POSTER PRESENTATION Open Access Scaling up HIV treatment -Karnataka, India experience Salma Fahim 1* , Suresh Shastri 1 , Reynold Washington 2 From 17th International Symposium on HIV and Emerging Infectious Diseases (ISHEID) Marseille, France. 23-25 May 2012 Background Karnataka a high HIV prevalence state in south India is home to 10 percent India’s HIV infected. The Government of India sponsored HIV treatment program was initiated on 1st April 2004. A systematic approach to scale up of the ART services is followed in Karnataka where Govern- ment is the lead agency to implement the program and all the donors/NGOs compliment the program. Methods A donor supported technical consultant was identified and located within the State AIDS Society. A logistic Management Information System is established to track procurement, distribution and supplies. Human resource recruitment, training and retention at the ART centres are decentralized to the district AIDS prevention and control units (DAPCU). Centralized classroom based training is complemented with field based onsite training and mentorship. A Google group is created for technical updates. DAPCU conducts coordination meetings to geographically distribute and allocate responsibility to all field level workers in HIV prevention and care programs to minimize loss to follow up. Results By Sept 2011, 189,179 persons living with HIV (PLHIV) are registered at ART centres and 64,104 are currently on ART. This was possible thanks to a scale up in the numbers of ART centres from 17 to 44 and CD 4 testing machines from 5 to 32 during the period 2008-2011. The proportion of PLHIV detected at Integrated Coun- seling and Testing Centres and registered in ART centres rose from 46% to 96% in this period. 122 link ART centres are established to decentralize drug distribution for those stable on ART. Lost to follow up among those on ART reduced from5.5% to 3.5%. However, death rates among those on ART remain high at around 17 %. The commonest cause of death is TB (21%), while unknown remains high (26%). Conclusions Despite a rapid scale up, loss to follow up of those initiated on ART has been significantly reduced and sta- bilized. This was possible because of coordination between government and civil society partners. The high death rates indicate the need for better integration between HIV and TB programs, strengthening clinical competencies, laboratory diagnostic facilities for oppor- tunistic infections and operations research. Author details 1 Karnataka State Aids Prevention Society, Bangalore, India. 2 Karnataka Health Promotion Trust, Bangalore, India. Published: 25 May 2012 doi:10.1186/1742-4690-9-S1-P71 Cite this article as: Fahim et al.: Scaling up HIV treatment -Karnataka, India experience. Retrovirology 2012 9(Suppl 1):P71. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit 1 Karnataka State Aids Prevention Society, Bangalore, India Full list of author information is available at the end of the article Fahim et al. Retrovirology 2012, 9(Suppl 1):P71 http://www.retrovirology.com/content/9/S1/P71 © 2012 Fahim et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Page 1: Scaling up HIV treatment -Karnataka, India experience

POSTER PRESENTATION Open Access

Scaling up HIV treatment -Karnataka, IndiaexperienceSalma Fahim1*, Suresh Shastri1, Reynold Washington2

From 17th International Symposium on HIV and Emerging Infectious Diseases (ISHEID)Marseille, France. 23-25 May 2012

BackgroundKarnataka a high HIV prevalence state in south India ishome to 10 percent India’s HIV infected. The Governmentof India sponsored HIV treatment program was initiatedon 1st April 2004. A systematic approach to scale up ofthe ART services is followed in Karnataka where Govern-ment is the lead agency to implement the program and allthe donors/NGOs compliment the program.

MethodsA donor supported technical consultant was identifiedand located within the State AIDS Society. A logisticManagement Information System is established to trackprocurement, distribution and supplies. Human resourcerecruitment, training and retention at the ART centresare decentralized to the district AIDS prevention andcontrol units (DAPCU). Centralized classroom basedtraining is complemented with field based onsite train-ing and mentorship. A Google group is created for tech-nical updates. DAPCU conducts coordination meetingsto geographically distribute and allocate responsibility toall field level workers in HIV prevention and care pro-grams to minimize loss to follow up.

ResultsBy Sept 2011, 189,179 persons living with HIV (PLHIV)are registered at ART centres and 64,104 are currentlyon ART. This was possible thanks to a scale up in thenumbers of ART centres from 17 to 44 and CD 4 test-ing machines from 5 to 32 during the period 2008-2011.The proportion of PLHIV detected at Integrated Coun-seling and Testing Centres and registered in ART cen-tres rose from 46% to 96% in this period. 122 link ARTcentres are established to decentralize drug distributionfor those stable on ART. Lost to follow up among those

on ART reduced from5.5% to 3.5%. However, deathrates among those on ART remain high at around 17 %.The commonest cause of death is TB (21%), whileunknown remains high (26%).

ConclusionsDespite a rapid scale up, loss to follow up of thoseinitiated on ART has been significantly reduced and sta-bilized. This was possible because of coordinationbetween government and civil society partners. The highdeath rates indicate the need for better integrationbetween HIV and TB programs, strengthening clinicalcompetencies, laboratory diagnostic facilities for oppor-tunistic infections and operations research.

Author details1Karnataka State Aids Prevention Society, Bangalore, India. 2Karnataka HealthPromotion Trust, Bangalore, India.

Published: 25 May 2012

doi:10.1186/1742-4690-9-S1-P71Cite this article as: Fahim et al.: Scaling up HIV treatment -Karnataka,India experience. Retrovirology 2012 9(Suppl 1):P71.

Submit your next manuscript to BioMed Centraland take full advantage of:

• Convenient online submission

• Thorough peer review

• No space constraints or color figure charges

• Immediate publication on acceptance

• Inclusion in PubMed, CAS, Scopus and Google Scholar

• Research which is freely available for redistribution

Submit your manuscript at www.biomedcentral.com/submit1Karnataka State Aids Prevention Society, Bangalore, India

Full list of author information is available at the end of the article

Fahim et al. Retrovirology 2012, 9(Suppl 1):P71http://www.retrovirology.com/content/9/S1/P71

© 2012 Fahim et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

http://creativecommons.org/licenses/by/2.0