|
|
AIDS Community |
|
|
|
Health Maternal and Child Health Community |
AIDS Community
Maternal and Child Health Community
Consolidated Reply
Query: Integrating PPTCT Programs, from SAATHII, Chennai (Experiences; Advice).
Compiled by E. Mohamed Rafique and Meghendra Banerjee Resource Persons; research provided by Rituu B. Nanda and Deeksha Sharma Research Associates
18 October 2006
Original Query: Subhasree Sai Raghavan, SAATHII, Chennai
Posted: 27 September 2006
We are progressing well in initiating PPTCT Programs up to Taluk Level in some districts and up to the PHC level in the Government sector. However, we have a few programs that are able to successfully link pregnant women and the babies to ongoing care, support and treatment before, during and after delivery.
I will be grateful if you can share examples where you are able to successfully link women and children to care, support and treatment programs before, during and after delivery. Please provide details on your program, learning experiences, challenges, number of women and children linked among others.
Responses received, with thanks, from:
1. T. S. Krishnan, Development Oriented Operations, Noida
2. Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (Response 1; Response 2)
3. Shreepal Saptasagar, Yerala Projects Society, Sangli
4. Nabeel M. K.,
Academy of Medical Sciences (ACM),
5. Waseem, Rizvi
6. Yamini Thankachy,
7. Deepa Burman,
8. Anitha P. M.,
9. Homyar Keki
Gardin, Tata Steel's Family Initiatives Foundation (TSFIF), Tata Steel
Ltd.,
10. Kusum Gopal,
11. Santosh S. Bagali, Consultant, Bijapur
12. Amrik Kapoor, Consultant in HIV and
Reproductive Health,
Further contributions are welcome!
As of December, there were only 488 Prevention of
Parent-to-Child Transmission of HIV (PPTCT) centers in
Integrating specialized PPTCT programs with mainstream care and support, and treatment programs, members felt, is a necessary step toward improving maternal and child health. The importance of integrating HIV programs were highlighted recently by two reports- the progress report on India’s movement towards achieving the “Declaration of Commitment on HIV/AIDS” issued by the UN General Assembly Special Session on HIV/AIDS and the “Concept Note on Inputs to HIV Component of Global Fund to Fight AIDS, Tuberculosis and Malaria.” Both these documents point to the need to focus on providing PPTCT and increase linkages between existing HIV care, support and treatment programs to ensure a continuum of care.
Respondents shared their experiences with several PPTCT
programs, which demonstrate different ways of linking services, either
formally or informally, and between implementing agencies, be they the
Government, NGO, Private sector or a mix. Currently government hospitals are
implementing , most of the PPTCT programs. The government in Kerala has a network of fourteen PPTCT centers, at
government Medical Colleges. Discussants provided details on two programs that
have integrated their PPTCT with other HIV programs, specifically the Medical
Colleges at Pariyaram and
The
Members also highlighted features from the Calicut Medical College HIV program. CMC has effectively integrated HIV services comprising the PPTCT center, voluntary counseling and testing center (VCTC) and ART clinic, which are all on the same campus. Pregnant women are tested and if positive, linked with care and support programs available through local NGOs, Partnerships for Sexual Health (PSH) projects and palliative care programs.
Delhi Medical Colleges are also linking PPTCT with other HIV programs.
Members mentioned the University College of Medical Sciences at
Along with government PPTCT programs, respondents mentioned two NGO-led integrated PPTCT programs. In Kerala, a local NGO is designing an integrated HIV project, which will link PPTCT activities with a wide range of other HIV services, including community based care and support centers. Another NGO is working in a high prevalence district in Maharashtra, and recently started a program to link pregnant women to a range of health services through public private partnerships (PPP) between the NGO and the government health system. The NGO collaboration provides a PPTCT kit as well as counselling to expectant mothers and their families on how to prevent transmission. The program is also creating linkages with government programs like the National Rural Health Mission (NRHM) and Reproductive and Child Health II (RCH).
A third type of PPTCT program discussed by members uses a ’single window’ health delivery approach. A private trust working in Jharkand is attempting to address the problem of stigma and discrimination, by integrating all of its programs into one center that has PPTCT, referrals to government VCTC, STI counseling and treatment, anti-retroviral and opportunistic infections treatment, treatment adherence counseling, prevention activities, and vocational training. The project covers a population of over one million, including adolescents and youth, industrial workers, slum dwellers and tribal communities.
Members mentioned challenges facing integration and delivery of services. One major issue is that not all programs have access to free ARV and therefore, refer poor patients, to other facilities, which are often some distance away. Another problem is the lack of private sector involvement. Respondents pointed out that private facilities tend to simply ‘move’ pregnant women testing positive to the nearest government hospital or center.
To improve integration and delivery of existing services, members made a few suggestions. Community level support and participation is essential, members pointed out and recommended local NGOs working on HIV related issues form associations coordinate their efforts to ensure linkages and complete coverage. Anganwadi workers could play a central part in developing community level networking; members felt and suggested building on the similarities between PPTCT and Anganwadi programs to integrate them. Another suggestion was for doctors to keep detailed case sheets of each patient to improve their understanding of cases. Also, as ART and VCT is not universally available, doctors need to invest more in social practices like counselling.
In conclusion, respondents noted that along with ensuring women and children access to a range of services, integrating PPTCT programs will also save time and resources. Discussants felt the query poser wanted just enough information to make a presentation. So the responses are not an exhaustive list of integrating strategies, as was invoked by other questioners eliciting responses on ensuing and related topics like ‘Integrating Counselling Services’ or ‘Testing in PPTCT’
Kerala
PPTCT Network Across the State (from Dr. Yamini Thankachy, Kerala State AIDS Control Society, Trivandrum)
There are more than ten PPTCT centers in various hospitals across the state. At ANC clinics, they test women for HIV and if positive, the women go with their spouse to PPTCT centers for counseling. Thereafter, they go to VCTC for pre and posttest counseling. The focus is now shifting to integrated counseling and testing center of services with all the three– ANC clinics, PPTCT centers and VCT- at one place to save time and resources. Read More
Informal Integration of Services in Pariyaram (from Dr. Nabeel M. K., Academy of Medical Sciences, Pariyaram)
In the Academy of Medical Sciences, integration of services is a feature of the PPTCT program. Counselors provide pre and post-test counseling. Then the counselor and medical personnel refer patients to the necessary specialists. Most of the required treatment and medication is available here. However, the program currently does not have access to free ART and therefore must refer patients to a hospital more than 100 km away. Read More
Formal Integrating of Services in Calicut (from Anitha P. M., Calicut Medical College, Calicut)
All pregnant women receive an HIV test, after counseling. If a woman tests positive, the counselor refers her to the VCT center. The VCT counselor provides additional counseling and she is tested again to confirm the diagnosis. Once confirmed, the counselor refers her to the ART clinic in the Dept. of Medicine, where the doctor administers a prophylaxis. Depending on the need, she is then referred to specialty clinics and/or NGOs providing care & support. Read More
Community Level Intervention Project (from Dr. Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram; response 1)
Punalur Social Service Society is planning a community HIV project in three panchayats, Kollam district, near the Tamil Nadu border and Punalur-Shencottah highway. A situational analysis will examine the situation to find weaknesses in the system and understand how to build linkages with between PPTCT, VCTC, STI, Anganvadis, and PHCs/hospital services. Based on the study, it will plan how to bring HIV+ individuals into the system, both public and private. Read More
Delhi
PPTCT Program at a Government Hospital(from Dr. Deepa Burman, University College of Medical Sciences, Guru Teg Bahadur Hospital, New Delhi)
The Departments of Pathology, Microbiology, and Gynaecology in Guru Tegh Bahadur Hospital have organized a small PPTCT program. The program helps create HIV awareness, identifies HIV cases through its ANC clinic and provides ART and follow-up. The program is new and has not finalized all of its activities. Read More
Maharashtra
Public Private Partnership to Deliver PPCTC (from Prof. Shreepal Saptasagar, Yerala Projects Society, Sangli)
Sangli district has high HIV rate and consequently higher chances of infants being born with HIV. Therefore, some NGOs and the Zilla Parishad recently started a program to cover 100% of pregnant women with ANC and PPTCT, and linkages to care, support and treatment, and counseling, during and after delivery. The Zilla Parishad CEO has also arranged for 10-15 lakhs to help fund the program. The program is new and its impact is still unknown. Read More
Jharkhand
Private Company Offering Integrated Services (from Dr. Homyar Keki Gardin, Tata Steel's Family Initiatives Foundation, Tata Steel Ltd., Jamshedpur)
Tata Steel Family Initiatives Foundation (TSFIF) operates 20 antenatal clinics in Jamshedpur. TSFIF healthcare workers assess pregnant women who attend their ANC clinics to identify those “at risk” and offer the “opt out” model for VCTC. They monitor women who test positive and link them to designated hospitals, including Tata Main Hospital, which provides free ART and uses the WHO protocol. After delivery, TSFIF refers HIV+ women for post-natal check-ups. Read More
Recommended Documentation
Concept Note on Inputs to HIV Component of GFATM Round-6 Proposal (from Waseem, Rizvi College of Management, Mumbai)
The India- Country Coordinating Mechanism (India-CCM); 2006
http://mohfw.nic.in/CONCEPT_NOTE_-_HIV-AIDS_COMPONENT.doc
Stresses on capacity strengthening and technical support to preventive services including PPTCT through collaboration with private sector and civil society organizations
United Nations General Assembly Special Session India Report (from Dr. Santosh S. Bagali, Consultant, Bijapur)
UNAIDS; 2006
http://data.unaids.org/pub/Report/2006/2006_country_progress_report_india_en.pdf (Size: 787.9 KB)
Addresses responses including PPTCT to expand healthcare access and mitigate the epidemic’s impact in India
In Good Company (from Dr. Homyar Keki Gardin, Tata Steel's Family Initiatives Foundation, Tata Steel Ltd., Jamshedpur)
By Saloni Meghani; Tata Steel; August 2003
http://www.tata.com/0_our_commitment/community_initiatives/articles/20030802_aids.htm
Article discussing the various HIV/AIDS prevention and treatment programs by Tata Steel in Jamshedpur is implementing
Punalur Social Service Society (PSSS), Punalur (from Dr. Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram; response 1)
PB No. 50 Punalur Kerala; Tel: 475-2222191/5369; contact@pusoc.org or plrsociety@sancharnet.in; http://www.pusoc.org
Non-profit voluntary organization which is committed to sustainable and equitable development of communities in Kerala
Academy of Medical Sciences (ACME), Medical College, Pariyaram, Kannur (from Dr. Nabeel M. K.)
Pariyaram Medical College, Kannur; Tel: 497-2808080/111/127; Fax: 497-2808131; kchc@mcpariyaram.com; http://www.mcpariyaram.com/index.html
Actively engaged in PPTCT programs with stress on integration of services in HIV treatment including both provision of counseling and ART drugs
From T. S. Krishnan, Development Oriented Operations, Noida
Tamil Nadu State AIDS Control Society (TNSACS), Chennai
417 Pantheon Road, Egmore, Chennai 600008 Tamil Nadu; Tel: 044-28190261/4917/0467 or 9840045215; nsacs@tn.nic.in
State AIDS control agency working to prevent the spread of HIV in Tamil Nadu, is trying to increase awareness regarding PPTC programs
National AIDS Control Organisation (NACO), New Delhi
Ministry of Health and Family Welfare, GoI, 9th Floor, Chandralok Building, 36, Janpath, New Delhi 110001; Tel: 23325343/731774/731778; Fax: 23731746; info@nacoonline.org; http://www.nacoonline.org/index.htm
Nationwide AIDS agency working to prevent spread of HIV and ensuring care, support and treatment is available- is trying to increase awareness regarding PPTC programs
Kerala State AIDS Control Society (KSACS), Thiruvananathapuram (from Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram; response 2 and Dr. Yamini Thankachy, Kerala State AIDS Control Society, Trivandrum)
IPP Building, Red Cross Road, Thiruvananathapuram 695037 Kerala; Tel: 0471-2304882/5183; sacs_kerala@nacoindia.org
State AIDS control agency devoted preventing the spread of HIV- it is in planning to extend PPTCT services to the district level
Yerala Projects Society, Sangli (from Prof. Shreepal Saptasagar)
Miraj Road Sangli 416 415, Maharashtra; Tel: 91-0233-2323318/22796; yps12@hotmail.com
NGO working in the drought prone areas of Sangli district with families in rural areas, is involved in implementing a program to link ANC and PPTCT with on going care services
University College of Medical Sciences, Guru Teg Bahadur Hospital, New Delhi (from Deepa Burman)
http://www.gtbhospital-gnctd.com/default.htm
Largest government hospital and training center in East Delhi- is running a small HIV awareness and treatment program for HIV positive women identified through ANC clinics
Calicut Medical College (CMC), Calicut (from Anitha P. M.)
http://www.calicutmedicalcollege.ac.in/
CMC has a PPTCT, counseling and ART clinic on its campus and provides a range of HIV services, including free ART
Tata Steel Family Initiatives Foundation (TSFIF), Jamshedpur (from Dr. Homyar Keki Gardin)
TSFIF, sponsored by Tata Steel, is working in Jamshedpur to provide family planning and reproductive health services, also has an integrated HIV program
T. S. Krishnan, Development Oriented Operations, Noida
I was associated with the evaluation program of NACO's campaign through DAVP and its ads over different media. The survey also covered Tamil Nadu and was conducted in Kancheepuram and Sivaganga. However, we could not get good results through the field survey team and the results could not be accepted as the results were contrary to the facts that I am already aware of about Tamil Nadu, as I belong to the place though now I live in Delhi.
Local level involvement of volunteers will go a long way in linking women and children with care. A consortium of various NGOS working in the field could be formed and they could work in coalition with concerted efforts so that the whole of Tamil Nadu is covered at the same time.
If you could detail your programs, we could see whether we could be of any help to you. Lot of efforts are being taken by NACO and Tamil Nadu State AIDS Control Society (TANSACS) too see that the awareness about PPTC gets increased and visits to the centers are induced.
Dr. Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (response 1)
I am associated with a community level situational analysis and problem finding, which has lead into a well-formed community level intervention project aiming at reducing stigma and discrimination. I am narrating below the salient features of the project. Punalur Social Service Society (PSSS) do the project, which is a non-profit Voluntary Development Organization working among various sections of the society including Persons living with HIV and Plantation workers in Kollam, Pathanamthitta and Alappuzha districts of Kerala, South India.
This project is implemented in three selected panchayats in Kerala from the border taluks close to Tamil Nadu on the Punalur-Shencottah Highway. We are doing the situational analysis now and planning for a community intervention and if possible, we aim at forming community based care and support centers. This project thereby helps in bringing HIV affected ones to the health systems both in public and private as well as in society for different service components that will include also services to expectant mothers in the project area.
Provided is the Objectives from the Situational Analysis of HIV/AIDS in Piravanthoor, Thenmala and Ariankavu Panchayats in Kollam District:
- To
study the situation of HIV/AIDS and general health problems in
Piravanthoor, Thenmala and Ariankavu Panchayats in four months.
- To
select, induct and capacitate project coordinator and 3 social workers to
initiate HIV/AIDS activities in the project area in 4 months.
- To
build linkages with PRIs, VCTC, STI, PSH project, PPTCT, Anganavadi, PHCs/
Hospitals.
- To
find out the gaps in the existing programmes.
- To
identify PLHA and their needs through base line survey in Piravanthoor,
Thenmala and Ariankavu Panchayats in four months.
- To
document the findings and prepare a project proposal, mainly aiming at
community level care and support of PLHA, and networking them with Health
systems, both public and private and also to alleviate stigma and
discrimination.
I would like to share the project proposal if it could be of use. I think this sort of integrating components especially across a bordering state is new in Kerala. Therefore, I also am looking at the suggestions from our community members, as well as the experiences shared by members who previously have done similar exercises.
Dr. Subhasree Raghavan (offline contribution)
I am happy to see members of the AIDS Community responding quickly to this query on integrating PPTCT. The time to reply for this query is short, as Indian examples that integrate PPTCT with Care and Support are required for a talk to be given by me within a few days. Every response that is used in my presentation will be acknowledged. In addition, please inform members that the responses will be of use after my presentation too.
Prof. Shreepal Saptasagar, Yerala Projects Society, Sangli
Sangli distirct is one of the districts that is hard-hit by HIV in India. A number of programs were initiated in the districts through SACS, NGOs and other private sectors. We are also at the same stage as you have presented in your query namely that SACS have rolled out PPTCT program up to the block levels and are planning to reach out to PHC level in the coming years.
In Sangli district, the annual deliveries are about 50000. With HIV prevalence rate, nearing 4% and the chances of transmission 30%, then without PPTCT care there is a possibility of 600 children per year being born with the virus. Considering this estimate in Sangli district, the NGOs and Zilla Parishad initiated an unique program of 100% ANC, baby coverage with PPTCT along with linking both of them to ongoing care, support and treatment before, during and after delivery. The initiation is still in its infant stage, and we are all waiting to see its results. The NGO came with the package of providing PPTCT kit required during delivery to be given to mother to prevent transmission. The local NGO, which is already working in every PHC, took the responsibility of providing Counseling services to the pregnant mothers and families. The Zilla Parishad with a CEO, who is optimistic and has a social approach, arranged for support with funds of about 10 – 15 Lakhs from its on going programs like RCH, NHRM etc. These funds helped to provide ongoing care; support and treatment before, during and after delivery both to tested positive mothers and their babies.
We feel that this is an innovative idea that saw the light of day through a trusted Public-Private Partnership.
Dr. Nabeel M. K., Academy of Medical Sciences (ACME), Medical College, Pariyaram, Kannur
We do have a PPTCT program going on here at the Academy of Medical Sciences in the Medical College at Pariyaram. I confirmed with Prof. Rajalakshmi, the Head of the Department of Obstetrics and Gynaecology and also with Prof. T. K. Chandrashekharan of the Department of Medicine, responsible for ART, regarding the efforts for integration of such services. Even though they are not doing it under the banner of "integration" or "horizontalisation" it’s fairly going on in an integrated way; may be because it is in a well established set-up like a medical college. I shall narrate the system briefly.
As usual, there is a counsellor who does the pre-test and post-test counselling to the client and the partner. Apart from the primary objective of the program of preventing the transmission of infection to the offspring, after proper evaluation both by the counsellor and the medical personnel, wherever required, she is given advise for consulting the physician responsible for ART; who based on set guidelines will be taking care of rest of the medical care. Also referrals to the Department of Skin and Venereal Diseases are done from the PPTCT unit for other STDs. One draw back we are facing here is that we do not have facility for free ART, which was initially proposed. Out of the six medical colleges including ours, in which it was proposed, it has now been started in five.
As a preparation to this roll out, thankfully our faculty members were also trained along with officers from the other five colleges where free ART is now available. It is hoped that our efforts in integration will be much better when the Government sanctions a free ART centre here which is expected soon; as we are forced to refer un-affording patients to Calicut Medical College which is more than a hundred Kilometers away. For the rest of the patients, drugs are available from the hospital pharmacy at rates less than the outside market. I believe that Integrated services at a much larger scale is established at other medical college hospitals in the state like Kozhikode (Calicut), Thiruvananthapuram (Trivandrum), Kottayam, Alappuzha (Aleppey) and Thrissur (Trichur).
Dr. Shibu Vijayan, Kerala State Health Services, Sree Chithra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (response 2)
In Kerala, SACS is planning to extend PPTCT services up to Taluk level, but the services existing is also not up to the mark even though the turnover is encouraging. I feel integrating these services, with ICDS, through Anganwadis will help to reach out to a wider section of this target group. Thus the mothers referred to concerned sub-centers, and from there to Taluk level centers, will be able to access these services.
The major gap is in the private sector, where testing without any counselling is rampant. If a mother is found positive, the norm in the private sector is to shunt the victim to the nearest Government Hospital, PHC, or sub-centre. This also can be addressed by agencies like IMA and Obstetricians and Gynecology associations taking a lead role in enforcing ethics among its members. The government could have a uniform PPTCT policy for both private and public, and they can make sure that these policies are implemented.
Waseem, Rizvi College of Management, Mumbai
http://mohfw.nic.in/CONCEPT_NOTE_-_HIV-AIDS_COMPONENT.doc provides the 'Concept Note on inputs to HIV Component of GFATM Round-6'. The India – Country Coordinating Mechanism (India-CCM) for the GFATM at its last meeting on 11th May 2006, has resolved to focus the entire Round-6 proposal on care, support and treatment. One of the potential areas for collaboration stated in this document is between the Private and Public sector in Prevention of Parent to child transmission.
Dr. Yamini Thankachy, Kerala State AIDS Control Society (KSACS), Trivandrum
There are 14 PPTCT centers, one in each district of Kerala, based at the Government Medical Colleges and at the District Hospitals. Here women at the Antenatal clinic are screened for HIV through a rapid test after a session of group counselling by the Counsellor at the PPTCT. If the test is positive, the woman is asked to meet the doctor with the spouse and they are referred to the VCTC for the confirmation tests. The HIV status is not revealed at the PPTCT. AT the VCTC, they go through the process of pretest counselling, testing and post-test counselling when the HIV status is revealed. The PPTCT unit is just next to the Antenatal OP. Now the concept of ICTC or integrated counselling and testing centre is being adopted for all the hospitals, which has both the VCTC and PPTCT so that it is one single unit. Here both the antenatal screening and the testing with counselling will be done at the same place. The person will not have to move from one testing facility at the PPTCT to another at the VCTC to confirm it. Thus, the services will be integrated at a single unit. This also saves time, resources, and manpower needed.
Dr. Deepa Burman, University College of Medical Sciences, Guru Teg Bahadur Hospital, New Delhi
Guru Tegh Bahadur Hospital in Delhi is the hospital where I work. Here, we have organized a small program to create awareness, identify the ANC sero-positive HIV cases, their follow-up on the administration of ART to them. The Departments involved are Pathology, Microbiology, and Gynaecology. We have just started and we are yet to see how far we can proceed.
Dr. Anitha P. M., Calicut Medical College, Calicut
We, at Calicut Medical College (CMC) Kerala do fortunately have PPTCT, VCTC (Jyotis) and an ART clinic in the same campus. Hence, we are to a certain extent able to integrate our services effectively.
All antenatal women attending the Maternity section are tested for HIV status at PPTCT after counseling. As only a rapid test is done at the PPTCT, positive patients are forwarded to the VCTC which is attached to the Department of Microbiology. Here the patients are again counseled and a confirmatory report is given after doing three tests. The patient is then referred to the ART clinic in the Department of Medicine for further management. A two-drug or three-drug prophylaxis depending on the CD4 counts, is then given free of cost. Patients are also referred to Specialty clinics like STD, Psychiatry and other clinics as is necessary. We, at the VCTC also are linked with RNTCP. So the patients do get benefit of DOTS, if needed. We also extend moral and monetary support to our patients by linking them with the various non-governmental organizations (NGO), PSH projects, pain and palliative care, etc.
We do have problems at times in dealing with very poor patients and destitute. However, most of our patients do seem satisfied with our services. Well, this is how our set up is. If you do have any queries, please contact me.
Dr. Homyar Keki Gardin, Tata Steel's Family Initiatives Foundation (TSFIF), Tata Steel Ltd., Jamshedpur
Greetings from Core Group - AIDS, Tata Steel. PPTCT program is one of the many interventions in HIV/AIDS undertaken by Tata Steel. I am sharing our experience herewith:
Tata Steel Family Initiatives Foundation (TSFIF) is a Trust sponsored by Tata Steel, and has been working in Jamshedpur for the past fifty years reaching out to the community with family planning and reproductive health services. It covers a heterogeneous population of over one million, including adolescents and youth, industrial workers, slums dwellers and those from the indigenous tribes of the area. TSFIF currently operates 20 antenatal clinics across Jamshedpur. Interventions pertaining to Adolescent Reproductive Health, Sexually Transmitted Infections (STIs) and HIV/AIDS are given a priority.
Need assessment in the community, including PLHIV, expressed a need for a centre free from stigma and discrimination, which would address the issues of PLHIV. TSFIF set up a “Single window” health delivery concept, Sneh Kendra. Apart from the Preventing Parent to Child Transmission (PPTCT) program this centre also provides Pre & Post test counselling for HIV, referral linkage with Government VCCTC, STI counselling and treatment, treatment of Opportunistic infections, Highly Active Anti-Retroviral Treatment (HAART) prescriptive advice and treatment adherence counselling, vocational training of members from families infected and affected by HIV and condom use promotion.
Pregnant women who attend any of the TSFIF Ante-Natal Clinics for their check up are assessed to identify those “at risk” and are offered the “Opt out” model for VCCTC. Those who subsequently test positive are regularly monitored and linked to designated hospitals, including Tata Main Hospital, which has always provided “treatment without discrimination”, for admission during labour to ensure safe delivery in a hygienic environment. We follow the WHO protocol of Nevirapine given to mother and baby followed by course of AZT, provided free of cost. The program also ensures, that should an HIV+ pregnant woman, who has never attended a TSFIF Ante natal clinic, get admitted for delivery, she will by default also benefit from the Nevirapine protocol.
After delivery, linkage is offered to Sneh Kendra for post-natal check up of these HIV positive women and for immunization of the baby. The spouse is encouraged to participate in all visits and play an active role in his family's well-being. To increase the reach of the PPTCT programs Peer leaders are identified in the community and trained. Internal and external experts are invited to conduct training and workshops for capacity building of knowledge and skills of all stakeholders in health and community-based care and support services on a regular basis. Regular workshops are held with the Obstetrics and Gynecology fraternity on latest developments in PPTCT protocols.
Dr. Kusum Gopal, London School of Economics, United Kingdom
In my work on MCH care in India, I noted that in instances where pregnant women tested positive they did not have the care that is ministered as stated in the Calicut experience by Dr. Anitha. Most of my work was in urban, semi-urban and rural regions.
In most cases, there was no availability of antiretrovirals or counselling. That is why I feel rather strongly that we recognize as medical and health practitioners the need for a much stronger involvement in social practices and participate in this at all levels.
I would like to suggest that we could keep the mandatory case sheet about each patient and note in them how she has been infected with HIV. These records will be extremely valuable for understanding the variety of problems, MCH practitioners experience. It can be written in any language, but it must be done.
Dr. Santosh S. Bagali, Consultant, Bijapur
The information provided at http://data.unaids.org/pub/Report/2006/2006_country_progress _report_india_en.pdf is the UNGASS INDIA REPORT. It is the Progress Report on the Declaration of Commitment on HIV/AIDS at the United Nations General Assembly Special Session on HIV/AIDS. Relevant section of page 10 is quoted below my signature. It could be of use to present the country's performance.
REDUCTION IN MOTHER-TO-CHILD TRANSMISSION
Program on Prevention of Parent-to-Child Transmission (PPTCT) of HIV has been given a high priority by the Government of India. The programme that was initiated in December 2002 has been scaled up to 488 PPTCT centres by December 2005. More than 90 percent of these centres are spread in the 6 high prevalent states, with Tamil Nadu having the maximum (193) centres. Cumulative data on the route of transmission among reported AIDS cases in India points out that perinatal transmission accounts for 3.6 percent of the total AIDS cases (NACO-CMIS 2005). Among the estimated 27 million pregnancies in India around 30 percent of deliveries take place in government institutions, 40 percent in private institutions and around 30 percent are non-institutional deliveries. With a 0.7 percent prevalence rate among ANC attendees, this translates into 189,000 infected pregnancies per year. At the estimated rate of 30 percent transmission of HIV from mother to child, there exists a cohort of 56,700 infected newborns per year.
Article 54: By 2005, reduce the proportion of infants affected with HIV by 20 percent and by 50 percent by 2010 by ensuring that 80 percent of pregnant women accessing antenatal care have information, counseling and other HIV prevention services available to them, increasing the availability of and providing access for HIV infected women and babies to effective treatment to reduce mother-to-child transmission of HIV, as well as through effective interventions for HIV infected women, including voluntary and confidential counseling and testing, access to treatment, especially antiretroviral therapy and, where appropriate, breast-milk substitutes and the provision of a continuum of
Comparing this with the coverage of PPTCT services, it is found that only 3.94 percent avail PPTCT services starting from the counselling stage onwards. Further, among those pregnant women who are expected to be HIV positive, 2.74 percent receive antiretroviral prophylaxis. Hence there is a shortfall of 18.83 percent in achieving UNGASS goal of 20 % coverage for 2005.
The high prevalence states of Andhra Pradesh, Maharashtra (including Mumbai with a total population of 18 million), Karnataka, Tamil Nadu, Manipur and Nagaland have a total population of 325 million with a pool of 27,105 infected babies delivered by 90,349 HIV positive pregnant women annually. In order to achieve the UNGASS goal of 2005 for these states, 5,427 babies need to be protected and Nevarapine need to be administered to 10,842 babies likely to be born from 35,799 HIV positive mothers. In order to reach them, approximately 2.88 million pregnant women need to be covered.
- In order to achieve UNGASS goals it is necessary to scale up PPTCT services to CHCs and PHCs by at least 50% by 2005/2006.
- Since a significant number of expectant mothers access institutions in the private sector, PPCT services provided through the private sector need to be enhanced by 50% by 2005/2006.
- Quality of services needs to be improved in the existing centres in order to retain all women coming to these centres.
Amrik Kapoor, Consultant in HIV and Reproductive Health, New Delhi
Integrating PPTC programs with Care and Support will go a long way for both HIV prevention cum management as well as fulfilling the MCH ideals.
Though I am not currently actively involved with the integrated mother and child development services in the country, a few years ago before I took up HIV education assignment with the UNDP, I had a brief stint to serve as one of the country managers assisting in overseeing integrated MCH services in various southern states under World Bank assisted projects. Tamil Nadu happened to be one of the States implementing it.
My experience shows that a very close networking with the Anganwadis can answer your vital concerns raised. The aims of both the programs seems be to safeguard the most vulnerable segments of our society from untold risks may it be malnutrition or contraction of HIV via the mother. Though I am not in active touch, I believe a close proximity between the two might already be on the ground in government programs, with the dynamic NACO head having stewarded such services. Their integration will provide big relief for the pregnant mothers not only in prevention and an early diagnosis of these maladies but also a timely care may be to keep the disasters at bay. This integration needs to be pursued with full vigor and commitment since it will ensure speedier results than many of our other interventions.
Many thanks to all who contributed to this query!
If you have further information to share on this topic, please send it to Solution Exchange for the AIDS Community in India at aids-se@solutionexchange-un.net.in or MCH Community at
se-mch@solutionexchange-un.net.in with the subject heading ‘Query: Integrating PPTCT Programs, from SAATHII, Chennai (Experiences; Advice)
Disclaimer: In posting messages or incorporating these messages into synthesized responses, the UN accepts no responsibility for their veracity or authenticity. Members intending to use or transmit the information contained in these messages should be aware that they are relying on their own judgment.
Copyrighted
under Creative Commons License “Attribution-NonCommercial-ShareAlike
2.5.” Re-users of this material must cite as their source Solution Exchange
as well as the item’s recommender, if relevant, and must share any derivative
work with the Solution Exchange Community.
|
|
|
|
|
|
Solution
Exchange is a UN initiative for development practitioners in
Download This Consolidated Reply – PDF (203 KB)