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‘Test and Treat Policy for HIV’
Anybody who is tested and found positive will get ART irrespective of CD count or clinical stage: J P Nadda
“As soon as a person is tested and found to be positive, he will be provided with ART irrespective of his CD count or clinical stage.” This was stated by the Union Minister for Health & Family Welfare, Shri J P Nadda at the launch of the ‘Test and Treat Policy for HIV’, here today. “This will be for all men, women, adolescents and children who have been diagnosed as a HIV + case. This will improve longevity, improve quality of life of those infected and will save them from many opportunistic infections, especially TB,” Shri Nadda further added.
The Health Minister also announced that India will soon develop a National Strategic Plan for HIV for next seven years and these seven years will be crucial for ending AIDS. Shri J P Nadda also felicitated eight scientists and community workers for their exemplary work in the field of HIV/AIDS.
Laying stress on addressing stigma & discrimination towards HIV, Shri Nadda said that ending stigma is of paramount importance to enable persons infected and affected with HIV access health services. “To facilitate reduction in stigma and discrimination, the long pending HIV/AIDS Act has been passed very recently, which is an historical step. Very few countries globally have such a law to protect rights of people infected with HIV,” Shri Nadda elaborated. The Health Minister further informed that the key provisions of HIV/AIDS Bill are prohibition of discrimination, informed consent, non-disclosure of HIV status, anti-retroviral therapy & opportunistic infection management, protection of property of affected children, safe working environment and appointment of ombudsman in every State.
Speaking on the occasion, Shri Nadda said that the Health Ministry has intensified its efforts to find all those that are estimated to be infected with HIV. “Out of 21 lakh estimated with HIV, we know only 14 lakh. To detect remaining we have revised national HIV testing guidelines and are aiming to reach out to people in community and test them where they are, of course with proper counseling and consent,” Shri Nadda mentioned.
Shri Nadda further said that all those who are positive should get treatment and for that the Health Ministry is constantly expanding treatment delivery sites. “We have nearly 1600 ART and Link ART sites where treatment is provided across the country and recently we crossed the 1 million people on ART, second country in world to have such large numbers on free lifelong treatment. We have been able to avert 1.5 lakh deaths due to ART and we will be able to avert 4.5 lakh more deaths by expanding provision of ART,” Shri Nadda informed.
Shri Nadda stated that the 90:90:90 strategy that the Ministry has adopted will help to identify 90% of those infected, place 90% of these on treatment and ensure 90% have their virus under control. “This strategy will offer us an opportunity to work towards our commitment during HLM and WHA on “ending AIDS by 2030” as a part of the Sustainable Development Goal (SDG),” Shri Nadda added.
Addressing the participants at the function, Shri Arun Panda, Additional Secretary (Health) and DG (NACO) said that this is a landmark event and a historic policy in the field of HIV/AIDS in India and shows how far we have come since 2004. “About 16 lakh people know they have HIV and we have to make sure that we reach out to each of them, Shri Panda said. He further stressed on the need to develop new partnerships.
Also present at the event were Ms. Prakin Suchaxaya, Acting Country Representative, WHO and Shri Oussama Tawil, UNAIDS Country Director in India, senior officials from Ministry and NACO, representatives from CDC, civil society organisations, Donor partners and network of positive people.
UW I-TECH in Nagaland
International Training and Education Center for Health (I-TECH) has a global presence and is a major initiative of the University of Washington, Seattle and University of California, San Francisco to build human and institutional capacity for HIV prevention, treatment and care. I-TECH has its global presence in sixteen countries and in India, UW I-TECH was established in 2003. Since then UW I-TECH through CDC India has been supporting National AIDS Control Organization (NACO), Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) to implement care, support and treatment (CST) services under the National AIDS Control Programme (NACP) for people living with HIV (PLHIV) in the country. The key focus areaincludes building human and institutional capacities, comprehensive and targeted care and support activities under the national program and mentoring clinical and operational research. UW I-TECH’s continuous technical assistance to central (NACO) and state governments (SACS) had produced many HIV experts through training and fellowship programs, as well as lead to interventions in priority thematic areas based on programme needs and maturity.
During 2018-19, UW I-TECH scaled up its program support activities in three North-Eastern cluster states viz, Manipur, Nagaland and Mizoram. In Nagaland, UW I-TECH team initiated its work with the launch of two Differentiated Service Delivery Models (DSDM) in the state – Multi month dispensation (MMD) at ART Plus Kohima & ART Plus Dimapur and Co-located OST & ARTCs (CAOC) at CAD Foundation in Dimapur. Before the formal launch by Nagaland State AIDS Control Society (NSACS), UW I-TECH team supported the SACS in preparatory work for the DSDM work, prepared concept notes for both models. At national level, UW I-TECH collaborates with CDC and NACO officials;in the state UW I-TECH is working closely with NSACS, NETSU (North East Technical Support Unit) and FHI 360 team as well as TIs & community members.
Differentiated Care is a Client centric approach where ART service is placed in a Cascade to reflect the preferences, expectations and needs of various population groups for prevention, testing and treatment services. Differentiated Care has a potential to reduce the unnecessary burden on the health system and to improve its efficiency and service quality.
Differentiating the care for PLHIV helps in improving health outcomes and leverage resources to treat all to achieve 90:90:90.
It needs to pilot and adopt Differentiated Care models to:
- Introduce Client centric systems to adapt HIV services to the needs of the patients.
- Meet preferences and expectations of different patient groups.
- Reduce avoidable burden on health care workers. NACO plans to expand its ART infrastructure while enhancing quality of care through differentiated care interventions.
Vihaan: Improving survival and quality of life of PLHIV
‘Vihaan’Care & Support programme is a Global Fund-supported initiative, a unique initiative under the National AIDS Control Programme for providing holistic care and support services for People Living with HIV (PLHIV). Vihaan works with the goal of ‘improving survival and quality of life of PLHIV. The specific objectives of the programme include early linkage of PLHIV to care, support and treatment services; improve their treatment literacy and adherence; expand positive prevention activities; and ensure social protection and wellbeing for them.
Currently, there are three CSCs in Nagaland, located in Dimapur, implemented by Chavara Home; Kohima, by Network of Kohima District People Living with HIV/AIDS; and Tuensang, by Network of Tuensang District people Living with HIV/AIDS. In addition to their respective ART centres, these CSCs cover the other ART centres in the state – Mokokchung, Kiphire, Phek, Peren and Zunheboto – by deploying dedicated outreach workers for each centre. Out of 9320 PLHIV in active care under the ART programme in the state, Vihaan has reached out to 6005 till the end of March 2018. Some of the important achievements of the programme since its inception in 2013 are the following:
- Brought 909 Lost to Follow Up (LFU) cases back to treatment through outreach
- Linked 686 PLHIV to various social welfare schemes and entitlements
- Spouse/family members of 616 PLHIV got tested for HIV
- 5528 PLHIV have been screened for TB symptoms. 1210 referred for testing, 47 cases found positive and linked to ATT
- Through local resource mobilization efforts, the CSCs have assisted 537 PLHIV with nutrition, medical and educational support
As per the National Strategic Plan 2017-24, one of the targets to be achieved by 2020 is 90-90-90 i.e. 90% of those who are HIV positive in the country know their status, 90% of those who know their status are on ART and 90% of those on ART achieve effective viral suppression. In view of the 90:90:90 approach, Vihaan programme adopted a ‘differentiated care model’ in January 2018 to provide comprehensive and differentiated care and support services to PLHIV of different profiles. Under this model, the high priority clients include PLHIV who are yet to be put on ART, those who are newly initiated on ART, and those having less than 80% treatment adherence. Through focused interventions among different categories of PLHIV, Vihaan programme aims to support the national programme to achieve its objectives of early linkage of PLHIV to treatment, retention in care, sustained viral load suppression, and elimination of HIV-related stigma and discrimination.
Implementation of Vihaan programme in Nagaland is supported by India HIV/AIDS Alliance through its Northeast Regional Office in Guwahati.