DAPCU Kodagu Response to DCC For TB-HIV

1.      Advantages of DCC in HIV-TB collaboration activity

v  DCC for HIV-TB will help us in understanding the HIV-TB activity in the District Quarterly

v  DCC will  strengthen supervision, monitoring and review of TB/HIV collaborative activities

v  As TB is the commonest co-infection among HIV Patients, by detecting TB at the earliest stage of AIDS , we can treat the person and improve his health & diminish the mortality & morbidity.

v  Co-ordination between two programme, RNCTC & HIV is benefited mutually for the benefit of the client.

v  As DC is the chairmen the District administration will understand the programme & help us in solving the constraints & challenges faced in the implementation of the programme.

v  We can have holistic approach in managing a co-infection patient & implement both the ATT & ART effectively

v  It will help in tracking the MIS & LFU co-infection clients

v  Intensified case finding at the facility will be reviewed

v  Monitoring & supervision by the DC

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)

v  Less cross referral facilities are  focused during the in the meeting

v  To follow the 10 point TB tool at ICTC & to refer all TB suspects to ICTC from RNTCP

v  Details of TB registered clients , HIV test among the them , Co-infection & linkages to ART will be reviewed in the meeting

v  The gaps & the strategies to improve the cross referral has been discussed.

v  Representation & suggestion  from DLN, DIC & NGO for betterment of the HIV-TB programme

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.

           
                      Monthly Facility Review:

·         ICTC centre wise   & ART review of TB-HIV activities

·         Discussion on TB diagnosed cases & co-infection clients

·         ATT & ART treatment for the co-infection clients

                  Monthly ART, ICTC & RNTCP Review:

·     Client wise HIV-TB activities are reviewed at the monthly ICTC,ART & RNTCP meeting at the ART on every 4^th Saturday. Where all the ART staff, ICTC Counsellors, RNTCP staff & DIC Staff will participate & the review done by the DACO, DIS & ART MO

·         PITC activity ( All TB suspects at the DMC  & ICTC are tested for HIV)are reviewed

·    Gaps in the above activity & gaps in treatment (ATT & ART) should be filled by adopting appropriate measures.

·         Follow-up of MIS & LFU co-infection clients by the ICTC, ART RNTCP & DIC staff.

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

                                     Role of ICTC :

·         Counselling on TB for all the clients attending ICTC  for  early detection

·         Referring symptomatic clients to RNTCP

·         Linking  co-infection clients for ATT & ART at the earliest, in order to reduce HIV-TB deaths 

·          Follow-up of co-infection clients

Role of ART :

·         Intensified case finding by all the ART staff

·         ART & ATT & initiation of CPT  for the co-infection clients

·         Adherence to the treatment

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

v  Early Detection through cross referral from ICTC , ART & RNTCP

v  Line listing of the clients

v  Client wise review at the ART centre

v  Ensuring Adherence to ATT & ART

DAPCU Khordha Response to DCC for HIV-TB

Good practices and challenges for HIV/TB collaboration activity in Khordha District 

Every month collection the DMC wise report i.e. referral of diagnosed TB patients from RNTCP to ICTC from RNTCP Khordha and Bhubaneswar.

Cross check with ICTCs CMIS report’s in-referral (RNTCP) and found the gaps.

As per DMC wise report I found the some gaps in between registered TB cases and referred to ICTC then registered TB patients tested for HIV.

Prepare an analysis report before meeting regarding gaps from RNTCP to ICTC and share with DACO, DTO and DPM, DAPCU and open discussion in monthly HIV-TB coordination meeting at the present of all ICTC counselors and STS and STLS which should be easy for reduce the above gaps.

CDMO instructed all STSs to personally contact all missing case who have discontinuing to taking DOTs. They need to ensure HIV testing of the client who has been detected as TB positive.

Instruction has been given to all counselors to enhance 100% referral (as per target given by OSACS) to DMC and follow up the cases for complete investigation.

Instructed all counselors to must be submitted HIV-TB line list in DAPCU with CMIS report.

All counselors are submitting concern line list in DAPCU after returned by STS every month which is an achievement.

DAPCU also co-ordinate with ART center regarding HIV-TB. ART center also share the HIV-TB report with DAPCU every month.

DPM DAPCU also suggested to counselor and staff nurse of ARTC to follow up the co-infection cases.

Suggested to all counselors of ICTCs, STS and STLS to ensure 100% the ART registration in co-infection cases and provide proper treatment.

DAPCU Phek Response to DCC for HIV-TB

Aadvantages of DCC in HIV-TB collaboration activity 

• Data sharing takes place which helps in cleaning data between the two offices.
• District specific issues can be solved during the meetings.

Strengthening of TB – HIV Collaborative activities 

• Taking the example of Phek district, initially referrals from RNTCP to ICTC was very low, but the data of this financial year shows that 90% of TB patients have been referred to ICTC for HIV testing. However, very sadly referrals from ICTC to RNTCP was very low; justification being that symptoms of TB could not be observed in clients entering ICTC first. It has also been learned that most of the clients are referred to RNTCP by OPD doctors.
• During one such meeting, we felt the need to be oriented on TB symptoms and therefore the DTO presented on such a topic to all the ICTC counsellors. To scale up referrals from ICTC-RNTCP, it has been decided that at least 10% of the total clients will be referred to RNTCP.
• One of our ICTC centres is not attached to any DMCs and therefore referrals to RNTCP were not taking place in that particular centre. In this situation, we linked the clients to the nearby DMC giving responsibility to the ICTC counsellor attached to it and therefore tracking of referred clients became easy. 

Intensified TB case findings in Phek District

During one such HIV-TB co-ordination meeting, we were introduced to a NGO identified by RNTCP wherein the particular NGO collects sputum during their outreach and when found TB positive, they are referred to ICTC for HIV testing. Targeted Intervention (HIV) NGOs also collect sputum from their clients and sent the samples to RNTCP. 

Challenges in treatment, care and support for TB–HIV co- infection cases

Linking positive clients to nodal ART centre is one of the greatest challenges faced in our district, because of two main reasons; distance between ICTC centre Phek and nodal ART centre is 145 kms away wherein estimation of expenses incurred for one visit to nodal ART centre by a client comes to Rs.4000 and almost all our clients coming from poor economic background cannot afford the cost.

During one of our HIV-TB meetings, we came to a consensus that in case of such HIV-TB co-infection cases; we will directly link up to ART as we came to learn that they are eligible for ART even before getting their CD4 count being tested.

DAPCU Akola Response to DCC for HIV-TB

DAPCU Organizes the DCC meeting on a quarterly basis, in which all the ground level working staff (STS, Counselors), WHO consultant TB, DTO, DHO, CTO, TB MO, DACO, DPO, DS, ART SMO contribute their views. DAPCU analyzed the gaps through detailed presentation. All the members worked out on the poor factors and find out the remedies for the problem.

     The regular conduction of the meetings and follow-up of the activities bring the best outcome in the HIV-TB functioning. The following data can shows the qualitative part of the HIV-TB functioning in the district.

     The ICTC annual referral percentage of the TB patients is more than 11% whereas the detection rate is more than 8%. The HIV testing of the TB clients goes more than 94% in Dec 12. The ART referral is more than 8% whereas the TB detection of PLHIV goes more than 62%. All the NGO’s working in the HIV sectors are equally contributing their efforts for TB referral and HIV testing of TB clients.

     DAPCU not only taken the initiative for IEC improvisation in HIV-TB coordination activity but also run the sensitization programs for PHC MO/Private practitioner. Due to continuous follow-up of the activities HIV department has a strong coordination with the TB department. Quarterly DCC meetings help to strengthen the HIV-TB coordination activity of the district.

DAPCU Araria Response to DCC for HIV-TB

1.  Advantages of District Coordination Committee (DCC)  

DCC Meeting Photo

DCC is established in Araria under the

chairmanship with District Magistrate. 

The basic    advantage of the DCC:

✏      Effective prevention and control of both the diseases through HIV-TB cross referral between ICTC & RNTCP.

✏      Strengthening for better follow- up of co-infection and helping to reduce LFUs 

✏      Supportive to attach with services.

2.   TB – HIV Collaborative activities

✏     RNTCP staff communicates to ICTC staff about TB diagnosis and treatment of all referred clients.

✏     ICTC staff, on the basis of information received from RNTCP, based on HIV status link with other services for better care support & treatment.

Cross referral between ICTC-RNTCP of F.Y. (2012-13)
Cross referral	April	May	June	July	August	September	October	November	December
In Referral to ICTC from  RNTCP	83	71	77	71	67	83	82	66	91
Out Referral to RNTCP from ICTC	29	27	41	24	31	28	23	33	36

3.      Measures for prevention

DAPCU have devised a Joint Action Plan for TB/HIV awareness regarding prevention & control of both the diseases. 

 ✏       Educate to reduce TB- associate

       morbidity and mortality in people living 

       with HIV/AIDS through collaboration with

       RNTCP 

✏       Stress regarding safe injection practices to ICTC & RNTCP staffs, take in practices of needle cutter after use the syringe and follow universal percussion for prevention and control HIV infection.

4.  Role of service facilities

HIV infection makes an individual more    prone to develop TB disease. ICTC clients are screened for TB symptoms irrespective of HIV status and if symptomatic refer to RNTCP & ART centre for further treatment and care.

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

HIV-TB coordination meeting held regular in the month. DAPCU share block wise data of TB–HIV co- infection cases with the RNTCP department and follow-up regularly by the STLS, STS and NGOs, which is helpful to link with service centers for better care support and treatment to all HIV-TB co infection cases.