IProject: Care, Support Centre Vihaan DNP+ have two CSCs under Vihaan
Started: June 2013
Office: Flat No. A1-5, H. No. 141, Gali No.3, Near IGNOU, Neb Sarai, New Delhi-110068
Project: Care, Support Centre Vihaan
Care, Support & Treatment (CST) is an integral component of the National AIDS Control Programme (NACP). Under the National AIDS Control Programme Phase – II, 122 Community Care Centres (CCCs) were set up to provide treatment for minor opportunistic infections (OIs), side effects of an – retroviral therapy (ART) and to provide psychosocial support through sustained counselling. CCCs were intended to function as a bridge between hospital and home-based care. Hence, CCCs were envisaged as stand-alone short-stay homes for people living with HIV (PLHIV). These were not linked to other activities of the programme.
The introduction of ART in 2004 brought about a change in the role to be played by the CCCs. The CCCs transformed from a stand-alone short-stay home to playing a critical role in enabling PLHIV to access ART as well as providing monitoring, follow-up, counselling support to those who are initiated on ART, positive prevention, drug adherence, nutrition counselling, etc.
Challenges in Care and Support under NACP III
NACP IV working group on care and support had identified the following gaps in care and support services provided under NACP III:
- Unmet care and support needs: Although the access to clinical services has improved significantly in NACP III, not all infected individuals receive comprehensive and holistic care and support, especially where psychosocial needs are concerned. There are limited strategies to mi gate the impact for PLHIV, children and their families. Additionally, the coverage of PLHIV from high risk groups (HRGs) and PLHIV living in rural areas and hard to reach areas with care and support services is inadequate. Though there are many service delivery points for different components in NACP III, the linkages and referrals among various service components such as Drop-in-centre (DIC)/District level network (DLN), ART, ICTC, and TI are inadequate.
- Inadequate utilization of existing schemes and structures: Though the utilization of services has been improving year-on-year, the proportion of HIV infected women accessing services continues to be a challenge due to stigma. The health care workers’ sensitivity is low. There is a lack of clarity of the roles of link and outreach workers.It is also not clear as to who they are accountable to. Their outreach services are covered in a vertical manner requiring strengthening of co-ordination. Mechanisms for referral are weak and inadequate.
- Lack of monitoring and evaluation (M&E) systems to measure care and support The current M&E system captures information on clinical services. However, it does not capture indicators of care and support or services provided to HRG. Additionally, there are no indicators that capture type and quality of services.
- Sub optimal use of human resources: Currently for activities involving community mobilization and coverage of PLHIV, the same PLHIV is reached by multiple ORWs from different components such as TI NGOs, CCC and DIC, resulting in sub-op mal utilisation of scarce resources.
Adapted from report of NACP IV working group on Care, Support and Treatment for PLHIV
Care, Support and Treatment under NACP IV
The overall goal of CST component under NACP IV is to provide universal access to comprehensive, equitable, stigma-free, quality care, support and treatment services to all PLHIV using an integrated approach.
Based on the recommendation of NACP IV working group on care and support, the strategy of implementation of the care and support is being completely revamped to ensure cost effectiveness and sustainability. In line with the priorities of NACP IV, medical services are being completely integrated into the existing health system and simultaneously e orts are being made to strengthen capacity of the existing health system for effective delivery of care, support and treatment related services.
Under NACP IV, Care & Support Centers (CSCs) will be established and linked to all ART centres across the country. The CSCs will serve as a comprehensive unit for treatment support for retention, adherence, positive living, referral, linkages to need-based services, and strengthening an enabling environment for PLHIV. This will be part of the national response to meet the needs of PLHIV, especially those from the high-risk groups, and women and children infected and affected by HIV. CSCs will be run by civil society partners including District Level Networks (DLN) and non-government organizations (NGOs). These partners have been selected primarily on the basis of their track record of working successfully with the local PLHIV community. The guideline focuses on the objectives, criteria for selection, required infrastructure, human resources, MIS tools, and financial guidelines for CSCs. This will also provide directions for se ng up new CSCs and guide the existing ones on effective implementation of the programme.
Brief introduction to Care & Support Centres
Care and Support Centre is a national initiative to provide expanded and holistic care and support services for PLHIV. It symbolises a ray of hope in the lives of PLHIV. CSC expands access to essential services, supports treatment adherence, reduces stigma and discrimination, and improves the quality of life of PLHIV across India.
Goal: The overall goal of CSC is to improve the survival and quality of life of PLHIV.
Specific objectives of the programme include the following
- Early linkages of PLHIV to care, support and treatment services: The CSC will support PLHIV in early linkage to care, support and treatment services.
- Improved treatment adherence and education for PLHIV: Adherence education and support can help PLHIV sustain and manage their treatment regimes.
- Expanded positive prevention activities: Early testing and diagnosis will be encouraged through appropriate counselling and peer support. All who are tested will be supported to engage their sexual partners, family members and children toward testing.
- Improved social protection and wellbeing of PLHIV: The CSC will facilitate linkage to the existing social welfare and protection schemes under different line departments, corporate sector, public sector undertakings, faith based organisations, and civil society organizations.
- Strengthened community systems and reduced stigma and discrimination: To ensure a robust system that supports the program goal and ensures reduced stigma and a discrimination free access to quality services. To meet the above objectives, 350 CSCs will be established and each CSC will undertake a series of activities such as providing counselling, treatment education, and linking the clients to various health and non-health services. These activities will be measured through specific indicators which are described in the chapter on supervision, monitoring and evaluation.
Cervices in CSC (Care Support Centre)
- On-ART & Pre-ART Registration
- Counseling (Thematic & Peer counselling)
- Support group meeting
- LFU track back to ART Center
- Follow-up for MIS-cases & CD4
- Link to Targeted Interventions
- Testing of partner/spouse, children and family member
- Referrals (OI management, side effects, general ailment, TB, STI treatment etc.)
- Support for Legal Aid (including stigma and discrimination)
Linkages to Social welfare, protection Schemes and entitlements