ࡱ> GIDEFq` bjbjqPqP .::|||||||t*r*r*r*rsbnsJxxxxzd}~$hf`5|$z"z$$5||xxJ222$B|x|x2$22r[t||xs \DSP*rfϦ|`0ݦƬƬ|Ƭ|g,~2=ɐ[~~~55( ~~~$$$$bbbd+Fd+bbbFd||||||  INCLUDEPICTURE "http://www.solutionexchange-un.net.in/images/icon_hiv.jpg" \* MERGEFORMATINET AIDS Community INCLUDEPICTURE "http://www.solutionexchange-un.net.in/logo.gif" \* MERGEFORMATINET  INCLUDEPICTURE "http://www.solutionexchange-un.net.in/images/icon_health_top.jpg" \* MERGEFORMATINET Health  Maternal and Child Health Community AIDS Community Maternal and Child Health Community Consolidated Reply Query: Integrating Counselling Services, Gujarat State Network of People Living with HIV, Surat (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: Jitendra, Gujarat State Network of People Living with HIV, Surat Posted: 01 October 2006 My name is Jitendra and I work as the Project Officer at the Gujarat State Network of People Living with HIV. At present there are various services provided through the HIV intervention programs particularly in Counseling. We are having three kinds of Counselling service centers. There are the Voluntary Counselling and Testing Centers (VCTC), the Prevention of Parent to Child Transmission (PPTCT) Centers and the Tele Counseling Centers in our area. In many hospitals, all these three or at least two are working. Thus, instead of focusing on one center we are allocating resources in a duplicate manner. Instead of establishing multiple centers for related services within the same premises we could strengthen existing centers with extra man power or other needs like infrastructure or materials. Then all the required services will be available under one roof and people can access all these easily and with more anonymity. In the present situation the patients go to one center, the counselor conducts counseling there; then the patient is referred to another center where also the counselor conducts sometimes the same counseling. This wastage of resources and the time of patient could be saved if there is only one integrated center. Resources thus saved could be used to open centers in different premises so that more of the population could be covered. Moreover, it will be easy to refer clients by the NGOs, other organizations and doctors who are working with PLHIV some of whom may require additional STI and RCH services. Suggestions to integrate the DOTS Centers have also been heard. Considering these NACP-III has proposed an Integrated Counseling and Testing Centre (ICTC). I would like to know the views of all of you specifically on: What are all the services that can be covered under the ICTC? Where should we draw the line for integration of services? How can we de-stigmatize ICTC services?  Responses received, with thanks, from: 1.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "hashim#hashim" S. Hashim Aadil, PRAGATI, Hyderabad 2.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "davidson#davidson" Davidson S. Solomon, Solomon center, Chirala 3.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "rajeev#rajeev" Rajeev Sadanandan, Consultant, New Delhi 4. Raja Solomon, Solomon center, Chirala ( HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "RajaSolomon#RajaSolomon" Response 1;  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "RajaSolomon2#RajaSolomon2" Response 2) 5.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "shalini#shalini" Shalini Khare, Independent Consultant, Kanpur 6.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "sanjeev#sanjeev" Sanjeev Kumar, Social Consulting, Hindustan Latex Family Planning Promotion Trust (HLFPPT), New Delhi 7.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Subhi Quraishi, ZMQ Software Systems, New Delhi 8. P. Joshila, International Labour Organisation, Delhi ( HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "joshila#joshila" Response 1;  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "joshila2#joshila2" Response 2) 9.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "aravinda#aravinda" Aravinda Devi, Project Support Unit, Andhra Pradesh State AIDS Control Society, Hyderabad 10.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "prakash#prakash" Prakash Nayak, State Water and Sanitation Mission, Bhubaneswar 11.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "rina#rina" Rina Dey, Core Polio USAID PLUS, Gurgaon 12.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "sherry#sherry" Sherry Joseph, International Planned Parenthood Federation, New Delhi 13.  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "sonalzavery#sonalzavery" Dr. Sonal Zaveri, Consultant, Mumbai Further contributions are welcome!   HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "summary#summary" Summary of Responses  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "comparative#comparative" Comparative Experiences  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "relatedresources#relatedresources" Related Resources  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "responsesinfull#responsesinfull" Responses in Full  Summary of Responses The experience-sharing regarding integration of counselling services received a wholesome response from the two communities. The members found integration to be effective in not only addressing various issues in a holistic manner but also reducing the stigma attached to Voluntary Counselling and Testing (VCT) services. The integrated centers can provide a single window system by pooling all Counselors and Lab Technicians working in ICTC, PPTCT, Blood Safety, STI, ART, OIs and HIV - TB together to offer round the clock counselling and testing services. Integration will enable both patients and clients to avail the facilities of counselling and testing established into the hospital system. Moreover, it will address the issues of prevention, care, support and treatment in one go in health care delivery system, and remove fear, stigma and discrimination among clients, patients, PLHIV and the referrals. What are all the services that can be covered under the Integrated Counselling and Testing Centre (ICTC)? The immediate candidates for integration, members felt, are Family Planning and Sexual Health counselling. Suggested was the integration of their counselling components that include Behavior Change, Prevention, RTI Management, Condom Promotion and Breast Feeding with those of VCT and Prevention of Parent to Child Transmission (PPTCT) programs. Respondents also recommended introduction of counselling on Drug Addiction, cancer, diabetes, other STI, Pre and Post-natal Counselling, General Health Counselling, Child feeding, Nutritional Counselling, Child Behavioral Counselling, Adolescent Counselling, Reproductive Health Counselling for the ICTC. Counselling of blood donors, members opined, are imperative as transmission of HIV, Hepatitis and other diseases occurs by blood transfusion. Respondents also felt that a pre-requisite for ICTC is strengthening the existing private and public health infrastructure in its entirety, through training that includes management information systems (MIS) and skills relevant to HIV and STI. Gender sensitization is important as women are biologically more vulnerable to acquiring RTI or STI and consequences of STI in women are more serious such as ectopic pregnancy, pelvic inflammatory disease and still births. Discussants mentioned that counselling must be a service by itself and the counselors given training in providing all types of counselling. However, some members raised a concern about de-segregating counselling and the extent to which it lowers the quality of services. Members provided several comparable examples of comprehensive package of information and service provision to the communities. Delhi State AIDS Control Society (DSACS) in its pilot project Mobile Integrated Testing and Wellness Access (MITWA) provide HIV Counselling, Testing and Syndromic Management of STI along with general medicines. In a Targeted Intervention program of Andhra Pradesh the Peer Educators are trained on basics of HIV, HIV-TB co-infection and the importance of HIV testing in Ante-Natal mothers which helps in identifying TB cases, making them access DOTS services and in motivating Ante-natal cases to access PPTCT centers. However, in three medical colleges of Orissa, the VCTC is located at the Out-Patient Department under the Department of Microbiology while the PPTCT is located in Obstetrics and Gynaecology. Discussants quoted numerous examples of home based or mobile VCT services at the request of a member. Where should we draw the line for integration of services? Members suggested that in integration of services the caseload would be a key issue. Some discussants mentioned that the increased caseload of integrated counselling centers would decide the number of counsellors they eventually employ. Some respondents felt, the physical integration of all the services might not be a feasible idea, especially on a tertiary care level. Here, there are limitations from the infrastructure point of view as already established departments like RCH, STI, TB, Skin and STI function independently. Therefore, only a thematic integration is possible. However, at the CHC or PHC levels such a physical integration is feasible as there is less scope for specialized care as they serve more as screening mechanisms for referral services. So, as a first step towards the merger members suggested integrating patient data in these local centers. How can we de-stigmatize ICTC services? Discussants suggested that the best way to de-stigmatize the ICTC service would be introduction of various services instead of keeping the centre HIV specific. Marketing of such centers as integrated counselling and testing centers through print and electronic media helped diminish discrimination. They felt that for stigma reduction and bringing in more positive results, a continuous contact and information dissemination is important. Along these lines, members recommended awareness campaigning in the communities as well as promoting AIDS awareness in the schools Respondents recommended that it is important to demonstrate the effectiveness of VCT services and to challenge discrimination so that people are no longer reluctant to be tested. Besides, the participation of a PLHIV can encourage a supportive environment of openness and may play a crucial role in creating a favorable ambiance for voluntary testing. Members surmised that community participation and the involvement of PLHIV are essential if these services are to be acceptable and relevant. Local players like Community Based Organizations and groups, respondents affirmed, could be encouraged to expose and address gaps in the system as well as support the setting up of community watchdog committees. In addition, constant provision of information on quality standards, monitoring and evaluation methods and management skills are necessary for the proper functioning of the ICTC. Discussants decided that convergence of HIV control programs with Health and Family Welfare programs would ensure effective service delivery. Therefore, respondents concluded that integration helps prioritize interventions, based on prevalence, infrastructure, current program efficacy, and resources. Furthermore, increased technical competence in HIV prevention and care interventions, strong infrastructure and shared resources would provide the larger capacity to reach out to wider sections of the community.  Comparative Experiences Comparative Experience Integrating Counseling in PPTCT Delhi Mobile Integrated Testing and Wellness Access (MITWA) (From  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "joshila2#joshila2" P. Joshila, International Labour Organisation, Delhi) Delhi State AIDS Control Society (DSACS) initiated a pilot project, Mobile Integrated Testing and Wellness Access (MITWA). In this unique model HIV Counseling, Testing, Syndromic Management of STD along with general medicines are provided through mobile vans in various slum and JJ clusters of Delhi. It is a comprehensive package of information dissemination and service provision to the communities. Andhra Pradesh Targeted Intervention program (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "aravinda#aravinda" Aravinda Devi, Project Support Unit, Andhra Pradesh State AIDS Control Society, Hyderabad) Project Support Unit (PSU) is implementing Targeted Intervention program in Andhra Pradesh. The Peer Educators (PEs) are trained on basics of HIV, HIV-TB co-infection and on the importance of HIV testing in Ante-Natal mothers. The Peer Education system is working well in integrating the services at the community level. The PEs have a reporting card where in they log the above details. Mainstreaming AIDS programme through RCH (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi) In India, CRS runs 71 programs in 15 states; the focus is on mainstreaming HIV/AIDS through the current RCH programs. In Andhra Pradesh, CRS has a three-pronged strategy that includes institutional strengthening, community support and self-help groups of women or youth. Gender and stigma issues are addressed through mutual support groups. Locale-specific IEC materials have been developed in the regional language. Orissa Integrated Counselling Centres in Medical Colleges (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "panda#panda" Dr. Sadhu Charan Panda, V.S.S.Medical College, Burla) In three medical colleges of Bihar state, the VCTC is located at the Out-Patient Department and is under Department of Microbiology. PPTCT is located in Obstetrics and Gynaecology. The idea of voluntary testing, counselling, ANC, STI, TB etc., under one roof is proving good. Tamil Nadu PPTCT & VCTC integrated with Womens Health Programmes (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi) ADRA works in Tamil Nadu on polio eradication and has also been involved in relief and rehabilitation post-tsunami. While working with the womens health programs, VCTC and PPTCT interventions have been integrated with the main stream programmes. They also have strong collaboration with the district administration. Gujrat (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi) VCTC & PPTCT in Hospital Setting Sir Sayajirao Gaikwad Hospital has 1500 beds along with one VCTC and one PPTCT service. All technical and paramedical staffs have been trained in HIV/AIDS services. VCTC, NGO liaisons and related trainings are implemented in collaboration with GSACS. Physicians are given a one-day orientation on HIV/AIDS. The outpatient Dept. treats 120 patients each day, 6 10 of whom are referred for HIV counseling. PPTCT Services A PPTCT service is located at the antenatal clinic. Cases are referred from the pediatric or gynecology department. The counselors provide basic information in a group setting, while difficult cases are counseled individually. Clients are women who bring along a friend, neighbor, a relative or mother-in-law. A support meeting for persons living with HIV/AIDS is held every month.  Related Resources Recommended Documents UNGASS India Report (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "hashim#hashim" S. Hashim Aadil, PRAGATI, Hyderabad) By UNAIDS; 2006  HYPERLINK "http://data.unaids.org/pub/Report/2006/2006countryprogressreportindiaen.pdf" http://data.unaids.org/pub/Report/2006/2006countryprogressreportindiaen.pdf(Size: 787.86 KB) Addresses requirements including integration of services to expand healthcare access and mitigate the HIV epidemics impact in India Convergence Between The National AIDS Control Programme (NACP) And The Department Of Health And Family Welfare (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "davidson#davidson" Dr. Davidson S. Solomon, Solomon center, Chirala) By National AIDS Control Organisation and Department of Family Welfare; January 2005  HYPERLINK "http://mohfw.nic.in/Convergence%20plan%20between%20NACP%20and%20DOHFW.htm" http://mohfw.nic.in/Convergence%20plan%20between%20NACP%20and%20DOHFW.htm The paper provides a framework for action to address the major convergence areas for scaling up HIV prevention responses Workshop Report Community-Based Programming for Prevention of Mother-to-Child Transmission of HIV and HIV Counseling and Testing (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi) By Sanjay M. Joshi (for Counterpart/India); Ahmedabad; May 16-20, 2005  HYPERLINK "http://www.coregroup.org/working_groups/India_HIV_Workshop_May%202005.pdf" http://www.coregroup.org/working_groups/India_HIV_Workshop_May%202005.pdf(Size: 647.94 KB) Workshop report stresses on importance of coordinating efforts in an integrated manner in HIV prevention programs Reducing Vulnerabilities of Young Women to STI / HIV / AIDS, Draft District Strategic Plan for Kishanganj District, Bihar (from P. Joshila, International Labour Organisation, Delhi,  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "joshila#joshila" response 1) by the CHARCA Steering Committee; Kishanganj; January 2002  HYPERLINK "http://www.youandaids.org/Charca/Resources/DSP%20Kishanganj.pdf" \l "search=%22Reducing%20Vulnerabilities%20of%20Young%20Women%20to%20STI%20%2F%20HIV%20%2F%20AIDS%2C%20Draft%20District%20Strategic%20Plan%20for%20Kishanganj%20District%22" Read More Strategic plan stressing on holistic approach to increase capacities of young women to protect against STI and HIV infections Integrating Voluntary Counselling and Testing-Guidelines for programme planner managers and service providers (from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "sherry#sherry" Sherry Joseph, International Planned Parenthood Federation, New Delhi) By International Planned Parenthood Federation and United Nations Population Fund; 2004  HYPERLINK "http://content.ippf.org/output/ORG/files/6139.pdf" http://content.ippf.org/output/ORG/files/6139.pdf (Size: 528.39 KB) Emphasizes on integrating voluntary counseling and testing for successful implementation with other HIV prevention programs Family Planning and HIV/AIDS Integration (from  HYPERLINK "mailto:emohamed.rafique@undp.org" \o "mailto:emohamed.rafique@undp.org" E Mohammed Rafique, UNAIDS, New Delhi)*  HYPERLINK "http://womenchildrenhiv.org/wchiv?page=wx-resource&rid=20587" \o "http://womenchildrenhiv.org/wchiv?page=wx-resource&rid=20587" http://womenchildrenhiv.org/wchiv?page=wx-resource&rid=20587 Contains several documents and materials stressing on the significance of incorporating family planning and other health programmes with HIV services *offline contribution Recommended Organisations Delhi State AIDS Control Society (DSACS), Delhi (From  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "joshila2#joshila2" P. Joshila, International Labour Organisation, Delhi; (response 2) B.S. Ambedkar Hospital, 1st and 2nd Floor, Dharamsala Block, Rohini Sector-6, Delhi 10085 Tele : (011)2705660, 2705650, 27055725; PD Phone: 23392019  HYPERLINK "mailto:sacs_delhi@nacoindia.org" sacs_delhi@nacoindia.org or  HYPERLINK "mailto:jpkapoor@rediffmail.com" jpkapoor@rediffmail.com Andhra Pradesh State AIDS Control Society (From  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "aravinda#aravinda" Aravinda Devi, Project Support Unit, Andhra Pradesh State AIDS Control Society, Hyderabad) Directorate of Medical & Health Services, Sultan Bazar, Hyderabad-500059 Tele: (040)-24657221, 24650776; Mobile: 9848015885  HYPERLINK "mailto:sacs_andhra@" sacs_andhra@nacoindia.org ADRA (Adventist Development & Relief Agency International) India(from  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.htm" \l "quraishi#quraishi" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi)  HYPERLINK "http://www.adra.org/site/PageServer?pagename=sos_progress_india" http://www.adra.org/site/PageServer?pagename=sos_progress_india  Responses in Full  HYPERLINK "mailto:pragatiindia1@rediffmail.com" S. Hashim Aadil, PRAGATI, Hyderabad  HYPERLINK "http://data.unaids.org/pub/Report/2006/2006_country_progresreport_india_en.pdf" http://data.unaids.org/pub/Report/2006/2006_country_progresreport_india_en.pdf is the UNGASS INDIA REPORT, as Dr. Santosh has pointed out in the previous query. It gives the Progress Report on the Declaration of Commitment on HIV/AIDS at the United Nations General Assembly Special Session on HIV/AIDS. The relevant section for Service Delivery is Page 36, which is quoted below my signature. The components that need to be integrated are emphasized by me. Of the nine recommended service delivery components, the six that are emphasized could be integrated. Service delivery: Scaling up of VCTC and PPTCT services both in number and quality of services offered is essential. Prevention and care and support needs to go hand in hand Mainstreaming of HIV/AIDS seems to be left primarily to NACO. Greater involvement is needed from all players (public and private) So far 31 ministries have been requested to make their action plans for HIV/AIDS and also allocate resources from their own budgets. TI among high risk groups is a successful strategy and saturated coverage of high risk groups through service delivery needs to be addressed along with law reform and sensitisation of law enforcement. 70-80% of health and health related institutional services are provided by the private sector and collaboration with private sector would be a key. Blood safety is important. This is the success story of the NACP where the spread through the route of blood and blood products have been brought down to less than 2%. Efforts need to be placed to ensure that blood transfusion is completely safe. Auto disabling syringes need to be universally used and this aspect also needs to be looked into. In the first phase the PPTCT services would be provided by all CHC and in the second phase it would be expanded up to the PHC level. The ground realities are that a large number of PHC are not functional and this needs to be changed through concerted efforts For 1, 80,000 people to be on ART is a huge commitment and the drug costs have been provided for only the first line of drugs. Second line requirement has emerged and the implications for resource requirement are far higher. ART service provision has been criticized for not reaching the targets in terms of numbers but the achievement in terms of number of centres providing services has been ignored. The target of 100 centres providing ART would be achieved by 2005 and the target of 1, 80,000 by 2010 on ART would be achieved through 280 centres providing ART. This itself is not adequate because service capability to reach all PLHA needs to be there and private sector must play an equal role in providing universal access to ART services.   HYPERLINK "mailto:update_shadows@rediffmail.com" Dr. Davidson S. Solomon, Solomon center, Chirala The web page at  HYPERLINK "http://mohfw.nic.in/Convergence%20plan%20between%20NACP%20an%20d%20DOHFW.htm" http://mohfw.nic.in/Convergence%20plan%20between%20NACP%20an d%20DOHFW.htm contains a document entitled, "CONVERGENCE BETWEEN THE NATIONAL AIDS CONTROL PROGRAMME (NACP) AND THE DEPARTMENT OF HEALTH AND FAMILY WELFARE (DOHFW)" Given below my signature is two paragraphs and a figure from the introductory section to enthuse you to read the whole page. Convergence between the National AIDS Control Programme (NACP) with over a decade of experience and technical competence in HIV/AIDS prevention and care interventions and the Health and Family Welfare programmes (HFW) with its infrastructure, human resources and capacity reach to every village and community is critical to ensure scaling up and effective service delivery. 1.4 Behavior Change, prevention/management of RTI/STI and condom promotion are the cornerstones of HIV/AIDS prevention. All three areas have a significant degree of overlap with interventions in the Reproductive and Child Health programme, since target groups and services fall in the same arena. Other areas of prevention linked to HIV/AIDS interventions and which have implications for services in the HFW are Voluntary Counseling and Testing, (VCTC), Prevention of Parent to Child Transmission (PPTCT), and ensuring safety of blood and blood products. Comprehensive HIV/AIDS Programmes include components of both prevention and care. VCTC and PPTCT are two areas of overlap between prevention and care strategies. Areas of cross cutting importance that need to be addressed in prevention and care strategies include: gender, private sector involvement, and reduction of stigma and discrimination among health care providers and communities   HYPERLINK "mailto:rsadanandan@gmail.com" Rajeev Sadanandan, Consultant, New Delhi The logic Jitendra has captured is the basis of the ICTC centre. The two services that will be candidates for integration straight away are PPTCT and VCT. As ART gets more strengthened backing up psycho-social support to persons on ART primarily provided by PLHIV networks and other CSOs, will get added. The key factor will be the case-load. In areas where the case-load exceeds what can be managed by two counsellors additional counsellors would be added. Where the numbers of persons on ART are substantial, a peer counsellor will be insisted upon. NACO will frame these as part of operational guidelines for NACP.   HYPERLINK "mailto:rajasolomn777@yahoo.com" Raja Solomon, Solomon center, Chirala (Response 1) Counseling is broad area for mastering and de-segregation helps in the increased quality of services by specialization of the field. In a Microscopic view, there is a lot of variations in approaching the client and getting to know the background. Combining or integrating this would dilute these factors. Secondly, Integrated Counseling and Testing Centre (ICTC), in resource poor settings would increase the client load per counselor, because, the programming and budgeting have a lot of gaps in between. In this Integrated Counseling and Testing Centre (ICTC), scaling down of the staff numbers could be reasonable and will be an important issue. This means that present staff structures will face over loads as will the present counselors. Disclaimer: The views expressed reflect my personal perception of the issues and not any organization(S).   HYPERLINK "mailto:drshalz@rediffmail.com" Dr. Shalini Khare, Independent Consultant, Kanpur Answering to your query, in my opinion, I feel that the ICTC can introduce counseling for other things such as drug addiction, cancer, Diabetes and other STI's. Besides the best way to de-stigmatize the ICTC service would be by introduction of various types of lab tests as any pathology lab would do. So, for instance, if a even a basic CBC test for Blood sugar level is also conducted there, people will feel more at ease and will be more comfortable coming in for tests. Hence, instead of keeping the centre HIV specific, it might help to diversify the services.   HYPERLINK "mailto:sanjeevkumar@hlfppt.org" Dr. Sanjeev Kumar, Social Consulting, Hindustan Latex Family Planning Promotion Trust (HLFPPT), New Delhi Are there any home based or mobile VCT services tried in India? Where? By whom? And what have the responses? Are there any international examples of the model? Why do we want people to come us? Can we go to them? I am not meaning a camp approach of health melas. I hear something like this has bee tried in Uganda? Does this address the confidentiality issue? Will it be useful in a high risk/high prevalence district?   HYPERLINK "mailto:zmq@vsnl.com" Dr. Subhi Quraishi, ZMQ Software Systems, New Delhi  HYPERLINK "http://www.coregroup.org/working_groups/India_HIV_Workshop_May%202005.pdf" http://www.coregroup.org/working_groups/India_HIV_Workshop_May%202005.pdf gives a report of a Workshop entitled, Community-Based Programming for Prevention of Mother-to-Child Transmission of HIV and HIV Counseling and Testing, May 16-20, 2005, Ahmedabad, Gujarat, India. It is full of examples of strategies that integrate VCTC, RCH, STI, TB and Care programs.   HYPERLINK "mailto:joshilla@ilodel.org.in" P. Joshila, International Labour Organisation, Delhi; (response 1) From the page at  HYPERLINK "http://www.youandaids.org/Charca/Resources/DSP%20Kishanganjpdf" http://www.youandaids.org/Charca/Resources/DSP%20Kishanganjpdf I quote below my signature the page 16 of a plan Prepared by the CHARCA Steering Committee, Kishanganj, called, "Reducing Vulnerabilities of Young Women to STI / HIV / AIDS, Draft District Strategic Plan for Kishanganj District, Bihar developed for The CHARCA Project in January 2002" 3.2.3. Improving access to and quality of STI/HIV Services Existing Situation Most people leave STI/RTI untreated. Those who sought treatment preferred local unqualified practitioners or private practitioners. Absence of lady doctors at Govt. Health Facilities was a reason for not accessing government facilities by women. Awareness about existence of STI/RTI cure/ treatment was mostly among urban respondents in Thakurganj and Diggalbank. 15% of the respondents reported that they were unable to get treatment for STI/RTI and 35% of all respondents were aware of places where STI/RTI could be treated. No Counseling facilities available for any health problem. A VCTC and a STD clinic are being set up. Strategic plan for Improving access to and quality of STI/HIV Services Strengthening the existing health infrastructure (Government, Pvt. Medical College, VCTC, STD clinic and practitioners providing STI care) through training and material incorporating Gender sensitivity and skills relevant to HIV/STI. Advocacy with Govt. departments to ensure provision of Female personnel in the Health Infrastructure. Encouraging local activists to address and expose gaps in the system and encourage setting up of community watchdog committees. Incorporating awareness of existing facilities into content of relevant programmes. Constant provision of information on quality standards, monitoring and evaluation methods and management skills. Identification Provision of training and information resources for counselors, medical and paramedical personnel.   HYPERLINK "mailto:joshilla@ilodel.org.in" P. Joshila, International Labour Organisation, Delhi; (response 2) Dear Dr. Sanjeev Kumar, Delhi State AIDS Control Society (DSACS) initiated a pilot project called Mobile Integrated Testing and Wellness Access (MITWA), a unique model through which HIV Counseling, Testing, Syndromic Management of STD along with general medicines are provided through mobile vans in various slum and JJ clusters of Delhi. It is a comprehensive package of information dissemination and service provision to the communities. Under the leadership of Dr. J. P. Kapoor, the services are reaching to the community. I would suggest that one get in touch with DSACS for more details.   HYPERLINK "mailto:saiaru_24@rediffmail.com" Aravinda Devi, Project Support Unit, Andhra Pradesh State AIDS Control Society, Hyderabad Project Support Unit (PSU) is working with 85 NGOs implementing Targeted Intervention program in Andhra Pradesh. We have 11 partners working with Migrant populations. The Peer Educators (PEs) are trained at first on basics of HIV and later on HIV-TB co-infection Prior to the training on HIV-TB they were able to refer cases only to VCTC but now they are also able to identify TB cases and refer appropriately. This is really shooting up the identification of TB cases as well and helping them to access DOTS services. As regards ANC cases, the PEs are educated on the importance of HIV testing in Ante-Natal mothers and are currently able to motivate ANC cases to access PPTCT centers. The positive cases are counseled for hospital delivery. The Peer Education system is working well in integrating the services at the community level. The PEs have a reporting card where in they log the above details. However, it is important to provide a strong follow up system at the different service centers level.   HYPERLINK "mailto:sukantabbsr17@rediffmail.com" Prakash Nayak, State Water and Sanitation Mission, Bhubaneswar Dear Mr. Sanjeev Kumar, During my Hindustan Latex Family Planning Promotion Trust (HLFPPT) days in Orissa, I went to Durbar Mahila Sammanayee Samiti (DMSS), an NGO working for commercial sex workers in Sonagachi, Kolkata in late 2004. They have used Mobile VCT in different pockets of the city. You could please ask Mr. Bachuda or Dr. Jana to know more details about this program.   HYPERLINK "mailto:no1rinadey@yahoo.co.in" Rina Dey, Core Polio USAID PLUS, Gurgaon Dear Mr. Sanjeev Kumar, Thanks for your mail. Definitely, there are experiences on providing health services through mobile clinics. Some of the organizations I know that work with mobile clinics are: Transport Corporation of India Foundation (TCIF), Delhi, Contact: Dr. Arvind 01243262873 MODI CARE Foundation, Delhi. Bhoruka Public Welfare Trust (BPWT), Kolkata Bhoruka Charitable Trust (BCT) Bangalore, Contact Dr. Surya Prakash, Transport House No. 57/58, 2nd Cross, Kalasipalyam New Extension, Bangalore-560 002 Tel.: 2291738/2222311 Fax : 2224393 e-mail: bctbng@bgl.vsnl.net.in Sewa Dham -Based in Pune Child survival of India-Based in Delhi   HYPERLINK "mailto:sjoseph@ippfsar.org" Sherry Joseph, International Planned Parenthood Federation, New Delhi Details of a document titled, Integrating Voluntary Counselling and Testing-Guidelines for programme planner managers and service providers at  HYPERLINK "http://www.ippf.org/ContentController.aspx?ID=6135" http://www.ippf.org/ContentController.aspx?ID=6135 It is also available as a download (528 KB PDF) at  HYPERLINK "http://content.ippf.org/output/ORG/files/6139.pdf" http://content.ippf.org/output/ORG/files/6139.pdf The guide considers integration within the context of family planning service provision. Family Planning and VCT service provision have similar aims of reaching sexually active people and promoting safe and healthy sexuality, including the prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancy. Family Planning settings offer specific opportunities for reaching women with VCT. There is a continuum of possibilities for integrating VCT services in sexual and reproductive health settings, and this guide supports those considering integration to determine the appropriate VCT components to integrate, and to plan, implement, monitor and evaluate an integrated service. In conjunction with IPPFs UNFPA-supported publication, Programme Guidance on Counselling for STI/HIV Prevention in Sexual and Reproductive Health Settings, this guide supports those overseeing the management of FP, maternal and child health (MCH) or STI services who are considering VCT within their current service provision, as a move toward developing more holistic sexual and reproductive health services. The guide is relevant for both public sector and NGO sector service providers.   HYPERLINK "mailto:zaveri_sonal@yahoo.com" Dr. Sonal Zaveri, Consultant, Mumbai. I have been following the discussions to this query and agree that without integration of counseling services, we cannot make it sustainable. My suggestion for de-stigmatization is that we need to look at counselling as an essential and routine part of any medical advice. This would require a great deal of sensitization of all personnel who communicate with the client, namely the variety of health providers and support staff that the client comes in contact. It is often the body language and language nuances that betray what the person's attitude is although the words used may indicate a superficial acceptance and referral for counseling services. I also do think we should be very careful how we use the word 'counseling' and that quality standards must be maintained - a few minutes of advice does not constitute counseling. These considerations - of capacity building and quality control - become particularly important once integration of services is attempted, as large numbers of staff responsible to different line departments will need to be addressed.   HYPERLINK "mailto:update_shadows@rediffmail.com" Raja Solomon, SHADOWS, Chirala, AP. (Response 2) Please find an abstract that describes the integration of tuberculosis screening into the activities of an HIV voluntary counselling and testing (VCT) centre in a country with endemic tuberculosis at the URL  HYPERLINK "http://cat.inist.fr/?aModele=afficheN&cpsidt=14088280" http://cat.inist.fr/?aModele=afficheN&cpsidt=14088280 The abstract concludes that in areas with a high HIV and tuberculosis prevalence, a high proportion of VCT clients have active pulmonary tuberculosis. The integration of tuberculosis screening offers several benefits, including the diagnosis and treatment of large numbers of individuals with tuberculosis, a decreased risk of nosocomial tuberculosis transmission, and the opportunity to provide tuberculosis prophylaxis to HIV-positive patients in whom tuberculosis has been excluded. Future studies are needed to determine the cost-effectiveness of integrated tuberculosis and HIV VCT services, and whether integration should be recommended in all countries with high HIV and tuberculosis rates.  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  HYPERLINK "mailto:aids-se@solutionexchange-un.net.in" aids-se@solutionexchange-un.net.in or MCH Community at  HYPERLINK "mailto:se-mch@solutionexchange-un.net.in" se-mch@solutionexchange-un.net.in with the subject heading Query: Integrating Counseling Services, Gujarat State Network of People Living with HIV, Surat (Experiences; Advice) Disclaimer: In posting messages or incorporating these messages into synthesized responses, the UN accepts no responsibility for their veracity or authenticity. 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For more information, please visit  HYPERLINK "http://www.solutionexchange-un.net.in/" www.solutionexchange-un.net.in  Download This Consolidated Reply  HYPERLINK "http://www.solutionexchange-un.net.in/aids/cr/cr-se-aids-mch-18100601.pdf" PDF (197 KB) `cdrst4 5 6 7 8 > ? @ A d f g h i w x 疋zeP)hWF5B*CJ OJQJ\^JaJ phf)hWF5B* CJ OJQJ\^JaJ ph hWF5CJOJQJ\^JaJhWF5CJ\aJj4{hWF5CJU\aJ%hWF5B*CJOJQJ\aJphfj5MhWFCJUaJj hWFUjhWFU%hWF5B* CJ OJQJ\aJ phhWFhWFCJaJjhWFCJUaJds8 ? A e f z $IfgdWF`kdL$$If4F`H_  G6    34a$If $$Ifa$ $If[$\$ f g i x ) + " : < $a$gdWF$a$gdWFgdWF`kd{$$If4F`H_  6    34a ( ) * + ! 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