in the ICTC in the month and ART enrollment. Along with highlighting the no of cases (from the ICTC) are not yet enrolled at ART Center.
2. Sharing of detected positive cases (source SIMS) of all ICTCs for the current month with the ART centre providing data in line listing format containing address, age, occupation, mode of transmission, ICTC where positive detected, date of detection etc to get filled Pre –ART number, Base line CD4, and ON ART Number if he/she eligible for ART.
3. Cross verification of these data with the concerned ICTCs through meetings and through telephonic discussion and feed backs.
4. All Counselors are suggested to ensure that the referred client has visited/reached to the ART center or not, through telephonic discussion / in a written format
5. ART linkages is also been discussed in the monthly ART coordination meeting where DPM is attending in a regular basis.
6. The drop out cases that are not visited to ART centre after detected positive, are the major challenge for us. Although we have no separate mechanism, but the concerned counselor is advised to visit her / his house with CSC / Link Worker/ ORW ( if it falls LWS/TI  area)  to convince them in each Saturday during the outreach activity.
7. Simultaneously the line list of the PLHA who is denying for ART registration after given consent at ICTC are to be shared with the CSC for tracking and in this effort, the concerned counselors are also going with the CSC.
8. Some long pending cases are also shared with CSC for tracking and the action taken report of those cases are submitted to DNO, DAPCU.
9. The cases who are belong to other district are ensured that they are linked with their nearest ART centre if he/she is not enrolled at our ART center. This is facilitated through telephonic discussion with the concerned DAPCU/ ART. (recently 3 cases are linked through this process)
10. Responsible also given concern TI NGO & LWS (for those cases referred by LWS/ TI and detected positive in ICTCs) to follow and ensure to ART registration.

10. DIS and other DAPCU staffs are joint visit with CSC and Concerned counselor to the PLHA who are not agreed to visit ART center.
11. CDMO & ADMO (PH) apprised concern counselors who are achieved 100% ART linkages in monthly meeting. So, that all counselors are taking initiate for achieved 100% ART linkages.

Constrains:

Difficulties to enrolled denying those cases who were agreed initially. Whereas the list of those cases could not be removed from the list.

100% enrollment is not happening due to death after detection and even for denying and absconded cases. 

Not achieving 100% in case of repeat cases.

DAPCU Thoubal (Manipur) Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

What strategies are currently being adopted to ensure linkages between ICTC and ART centre in your District?
DAPCU is making an effort to integrate the CST services within the health system. Accessing of free Health Check-up , free treatment  under government, giving of Transportation charges to all PLHIV who are  taking  drugs from ART centre under the NACO guideline, intercommunication or sharing of information in between the ART and ICTCs. ART Visit by ICTC Counselor, utilization of Outreach worker of TI –NGOs to link all the Positive Clients to ART, co-ordination with RNTCP Staffs and DOTs providers, ASHA are the main current strategies which are adopted by DAPCU Thoubal.
The delivery of Care and treatment services to the people living with HIV/AIDS   need three –tier service structure, a part from the maintenance of reconciliation sheet of ICTC- ART linkages data because these three-tier systems will help a lot to strengthen the ICTC and ART linkages. So, we need various level of service accessibility.
They are: -

1. Centre of Excellence and link ART.

2. ART Centre.

3.  Decentralized Link- ART centre& link ART plus centre.

 ART centres are also linked with community support centre run by NGOS for a comprehensive packages of services. Detection of HIV positive is the normal duty of the ICTC and accessing of treatment and care activity is for ART centre, both are the two sides of a coin. There  are many challenges for PLHIV and care givers  for taking of Drugs  and for giving drugs, in terms of transportation, cost to access ART and  Stock availability, late entry of PLHIV into ART  and also the poor ownership of ART centres by Health system etc. so, the understanding these problem of Staffs and PLHIV help to strengthen the  linkages of ICTCs /ART. Proper pre –ART counseling , regular follow –up  of every 6 months, strengthening coordination and flow of information between the various services  starting from  Pre-ART enrollment to  continuum care will also  support to strengthen the linkages of ICTC/ART centres.

What steps can DAPCU take to link all the patients who are detected positives for HIV at the ICTCs to ART?

DAPCU is the monitoring and supervision unit. DAPCU has taken some steps to link all the positive clients to the ART centre:

They are: -

1. Maintenance of proper reconciliation sheet.
2. Regular field visit.
3. Organized monthly ICTC/ART Review meeting and sharing of all the information between the ICTC/ ART center.
4. To Link to the Line department for the entitlement of Social benefits scheme & nutritional support to PLHIV.
5. Reduction of Stigma and Discrimination at the health facilities and community link to the Line department for the entitlement of Social benefit scheme & nutritional support to PLHIVs are also the main activities of DAPCU.
6.  Organizing District coordination meeting of CSC/ART and TI-NGO etc.

DAPCU Central Delhi Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

Following are the strategies currently being adopted to ensure linkages between ICTCs and ARTC in our district:

1. Proper documentation of address & contact details of all clients visited at ICTC.
2. Gapless Line Listing of all HIV Positive Clients.
3. Outreach by ICTC Counselors to motivate the HIV Positive clients who are reluctant to register themselves at ART.
4. Also, outreach by DSRC & TI-NGO staff of their respective clients (detected HIV Positive at ICTC) to ensure their ART Registration.
5. Strengthening linkages between ICTC & ARTC through regular meetings.
6. Support ICTC staff for ART Registration of HIV Positive Clients if they face any difficulty at ARTC.
7. An intensified LFU Tracking Exercise was coordinated, monitored & facilitated by DAPCU-Central Delhi in Central, West & New Delhi Districts (in 2013-14) through following activities:
   1. Facility & Area wise scrutiny of all LFU data provided by Delhi SACS & 9 ARTCs of Delhi.
   2. Scrutinized details of LFUs were disseminated to the concern ICTC, PPTCTC, DSRC & TI-NGO staff for tracking of the same.
   3. LFU tracking were done by the concern facility staff and reported the same to the DAPCU.
   4. 1355 LFU cases were tracked out of total 1612 LFU cases provided during the Intensified LFU Tracking Exercise.

Following steps can be taken by DAPCU to link all the patients with ART who were detected HIV at the ICTCs:

1. DAPCU can emphasis ICTC/ PPTCTC staff to note the proper addresses & details of ID Cards (particularly Aadhar Card details) of all the clients visited at the Center.
2. More stress can be given on Out Reach activities by ICTC/ PPTCTC staff.
3. Intensified LFU Tracking Exercise as cited above can be undertaken annually to minimize the gaps at ICTC-ARTC Level.
4. DAPCU can coordinate with, and take support from other DAPCUs of the State for effective follow-up of clients missed/ LFU for ART.
5. The help of CSC/ Help Desks can be taken, in case of the clients who do not have any Id-Card. Address of the client can be verified by the CSC/ Help Desk after proper visit at and client can be registered at ART on the behalf of the reported address verification of the Client by CSC/ Help Desk.
6. The HIV Positive Clients can be motivated to register themselves at ART by aware them the benefits (including benefits of Financial Assistance Scheme of Delhi Govt.) which they can avail after ART Registration.