Concept Note on Proposals for HIVAIDS Component of GFATM Round 7

By Joan Ross,2014-05-07 17:14
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Concept Note on Proposals for HIVAIDS Component of GFATM Round 7

    Concept Note on Proposals for HIV/AIDS Component of GFATM Round 7

1. Preamble:

    The intrinsic challenging nature of the virus and heterogeneous socio culture fabric of India has led the Government of India’s response to combat HIV infection with dynamism. National AIDS Control Program (NACP) is being implemented across the country since 1992.

    The activities are coordinated and monitored by the State AIDS Control Societies

    established in all the states of the country. The program lays specific focus on high-risk

    population, local needs and nature of spread of the infection.

NACP has been evolving over the years and has gone through a process of progress and

    expansion by cutting across several boundaries. The response to HIV/AIDS could be seen

    through three phases of National AIDS Control Program. NACP I (1992-99) focused on the

    awareness generation, infrastructure development at states level and promoting prevention

    program particularly blood safety. NACPII (2000-07) moved on further scaling up of

    awareness building, prevention strategies through Voluntary Counseling and Testing (VCT),

    Prevention of Parent to Child Transmission (PPTCT), Targeted Interventions (TIs) for high

    risk vulnerable groups, treatment of Opportunistic Infections (OIs), Blood safety low cost

    strategies for care and support and introduction of Anti-retroviral Treatment (ART).

     NACP III (2007-12) aims at up-scaling above mentioned services, decentralizing

    implementation up to district level, developing Public-Private Partnerships in various

    interventions and mainstreaming various activities with other sectors. It also focuses on

    integration with National Rural Health Mission (NRHM) and other National Health Programs

    notably the Reproductive and Child Health (RCH) program and Revised National TB Control

    Program (RNTCP).

2. NACP-III Framework:

    The commitment of Indian Government is reflected in the design of NACP III with the

    following services provided within different components:

    Preventive Services Care Support and Treatment Services 1. Creating awareness about symptoms, spread, 1. Management of Opportunistic Infections

    prevention and treatment 2. Control of TB in PLHA (RNTCP) 2. Screening for STI and RTI and treatment 3. Anti-retroviral Therapy 3. Condom promotion 4. Outreach community/home based care 4. Integrated Counseling and Testing (ICT) 5. Reducing stigma and discrimination 5. Promotion of voluntary blood donation and

    access to safe blood.

    6. Prevention of Parent to Child Transmission

    7. Promotion of safe practices and infection control

    Targeted Interventions for High Risk Groups 1. STI services IDU (Additional components) 2. Condoms free and social marketing 1. Detoxification, de-addiction and rehabilitation 3. BCC through peer and outreach 2. Needle exchange 4. Building enabling environment 3. Substitution therapy 5. Community organizing and ownership building 4. Abscess management & other health services 6. Linking HIV related care and support services MSM (Additional components)

    1. Lubricants and appropriate condoms

    As per NACP III following are the persons having primary responsibility of service delivery at

    different levels of health care given below:

    Personnel delivering Type of Services Levels of service Services

    1. ASHA (Accredited Social Referring pregnant women for test Health Activities (NRHM states) Creating awareness of HIV

    2. Community Associations Promotion of voluntary blood 1 Community 3. Religious leaders Reducing stigma and discrimination

    4. SHG members

    5. PRI functionaries

    1. ANM (Auxiliary Nurse Midwife) Referring pregnant women for testing, 2 Sub-centre 2. RMP (Registered Medical condom promotion Practitioner)

    1. PHC doctor/Private practitioner STD control and condom promotion

    2. Nurse AIDS case diagnosis and referral PHC/Private 3 3. Lab Technician treatment of OI provider 4. Pharmacist/Dispenser Antenatal care and counseling

    5. Record Keeper Diagnosis of common STIs and OIs

    1. CHC doctor/ Trust hospital STD control and condom promotion

    doctor AIDS case diagnosis and referral

    2. Counselor Treatment of common OIs

    CHC/NGO 3. Nurse Integrated health counselling/testing 4 Hospitals 4. Lab Technician PPTCT services

    5. Pharmacist/Dispenser Diagnosis of common STIs and OIs

    6. Record Keeper Dispensing of OI and STD medicines

    Maintaining record

    1. Specialists Management of complications of HIV

    2. Doctors ART

    3. Nurse Support care

    District Hospitals/ 4. Counselors Integrated counselling/testing 5 Teaching hospitals 5. Lab Technician Diagnosis of STD and OI

    6. Manager Drugs and Supply PPTCT

    Chain Ensuring drug supply at district level

    7. Community Care Coordinator Facilitating access to care and support

    1. NGO/CBO in administering Palliative care, treatment of minor OI,

    CCC and family support STD treatment

    6 NGO/CBO/FBO centres Counseling, social service

    2. NGO/FBO/other managing TI Adherence monitoring

    3. Outreach worker

    4. Areas for Support under GFATM Round 7

    Following areas of NACP-III have been identified for support under Round 7:

(a) Strengthening capacity of training institutes relating to counseling and

    nursing care;

    (b) Implementation of a Link Workers scheme ’ to provide an array of

    preventive/BCC services, through development of multi-sectoral linkages in

    A & B category districts; and

    (c) Implementation of workplace policy in private industries, independently or in

    partnership with NACO.

    (a) Strengthening capacity of training institutes relating to counseling and nursing


    The Program envisages increasing accessibility to services. In order to enhance coverage of the target population, NACO proposes to develop capacity of available Nurses, Doctors and other health care professional, para professionals such as Counselors working in Testing Centres and community members from the target population.

    Since the traditional curriculum of nursing training does not have specific focus on care and treatment component for HIV, NACO plans, to strengthen the competence of nurses and other paramedics to build in systems and skills in care for scaling up the capacity to deal with this public health problem at all levels of health care. Special training packages will be prepared to train, motivate and continuously support nurses for counseling, testing, community preparation for palliative care, administering treatment and monitoring drug adherence.

    The continuum of services consists of a package ranging from prevention, care, support and treatment in keeping with the progression of the disease in the individual and for the community as a whole. At each stage of the disease manifestation at the level of the individual, the households or the community, there is need for consistent counseling and education to prevent the onset of the disease as well as for coping with the disease when it does set in; for ensuring appropriate behaviour for optimizing efficacy of the treatment being administered. In this role of prevention and support, nurses are the first contact point for the community and the individual patients with the providers of care. As the primary care givers, be at the community level either the primary health care and CHCs, district hospitals or the

    medical colleges, in the out-patients ward or for in-patient treatment, nurses bear at least half of the burden of counseling and treating the persons living with HIV/AIDS.

    The shortage of nursing personnel adversely affects the policy to provide access to essential services to women and in particular pregnant women to ensure that HIV positive mothers do not pass their infection to their babies. The nurses played a significant role in a pilot project implemented in Andhra Pradesh, Nursing staff appointed at the Primary Health Centres have proven to be able to provide essential services such as in conducting safe delivery to HIV pregnant women.

    Keeping the above in view, the proposal under Round 7 seeks to encourage schools imparting training in counseling and Nursing Training Institutions in the public sector and the NGO not for profit sector, to develop appropriate capacity for training, concurrent monitoring and building capacities among nurses in the public and private sector. This shall include both public health as well as hospital based nurses in counseling, care and support system, at home and community level for providing access to HIV prevention and treatment among vulnerable groups. Therefore, institutions/organizations interested in providing training to these two categories of care givers and who have the institutional capacity and skills to do so, but requiring additional support both in terms of infrastructure and teaching faculty may apply in the prescribed format. The application can be either by an individual institution or a consortium of institutions, which must have capacity to train a minimum of 1000 nurses/counselors during the next five year period.

    (b) Implementation of a Link Workers scheme ’ to provide an array of

    preventive/BCC services, through development of multi-sectoral linkages in A &

    B category districts

    One of the core activities of the NACP-III strategy is saturation of the high risk group population namely - sex workers, Injectable Drug Users (IDUs), Men having sex with Men (MSM), truck drivers and cleaners and short stay migrant workers in urban and semi-urban areas. For total saturation of these groups, the NACP-III envisages the use of link workers- residents of villages/towns of not more than 5000 population. It is envisaged that these persons who would be in the age group of 19-25 years would be allotted some 10-15 villages depending on the geographical proximity in that area, where they will identify high

    risk and highly vulnerable households and provide them intensive prevention education to protect them from getting the infection. Alongside, the link workers would also be expected to actively work with the community and based on the mapping of civil society resources available, mainstream HIV prevention messages with the Panchayati Raj bodies, Mahila Mandals, self-help groups, youth clubs, school children etc. The objective is to ensure that these peripheral areas in high prevalence districts are protected from HIV/AIDS.

    Link workers will also be expected to encourage those they feel may be least willing to undertake testing, provide psycho-social support at the house-hold level to the HIV infected persons, develop an enabling environment in the community which is non-discriminatory and ensure that the HIV-infected get support of the community and also access to critical services at all times. Since youth will be the focus, the link workers will be expected to run youth clinics once a week, where they can impart necessary information, clarify doubts and help the youth to cope up with their vulnerability to the HIV infection.

    The NACP-III envisages the link workers scheme to be implemented in 186 districts which have high prevalence of HIV or a highly vulnerable to HIV infection. The list of districts is annexed (Annex-1).

    NGOs, community based organizations, faith organizations, etc. having a good capacity to implement such community based strategies and link workers scheme could apply with the minimum unit eligibility of the coverage being of one district.

    (c) Implementation of workplace policy in private industries, independently or in

    partnership with NACO.

    The private sector in India is estimated to employ 8-10 million work force. In addition, an estimated 4 million could be the population that lives and sustains on the industry by providing support services to those working in the industries. Workplace policy implies having a non-stigmatizing and non-discriminatory policy against the HIV infected; ensuring that all workers - white collar, blue collar, manual, direct or informal, contractual or regular - are provided information on HIV infection, counseled to change behaviour among those prone to high risk behaviour practices and life styles and motivate/encourage them to undertake testing to know their status for not only preventing transmission of the infection to others but also availing of treatment at an early stage of the onset of the infection and having the systems in place to ensure that those who are HIV positive and requiring treatment, have access to ART treatment and monitor drug adherence. For such a work place policy, the industry would need to develop IEC materials to educate their work force and also have clinics or access to medical and para-medical services, to provide continuum of care and services; and establish with professional social marketing organizations continued supply of condoms and other consumables required under this programme. As model employers, industries are expected to institute such work place policies in their organizations.

    Those industries having a large work force, particularly, of a migratory nature, are encouraged to apply. Since the private sector industry is expected to contribute to the national efforts for arresting this infectious disease, the Global Fund grant will necessarily have to be on a shared basis on the proportion of 75:25 where the private sector industry will need to provide 75 percent of the investment for a matching grant of 25 percent from the Global Fund. The minimum number of work force to be covered under this will be 5000 workers. The application could either be submitted from an industry or from a consortium of industries or a professional organization of industrialists.

    Interested parties may apply as per relevant application formats annexed with this document.

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