Delhi State AIDS Control Society
Government of NCT of Delhi

 

• The concept of Community Care Centres (CCC) has been redefined from a "Standalone Care Centre" to Care and Support centre providing Follow up, Monitoring & Counseling support, Drug adherence and Treatment of minor OIs.
• The concept of Link ART centre has also been formulated to make ART more accessible.
• The second line ART has been rolled out in a phased manner.
• 10 centers of excellence are in the process of being established.

Weaknesses In ART Services Of Delhi

• Lost to follow -up problem.
• Poor reporting of OIs & non availability of many OI drugs.
• CD 4 testing facility not available in all ART centres(linked service ) there is a delay in delivery of reports to clients.
• No financial assistance being provided to PLHAs for child education & improving nutritional status.
• Poor linkage with CCCs: the new guideline of 5 days admission not yet implemented.
• Low institutional delivery rate of HIV +ve ANC cases. So data on ARV prophylaxis for non institutional HIV + ve deliveries not available.

Steps taken By DSACS to Improve ART Services in Delhi

Tracking Miss Category : It is important to track patients lost to follow up but it is all the more important to ensure that patient are not lost to follow up in the first instance (LFU is designated after three months).
Following directions have been issued to all ART centres :

• All ART centers must closely monitor MISSED cases. The data manager should prepare a daily "due list" which indicates all PLHAs due to visit ART centre on that day. This can be prepared from either CMIS or white card where patient is given next appointment or from the drug dispensing register.
• All those patients in this list who fail to collect drugs on that day must be followed up with in 48 hrs through phone calls or through home visit by ORW of TCC/CCC or ICTC counselors/DLN members. This will not only reduce the LFU but will also ensure reduction in chances of drugs resistance among those who MISS their visits.
• The team should also hold a meeting with linked CCC manager/ ICTC to explain the process of tracking LFU / MISS cases to ensure the Operationalization of this system. In the same meeting the referrals between ICTC to ART center should be line listed and reviewed.
• ARTC to Build coordination with neighboring SACS with help of DSACS to track LFU patients.

Conceptualization and Operationalization of Link ART Centres : These centres have been opened in places where services of a doctor, nurse, counsellor and pharmacist are available.
Thus following facilities may qualify for designation as LAC :

• Integrated Counselling and Testing Centres in Government Hospitals.
• Community Care Centres in Non-Government sector.
• Criteria used to Select Site for LACs:
• ARTC to Build coordination with neighboring SACS with help of DSACS to track LFU patients.

Criteria used to Select Site for LACs :

• High Prevalence (category B districts)- ART centres where patient load is high (>1000 PLHAs on ART. ART centres where patients are coming from neighbouring districts in large numbers.
• There are minimum 50 HIV patients from the catchment area of LAC or 10 patients on ART.

Objectives :

• Screening for opportunistic infections in HIV Positive individuals by a trained medical personnel, their treatment & referrals to tertiary care hospitals.
• Provide ARV drugs to clients on ART registered at any of the 9 ART centers in Delhi viz; BSAH, LNH, RMLH, DDUH, AIIMS, SJH, GTBH & LRS institute of TB. These drugs will soon be provided by DSACS/NACO.

Responsibilities of the LAC :

• Constitution of a Link ART Centre Team with representation from Paediatrics, medicine & O&G departments headed by a Nodal Officer preferably, MD (medicine or pediatrics) or a MBBS doctor as I/C of the LAC.
• Space & furniture available in the existing ICTC/VCTC to utilized for establishing the LAC. Additional furniture, if required, may be provided by the hospital.
• A pharmacist & a staff nurse are also deputed for dispensing ARV drugs & maintaining the records. The registers & the training will be provided soon by DSACS on receiving the nomination.

Responsibilities of DSACS :

• Training of staff
• Provision of ARV drugs
• Develop Coordination Linkage B/W LAC & ART centers.
• Provision of Reporting formats, registers & signage's
• Provision of annual contingency grant.

LACs Established in Delhi & Their Linkages :

• ICTC , Central Jail Tihar, Hari Nagar
• ICTC , R.B.T.B. Hospital, Kingsway Camp
• ICTC , Malviya Nagar Hospital, Malviya Nagar
• ICTC , Chacha Nehru Bal Chikitsalya, Geeta Colony
• CSI, BPS, Burari
• CCC, CSI, Khera Khurd, Narela

Current Status of LACs :

• MOs of LACs have been trained by NACO
• DSACS has released funds for initial establishment of LACs
• However, till June 2009, none of the patients have been transferred by linked ART centre to any of the LACs.
• Nodal Officers of all ART centres have been requested to make use of the services of the LACs; otherwise, LACs will be closed down by NACO/DSACS.
• CSI, BPS, Burari
• CCC, CSI, Khera Khurd, Narela

Medicines for Opportunistic Infections (OIs) :

• DSCAS provided OI drugs to all ART centres during 2008-09
• For 2009-10, DSACS has released Rs. 50,000/- to all the 9 ART centres to procure OI drugs

Medicines for Opportunistic Infections (OIs) :
Linkages have been revised after establishing new CCCs during 2008-09. CCC-ART coordination meeting are being regularly conducted.

Medicines for Opportunistic Infections (OIs) :
An ART Review Committee has been constituted under the Chairmanship of Pr. Secy (H&FW), GNCT of Delhi and its first meeting held. The main role of the committee is to examine the problem of stigma & discrimination against PLHAs and evaluate the services provided by ART centres on quarterly basis.