Components
A. Care Support & Treatment (CST) :
Care, Support & Treatment services is an important component of the National AIDS Control Program and entails provision of free Anti-retroviral Therapy and quality care to the People Living with HIV (PLHIV)s.
Various initiatives have been undertaken in the last few years like introduction of alternative first line and second line ART, Centres of Excellence for adults and pediatrics, ART plus centres, Link ART centre, Link ART plus centres and Pediatric ART.
India has an estimated 2.1 million people living with HIV/AIDS. The free ART initiative under NACP II was launched on 1st April 2004 at eight institutions in six high prevalent states and the National Capital Territory of Delhi. Since then, it has been scaled up in a phased manner. As on November 2016, a total of 528 ART centres are functional across the country including 88 ART Plus sites and 17 Center of Excellence. There are additional 1108 Link ART Centers & 361 CSCs providing ART nearer to home. There are approx. 12.28 Lakh patients are alive in HIV care out of which more than 10.05 lakh are on ART including approx. 15,500 on second line ART and 270 on third line ART.
In the State of Assam, it is estimated that a total of more than 12000 people are infected with the virus and as on March 2017, out of which a total of 9574 numbers of PLHIV, clients have been detected and 5747 numbers of PLHIV clients are alive on Anti Retroviral Therapy treatment.
The main objectives of this division are:
Functioning of ART Centres, ART Plus & Link ART Centers;
ICTC-ART Linkages, Pre-ART & ART data gaps,
Lost to Follow Up (LFU) Tracking,
CD4 Testing, viral load scale up,
Monitoring and functioning of Care Support Centers (CSC)s,
Early Infant Diagnosis (EID) and HIV-TB implementation.
To review through the proper coordination with the Govt. of Assam and different stakeholders of Assam State AIDS Control Society.
The regular uptake and status of state level review meetings, through State Grivances Redressal Committee (SGRC) meetings, ART-CSC coordination meetings and State Over sight Committee Meeting (SOC) etc which are supposed to be conducted at state level periodically.
The qualitative indicators such as Retention cascade, 12 month retention rate, LFU/Death Rates, Adherence, LFU tracking.
The Supply Chain Mechanism (SCM) for ARV drugs within the state from the Sacs Store,
Reporting and close monitoring of the data concerning SCM and regularly compiling and sending it to the National Level.
The recording and reporting mechanism to NACO , SACS on M&E indicators by all ARTC/ LAC and FIARTC.
Antiretroviral Therapy (ART) program:
To implement the Antiretroviral Therapy program, ART Centres are established where eligible persons with HIV/AIDS requiring ART are identified through laboratory services (HIV testing, CD4 Count and other required investigations) and provide free ARV drugs to eligible persons with HIV/AIDS continuously by counseling before and during treatment for ensuring drug adherence. AT present 6 ART Centres (including 2 ART Plus Centres and 1 FIART Centre) and 11 Link ART Centres (2 Link ART Plus Centres) are functioning in the state.
To measure the CD4 counts of the ART registered patients, four CD4 testing centres have been established so that ART treatment can be initiated to the ART registered patients on accurate time. At present 4 (four) CD4 testing centres are functioning in the 4 Medical Colleges of the state.
Care and Support Services (CSC)
Under this service, care & support are provided to the persons infected and affected with HIV/AIDS. At present 4 CSCs are functioning in the state in NGO set up.
Opportunistic Infection (OI) & Post Exposure Prophylaxis (PEP) Management:
Drugs for OI are provided and distributed free of cost to the HIV patients through the ART Centres and Link ART Centres of the state. PEP is also provided to the Health care providers all over the state through Medical Colleges, District hospitals and FRUs/CHCs (with ICTC) of the State. The drugs are made available with the Superintendents of these Hospitals.
B. IEC & Mainstreaming :
Information, Education and Communication : In the absence of a vaccine to prevent HIV infection, public education and information remain the corner stone of AIDS prevention programmes. Strategic Communication plays a vital role in the spectrum from HIV prevention to treatment, care and support in NACP, building on learning from the earlier three phases, and taking into account the context and environment of Phase IV.
Activities under the division includes the behaviour change communication strategies for HRGs, vulnerable groups and hard to reach populations and to create awareness among general population, particularly women and youth. Mainstreaming with various departments is also done under these activities. Red Ribbon Clubs (RRC) are formed in different Colleges and Universities to create awareness on HIV/AIDS and Voluntary Blood Donation among the youth and students. Under Adolescence Education Programme (AEP), Schools/colleges are covered for HIV/AIDS Education among the school/college students.
The following activities are conducted regularly under this division:
Radio and TV spots on various issues are being broadcast/telecast regularly.
Special programmes targeting various vulnerable groups are also produced and broadcast/telecast regularly.
Advertisements on the themes centering on the various aspects of HIV/AIDS are being published regularly in newspapers.
Scroll is going on in local cable throughout the State.
Jingles are being broadcast in AIR’s FM stations.
Phone-in-progammes have been telecasted/broadcast in Doordarshan Kendra and AIR respectively.
Mobile theater is very popular in rural areas of the State. Considering this fact, different programmes like slide shows and dance drama/drama on HIV/AIDS have been organized through these mobile theatres that perform shows in different places of the State.
School AIDS Education Programme is being implemented in the State through Education department.
Various events like World AIDS Day, Voluntary Blood Donation Day, International Women’s Day, International Day against Drug Abuse and Illicit Trafficking, World Population Day, etc. are being observed regularly.
For mainstreaming and sharing responsibilities for prevention of HIV/AIDS, different Govt. departments, public sector and private sector agencies have been involved:
The departments involved: Department of Social Welfare, Department of Sports & Youth Welfare, Assam Police, Tea Sector, Municipal Councils and Oil Companies, Transport, Judiciary, Labour, Panchayat, Nehru Yuba Kendra, Industries Department.
Advocacy workshops: Advocacy workshops for media persons, members of non-HIV NGOs, members of Kalyani Health Club of Doordarshan Kendra, Guwahati, members of different women’s organizations, members of different Red Ribbon Clubs and NSS officers, officials of Industry department, police officials, NRHM officials, officials of Directorate of Information and Public Relations, the District Member Secretaries of Women Cell under the State Commission for Women, etc. have been organized.
For mainstreaming and sharing responsibilities for prevention of HIV/AIDS, different Govt. departments, public sector and private sector agencies have been involved:
The departments involved: Department of Social Welfare, Department of Sports & Youth Welfare, Assam Police, Tea Sector, Municipal Councils and Oil Companies, Transport, Judiciary, Labour, Panchayat , Nehru Yubak Kendra, Industries Department.
Advocacy workshops: Advocacy workshops for mediapersons, members of non-HIV NGOs, members of Kalyani Health Club of Doordarshan Kendra, Guwahati, members of different women’s organizations, members of different Red Ribbon Clubs and NSS officers, officials of Industry department, police officials, NRHM officials, officials of Directorate of Information and Public Relations, the District Member Secretaries of Women Cell under the State Commission for Women, etc. have been organized.
C. Blood Transfusion Services (BTS) :
The Blood Safety program aimed to ensure reduction in the transfusion associated with HIV transmission to 0.5 percent, while making available safe and quality blood within one hour of requirement in a health facility. The activities and functioning of a network of Blood banks in the state is supervised to ensure optimal quality. In addition to this, the programme also encourages Voluntary blood donation in association with other organization like Red Cross Society, Nehru Yuva Kendra, National Service Scheme, etc in all the districts.
At present there are 63 licensed blood banks in the state 26 of which are NACO supported blood banks and 37 are private. The blood banks of GMCH Guwahati & AMCH Dibrugarh are state of the art model blood bank and SMCH Silchar is Major blood bank with blood component separation units (BCSUs). These three blood banks are also functioning as Regional Blood Transfusion centres in the state. The blood banks of Kanaklata Civil Hospital Tezpur, BP Civil Hospital Nagaon, KK Civil Hospital Golaghat and Jorhat Medical College Hospital, Jorhat are upgraded to major blood banks. Apart from this, 41 FRUs/CHCs have been licensed as Blood Storage Centres. For maintaining the quality of the blood banks through External Quality Assurance Scheme (EQAS) there are 3 State Reference Laboratories. Also one blood mobile van for GMCH blood bank and 6 blood transportation vans have been provided to 6 Government blood banks of Assam in 2010-11.
D. Basic Service Division
a) Integrated Counseling & Testing Centers (ICTC) : Under these services, Integrated Counseling and Testing Centres (ICTC) are established where a person is counselled and tested for HIV free of cost on his/her own freewill or as advised by a medical provider. These centers can be entry points for linking the diagnosed people to HIV Care services. At present 227 ICTCs are functioning in the state.
List of Integrated Counseling and Testing Centres (ICTCs) :
b) Prevention of Parent to child transmission (PPTCT) : Prevention of Parent-To-Child Transmission (PPTCT) is a specific programme that provides a comprehensive, family-centered spectrum of support and clinical services along with other public health initiatives, to prevent the transmission of HIV from parents to their baby.
The PPTCT programme comprises of the following activities:
Ante-Natal Check-up registration at health centres using Mother-Child Health card.
HIV Counseling, Group Counseling on – Nutrition, Health & Hygiene, importance of regular antenatal check-up, motivation for institutional delivery, immunization, Safe Sex Methods.
HIV testing of ante-natal mothers.
Partner counseling and Testing.
If positive, compulsory ART registration at the ART centre and Pre-ART preparation, CD4 count.
Relevant referrals - TB, STI
Enrolment and Line listing positive mothers for offering follow up services.
Choices offered to the positive mothers – Termination of pregnancy, Continuation of pregnancy.
Planning the delivery with the mother and her family – Place of delivery, mode of delivery (vaginal/caesarean - If the mother decides to deliver in another district, linkages with the respective district PPTCT and NGO is ensured by introduction to the block-in-charge, and Out-Reach Worker (ORW) for further follow-up.
ART prophylaxis – Single dose Nevarapine to the Mother at the onset of labour pain and Baby on birth.
ART- For those eligible for ART.
Follow-up every month by ORW in selected districts namely Kamrup, Cachar and Karimganj using the ‘ORW Blue book’ - Regular home-visits by the ORW with consent of the mother/family. The Out-Reach Workers accompany the mother during labour to hospital.
c) Sexually Transmitted Infections/Reproductive Tract Infections Services (STI/RTI):
Under this services, Designated Sexually Transmitted Infections (STI)/Reproductive Tract Infections (RTI) Clinics (DSRC) are established in Govt. Medical Colleges and Civil Hospitals where free treatment are provided to the patients with as early diagnosis and effective treatment of STI/RTI can significantly reduce the transmission of HIV. Also STD patients are more vulnerable to acquire or transmit HIV infection. NGO set up TI Projects are also provided STI services to the HRGs. At present 28 DSRCs are functioning in the state.
E. Targeted Interventions (TI) : Targeted Intervention: Objective of the component
Targeted Intervention (TI) Projects:
NGOs are contracted for reaching out to the High Risk Groups (HRGs) and the bridge population i.e. migrants and truckers who have not access and use the preventive services of the programme. At the TI set up, they are provided access to free condom, HIV Counseling and Testing, Screening and Treatment of STIs, etc. At present 54 TI Projects are functioning in the state.
Opioid Substitute Therapy programme:
Under this programme, the IDUs are provided with oral drug, Buprenorphine as a substitute of Injecting Drugs. At present , 2 OST Centres are functioning in the state.
F. Lab Services : (source http://naco.gov.in/lab-services-division) Universal and routine access to quality assured HIV related laboratory services are made available through the activities of Laboratory Services Division. It is recognized that work related to laboratory services are not confined to HIV testing, but are overarching and have an impact on other interventions included under prevention, care, support and treatment, STI management, blood safety, procurement and supply chain management. Emphasis on quality assured laboratory service delivery is important to the success of NACP.
To ensure quality of HIV testing under the NACP, NACO has an External Quality Assessment Programme administered to all HIV testing laboratories. The HIV testing laboratories are arranged in a tiered manner with apex laboratory (NARI, Pun) at the very top. 13 National Reference Laboratories (NRLs) and 117 State Reference Laboratories (SRLs) form the two subsequent tiers of the laboratory framework and are involved in supervision of testing in all peripheral testing centers (ICTCs).
The testing activities of 272 CD4 testing laboratories, 6 laboratories for testing under EID Programme and 10 Viral Load Testing Laboratories under the NACO umbrella are supervised by the Laboratory Services Division
Major activities of Laboratory Services Division:
Framing guidelines for HIV testing, Quality in HIV Testing, Enumeration of T lymphocytes and Laboratory guidelines for Early Infant Diagnosis
Accreditation of HIV testing Laboratories.
Establishing and improving Quality Management Systems in CD4 testing laboratories, STI laboratories and ICTCs.
External Quality Assurance Programme for HIV testing laboratories
Consortium for ensuring kit Quality in NACP
Testing Services in National Programme on Early Infant/child less than 18 months Diagnosis.
CD4 testing for initiation and monitoring of patients on antiretroviral therapy (ART)
Viral Load testing for second line ART
Training of laboratory personnel.
G. Finance Administration and Finance Management:
Under administration, all the appointment related issues of Staffs, their salary, training etc. are reviewed. For finance management, there is CPFMS (Computerized Program & Finance Management System) software where all the accounts related matter is booked under different activities.
H. Procurement : For procurement of goods and services, Assam State AIDS Control Society has a separate division called Procurement Section. This section is handling all the procurement related works of Assam SACS.
I. Store : Assam State AIDS Control Society has one central store centre which is located near the Office of the Project Director, Assam State AIDS Control Society. It is headed by Store officer and assisted by 2(two) Divisional Assistant and 1 (one) Grade Four staff.
J. M & E and Research Surveillance
HIV Sentinel Surveillance is an epidemiological tool by which samples of pre-designed size are collected over time, from among the identified risk groups known as sentinel groups. This sample size represents the larger group with similar risk and other characteristics. In HIV Sentinel Surveillance, unlinked anonymity means that the blood is primarily collected for some other purpose and the results are not linked to any individual. This methodology is adopted in order to minimise participation bias in the whole procedure. In order to minimise the selection bias of samples, consecutive sampling procedure is adopted and it is ideally a clinic based approach. HIV Sentinel Surveillance data is used to understand and monitor time trends, know HIV prevalence levels in various risk groups in states/UTs and work out total HIV burden in various sub-populations.