Step 1: Introduction, Session Objectives (Slides 1-2) - 2 minutes Trainer Notes: This session should take approximately 45 minutes to implement. Step 1: Introduction, Session Objectives (Slides 1-2) - 2 minutes Step 2: Link ART Centres: Rationale and Objectives (Slides 3-8) - 10 minutes Step 3: Link ART Centres: Functions and Responsibilities (Slides 9-10) - 7 minutes Step 4: Link ART Centres: Site selection, Infrastructure & Human Resources (Slides 11-16) - 12 minutes Step 5: Link ART Centres: Assessment and LAC Plus (Slides 17-21) - 12 minutes Step 6: Summary and Key points (Slides 22) - 2 minutes
Step 2: Link ART Centres: Rationale and Objectives (Slides 3-8) - 10 minutes Trainer Notes:
Step 3: Link ART Centres: Functions and Responsibilities (Slides 9-10) - 7 minutes Trainer Notes:
Step 4: Link ART Centres: Site selection, Infrastructure & Human Resources (Slides 11-16) - 12 minutes Trainer Notes:
Step 5: Link ART Centres: Assessment and LAC Plus (Slides 17-21) - 12 minutes Trainer Notes:
Trainer Notes: The trainer then continues the discussion on LAC Plus centres and their manpower.
Trainer Notes: The trainer then continues the discussion on LAC Plus centres and their manpower. The roll out of the revised scheme shall be initiated at existing LAC with a patient load of more than 100 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
Step 6: Summary and Key points (Slide 22) - 2 minutes Trainer Notes: Trainer has to summarise the key points and clarify the doubts of the trainees.
Link ART centres concept
Link ART Centres Concept, Objectives, Structure, Roles and responsibilityLink ART Centres Concept
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 schemeLink ART Centres Concept 2
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 treatmentLink ART Centres Concept 3
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 costLink ART Centres Concept 4
Link ART Centre: Rationale • 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 ARTLink ART Centres Concept 5
Link ART Centre: Rationale • 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 costsLink ART Centres Concept 6
Link ART Centre: Objectives • 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 & ARTLink ART Centres Concept 7
HIV Care in Integrated General Health System Model of HIV Public Health HIV-Related treatment Infrastructure Services service & HIV-Relevant Staff Centres of Excellence - alternate First line & Second line ART Medical College ART Centres + Referral tertiary level care District District with low Sero-positivity ART Centre/ Link ART Hospital may have LAC only. Centre Community Health Link ART Centres Centre ICTC, Primary Health Centre (PHC) Designated & 24/7 PHC Microscopy Centre Community-Based HIV Screening Sub-Centres & Anganwadi Centres CCC / NGOsLink ART Centres Concept 8
Functions of LAC Back Referral Provide ARV to ART Centre Drugs to Stable PLHIV on ART Screening of HIV-TB Co infection Adherence LAC Counselling and Monitoring PLHIV for side effects Psycho-Social Support To PLHIV Treatment of Minor OIsLink ART Centres Concept 9
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 patientLink ART Centres Concept 10
Link ART Centre: Site Selection • 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 Centres Concept 11
Link ART Centres: Ideal Sites • 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 LACLink ART Centres Concept 12
Link ART Centres: Infrastructure • 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 dailyLink ART Centres Concept 13
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.Link ART Centres Concept 14
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.Link ART Centres Concept 15
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 CentreLink ART Centres Concept 16
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 decreasedLink ART Centres Concept 17
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 servicesLink ART Centres Concept 18
Roll out of LAC Plus Scheme • 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 providedLink ART Centres Concept 19
Roll out of LAC Plus Scheme Enrollment of Back Referral PLHIVA in HIV Care and basic investigations Psycho–social Support to PLHIV LAC Pre-ART Management Screening of HIV -TB Coinfection Treatment of OIs Monitoring of PLHIV on ART 9Link ART Centres Concept 20
Functions of LAC & LAC Plus LAC LAC PlusARV Drug distribution Enrolment of PLHIV into HIV care and ART Care Pre-ART management including basic investigationsMonitoring of PLHIV on ART and sample collection for CD4 count Follow up of pre-ART patients not eligible for ARTCounselling on adherence,nutritional & positive prevention Referral of eligible patients to Nodal ART Centre for ART initiationIdentification of side-effects Screening of HIV-TB co infectionTreatment 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)Link ART Centres Concept 21
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 sessionLink ART Centres Concept 22
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