PEPFAR/India - Care and Support
Caring for individuals infected and affected by HIV and AIDS is a critical element of a comprehensive HIV management program. As defined within PEPFAR, there are three key dimensions to care: care and support (other than antiretroviral treatment) for people infected with or affected by HIV/AIDS; care for orphans and vulnerable children; and HIV counseling and testing.
Adult Care - USG partners contributed to developing the third National AIDS Control Program's (NACP-III) care and treatment strategy, including chairing the Care and Treatment Technical Working Groups at national and state levels and helping NACO to develop overall quality standards and clinical care guidelines. USG has developed various models of care in community, public and private hospital settings, including support for Drop-in Centers for People Living with HIV/AIDS (PLHAs) and strengthening the capacity of organizations of PLHAs. USG partners in Karnataka and Andhra Pradesh support facility based interventions such as community care centers that support patients throughout their illness by linking clinical facilities with community support, in line with the national program's model for care. Linkages with the national TB program and other health systems which provide antenatal care make these interventions robust and effective. USG also works to develop and scale-up private (for-profit) models for HIV care services, with the goal of increasing the level of engagement and quality of HIV services among private sector physicians and hospitals in areas such as preventing mother to child transmission (PMTCT) and counseling and testing (CT).
Pediatric Care - UNICEF and the Clinton Foundation are the lead agencies and key technical partners for the National AIDS Control Organization (NACO) in the implementation of pediatric treatment. However, USG-funded programs contribute significantly to identification, referral and follow-up of pediatric cases and pediatric ARV counseling, for children of most-at-risk populations (MARPs) and children of registered adults living with HIV/AIDS. USG also supports link workers and peer counselors who facilitate outreach activities for identification, early diagnosis, referral, and follow-up of children affected and infected by HIV/AIDS. The main focus of USG's efforts in pediatric care, however, is human capacity development of health care providers. USG is working towards creating demonstration sites for provision of care and support services for children affected by HIV/AIDS.
Orphans and Vulnerable Children (OVC) - USG was one of the first donors to initiate OVC programs in India. Over the last six years, USG has invested in programs for care and support; stigma reduction; community training; prevention education; socio-economic support; family strengthening and foster care for children affected by HIV/AIDS and vulnerable children. USG is currently a key member of the National Task Force Committee on Children Affected by HIV/AIDS, and has contributed significantly to the policy development and guidelines for implementation of OVC programs under the National AIDS Control Plan. Collaboration with other donors (UNICEF) has successfully resulted in the launch of a national policy framework for children and AIDS, followed by USG-supported development of national guidelines. USG has been one of the key players in working closely with the Government of India's Ministry of Women and Child Development for establishing the HIV/AIDS cell within the ministry to ensure that protection, care and nutrition services are provided to OVC. USG along with UNICEF is also actively engaged with NACO in rolling out the pilot projects across ten districts for OVC program implementation. USG prime partner in Tamil Nadu as partnered with the Tamil Nadu State AIDS Control Society, to establish the first state-supported HIV/AIDS Orphan and Vulnerable Children Trust. This Trust provides education, health and nutritional support to HIV infected and affected children.
Tuberculosis/HIV - India has the highest tuberculosis (TB) burden of any country of the world, with 22% of the world's TB cases, but has a well-designed and implemented program for diagnosing and treating TB. USG support focuses on fostering linkages between the national TB program (Revised National Tuberculosis Control Program ([RNTCP]) and the NACP-III, by providing technical and resources support at the national-level and in the high-prevalence states of Tamil Nadu, Andhra Pradesh, Maharashtra, Manipur and Nagaland.
USG technical support assists the RNTCP in the development of national TB infection control guidelines, and to integrate principles of TB-HIV coordination into training programs and develop an action plan for implementation. USG also supports state and district-level activities aimed at linking Integrated Counseling and Testing Centers (ICTCs) and community care centers and drop-in centers with Designated Microscopy Centers (DMCs) to improve access to TB diagnosis and treatment of PLHAs.
Counseling and Testing - USG provides technical support to the State AIDS Control Societies (SACS) in USG-supported focus states in establishing systems to achieve significant coverage of Counseling and Testing (CT) services down to the sub-district level. Approaches to achieve this coverage include: scaling-up provider-initiated counseling and testing (PICT) services; reaching the high-risk rural population; strengthening linkages with the TB program and prevention programs; and expanding CT services through public-private partnerships (PPPs). NACO also aims to ensure the quality of HIV testing, including availability of quality test kits, and to support demand generation for CT services. The USG supported cost effective model for CT through whole blood testing is now being adopted by NACP. To ensure quality of HIV testing an External Quality Assessment Scheme (EQAS) is implemented in most states in which all ICTCs participate. To strengthen this activity training of ICTC technicians by the state reference laboratories is undertaken. USG's involvement in such trainings will facilitate the process.
USG also implements programs to support those who test positive. These include the development and dissemination of a Prevention with Positives training package for counselors and community outreach strategies to address stigma and discrimination against women who test positive. Positive women often face forced estrangement from their marital homes, physical and psychological abuse, loss of property rights, and custody of their children.
Positive Prevention - The complex physical, psychological and social vulnerabilities associated with being a person who is HIV positive, necessitates the integration of follow-up counseling and Positive Prevention strategies into the existing counseling infrastructure. The globally accepted goals of Positive Prevention are to: prevent HIV transmission to partners; protect the HIV-infected patient from new strains of HIV and other STIs; and to prevent mother-to child transmission of HIV. Additionally, Positive Prevention has scientifically been shown to be both efficient and effective at preventing secondary infections. Changes in risk behavior of HIV positive persons are likely to have a larger effect on the spread of HIV than commensurate changes in risk behavior of HIV negative persons.
USG developed the Living Positively with HIV- A Follow-up Counseling Toolkit. In 2009, Peer Treatment Counselors across the state of Tamil Nadu will be trained on the purpose and effective usage of the Toolkit.
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