Pediatric Centers of Excellence Scheme Final Dec 2011

8/12/2019 Pediatric Centers of Excellence Scheme Final Dec 2011

1/23

National AIDS ControlOrganisation

Ministry of Health & Family

Welfare

Government of India

November !""

SCHEME FOR

PEDIATRIC CENTRES OF

EXCELLENCE


2/23

1. BACKGROUND

India has the third highest estimated number of individuals infected by HIV/AIDS in the world

after Nigeria and South Africa - an estimated 2! million "#$HA %National AIDS &ontrol

'rgani(ation and )NAIDS* 2+,+ &urrently there are an estimated ,,.*+++ children under the

age of ,. years who are HIV infected %)NAIDS* 2++ 0he National AIDS &ontrol

'rgani(ation launched National "aediatric Initiative in November 2++1 to raidly scale u access

to care* suort* and treatment for aediatric atients across the country &urrently*

aro3imately 4*4, of HIV infected children have been registered at an A50 &entre and

22*6.6 are on treatment across the country %NA&' &7IS 5eort* December 2+,+

In addition* the "revention of "arent to &hild 0ransmission %""0&0 rogramme has e3anded to

over .+++ integrated counseling and testing centres offering ""0&0 services However* ""0&0

uta8e is still limited amongst HIV ositive women and there are an additional estimated 2+*+++

infants infected yearly through 7other to &hild 0ransmission %70&0 %NA&'* 2++ NA&'9s

recent launch of :arly Infant Diagnosis for children and infants u to ,6 months of age using

DNA "&5 testing and raid scale u of the same is a huge ste in addressing the disease* as these

efforts will result in the identification of many more HIV ositive children and an associated rise

in the number of children re;uiring A50

0he limited number of children currently enrolled into care* as well as the anticiated influ3 of

newly identified ositive infants into the health care system means there is an urgent need to both

evaluate current ractices in aediatric HIV care and treatment and lan for the scaling u of

services to reach all HIV ositive children Additionally* as HIV ositive children survive

longer* treatment strategies imrove and second line drugs become available* there is an

increasing level of comle3ity in clinical management* necessitating ongoing training of

clinicians entrusted with the care of these atients

$ith the e3cetion of a few e3clusively "aediatric &entres* the ma


3/23

including recognition of HIV symtoms and the need for early testing and enrolment Hence* it is

a felt need to have Paediatric Centres of Excellence (PCoE) in !" care# that are model

treatment and referral centres and at the same time imart ;uality training to other eole

involved in caring for aediatric HIV atients 0hese centres should be the rimary sites for

underta8ing research* including oerational research on a large scale "&o:s are e3ected to

conduct high ;uality research relating to different asects of "aediatric HIV care and treatment

=or this they need to actively see8 collaborations with other deartments and institutions

$. BR!E%PROGRA&&EDE'CR!P!ON

0o ensure rovision of high ;uality "aediatric HIV care and caacity building activities in

"aediatric HIV across the country* it is roosed that reuted centres that are currently

nominated as Re*ional Paediatric Centres (RPCs) would be develoed and strengthened asPaediatric Centres of Excellence (PCoE). 0hese centres will focus on building their own

caacity in roviding high ;uality care in "aediatric HIV and subse;uently suort the necessary

caacity building related to "aediatric HIV for the staff being recruited for the A50 scale u

>y e;uiing these centres for training and research* it is e3ected that the faculty from these

"&o:s will carry out eriodic site visits to the different A50 centres to assess ;uality of care?

monitor ;uality of care through a commonly agreed uon set of ;uality of care indicators for

aediatric HIV? encourage oerational research on aediatric HIV and related issues? suort

ublication of research aers in reuted


4/23

0he goal of these institutions is to ma8e all services essential to the ac8age of comrehensive

care of &hildren living with HIV/AIDS %HA available under one roof* without the atient

having to rely on referrals or travel from one centre to another

+. RA!ONA,E%ORPAED!AR!CCENRE'O%E-CE,,ENCE(PCOE')

0he Re*ional Paediatric Centres (RPCs)were established with the vision of roviding ;uality

HIV care and treatment at tertiary level to suort the A50 centres in the region as art of

National "aediatric Initiative in 2++1 As art of NA&" III midterm review* 5"&s were

evaluated 0he 8ey findings and recommendations included@

7ost A50 &entres were not staffed by aediatricians or secialists in aediatric HIV?

thus* a shift to an integrated atient management aroach with the referral aediatric

deartments within each hosital is re;uired

&onstant training and ugrading of 8nowledge and s8ills among roviders is re;uired to

address the need for s8illed healthcare roviders on ;uality aediatric HIV care* including

8nowledge of issues surrounding long term treatment adherence and HIV drug resistance

"aediatric &entres should rovide vision* leadershi and strategic direction on "aediatric

HIV care treatment for National rogramme

In 2++1* Re*ional Paediatric Centres (RPCs)were selected by NA&' with the e3ectation

that they would directly rovide ;uality care to HIV ositive children and also wor8 towards

building caacity in their resective regions 0hese RPCswere selected in states with either

high numbers of HIV ositive children enrolled into care and/or aediatric e3ertise in the field

of HIV medicine It is these RPCs which are being ugraded to be Paediatric Centres of

Excellence (PCoEs)as a art of this roosed scheme@

'l.

NoNae of t/e PCoE

'tates lin0ed for Caacit2 B3ildin* and

&entorin*

, Indira Bandhi Institute of &hild Health %IBI&H*

>angalore* Carnata8a

, Carnata8a

2 Cerala

2 Institute of &hild Health %I&H*&hennai* 0amil Nadu

! 0amil Nadu "ondicherry

. Andaman Nicobar

! #o8manya 0ila8 7unicial Beneral Hosital %Sion*

7umbai* 7aharashtra

1 7aharashtra

4 Bu


5/23

'l.

NoNae of t/e PCoE

'tates lin0ed for Caacit2 B3ildin* and

&entorin*

&alcutta 7edical &ollege %&7&*

Col8ata* $est >engal

,2 $est >engal

,! 'rissa

, Assam

,. >ihar

,1 &hhattisgarh

,4 Ehar8hand

,6 Si88im

. Niloufer &hildren9s Hosital*

Hyderabad* Andhra "radesh

, Andhra "radesh

1 Calawati Saran &hildren9s Hosital

#ady Hardinge 7edical &ollege* Delhi

2+ Delhi

2, )ttar "radesh

22 "un


6/23

4. CR!ER!A%OR'E,EC!NGPAED!AR!CCENREO%E-CE,,ENCE

0he e3ectations for a "aediatric &o: are as follows@

0he ability to demonstrate ;uality care in the following areas %see Aendi3 A for further

details in each area@

o Beneral "aediatric &are

o HIV Awareness/Sensitivity/Stigma 5eduction

o HIV Diagnosis in &hildren %including clinical staging

o HIV :3osed Infant &are

o "aediatric &ounselling

o "aediatric A50 7anagement

o "aediatric 2ndline

o 7anagement of "aediatric 'I9s/0>

o 7onitoring and :valuation/"aediatric &ohort Analysis

o HIV and Nutrition

0he caacity for "aediatric &are* which includes secialty faculty* strong lin8ages acrossdeartments and a lac8 of stigma in wards/deartments with regards to treating HA

0he sace needed to create a child friendly* dedicated A50 &entre? as well as the ability

to rovide rimary A50 care to arents of HAs

0he otential to be a referral centre for tertiar2 carein aediatric HIV care suort and

treatment in the region

A strong academic inclination/trac8 record of carrying out analysis and ublications? in

addition to a strong research tradition - basic and oerational

0he laboratory facilities necessary for routine investigations and the diagnosis of

oortunistic infections

Dedicated and e3erienced faculty with a commitment to roviding high ;uality services

to children affected* infected* or e3osed by/to HIV and willingness to continually

imrove care through a rocess of ;uality monitoring and oerational research

A commitment to roviding the essential ac8age of comrehensive services

0he caacity and commitment needed to develo effective lin8ages with the other

institutions eg for the training of medical and ara-medical staff in the region

0he willingness to be reositories of information related to care and suort for aediatric

HIV

0he commitment to scaling u caacity in "ediatric HIV by actively engaging in training

and mentoring activities within their regions

1


7/23

5. RE'OURCE'AEPAED!AR!CCENRE'O%E-CE,,ENCE

5.1 H uman 5esources6

Faculty members/ residents of the institution and the ART center staff will support the

functioning of the CoE. Additional staff for the functioning of the CoE will be provided

by NAC.

Steering Committee

A !teering Committee shall be constituted at CE headed by the head of the

institution and consisting of "rogramme #irector$ #eputy #irector$ A"#/%# &C!T' of

concerned !AC! and a NAC representative &RC to represent NAC in case NAC

official cannot participate'. This committee shall meet once in ( months for review of

functioning of "CE / to sort out any issues related to its functioning.

ne "rogramme #irector and one #eputy #irector of the CE will be identified from

the faculty at the institution. )n the e*isting "CoEs$ the Nodal fficer will be re+

designated as "rogram #irector$ CoE. The "rogram #eputy #irector will be selected

by the "rogramme #irector in consultation with the ,ead of the )nstitution and

NAC. )n newly designated CoEs$ preference for the position of "rogramme #irector

will be given to faculty associated with the ,)- program and in consultation with the

,ead of the )nstitution and NAC.

Programme Director PCoE %e3isting Nodal 'fficer redesignated* who is already a

faculty of the Institution to oversee activities of the "&o: 0his aointment will be the

resonsibility of the Head of the Institution "rogramme Director "&o:9s duties are to@

o "rovide strategic direction to the lans and activities of the &o:?

o Set u the &o: as er NA&' guidelines/ NA&' aroved "&o: scheme?

o Devise wor8-lans and timelines for moving activities forward?

o :nsure timely imlementation of all activities related to &o: and A50 centre

including@

&omrehensive HIV care?

0raining* mentoring* and research?

'ther caacity building activities

4


8/23

o 7a8e fre;uent visits to the lin8ed A50 centres and rovide feedbac8 to the "&o:

members based on the observations during the visits so that the action lan may be

modified as re;uired?

o :nsure concrete results for the successful imlementation of the "&o: activities?

o :nsure contacts with A50 centre ersonnel to elicit their cooeration and

convergence with the "&o: activities?o 7anage all administrative issues related to "&o: and A50 centre?

o >e the focal erson for all communication and corresondence related to functioning

and activities of &o:?

o 'versee monthly reorts on "&o: activities* training and other critical issues* etc?

o 7aintain financial control and monitors "&o: budgets on a eriodic basis to ma8e

sure that budgets are sent according to aroved allocation

#rogram De$%ty Diretor Co'(

S/he will@

>e in charge of training and mentoring

>e a member of the SA&:"

Deuti(e the "rogramme Director in his/her absence

A50 Staff as er NA&' A50 'erational Buidelines %SMO/MO Nurse, Counsellor,

Data Entry Oerator, P!armacist, "a# tec!nician, Care Coordinator Number of A50

Staff deends on load of the centre

Nutritionistost under 5egional "aediatric &entre will continue

Additional Staff under "&o: Scheme@

Contractual appointments for the CE will be carried out by the !teering

Committee. The procedure for the selection of contractual staff for ART centres

should be followed for " CoE staff selection.

One M$E and %esearc! Officer& 0o analyse data* coordinate research activities*

rovide necessary technical assistance to 7entoring team on the erformance of the A50

&entres and ;uality of "aediatric care in the region 0his osition will@

6


9/23


10/23

o Suort the analysis of all ;uantitative and ;ualitative data from ro


11/23

.2 Infrastructure at "&o:6

0hese "&o:s should have ade;uate accommodations for an A50 centre* as rescribed by

NA&' guidelines* which outline the need for ade;uate sace* rivacy* a waiting area*

counselling rooms* a harmacy* AV aids* dedicated drin8ing water and well maintained toilet

facilities etc 0he facility should rovide a child-friendly sace* including toys and a layarea In addition* as the institution is a teaching facility* the centre should rovide

auditorium/lecture facilities %including AV :;uiment* a conference area/meeting room* I0

e;uiment for data analysis and teleconferencing* an #&D ro


12/23

, room for documentation

, 7ini / 7a3i Auditorium with re;uired AV facilities

AV conference room with internet facility for tele/video conference activities

5.$.+ Euiments to #e Oned #y PCoE&

0he "&o: will urchase and maintain the following e;uiments for e3clusive use for

"aediatric HIV care and treatment rogramme

o 2 Des8to &omuters

o 2 #atos

, "ortable #&D ro


13/23

7.$ #in8ages and 5eferrals for Secialised &are@

0here should be aroriate adult and aediatric lin8ages and referral for care* including

inpatient care"with all other secialty deartments #in8ages and referrals to aediatric sub-

secialty care should be emhasised and includes lin8ages to child sychology* dentistry*

intensive care* athology* aediatric surgery* ulmonology* cardiology* hematology and

neurology Adult referral level care should be available in those centres where adult services

are not available =ormal lin8ages should also be established to ""0&0 services* I&0&

services* 5N0&" services* community-based suort services* social wor8

deartment/organisations* nutritional rehabilitation services and "#HA networ8s

7.+ "harmacy at the "&o:6

0he centres will be rovided with an essential list of drugs to be maintained* as well as stoc8s

of the same 0he "harmacy at the "&o: will stoc8 and disense secialised "aediatric and

adult formulations of A50* both first line and second line treatment regimens* "aediatric and

adult formulations of cotrimo3a(ole and aediatric formulations 'I drugs 'n a case by case

basis* with the aroval of the "rogramme Director* the "&o: can authorise use of

contingency funds for the urchase of drugs which are not included in the NA&' aroved

list

7.4 Additional Services for &ontingency6

A small contingency fund of IN5 , la8h er annum will be set aside for contingencies related

to secialised investigations* harmaceuticals and other incidental e3enses* which will be

considered on a case by case basis It is e3ected that the "rogramme Director of the "&o:

will 8ee clear written notes of each case* which will detail the case and e3lain the decisions

reached

Additional local suort can be solicited by each "&o: should the need arise

,!


14/23


15/23

has access to ;uality medical and sychosocial care 0hese caacity building activities

will serve to increase 8nowledge and s8ill in "aediatric HIV care within their resective

institutions* as well as other relevant medical and community-based institutions within

their region

.$.1 Mentoring

7entoring can be defined as Ga sustained" collaborative relationship in #hich a

highly e$perienced health care provider guides improvement in the %uality of care

delivered by other providers and the health care systems in #hich they #ork

7entoring will be both rogrammatic and clinical 0he "&o: should be able to

lan* organise and carry out all mentoring activities* both rogrammatic and

clinical A core grou of mentors will be identified and will be trained as mentors

7entoring will be for A50 centres lin8ed to the "&o: and* also* for the trainees

from the same institute and other facilities

>y maintaining this e3ertise and develoing a strong caacity building

rogramme* the mentors will serve as resources for roviding technical suort

and trainers for all asects of the NA&' and SA&S training networ8 0he "&o:

should establish a Core Caacit2 B3ildin* ea (CCB) comrised of a

"aediatrician* 7icrobiologist* "athologist* 'bstetrician* &ommunity 7edicine

secialist* Nutritionist* counsellor* and 7: e3ert under the leadershi of

"rogramme Director "&o: 0he members for &&>0 will be selected based on

his/her technical e3ertise in the resective field* training s8ills* related facilitation

s8ills and availability 0he &&>0 must be trained and committed in the resective

areas of e3ertise defined above and resonsible for carrying out all training and

mentoring related activities 0hese &&>0 members will underta8e field visits to

A50 &entres* have regular case discussions %through hone or web based media

and mentor the trainees

0he &&>0 will networ8 and contribute regularly to the construction* revision and

udating of training curricula and =As for "aediatric HIV* with an aim to

,.


16/23

broaden the s8ill and 8nowledge base of the "&o: ersonnel 0his will be done

under the suervision and aroval of NA&' 0his will include Beneral "aediatric

&are* HIV awareness/sensitivity/non-stigmatising behaviour* HIV diagnosis in

children %including clinical staging* HIV e3osed infant care* aediatric

counselling* sychosocial suort* aediatric A50 management* including 2ndline

management* management of aediatric 'ortunistic Infections/0> treatment

and lin8ages* nutrition management of SA7 and 7A7* lin8ages with social

rotection and welfare schemes* and management of A50 side effects

0he "&o: will thereby underta8e the following activities towards strengthening

"aediatric HIV care and treatment services in the region* with funding and

coordination suort from resective SA&S 7entoring of A50 &entres towards

;uality "aediatric care will include@

"roviding &7:s for "aediatricians and S7'/7's of the A50 centres in the

region* to be conducted by the "rogramme Director of the "&o: and one other

e3ert aediatrician identified by the "&o:?

&onducting review meetings to monitor and imrove the ;uality of "aediatric

care J this will be convened by the resective 5egional &oordinator %A50*

NA&'* chaired by the "rogramme Director of the "&o:?

'rganising regional wor8shos/conferences J this will be conducted by the"&o: under the overall suervision of the "rogramme Director* and with

funding and coordination suort from the SA&S?

&ontinuous mentoring of selected A50 centres J the 5egional &oordinator and

the "rogramme Director will wor8 closely in this rocess* with the 5& leading

the coordination of the rocess from the A50 centres9 end* vi( scheduling of

mentoring visits* coordination between the 5esource "erson and the I&0& and

A50 centre scheduled for this will be drawn u under the overall leadershi of

the 5egional &oordinator*

7aintaining the involvement of )B and "Bs fellows in "aediatric HIV care

It is e3ected that each "aediatric &': will have a defined geograhic area* and

the aediatric HIV care and treatment service delivery oints in that geograhic

,1


17/23

areas should be lin8ed to the resective "aediatric &': for trainings* technical

assistance and mentoring "aediatric &':s should conduct ;uarterly regional

meetings in coordination with their regional SA&S to discuss &S0 and ""0&0

issues %include SA&S* artners* other A50 &entres etc and how to address them

0he "aediatric &': should communicate regularly with NA&' and share notes

from these meetings

.+ &aacity >uilding of &&>06

NA&' will design and imlement the caacity building of &&>0* as re;uired with the

suort of e3erts "&o:s will continuously imrove uon their s8ills and stay u to date on

the latest information relating to "aediatric HIV %in the form of 0 team will be resonsible for this As information

management and communication imroves* each "&o: can use monthly ;uality scorecards to

,4


18/23

target centres that need more hel 'ver a eriod of a year* "&o:s should continue

monitoring ;uality at centres that have been visited to ensure that e3ertise is maintained

.5SA&:"6

p!ACE" will be constituted in the "CoEs based on the patient load $ after approval

of NAC

The p!ACE" will consists of

K "rogramme #irector of "CE/ Nodal fficer of ART centre

K E*ternal ART e*pert &panel to be formed by NAC$ preferably not from the same

ART centre'

K Regional Coordinator/%oint #irector &C!T' / Consultant &C!T' at !AC!

)he f%ntions of $SAC'# *ill inl%de

K Reviewing and deciding on paediatric cases referred by the referring ART centres

for second+line ART provision both for eligibility for viral load testing and

initiation of second line ART

K Reviewing referred paediatric cases for alternative first line ART

K Reviewing cases every fi*ed wee0day &for e.g. Tuesday' or ne*t wor0ing day &in

case the fi*ed day being a holiday'. This is to ensure that there is no delay in

review /and processing of the case referred for review of suspected treatment

failure. A ma*imum of 12+34 patients shall be reviewed at each meeting &old and

new'. ,owever$ if there are very few patients$ the meeting may be deferred to the

ne*t wee0.

K 5entoring and ensuring high 6uality case management of the "7,)- on second+

line ART by the referring ART centre

K #ocumenting the registration and monitoring progress of all patients sent for

!ACE" review

8. &ON!OR!NGE9UA,!:O%PAED!AR!C!" CARE!NEREG!ON

:ach institution should be able to demonstrate measurable ;uality imrovement through the use

of a set of ;uality of care indicators % Detailed in Anne3 ,* which will be calculated on a regular

basis and disseminated to 8ey sta8eholders* including SA&S* NA&' and other A50 centres

,6


19/23

uarterly analysis of a set of ;uality indicators will allow "&o:s to oby instituting a rogramme for ;uality imrovement* "&o:s should be able to

maintain a high standard of care* while wor8ing towards continuous imrovement In addition*

"&o:s will serve as an e3ert resource for aediatric referral level care %ie treatment

failure/second line* comlicated 'I management for other centres within their resective

regions

SA&S will facilitate "&o:s to collect all HA data from A50 centres* including monthly &7IS

reorts 0he "&o:s will underta8e the resonsibility of analysing core indicators for all A50

centres within their regions and share findings with resective A50 &entres* SA&S and NA&'

networ8 of "&o:s can be created with defined communication lin8ages %web-based* hotline* e-

learning to rovide ongoing suort across regions

$ith inuts from the e3ert aediatricians in the country* including members of the "aediatric

0echnical 5esource Brou %05B* NA&' will design the 7: to trac8 the s8ill and 8nowledge

ugrade affected by this initiative "&':s will develo ;3alit2 indicators for aediatric careto

review their own function as well as functioning of attached A50 centres A "rogramme Steering

&ommittee will be formed for reviewing the rogress eriodically A "rogramme Steering

&ommittee comosed of ermanent reresentatives from NA&'* SA&S* )NI&:=* &HAI* and

$H' is roosed and would be set u under the guidance of NA&' 0his &ommittee would be

resonsible for monitoring and roviding overall management guidance for the imlementation

of the rogramme* as er NA&'9s aroval Additionally* ,-2 rotating reresentatives from each

of the "&o:ss are also roosed to be included in the committee for holistic steering and to hel

incororate each " &o:9s ersective for caacity building 0his committee of 1 to ,+ individuals

will meet on a ;uarterly basis and will be resonsible for guiding and monitoring the rogress of

the caacity building rogramme and ensuring that lessons learned and best ractices are shared

between the different "&o:s


20/23


21/23

1=. NACO %!NANC!A,A''!'ANCEOPCOE'

2,


22/23

22

A. NON RECURR!NG GRAN

No. B3d*et !te Ao3nt Details

, "hysical Infrastructure 5s !+*++*+++

%0hirty #a8hs

Includes refurbishment / new construction? roer

furniture? ade;uate sitting arrangements at the

seminar halls etc based on need

2 :;uiments 5s .*++*+++%=ive #a8hs

K 0wo Des8 to &omuters K 0wo "rinters

K 0wo latos

K 'ne #&D ro U&AN RE'OURCE'

No. 3an Reso3rce

Ran*e of

'alar2 er

ont/

Ao3nt Per

Ann3Essential 93alifications

, 7: and 5esearch

'fficer J ,

&andidates with medical

;ualification can also be

aointed for the this ost=or 7D candidates*

remuneration range will

be same as A50 S7'

=or 7>>S candidates*

remuneration range same

as A50 7'

Rs.3(444+38444

Rs.32444+384449

Rs 3$:;$444

Rs ($(;$4449

5 !c &any one of the 7ife!cience


23/23

Documents

Pediatric Centers of Excellence Scheme Final Dec 2011