Link ART centres concept

Link ART Centres Concept

Link ART Centres

Concept, Objectives, Structure,

Roles and responsibility


Session Objectives

By the end of the session the participant will understand:

• The Concept and Rationale of Link ART Centres

• Objectives of Link ART Centres

• Role of Link ART Centres in National Health System Strengthening for HIV treatment and Care

• Infrastructure, Human Resources and Roles and Responsibilities

• LAC Plus scheme

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Access to ART: Current situation

• The ART roll out is mostly confined to:

1) Medical Colleges

2) Tertiary Hospitals

3) Some big District Hospitals

• As a result, many a times, patients have to travel long distances to get the treatment

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Link ART Centre: Rationale

• As the treatment is lifelong and drugs are provided once a month, this leads inconvenience and long travel

• May lead to missing of visits, particularly when patient is otherwise feeling healthy

• Monthly visits may also entail the patient’s stay in the city leading to escalation of costs in addition to travel cost

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• At times, natural phenomenon like heavy rain, floods, landslides, extreme weather conditions make drug collections on scheduled visit dates almost impossible

• All these factors have been perceived as potential barriers to an optimal adherence for ART

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• To minimise the travelling needs for the patients stable on ART and improve drug adherence , it was envisaged to set up LINK ART CENTRES

• The Scheme of Link ART Centres was initiated in 2007

• It is a low cost facility and expenditure is only on facility development, training and operational costs

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• To integrate ART services with the Primary / Secondary Health Care system

• To build capacity of the health care staff at the Primary Health Care Level in ART treatment

• To act as bridge between testing & treatment services

• Reduce the travel cost and travel time of PLHIV to increase access to HIV care services

• Improve quality of ART services by decongesting ART Centres

• To improve the adherence of PLHIV to HIV care & ART

Link ART Centre: Objectives

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Model of HIV treatment

service

Public Health Infrastructure

& HIV-Relevant Staff

HIV-Related Services

Medical College

ART Centre/ Link ART Centre

Link ART Centres

Community-Based HIV Screening

CCC / NGOs

Re

ferra

l District Hospital

Community Health Centre

Primary Health Centre (PHC)& 24/7 PHC

Sub-Centres & Anganwadi Centres

ICTC,Designated

Microscopy Centre

District with low Sero-positivity may have LAC only.

ART Centres +

tertiary level care

Centres of Excellence - alternate First line &

Second line ART

HIV Care in Integrated General Health System

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LAC

Back Referral to ART Centre

Screening of HIV-TB

Co infection

Psycho-Social Support

To PLHIVTreatment ofMinor OIs

Provide ARV Drugs to Stable PLHIV on ART

Adherence Counselling and

Monitoring PLHIV for side effects

Functions of LAC

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Main Responsibility of LAC

• Adherence counseling and monitoring

• Provide ART drugs to stable patients on ART linked out by Nodal ART Centre

• Identification of the critical side effects of ART / medication for Opportunistic Infections (OIs)

• Identification of symptoms suggestive of OIs, side effects of drugs

• Referral to the main ART centre at the earliest

Link ART center shall not initiate ART in any patient

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• Baseline analysis of the geographic distribution of the patients is required.

• Mapping of the PLHIV seeking ART at all the centres in the state to be done and then, we should identify the number of patients coming from the districts and identify the districts with at least:

– 50 patients on ART in plain and

– 25 patients on ART in hilly areas can be reduced to as low as 10 patients.

Link ART Centre: Site Selection

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• The Link ART Centre should ideally be opened at Integrated Counselling and Testing Centres (ICTC) in Government Hospitals including Rural / Taluk Hospitals (Block level) and CHCs

• Each LAC will be linked to the CLOSEST NODAL ART Centre

• Each LAC will have one Nodal ART Centre. However, one Nodal ART Centre may have more than one LAC

Link ART Centres: Ideal Sites

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• Two rooms about 10 X10 feet are minimally required

– One room for the drug storage, and

– Second room for the drug dispensing, record keeping and counseling.

• Rest of the infrastructure is adequately provided under the ICTC

• The Link ART centre will utilize the computers facility already available with the site (ICTC / CCC). The LAC shall get a broad band internet connection from the funds provided as per the LAC approved financial support

PLHIV will be attended in General OPD of the centre daily

Link ART Centres: Infrastructure

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Personnel at LAC (No additional Manpower is provided)

Doctor:

• The institute (ICTC in hospital setting) should identify 2-3 Doctors (at least 2) in such a way that the patient can be attended and examined on all working days.

• If this is not feasible (eg due to shortage of manpower) this should be done on at least on two to three days a week, but even if patient comes on days other than the scheduled days, care should not be denied.

• The senior most doctor amongst them (preferably a specialist physician) shall be the LAC In- charge and responsible for day to day activities and reporting to the Nodal ART centre.

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Personnel at LAC• Counsellor:

The ICTC counsellor shall bear the responsibility of ART counselling of PLHAs on ART.

• Nurse:

Institute should depute a nurse to assist the Doctor and the Counsellor. Computer literate nurses should be given preference for deputation in the LAC.

• Pharmacist:

The institutional pharmacist shall be the in charge of drug storage, dispensing and drug record keeping.

Note: Nurse and counsellor will assist in record keeping and reporting.

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Setting up of LAC

• Training of Staff of identified for LAC (Institutional & ICTC)

• Transfer of PLHIV on ART from the nodal ART Centres to LAC

• Transfer of ARV drugs

• Monthly reporting system to Nodal ART Centre

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Assessment of LAC

• By December 2010, 545 LACs were functioning

• Over 25,000 PLHIV are accessing ART services at LACs

• An assessment study was undertaken in four states: Gujarat, Maharashtra, Rajasthan & UP

• The study revealed that patient satisfaction had increased significantly and cost and time on travel to access ART had decreased

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Findings of LAC Assessment

• Time taken for travel reduced considerably (Median time taken: 60 minutes)

• The distance traversed also reduced (Median distance: 25 Km)

• 97 % of the patients were attending LAC regularly every month

• 95 % PLHIV reported that waiting time <30 minutes for availing counselling & collection of drugs

• Median expenditure on travel Rs. 40

• >90 % PLHIV were satisfied with services

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• The roll out of the revised scheme shall be initiated at existing LAC with a patient load of more than 75 PLHIV on ART and will be expanded in a phased manner after getting prior approval from NACO

• Manpower:

• The LAC will utilise the existing human resources of the facility

• Considering the additional functions of LAC, presently a staff nurse will be provided

Roll out of LAC Plus Scheme

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Monitoring of PLHIV on ART

Screening of HIV -TB Coinfection

Enrollment of PLHIVA in HIV Care

and basic investigations

Pre-ART Management

Treatment of OIs

Psycho–social Support to PLHIV

LAC

Back Referral

Roll out of LAC Plus Scheme

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Functions of LAC & LAC PlusLAC LAC Plus

ARV Drug distribution Enrolment of PLHIV into HIV care and ART Care

Monitoring of PLHIV on ARTPre-ART management including basic investigations and sample collection for CD4 count

Counselling on adherence, nutritional & positive prevention

Follow up of pre-ART patients not eligible for ART

Referral of eligible patients to Nodal ART Centre for ART initiation

Identification of side-effects Screening of HIV-TB co infection

Treatment of Minor OIs Monitoring of PLHIV on ART Drug distribution

Treatment of Minor OIs

Monitoring of side-effects of ARV drugs

Counselling on adherence, nutritional & positive prevention

Tracing of LFU and Missed Cases (Pre-ART & ART)

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Key Points• The Concept, Objectives and Rationale of Link ART

Centres were discussed

• The Role of LAC in the National Health System in providing HIV care services were discussed

•Method of site selection of LAC and the details of infrastructure and Human resources were provided

• Roles and responsibilities of LAC staff were discussed

• The extended LAC Plus scheme was described

• Standard operating Procedures of LAC will be considered in detail in a separate session

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Documents

Link ART centres concept