The document describes a project in Karnataka, India called Samastha that aimed to improve adherence to antiretroviral therapy (ART) for people living with HIV (PLHIV) in rural areas. It discusses a case of a 10-year-old girl who missed doses of her ART after running out of medication on a trip. Samastha worked to coordinate community groups, government agencies, and NGOs to recruit more PLHIV into care, keep them engaged, and retrieve those who were lost to follow up. It developed networks and deployed outreach workers to improve access to treatment in remote, rural areas and monitor patients' status.
David Levine: Environmentally conscience planningNuffield Trust
This document outlines the reform of Quebec's health and social services system. Key points include:
- The reform introduced a population-based managed care model with multidisciplinary teams responsible for rostered clients.
- Health and Social Services Centers were created by merging various institutions to provide integrated services through local networks.
- The reform aimed to improve access to services, care continuity, and population health while reducing costs through prevention and chronic disease management.
- Primary care teams play a central role in coordinating services and guiding clients to the appropriate level of care.
This document describes an integrated primary health care partnership model between the Aga Khan University East Africa, the University of California San Francisco, and the government of Kenya. The model aims to test mechanisms for partnership between district health systems and higher education to increase access to high-quality primary health care, focusing on maternal, newborn, and child health. An initial planning grant supported partnership development and needs assessment in Kaloleni District, Kenya. Key learnings included identifying barriers to maternal care access and priorities for community engagement, training, and innovations like mobile technology to strengthen the health system and referral pathways. Next steps involve developing a multi-year partnership proposal and mobilizing resources to provide critical supports applying the integrated primary health care model.
The document outlines objectives for a nursing fundamentals course focusing on health care delivery and professional nursing. It discusses the current U.S. health care delivery system, the role of nursing within it, and different levels of health care providers. It also covers primary, secondary, and tertiary health care services; diversity in health care; trends in health care delivery systems; and examples of health care institutions and practitioners.
The document proposes introducing an electronically barcoded health-cum-insurance card for all eligible Indian citizens. The card would contain biometric and medical information to expedite healthcare services. It could reduce costs, prevent impersonation, and minimize paper usage. Similar programs have seen success in other regions. Implementing the plan would require strengthening rural healthcare, coordinating different government levels, and gaining public support over time. The card is envisioned as one part of improving primary healthcare access.
The document introduces community health agents (CHAs) in Tanzania to improve maternal and child health outcomes. It outlines the CHA's role in 3 areas: 1) improving household and community health practices, 2) enhancing community-based case management of childhood illnesses, and 3) strengthening the local health system. The CHA's activities include distributing health technologies, educating communities, monitoring pregnancies, treating childhood illnesses, and linking communities to health services and planning. The goal is for CHA interventions to generate better health outcomes by improving access, quality, and efficiency of services.
This document provides an overview of NHS Continuing Healthcare. It discusses the differences between health care and social care, and outlines the framework and tools used to determine eligibility for NHS Continuing Healthcare, including the Fast Track Pathway Tool, Checklist, and Decision Support Tool. The document emphasizes that eligibility is based on the level of an individual's care needs and whether their primary need is for health care rather than social care. It provides guidance on assessing needs against the criteria of nature, intensity, complexity and unpredictability to determine if someone has a primary health need.
This document provides an overview and introduction to NHS Continuing Healthcare. It discusses the difference between health care and social care, and how the NHS Continuing Healthcare framework determines if a person has a "primary health need" and is eligible for fully funded NHS care. The key steps in the NHS Continuing Healthcare process include using the Fast Track Pathway Tool, Checklist, and Decision Support Tool to assess a person's needs and make a recommendation about their eligibility.
David Levine: Environmentally conscience planningNuffield Trust
This document outlines the reform of Quebec's health and social services system. Key points include:
- The reform introduced a population-based managed care model with multidisciplinary teams responsible for rostered clients.
- Health and Social Services Centers were created by merging various institutions to provide integrated services through local networks.
- The reform aimed to improve access to services, care continuity, and population health while reducing costs through prevention and chronic disease management.
- Primary care teams play a central role in coordinating services and guiding clients to the appropriate level of care.
This document describes an integrated primary health care partnership model between the Aga Khan University East Africa, the University of California San Francisco, and the government of Kenya. The model aims to test mechanisms for partnership between district health systems and higher education to increase access to high-quality primary health care, focusing on maternal, newborn, and child health. An initial planning grant supported partnership development and needs assessment in Kaloleni District, Kenya. Key learnings included identifying barriers to maternal care access and priorities for community engagement, training, and innovations like mobile technology to strengthen the health system and referral pathways. Next steps involve developing a multi-year partnership proposal and mobilizing resources to provide critical supports applying the integrated primary health care model.
The document outlines objectives for a nursing fundamentals course focusing on health care delivery and professional nursing. It discusses the current U.S. health care delivery system, the role of nursing within it, and different levels of health care providers. It also covers primary, secondary, and tertiary health care services; diversity in health care; trends in health care delivery systems; and examples of health care institutions and practitioners.
The document proposes introducing an electronically barcoded health-cum-insurance card for all eligible Indian citizens. The card would contain biometric and medical information to expedite healthcare services. It could reduce costs, prevent impersonation, and minimize paper usage. Similar programs have seen success in other regions. Implementing the plan would require strengthening rural healthcare, coordinating different government levels, and gaining public support over time. The card is envisioned as one part of improving primary healthcare access.
The document introduces community health agents (CHAs) in Tanzania to improve maternal and child health outcomes. It outlines the CHA's role in 3 areas: 1) improving household and community health practices, 2) enhancing community-based case management of childhood illnesses, and 3) strengthening the local health system. The CHA's activities include distributing health technologies, educating communities, monitoring pregnancies, treating childhood illnesses, and linking communities to health services and planning. The goal is for CHA interventions to generate better health outcomes by improving access, quality, and efficiency of services.
This document provides an overview of NHS Continuing Healthcare. It discusses the differences between health care and social care, and outlines the framework and tools used to determine eligibility for NHS Continuing Healthcare, including the Fast Track Pathway Tool, Checklist, and Decision Support Tool. The document emphasizes that eligibility is based on the level of an individual's care needs and whether their primary need is for health care rather than social care. It provides guidance on assessing needs against the criteria of nature, intensity, complexity and unpredictability to determine if someone has a primary health need.
This document provides an overview and introduction to NHS Continuing Healthcare. It discusses the difference between health care and social care, and how the NHS Continuing Healthcare framework determines if a person has a "primary health need" and is eligible for fully funded NHS care. The key steps in the NHS Continuing Healthcare process include using the Fast Track Pathway Tool, Checklist, and Decision Support Tool to assess a person's needs and make a recommendation about their eligibility.
The document discusses telehealth initiatives in Virginia, including the Virginia Telehealth Network (VTN) and the Virginia Stroke Systems (VAST) pilot program. VTN aims to improve healthcare access across the state through telehealth, starting with an acute stroke care network. The VAST program will test an integrated stroke system across central Shenandoah Valley using telemedicine, including remote neurology consultations via robot, to evaluate and treat stroke patients in rural hospitals. The goal is to create a replicable model to improve stroke outcomes and reduce disability statewide.
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
Spotlight on continuing health care in strokeNHS Improvement
Stroke patients often have complex needs that make them eligible for NHS continuing healthcare (CHC) funding. However, the CHC process can be time-consuming and delay discharge from hospitals. Several recommendations are provided to streamline the process, including designating a coordinator, integrating social workers into care teams, and conducting assessments in post-acute settings rather than hospitals. Examples from hospitals in England demonstrate how roles like discharge coordinators and computer systems can reduce duplication and speed up the process.
Presentación de Nick Goodwin y Judith Smith en el proyecto de The King’s Fund y the Nuffield Trust: "Developing a National Strategy for the Promotion of Integrated Care"
Martin McShane outlines how the NHS Commissioning Board works and how it supports clinicians, health care professionals and people in the community to enhance the quality of life for people with long-term conditions.
This document provides information about Glasgow City Council's telecare services. It defines telecare as using telecommunications to remotely deliver care services to people in their homes. The basic telecare system includes an alarm unit and pendant that connects people to a response center for assistance. Additional devices monitor for specific risks like seizures or falls. Over 15,000 people have basic systems, while 3,000 have enhanced systems with movement sensors. The response center handles over 50,000 emergency calls per month. Social workers currently refer clients for extra devices. Future plans include staff training and new assessment tools.
This document provides an overview of health information exchange (HIE) in Vermont. It discusses VITL, a non-profit organization that operates the statewide HIE, connecting hospitals, practices, and other providers. It describes how HIE is integrated into Vermont's health reform efforts like the Blueprint for Health, which uses clinical data to support practices' transformation to the patient-centered medical home model and provide population health management. The document also notes some learnings around vendor challenges, interoperability issues, and ensuring HIE sustainability beyond public funding as payment models evolve.
Integrated care seeks to address fragmentation in health and social care systems that allows individuals to "fall through the gaps" in care. It is centered around the needs of patients, especially those with complex, long-term conditions like frail older people, people with chronic diseases, and people with mental health issues. Examples provided illustrate integrated care achieved through multi-disciplinary teams, pooled budgets, and coordination of services across primary, community and hospital settings to better meet patient needs.
Katrina Percy: Working with partners to deliver high quality health and socia...The King's Fund
Katrina Percy, Chief Executive of Southern Health NHS Foundation Trust, talks about the health system in Hampshire and the key elements of Southern Health’s integrated care strategy.
What your organisation needs to know about personal health budgets, communica...CharityComms
Jaimee Lewis, Think Local, Act Personal
Changing the game: positioning your charity to succeed in the new health service market conference
www.charitycomms.org.uk/events
The National Council has played a leading role in advocating for policies and practices that break down barriers to integration and collaboration, developing clinical and business models that support seamless and comprehensive healthcare, and fostering collaborative opportunities. Advocating for funds to bring primary care services to behavioral health organizations has been a National Council legislative priority. We've also been active on the practice improvement front and have helped member organizations and their primary care partners overcome clinical, cultural, and communication barriers to collaboratively provide comprehensive healthcare.
Multimodal Messaging within The EMR, September 2007pberzins
The document discusses a roundtable on health, technology and society held on September 19, 2007 at Stevens Institute of Technology. It features quotes from several physicians, nurses, healthcare administrators and technology experts on the importance of integrated, multimodal messaging within electronic health records and healthcare delivery more broadly. It provides background on the participants and their views on using communication technologies to improve care coordination, outcomes and efficiency.
Community services are complex and fragmented, making care difficult to navigate. To transform care, services need to simplify, wrap around primary care in local teams, and build multidisciplinary teams for those with complex needs. These teams must include mental health, social care, and work closely with specialists and hospitals to coordinate rapid response care in communities or homes. This integrated model can significantly reduce hospital use for those with multiple conditions, but requires changes to contracting, payments, and harnessing community support.
The document provides guidance for domiciliary care organizations and staff on delivering high quality end of life care for people in their own homes. It outlines six key steps in the end of life care pathway: 1) discussions as end of life approaches, 2) assessment, care planning and review, 3) coordination of care, 4) delivery of high quality care, 5) care in the last days of life, and 6) care after death. The guidance addresses important considerations for organizations and the roles of care workers at each step to help ensure people receive dignified and compassionate care at the end of life in their own homes.
The National Center for Trauma-Informed Care (NCTIC) promotes a new framework called Trauma-Informed Care that recognizes the widespread impact of psychological trauma. NCTIC provides consultation, training, and resources to help mental health and human services organizations transform the way they operate to focus on trauma and empower those seeking help. Trauma-Informed Care shifts the perspective from "what is wrong with you?" to "what has happened to you?" and prioritizes creating safe, strength-based environments where individuals' experiences are acknowledged and they have choice and control over their recovery. NCTIC works to make Trauma-Informed programs and policies the standard approach.
Spotlight on patient and public engagement and experience in stroke careNHS Improvement
The document summarizes efforts to improve patient and public engagement and experience in the NHS, specifically for stroke care. It describes how the South Central Cardiovascular Network developed a model for meaningful involvement through a "people bank" to recruit and train patient representatives. It also highlights a resource directory for stroke patients and families developed in Shropshire, and a three-year project working with stroke survivors and carers to develop an engagement charter.
Parallel Session 3.6 Reshaping Care - Shifting the Focus and Shifting the Power?NHSScotlandEvent
This document summarizes presentations from a conference on shifting the focus and power of healthcare to communities.
The first presentation discussed community engagement, resilience and health service development initiatives in Scotland's Annandale and Eskdale regions to better support older adults, those with long-term conditions, caregivers and people with dementia.
The second presentation described a project in Clackmannanshire, Scotland that employs community development workers and an older adult support worker to map resources, gather community input, identify hidden caregivers and co-produce new support services.
The third presentation was about a lifestyle management program for long-term conditions run by the Thistle Foundation. It is staff-led but co-facilitated
The ReMiND project in Uttar Pradesh, India developed a mobile application to support Accredited Social Health Activists (ASHAs) and their supervisors in improving maternal and child health. The app helps ASHAs counsel clients and access health services, while the supervisor app aids in monitoring the ASHAs' work. By strengthening supervision and interpersonal communication skills, the project has helped boost ASHA performance and coverage of key health practices in rural communities.
The document discusses the PAS 150 standards for rehabilitation services and factors that can affect the delivery of specialist rehabilitation services in the UK. It outlines three levels of rehabilitation services (local general, district specialist, and complex specialized) and describes the types of conditions and needs addressed at each level. It also identifies challenges in areas like commissioning, bed availability, discharge pathways, access to tertiary services, and consultant and staff shortages that can impact specialist rehabilitation services. The PAS 150 is presented as a tool to set standards and drive quality improvement across rehabilitation services.
This document introduces standards for social work practice in health care settings developed by the National Association of Social Workers (NASW). It provides background on the role of social workers in health care, outlines guiding principles for social work, and defines key terms. The standards are intended to enhance social workers' skills and knowledge when working with individuals, families, providers, and communities in health care.
AIDSTAR-One Case-Study: Integrated HIV Care in IndiaAIDSTAROne
The document describes an integrated care program in Maharashtra, India that aims to improve HIV care and support for people living with HIV. The program establishes drop-in centers that provide economic support, counseling, and help navigating services. This reduces stigma and improves utilization of clinical services. The program strengthens coordination between public health services and community groups to provide more comprehensive support. It has led to significant improvements in care access and continuity while reducing loss to follow up. The drop-in centers offer a supportive community for clients where they feel at home.
AIDSTAR-One Breaking New Ground in VietnamAIDSTAROne
1) The STEP program in Vietnam aims to integrate gender considerations into CARE's work by providing support services to male and female drug users and sex workers both before and after their release from detention centers.
2) The program recognizes that gender inequality increases vulnerability and provides gender-sensitive counseling, health services, job training, and social support to help prevent violence and relapse.
3) Services include pre-release counseling at detention centers and post-release drop-in centers that provide counseling, referrals, home visits, and community education with the goal of smooth reintegration.
The document discusses telehealth initiatives in Virginia, including the Virginia Telehealth Network (VTN) and the Virginia Stroke Systems (VAST) pilot program. VTN aims to improve healthcare access across the state through telehealth, starting with an acute stroke care network. The VAST program will test an integrated stroke system across central Shenandoah Valley using telemedicine, including remote neurology consultations via robot, to evaluate and treat stroke patients in rural hospitals. The goal is to create a replicable model to improve stroke outcomes and reduce disability statewide.
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
Spotlight on continuing health care in strokeNHS Improvement
Stroke patients often have complex needs that make them eligible for NHS continuing healthcare (CHC) funding. However, the CHC process can be time-consuming and delay discharge from hospitals. Several recommendations are provided to streamline the process, including designating a coordinator, integrating social workers into care teams, and conducting assessments in post-acute settings rather than hospitals. Examples from hospitals in England demonstrate how roles like discharge coordinators and computer systems can reduce duplication and speed up the process.
Presentación de Nick Goodwin y Judith Smith en el proyecto de The King’s Fund y the Nuffield Trust: "Developing a National Strategy for the Promotion of Integrated Care"
Martin McShane outlines how the NHS Commissioning Board works and how it supports clinicians, health care professionals and people in the community to enhance the quality of life for people with long-term conditions.
This document provides information about Glasgow City Council's telecare services. It defines telecare as using telecommunications to remotely deliver care services to people in their homes. The basic telecare system includes an alarm unit and pendant that connects people to a response center for assistance. Additional devices monitor for specific risks like seizures or falls. Over 15,000 people have basic systems, while 3,000 have enhanced systems with movement sensors. The response center handles over 50,000 emergency calls per month. Social workers currently refer clients for extra devices. Future plans include staff training and new assessment tools.
This document provides an overview of health information exchange (HIE) in Vermont. It discusses VITL, a non-profit organization that operates the statewide HIE, connecting hospitals, practices, and other providers. It describes how HIE is integrated into Vermont's health reform efforts like the Blueprint for Health, which uses clinical data to support practices' transformation to the patient-centered medical home model and provide population health management. The document also notes some learnings around vendor challenges, interoperability issues, and ensuring HIE sustainability beyond public funding as payment models evolve.
Integrated care seeks to address fragmentation in health and social care systems that allows individuals to "fall through the gaps" in care. It is centered around the needs of patients, especially those with complex, long-term conditions like frail older people, people with chronic diseases, and people with mental health issues. Examples provided illustrate integrated care achieved through multi-disciplinary teams, pooled budgets, and coordination of services across primary, community and hospital settings to better meet patient needs.
Katrina Percy: Working with partners to deliver high quality health and socia...The King's Fund
Katrina Percy, Chief Executive of Southern Health NHS Foundation Trust, talks about the health system in Hampshire and the key elements of Southern Health’s integrated care strategy.
What your organisation needs to know about personal health budgets, communica...CharityComms
Jaimee Lewis, Think Local, Act Personal
Changing the game: positioning your charity to succeed in the new health service market conference
www.charitycomms.org.uk/events
The National Council has played a leading role in advocating for policies and practices that break down barriers to integration and collaboration, developing clinical and business models that support seamless and comprehensive healthcare, and fostering collaborative opportunities. Advocating for funds to bring primary care services to behavioral health organizations has been a National Council legislative priority. We've also been active on the practice improvement front and have helped member organizations and their primary care partners overcome clinical, cultural, and communication barriers to collaboratively provide comprehensive healthcare.
Multimodal Messaging within The EMR, September 2007pberzins
The document discusses a roundtable on health, technology and society held on September 19, 2007 at Stevens Institute of Technology. It features quotes from several physicians, nurses, healthcare administrators and technology experts on the importance of integrated, multimodal messaging within electronic health records and healthcare delivery more broadly. It provides background on the participants and their views on using communication technologies to improve care coordination, outcomes and efficiency.
Community services are complex and fragmented, making care difficult to navigate. To transform care, services need to simplify, wrap around primary care in local teams, and build multidisciplinary teams for those with complex needs. These teams must include mental health, social care, and work closely with specialists and hospitals to coordinate rapid response care in communities or homes. This integrated model can significantly reduce hospital use for those with multiple conditions, but requires changes to contracting, payments, and harnessing community support.
The document provides guidance for domiciliary care organizations and staff on delivering high quality end of life care for people in their own homes. It outlines six key steps in the end of life care pathway: 1) discussions as end of life approaches, 2) assessment, care planning and review, 3) coordination of care, 4) delivery of high quality care, 5) care in the last days of life, and 6) care after death. The guidance addresses important considerations for organizations and the roles of care workers at each step to help ensure people receive dignified and compassionate care at the end of life in their own homes.
The National Center for Trauma-Informed Care (NCTIC) promotes a new framework called Trauma-Informed Care that recognizes the widespread impact of psychological trauma. NCTIC provides consultation, training, and resources to help mental health and human services organizations transform the way they operate to focus on trauma and empower those seeking help. Trauma-Informed Care shifts the perspective from "what is wrong with you?" to "what has happened to you?" and prioritizes creating safe, strength-based environments where individuals' experiences are acknowledged and they have choice and control over their recovery. NCTIC works to make Trauma-Informed programs and policies the standard approach.
Spotlight on patient and public engagement and experience in stroke careNHS Improvement
The document summarizes efforts to improve patient and public engagement and experience in the NHS, specifically for stroke care. It describes how the South Central Cardiovascular Network developed a model for meaningful involvement through a "people bank" to recruit and train patient representatives. It also highlights a resource directory for stroke patients and families developed in Shropshire, and a three-year project working with stroke survivors and carers to develop an engagement charter.
Parallel Session 3.6 Reshaping Care - Shifting the Focus and Shifting the Power?NHSScotlandEvent
This document summarizes presentations from a conference on shifting the focus and power of healthcare to communities.
The first presentation discussed community engagement, resilience and health service development initiatives in Scotland's Annandale and Eskdale regions to better support older adults, those with long-term conditions, caregivers and people with dementia.
The second presentation described a project in Clackmannanshire, Scotland that employs community development workers and an older adult support worker to map resources, gather community input, identify hidden caregivers and co-produce new support services.
The third presentation was about a lifestyle management program for long-term conditions run by the Thistle Foundation. It is staff-led but co-facilitated
The ReMiND project in Uttar Pradesh, India developed a mobile application to support Accredited Social Health Activists (ASHAs) and their supervisors in improving maternal and child health. The app helps ASHAs counsel clients and access health services, while the supervisor app aids in monitoring the ASHAs' work. By strengthening supervision and interpersonal communication skills, the project has helped boost ASHA performance and coverage of key health practices in rural communities.
The document discusses the PAS 150 standards for rehabilitation services and factors that can affect the delivery of specialist rehabilitation services in the UK. It outlines three levels of rehabilitation services (local general, district specialist, and complex specialized) and describes the types of conditions and needs addressed at each level. It also identifies challenges in areas like commissioning, bed availability, discharge pathways, access to tertiary services, and consultant and staff shortages that can impact specialist rehabilitation services. The PAS 150 is presented as a tool to set standards and drive quality improvement across rehabilitation services.
This document introduces standards for social work practice in health care settings developed by the National Association of Social Workers (NASW). It provides background on the role of social workers in health care, outlines guiding principles for social work, and defines key terms. The standards are intended to enhance social workers' skills and knowledge when working with individuals, families, providers, and communities in health care.
AIDSTAR-One Case-Study: Integrated HIV Care in IndiaAIDSTAROne
The document describes an integrated care program in Maharashtra, India that aims to improve HIV care and support for people living with HIV. The program establishes drop-in centers that provide economic support, counseling, and help navigating services. This reduces stigma and improves utilization of clinical services. The program strengthens coordination between public health services and community groups to provide more comprehensive support. It has led to significant improvements in care access and continuity while reducing loss to follow up. The drop-in centers offer a supportive community for clients where they feel at home.
AIDSTAR-One Breaking New Ground in VietnamAIDSTAROne
1) The STEP program in Vietnam aims to integrate gender considerations into CARE's work by providing support services to male and female drug users and sex workers both before and after their release from detention centers.
2) The program recognizes that gender inequality increases vulnerability and provides gender-sensitive counseling, health services, job training, and social support to help prevent violence and relapse.
3) Services include pre-release counseling at detention centers and post-release drop-in centers that provide counseling, referrals, home visits, and community education with the goal of smooth reintegration.
This is an invited presentation made in the HIV & Law ALA Fellow Program held at NCHSR, UNSW, organized by Shingua Univeristy & UNSW (Sponsored by AusAID, Govt. of Australia)
The document summarizes the activity report of Project Axshya, a civil society initiative in India to strengthen TB care and control. It aims to improve access to quality TB services through partnerships between government and civil society. In its first year, Project Axshya worked with NGO partners in 90 districts to expand TB screening, treatment and awareness through community engagement efforts. Challenges remained in managing complex community interventions at scale, but successes included establishing training to improve patient-provider interactions and increasing local ownership of TB care.
Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India
This document summarizes an article from the journal AIDS Care. The article discusses expanding access to antiretroviral therapy (ART) in resource-constrained settings and the related social and policy challenges. A conference was held bringing together researchers to share social science research on ART delivery and its effects. The papers in this document examine the social processes and impacts on individuals, families, communities, and health services resulting from increased access to ART for HIV, including effects on identity, living with HIV, and health services.
AIDSTAR-One Case Study: Avahan-India HIV/AIDS InitiativeAIDSTAROne
Launched in 2003, the Avahan-India HIV prevention program has become a global model for combination HIV prevention programming that meets the complex and varied needs of most-at-risk populations. This case study describes Avahan’s behavioral, biomedical, and structural components and how the program was able to quickly scale up its activities across 82 districts in India. To view this and other combination HIV prevention resources: http://j.mp/ztESbn
Level of male involvement in home based care for people living with hiv and a...Alexander Decker
This study examined the level of male involvement in home-based care (HBC) for people living with HIV/AIDS (PLWHA) in Nyando District, Western Kenya. The study found:
1) Most men (84%) were knowledgeable about HBC services but only 3% had received training. Counseling was the service men were most involved in providing (60.7%), while clinical care saw the lowest involvement (19.3%).
2) Men preferred providing nursing care and clinical care to male PLWHA compared to females. Social support was given more to female PLWHA. The majority of primary caregivers for PLWHA were women (83.6%).
3) L
Knowledge, Attitude and Practices of Contraceptive Methods in Women of Reproductive Age Group in an Urban District of Haryana
http://dx.doi.org/10.21276/SSR-IIJLS.2020.6.1.2
Right to Health - A TRS initiative to guarantee support to systems that enable universal healthcare access . Supported by Teleradiology Solutions Pvt Ltd.
This presentation was conceptualised and made by me as a part of my Summer training project work. The project was a real time activity carried out by the Public Health division of ASTRON Hospital & healthcare Consultants Pvt. Ltd.
This document summarizes a participatory action research study that aimed to explore barriers to HIV prevention, testing, and treatment services among commercial sex workers in Lilongwe, Malawi and identify solutions. The study found high HIV knowledge but low uptake of services due to barriers both within the community and health services. Through participatory meetings, priorities were identified as lack of early treatment seeking, poor treatment of sex workers at facilities, and lack of adherence. An intervention was implemented involving counseling, engagement at workplaces, joint committees, and health worker sensitization. Follow up surveys found improvements across areas, suggesting the process addressed barriers and increased service uptake. The study highlights the need for community involvement, addressing stigma, and integrating services to improve access
AIDSTAR-One District Comprehensive Approach for HIV Prevention and Continuum ...AIDSTAROne
Social stigma and fear impede HIV prevention, treatment, care, and support efforts. This case study examines how a collaboration led by the Avert Project implemented a District Comprehensive Approach (DCA) in two districts of Maharashtra, linking available public, private, and community resources to identify and reach people who are most vulnerable to HIV with comprehensive services.
www.aidstar-one.com/focus_areas/care_and_support/resources/case_study_series/district_comprehensive_approach_india
ECONOMIC ASSESSMENT OF THE LEVEL OF EFFECTIVENESS OF PRIMARY HEALTHCARE SERVI...JobOpue1
his study examined the level of effectiveness of primary healthcare services in Cross River State (CRS). The data generated were analyzed using the t-test of mean difference and the confidence interval analysis. The results showed that there was a disparity in access to healthcare services between the Northern and Central senatorial districts, while there was no disparity in the level of accessibility to healthcare services between the Northern and Southern and the Central and Southern districts. There was no disparity in the level of government funding and management of healthcare services between the three senatorial districts, but there was a disparity in the level of infrastructural amenities distributed among the three senatorial districts. The government should increase its budgetary allocation for healthcare in line with the World Health Organisation’s 15 per cent of the total budget benchmark to boost the effectiveness of primary healthcare services, among others was recommended.
1) The document discusses a study evaluating the impact of a biometric fingerprint scanning system used to track patient attendance and medication adherence at tuberculosis treatment centers in slum communities in India.
2) Interviews with health workers, center owners, and patients suggest that the biometric system helps draw patients to the centers and improves their medication adherence by making in-person visits and monitored dosing more important.
3) While some inconvenience was reported, overall the biometric system was perceived positively and as creating solidarity between health workers and patients in ensuring proper treatment.
The document discusses addressing denial, stigma, and discrimination faced by people living with HIV/AIDS. It shares experiences of various organizations that have created more enabling environments through approaches like increasing openness, counseling family members, training healthcare workers, and empowering people living with HIV/AIDS. It also recommends forming a group called AAROHII to document work on stigma and discrimination and influence policies to reduce it.
Involvement of hub nurses in hiv policy developmentAlexander Decker
This document summarizes a study on the involvement of nurses in HIV policy development in Nyanza Province, Kenya.
1. The study found that nurses are involved in policy development at local and district levels but their involvement is still minimal at provincial and national levels. Linkages and collaborations with other organizations provided the greatest benefit.
2. Nurses perceived they were more involved in policy implementation than formulation due to lack of knowledge and skills. They also lacked confidence to participate.
3. Benefits of involvement included improved nursing care, support from workplaces, and relationships built with other health professions through collaborations. Linkages were formed with government departments, NGOs, communities, and learning institutions.
This qualitative study examined community members' knowledge of emergency medical conditions like obstetric and neonatal complications in northern Ghana. The study aimed to understand barriers to utilizing emergency referral services and inform the development of a community education program. Focus group discussions revealed varying and sometimes inaccurate understandings of different medical emergencies. Certain conditions were believed to be spiritual or traditional problems requiring non-medical treatment. The discussions identified misconceptions and cultural practices that hindered emergency care seeking. The results provided guidance on addressing knowledge gaps and misperceptions through community education materials and programs to improve emergency service utilization.
Similar to Aidstar one case-study_linkingart_india (20)
AIDSTAR-One Report: Rapid Assessment of Pediatric HIV Treatment in NigeriaAIDSTAROne
This document summarizes a rapid assessment of pediatric HIV treatment in Nigeria conducted by AIDSTAR-One in 2011.
Part I identified several barriers to providing quality pediatric HIV care: human resource constraints, lack of caregiver involvement, limited disclosure to children and adolescents, adherence challenges, and inadequate resources at sites. It provides recommendations to address these barriers, such as limiting staff transfers, improving caregiver support, using age-appropriate adherence tools, and expanding electronic medical records.
Part II reviewed outcomes of 1,516 pediatric patients and found 4.2% mortality and 19.1% loss to follow up. Few health systems challenges significantly impacted treatment outcomes. Earlier treatment initiation and reduced loss to follow up are needed.
AIDSTAR-One Case Study: Targeted Outreach Program BurmaAIDSTAROne
The document summarizes the Targeted Outreach Project (TOP) in Burma, which works to scale up HIV programming among sex workers. TOP was launched in 2004 by Population Services International to provide health services and empowerment opportunities to female sex workers and men who have sex with men. It has expanded to 18 cities across Burma, reaching over 70% of estimated sex workers and 25% of estimated men who have sex with men. TOP operates drop-in centers that provide a range of free health services including STI testing/treatment, family planning, and HIV counseling/testing. It also offers social/economic support through small loans, education, and advocacy to improve participants' well-being and reduce risky behaviors. Evaluation data
AIDSTAR-One Co-trimoxazole Pilot Assessment ReportAIDSTAROne
AIDSTAR-One developed and piloted provider and patient educational tools to increase appropriate prescription and use of co-trimoxazole for eligible people living with HIV. Before and after the pilot, AIDSTAR-One conducted a mixed-methods assessment to analyze the effectiveness and acceptability of the co-trimoxazole tools. This report recommends adoption and scale-up of the tools in Uganda and other countries.
AIDSTAR-One Issue Paper: The Debilitating Cycle of HIV, Food Insecurity, and ...AIDSTAROne
This document aims to facilitate an understanding of the bi-directional relationship between HIV and food and nutrition security. It illuminates the causes of HIV-related food and nutrition insecurity, and points to a list of programmatic interventions and resources to consider for addressing each cause in detail. http://j.mp/U1L0iV
AIDSTAR-One conducted a 3-year demonstration project in Namibia to reduce heavy drinking and risky sexual behavior among bar patrons in a low-income neighborhood on the outskirts of Namibia's capital, Windhoek. This report describes how the intervention was implemented, monitored, and evaluated, and reports the final assessment results. It also offers key recommendations for future research and programming. http://aidstarone.com/focus_areas/prevention/resources/reports/alcohol_namibia_intervention_report
AIDSTAR-One Faith-Based Organizations and HIV Prevention with MARPs in MexicoAIDSTAROne
La Iglesia de la Reconciliación, VIHas de Vida, and El Mesón de la Misericordia are three faith-based organizations in Mexico that implement innovative HIV prevention activities with most-at-risk populations, including men who have sex with men and sex workers. They integrate messages on HIV prevention within a holistic approach that addresses spirituality, sexuality, and health. Through diverse activities like educational talks and workshops, as well as referrals to testing and care, these organizations help fill gaps and reduce stigma for at-risk groups.
AIDSTAR-One HIV Treatment Guidelines in Guyana - The Fast Track to Diagnosis ...AIDSTAROne
This case study details Guyana's process for revision of their national HIV treatment guidelines, based on WHO's 2010 revised recommendations . While many countries are still working to revise their national guidelines in response to WHO's latest guidance, the National AIDS Programme in Guyana has been implementing elements of WHO's 2010 recommendations since 2006.
www.aidstar-one.com/focus_areas/treatment/resources/case_study/guyana_treatment_guidelines
AIDSTAR-One Implementation of WHO's 2008 Pediatric HIV Treatment GuidelinesAIDSTAROne
In April 2008, the WHO Technical Reference Group for Pediatric HIV/ART and Care released a series of nine updated recommendations for diagnostic testing, initiation of treatment, and appropriate treatment regimens for HIV-exposed and infected infants. This technical brief outlines practical implementation considerations for program planners and policymakers working to incorporate these recommendations into their local efforts.
http://www.aidstar-one.com/implementation_whos_2008_pediatric_hiv_treatment_guidelines
AIDSTAR-One Protecting Children Affected by HIV Against Abuse, Exploitation, ...AIDSTAROne
This document is intended to explore strategies to protect children orphaned or made vulnerable by HIV (OVC) from abuse, exploitation, violence, and neglect. The report draws from lessons learned by OVC program managers, designers, and policy developers—particularly those associated with the President’s Emergency Plan for AIDS Relief (PEPFAR).
http://www.aidstar-one.com/focus_areas/OVC/reports/protecting_children_affected_by_HIV
AIDSTAR-One Increasing Access to Prevention of Mother-to-Child Transmission S...AIDSTAROne
This technical report discusses the many services needed throughout the prevention of mother-to-child transmission (PMTCT) and infant care services continuum and identifies potential barriers to service coverage, access, and utilization. AIDSTAR-One provides examples of evidence-based and emerging practices to mitigate these barriers.
www.aidstar-one.com/focus_areas/pmtct/resources/report/increasing_access_to_pmtct_services
AIDSTAR-One Prevention of Alcohol-Related HIV Risk BehaviorsAIDSTAROne
A growing body of research suggests that alcohol consumption is associated with the sexual behaviors that put people at risk for HIV. In developing countries battling severe HIV epidemics, addressing harmful drinking in conjunction with interventions to reduce sexual risk behavior may reduce HIV transmission more quickly than conventional HIV prevention interventions alone. Developed for program planners and implementers, this technical brief reviews the evidence on new and innovative programs in this emerging area. The brief catalogs what is known about the relationship between harmful alcohol use and HIV sexual risk behavior and offers a critical analysis of interventions to address the issue.
www.aidstar-one.com/focus_areas/prevention/resources/technical_briefs/prevention_alcohol_related_risk_behavior
AIDSTAR-One Meeting the Psychosocial Needs of Children Living with HIV in AfricaAIDSTAROne
An abbreviated version of the Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV in Africa report, this technical brief documents promising practices in critical services related to the psychological and social wellbeing of perinatally-infected children in Africa. These promising practices include the identification, testing, and counseling of children so that they are linked to appropriate care as early as possible, as well as on-going support to help children and their families manage disclosure, stigma, grief and bereavement processes.
www.aidstar-one.com/focus_areas/care_and_support/resources/technical_briefs/foundation_future
AIDSTAR-One NuLife—Food and Nutrition Interventions for UgandaAIDSTAROne
This technical report examines a nutritional assessment, counseling, and support (NACS) program in Uganda that uses a quality improvement approach to services.
www.aidstar-one.com/focus_areas/care_and_support/resources/report/nulife_food_and_nutrition_interventions_uganda
AIDSTAR-One PRASIT: Using Strategic Behavioral Communication to Change Gender...AIDSTAROne
1) The PRASIT program in Cambodia uses strategic behavioral communication to promote positive gender norms and reduce HIV risk among at-risk populations.
2) It comprises three initiatives - SMARTgirl focuses on entertainment workers, MStyle targets men who have sex with men, and You're the Man addresses gender norms among male clients of entertainment workers.
3) The initiatives use branding, peer outreach, and educational sessions to promote safer sexual practices and empower at-risk groups. The goal is to challenge norms that increase HIV vulnerability and portray at-risk populations as intelligent and able to protect their health.
AIDSTAR-One Outreach to Most-at-Risk Populations through SIDC in LebanonAIDSTAROne
Successful outreach to most-at-risk populations (MARPs) recognizes the sociocultural context and particularly the gendered norms in which MARPs live. This case study (one of nine in a series) documents how outreach workers in Lebanon raise awareness about how gender norms can increase HIV risk; deliver basic information on HIV, hepatitis, and other STIs; offer counseling to support positive behavior change, and distribute free condoms, syringes, and lubricants.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/sidc_lebanon
AIDSTAR-One STIGMA Foundation in IndonesiaAIDSTAROne
Integrating strategies to address gender inequity and change harmful gender norms is an increasingly important component of HIV programs. However, gender integration among programs targeting most-at-risk populations (MARPs) is much less prevalent. In Indonesia, the STIGMA Foundation uses a peer outreach model to help men and women who inject drugs live safer, healthier, more productive lives through community organizing, advocacy, and networking.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/STIGMA_foundation
Prompted by a growing knowledge of the complexity of HIV transmission, many countries are reassessing the nature of their HIV epidemics. "Mixed" epidemics, or concurrent epidemics experienced by both the general population and members of most-at-risk populations (MARPs), are of growing importance in HIV programming. Nigeria, a country with a range of regional and local epidemics, is now attempting to incorporate programming for MARPs into the national HIV response. This case study documents the country's analysis of its epidemics and the efforts of the Nigerian government to adjust their national strategic plan according to the results of the analysis.
www.aidstar-one.com/focus_areas/prevention/resources/case_study_series/nigeria_mixed_epidemics
AIDSTAR-One Caring for Children Living with HIV in AfricaAIDSTAROne
This report, Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV in Africa, provides information to better understand the psychological and social challenges faced in Africa by perinatally-infected children (aged 0-12 years), their parents/caregivers, and their health providers. It explores factors that contribute to the ability of children living with HIV to cope and thrive, and identifies the tools and approaches being used to help parents/caregivers and health providers provide psychosocial support (PSS) to these children. The report elaborates on the themes discussed in the Meeting the Psychosocial Needs of Children Living with HIV in Africa technical brief.
www.aidstar-one.com/focus_areas/care_and_support/resources/report/clhiv_pss_needs_africa
AIDSTAR-One Sex Work and Life with Dignity: Sex Work, HIV, and Human Rights P...AIDSTAROne
In Peru, where cultural norms emphasize women's subordination and the importance of masculinity, programs with a focus on gender—particularly those involving sex workers—are often underfunded and underrepresented. This case study (one of nine in a series) describes how three organizations focused on sex workers and transgendered and transsexual people have joined together to advance the rights of sex workers. The Sex Work, HIV, and Human Rights Program uses a democratic and participatory approach in order to raise awareness of human rights and advocate for sex workers' rights on both national and local levels.
www.aidstar-one.com/focus_areas/gender/resources/case_study_series/life_with_dignity_peru
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Post-Menstrual Smell- When to Suspect Vaginitis.pptx
Aidstar one case-study_linkingart_india
1. AIDSTAR-One | CASE STUDY SERIES July 2012
Linking Resources for
Antiretroviral Therapy Adherence
The Samastha Project in Karnataka, India
A
10-year-old girl and several field workers are sitting in a
room in the village of Kurugodu in the southwestern state of
Karnataka, India. The girl looks happy and healthy. However,
Courtesy of Herman Willems
the small green booklet she carries shows that she is a child
living with HIV. She is on antiretroviral therapy (ART) and outreach
workers from Vimukthi, a nongovernmental organization (NGO)
and partner in the Samastha project, have identified adherence
problems. Because she accompanied her mother on a trip to a
neighboring district and ran out of medication, the girl has missed
Meeting of Samastha link workers,
accredited social health activist, her ART drugs for a number of weeks. The outreach workers are
and Vimukthi supervisors in Bellary talking to her and her guardian to help determine the best way to
District.
get her back on treatment and avoid missing ART doses in the
future.
Her situation is not unusual: adhering to long-term HIV care and ART is
challenging for all people living with HIV (PLHIV). It is especially so for
PLHIV in rural villages such as those in Kurugodu, which is about three
hours away from the nearest HIV care and ART center. Though the
number of ART centers in Karnataka has increased dramatically over
the past years, such problems as transport and incomplete information
remain obstacles to care for PLHIV, and many are lost to follow-up
(LFU) after diagnosis. Those who drop out of care will not receive the
care or treatment for which they are eligible. And those who are on
ART may have adherence problems or may default, rendering them
more likely to transmit HIV or become ill.
By Herman Willems
Keeping PLHIV adherent to treatment was a key goal of Samastha, a
five-year project that was launched in January 2007 with support from
the U.S. President’s Emergency Plan for AIDS Relief through the U.S.
AIDSTAR-One
John Snow, Inc.
This publication was made possible through the support of the U.S. Agency for Interna-
1616 North Ft. Myer Drive, 16th Floor tional Development under contract number GHH-I-00-07-00059-00, AIDS Support and
Arlington, VA 22209 USA Technical Assistance Resources (AIDSTAR-One) Project, Sector I, Task Order 1, funded
Tel.: +1 703-528-7474 January 31, 2008, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
Fax: +1 703-528-7480
Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United States
www.aidstar-one.com Agency for International Development or the United States Government.
2. AIDSTAR-One | CASE STUDY SERIES
Agency for International Development. Implemented Indian Council of Medical Research and Family
through a consortium of international and Indian Health International 2009).
partner NGOs, including Vimukthi, Samastha
sought to provide comprehensive HIV services The HIV epidemic in Karnataka has a strong rural
in 12 high-prevalence rural districts and 3 urban component (Becker et al. 2007), driven by migratory
centers in Karnataka, as well as 5 coastal districts labor and the availability of cash that attract
in neighboring Andhra Pradesh. The project was commercial sex workers. In many parts of northern
designed to reduce the risk of HIV transmission Karnataka, sex work in the context of the Devadasi1
among the most at risk populations, as well as tradition is socially accepted (O’Neil et al. 2004).
vulnerable populations in rural areas, while building Devadasi female sex workers are more likely to
the capacity of existing health care institutions to work in rural areas compared to other female sex
provide quality HIV care, support, and treatment workers (Blanchard et al. 2005).
services (Karnataka Health Promotion Trust [KHPT]
2008) and to promote the utilization of these Samastha worked in several ways. The project
services by PLHIV. trained, collaborated with, and coordinated existing
community-based services (ASHA,2 anganwadi,3
and auxiliary nurse midwives), government cadres
Samastha used a number of innovative strategies
and structures (such as the District AIDS Prevention
to improve access and adherence to treatment,
and Control Unit [DAPCU] and integrated
a particular challenge in rural areas. The project
counseling and testing centers [ICTCs]), NGOs,
developed networks that helped government
and PLHIV networks. Samastha also provided
agencies and NGOs coordinate their work, which
preventive services directly and strategically
enhanced their capacity to recruit new patients,
deployed a number of trained outreach and link
keep them in care, and monitor their status at the
workers (see Box 1).
district level. Procedures developed by Samastha
also helped HIV workers to track and retrieve
patients who had been LFU, a difficult population in
these remote areas. Implementation
Samastha developed a network in which trained
Karnataka’s Rural HIV workers, village health committees, government
facilities, PLHIV networks, and participating NGOs
Epidemic collaborated to improve recruitment and retention
1
A 2008-2009 survey estimated HIV prevalence
1
Traditionally, Devadasi were girls who were dedicated to marriage
in Karnataka’s adult population at 0.63 percent, to a god and were required to perform duties at temples. These
compared to 0.31 percent in India overall (National duties commonly included sexual favors to priests and patrons of the
Institute of Medical Statistics and National AIDS temple. Over time the system has changed, but sexual exploitation of
the Devadasi, especially those from lower castes and economically
Control Organization [NACO] 2010), while other vulnerable families, is common (Halli et al. 2006).
studies document a high prevalence among certain 2
One of the key components of the National Rural Health Mission is to
provide every village in the country with a trained female community
populations, such as women in antenatal care (1.1 health activist or accredited social health activist (ASHA). Selected
percent; National Institute of Health and Family from the village itself and accountable to it, the ASHA has been trained
Welfare and NACO 2007) or female sex workers to work as an interface between the community and the public health
system (National Rural Health Mission n.d.).
(ranging between 9.5 to 34.2 percent by district; 3
Government sponsored child- and mother-care center.
2 AIDSTAR-One | July 2012
3. AIDSTAR-One | CASE STUDY SERIES
of PLHIV while strengthening and supporting their adherence to
treatment. BOX 1.
MAIN COMPONENTS
OF SAMASTHA
PROJECT IN SUPPORT
Link Workers and Outreach Workers: OF ADHERENCE
Coordinating Treatment, Care, and 1. Link workers and other
Adherence outreach workers
coordinate follow-up and
The “link worker” model was a central component of Samastha’s rural tracing activities according
outreach. Link workers were PLHIV who were selected by Samastha to geographic areas
from a small number of HIV-positive candidates proposed by their
community; they received an allowance for their work. The link 2. Community- and facility-
workers’ key tasks revolved around prevention, stigma reduction, and based care for PLHIV
support for PLHIV that included adherence support to both treatment
3. Detailed mapping, micro-
and care.
planning, and home visits
While link workers were recruited in rural high prevalence areas, 4. Organizational capacity
Samastha supported HIV-positive outreach workers at community care building and training of
centers and at integrated positive prevention and care drop-in centers. outreach workers
Outreach workers’ main task was to support PLHIV’s adherence to
care and treatment. Community care centers are hospitals that provide 5. Support groups
inpatient and outpatient care for PLHIV, including ART. The community
6. Support to village health
care center outreach workers operate in a 30 kilometer radius around
committees
the hospital. The drop-in centers were Samastha centers that initially
provided non-ART care for PLHIV. As government facilities gradually 7. Links to government
increased their provision of clinical services for PLHIV, Samastha programs
progressively shifted drop-in center focus to outreach. The drop-
in center outreach workers have a strong link with the numerous 8. Facility-based adherence
ICTCs. This made the ICTCs into entry points for Samastha outreach monitoring.
services.
Samastha provided the outreach and link workers with a five-day
induction training in mapping, micro-planning, the basics of HIV,
sexually transmitted infections and HIV care, needs assessment,
and counseling. The induction training was followed by three days of
communication skills training. Link workers were also introduced to
the concept of “shared confidentiality” (sharing medical information
with family, health workers, and others as needed) and many received
additional training packages.
Coordination: Over the course of the project, it became clear that
numerous public, private, and community resources were available.
Linking Resources for Antiretroviral Therapy Adherence: The Samastha Project in Karnataka, India 3
4. AIDSTAR-One | CASE STUDY SERIES
Scores of NGOs and local networks of PLHIV Home visits: Samastha provided home visits
were working in rural areas; the government had through three different cadres of field workers.
strong programs, all providing community outreach Home visits to consenting PLHIV were a
services; and village-level organizations had access fundamental part of the link workers’ follow-up.
to certain local resources—but these organizations They maintained a set of maps of their catchment
were not working together. Samastha worked with villages: a social map identifying formal and
all of the local human resources and developed informal facilities and services in the village (Figure
mechanisms to bring all players together, initially 1), and detailed maps indicating the houses of the
in two pilot districts, and expanded the model different types of clients—PLHIV, orphans and
throughout the 12 Karnataka districts. vulnerable children, widows, female sex workers,
pregnant women, and others (Figure 2). The maps
Ultimately, the link workers’ coordinating role were updated every quarter. PLHIV who feared
became a hallmark of Samastha’s interventions HIV-related stigma, a significant issue in Karnataka,
in high prevalence rural areas. Link workers could also opt to meet the link workers at other
formed the essential connection between PLHIV, locations. Those who refused home visits were
government and community structures, and mapped but not visited.
HIV care and treatment services, commonly
During visits, the workers checked the government-
accompanying persons from their catchment area
issued “Green Book” (the clinical log), discussed
to these services.
past and upcoming clinical appointments, and
conducted and documented a pill count to
Newly diagnosed clients who consented to shared check adherence. The pill count was instituted
confidentiality were connected at public ICTCs with
link workers for community-based follow-up. Where
possible, Samastha worked through pairs of link BOX 2. LINK WORKERS’
workers to enhance accessibility to both genders. RESPONSIBILITIES
A pair of link workers typically covered three to five
●● Monitoring ART adherence
villages. These workers followed all PLHIV in their
catchment villages based on continually updated ●● Tracing missing and LFU clients
lists from the ICTC registers. ●● Caring for orphans and vulnerable children
●● Promoting positive prevention for people who
The link workers helped PLHIV connect with
tested positive for HIV
government and community agencies, kept track
of adherence, provided home care, and performed ●● Reducing stigma
numerous other tasks as necessary (see Box 2). To ●● Linking PLHIV with government and other
ensure quality and consistency, Samastha project programs
supervisors—one for every 8 to 10 link workers—
●● Liaising with ART centers
monitored the workers’ activities. Supervisors also
helped to plan activities, conduct village training, ●● Mobilizing community resources
establish connections with resources such as the ●● Providing home-based care
ICTCs and social welfare agencies, and collect
●● Spearheading prevention activities at the
basic statistics on the number of clients and visits to
community level.
clients.
4 AIDSTAR-One | July 2012
5. AIDSTAR-One | CASE STUDY SERIES
mid-project because the previous approach, a Figure 1. Social map of a participating village.
three-day recall, appeared to be unreliable. The
Samastha database, which collected information
on all adherence assessments performed by link
workers, showed that overall adherence was high:
nearly all (95 percent) of over 24,000 PLHIV on
ART who participated in the project showed good
adherence (adherence greater than 95 percent).4
Another 2.7 percent had some adherence problems
(80 to 95 percent), while 2.3 percent had poor
adherence (less than 80 percent adherence).
When link workers found inconsistent compliance
with treatment, they provided extra counseling and
helped clients identify ways to improve adherence.
Outreach workers’ home visits largely focused on
retrieving PLHIV who were missing or LFU. They
did so in villages that were not covered by link
workers and in urban areas where no link worker
scheme was implemented. While both link workers
and outreach workers would respond to adherence
problems that were identified at the facility level, link
workers would provide more continuous support
through regular visits to homes of PLHIV.
The female sex worker peer educators were a third
type of field worker that Samastha used. Their role
in adherence support was similar to that of the
outreach workers and link workers, but limited to the Figure 2. Detailed village map showing locations and types
of Samastha clients.
female sex worker community.
Documenting clinical care and
compliance: Link workers documented their
work systematically in handwritten registers. The
registers record how long it took to get clients into
the clinical care system after being diagnosed with
HIV, when each client’s last clinical visit took place,
and when they last collected their antiretroviral
drugs, among a string of other important facts about
the medical follow-up for each patient.
1
4
However, accurate documentation of adherence proved problematic
(see the “Challenges” section).
Linking Resources for Antiretroviral Therapy Adherence: The Samastha Project in Karnataka, India 5
6. AIDSTAR-One | CASE STUDY SERIES
From October 2009 to September 2010, over 350 that were organized by Samastha (KHPT 2011b).
Samastha link workers reached more than 45,000 ART adherence is one of the areas that were
PLHIV in the state of Karnataka (KHPT 2011a). The covered in detail during this training. Samastha’s
adherence of pre-ART clients—those who have capacity building has provided strong support for
been diagnosed but are not eligible for ART—was the establishment of 93 link ART centers during
not monitored at all facilities. In such cases, link the life of the project. These centers are located in
workers provided the only systematic monitoring of taluka (subdistrict) hospitals and continue ART for
adherence to care. patients who are stable and have no adherence
problems. Thus, the link ART centers bring ART
Linking PLHIV with other services: Link closer to patients and provide an incentive for good
workers commonly helped their clients obtain a food adherence.
ration card or a widow’s pension, arranged links to
government agencies to ensure care for pregnant
women, linked beneficiaries to the orphans and Supporting Adherence
vulnerable children scheme of the Women and
Child Welfare Department, and occasionally through Village Health
guided a client through the process of applying for
government housing. Anecdotal responses from
Committees
PLHIV suggested that assistance such as this Link workers were assisted in their work by
indirectly supported their adherence to treatment. village health and sanitation committees made
up of community leaders, representatives
Establishing support groups: Samastha from community-based organizations, NGOs,
helped PLHIV improve their own lives by disadvantaged communities, other community
establishing support groups, often with help from representatives, and village health workers.
government or community workers or from NGOs Samastha’s link workers initiated community
(thus helping to build the NGOs’ capacity as well). discussion to improve understanding of HIV and
Support groups can help PLHIV regain self-esteem provided a monthly report to the committee on
and confidence. the latest HIV statistics, PLHIV needing support,
adherence problems, and other issues.
Building Local Capacity to Link workers approached the village health and
sanitation committee as needed to obtain support
Provide HIV Treatment for PLHIV. For example, the committee might
pay bus fare or school fees, or provide food
Samastha’s capacity building efforts helped to support. Funding was provided by the village’s
establish and scale-up a network of lower-level cooperative society, which gathers financial support
centers for HIV care in Karnataka. Initially ART was from business people, wealthier villagers, and
provided by government ART centers at the district neighboring industries; this funding has enabled
level. By the end of 2010, Samastha had conducted some villages to maintain successful activities
basic six-day training sessions for 359 clinical beyond the end of the projects that initiated them.
staff members from both private and government The visibility of Samastha’s link workers, and their
institutions, many of whom went on to benefit from efforts to combat HIV-related stigma, probably
clinical mentorship or practice at learning sites contributed to the growing number of village-
6 AIDSTAR-One | July 2012
7. AIDSTAR-One | CASE STUDY SERIES
initiated volunteer activities that directly or indirectly the registration of newly diagnosed PLHIV at the
support PLHIV adherence. In one village, some of ART center was tracked. As clients were contacted
the students who owned scooters agreed with the by phone and came back for follow-up, or did not
village health and sanitation committee to provide return, the lists were adapted.
PLHIV with transport to the ART center, and in
another, a private bus company provided free Once a month these lists of missing and LFU
transport to PLHIV. Initiatives like these that emerge clients, including newly diagnosed, pre-ART, and
spontaneously are among the most likely to be ART, were discussed at a meeting at the DAPCU
sustained. office of each participating district. Representatives
from all organizations engaged in tracing missing
clients attended these meetings. Participants
Facility-based Adherence separated into breakout groups to discuss the
lists from their geographic region, sort data, and
Monitoring compare lists (see Figure 3). The result of each
meeting was a series of clean and corrected lists
While link workers maintained contact with their that were handed out to participating organizations
clients and supported their adherence through based on where they worked. Together with the
community-based initiatives, ART center and ICTC DAPCU, Samastha carefully coordinated complete
staff systematically monitored adherence at the geographic coverage of a district. Typically,
institutional level. Ensuring adherence entailed Samastha link workers would trace missing and
not only helping clients stay with their medication LFU clients in the villages under their responsibility
regime, but also finding and recovering those who while outreach workers based at community care
were “missing” (missed a scheduled appointment centers and ICTCs covered the area around
fewer than 90 days ago) or LFU (have not returned their center. NGOs, PLHIV networks, and drop-
since missing an appointment more than 90 days in centers (places where PLHIV can meet and
ago). A major innovation by Samastha was to have receive psychosocial support, usually managed by
the medical staff of DAPCU, the key government PLHIV networks) would ensure coverage of those
agency for HIV-related activities in Karnataka, take areas that were not serviced by Samastha and
on a central coordinating role in the identification that were too far from community care centers or
and recovery of these clients. ICTCs. Participating organizations paid their own
costs for tracing defaulters, and most organizations
DAPCU relied on a three-level tracking system incorporated this task in their daily work so that it
implemented at ART centers. In these centers, daily did not require additional funding.
adherence monitoring and support were routine.
Each day, pharmacists kept track of expected At the same meeting, participants discussed the
ART clients who did not show up to receive their outcome of efforts to recover missing and LFU
pills. At ART centers, counselors tracked patients’ clients identified during the previous month’s
compliance with their clinical visit schedule, and meeting, and checked to make sure that the
laboratory technicians did a similar exercise for lists also included the names of those who were
pre-ART clients with a CD4 count < 350 cells/mm3. diagnosed at the ICTC but did not register for ART
The result was a series of “due lists” for people services. New diagnoses were a problematic area
who were scheduled to come in for a clinical visit, where much LFU occurred. In some cases, link or
receive ART, or check CD4 counts. On a third level, outreach workers accompanied newly diagnosed
Linking Resources for Antiretroviral Therapy Adherence: The Samastha Project in Karnataka, India 7
8. AIDSTAR-One | CASE STUDY SERIES
clients to the ART center so that they could be
registered immediately. As a result, the proportion
of newly diagnosed PLHIV who are registered at
the ART center increased from 47 percent in 2007
to 98 percent in 2010 (NACO 2011). This improved
linkage had the additional effect of strengthening
ART centers and the counseling that PLHIV
received.
This coordination among various actors during the
monthly meetings at DAPCU was a major factor
Herman Willems
in Samastha’s success in retaining or recovering
PLHIV who were missing or LFU in this challenging
rural area. At the start of the Samastha project,
limited data were available on LFU clients. A vital Figure 3. Comparing the pharmacy and antiretroviral
element in Samastha’s adherence efforts was to registers to clarify status of people living with HIV in
Karnakata.
ensure that state-level agencies also understood
the need for accurate data on missing and LFU
clients. To this effect, project staff members request for transfer and submitted this to the ART
collaborated with officials at the Karnataka State center, which issued a referral letter. However, it is
AIDS Prevention Society, who subsequently began clear that not all transfers worked well. Transfers
to request district-level data on LFU clients from across state borders posed more problems than
the DAPCUs. These requests spurred DAPCUs to those between districts within Karnataka—in the
improve and coordinate the collection and use of case of seasonal laborers for instance, who may
data on missing and LFU. migrate for three to six months at a time. Continuity
of services for such cases still needs to be worked
As a result, some districts were able to account out.
for all of the PLHIV who had initiated ART since
the beginning of the ART program. Verification of Also, not all pre-ART clients are accounted for.
the missing and LFU client lists in various districts For example, an estimated 3,500 to 4,000 pre-
shows that most clients who had ever initiated ART clients who initiated care prior to 2006, when
ART were accounted for. They were categorized the ART program began in Karnataka, were not
according to six categories (died, transferred out, accounted for in the district of Bagalkot (out of a
stopped treatment, missing, LFU, and alive and on total of more than 14,400 ever enrolled). Most of
ART). The proportion of LFU clients reduced from these were clients who were LFU between the start
5.4% to 3.4% and has been stable over the past few of the HIV program in 2002 and the start of the ART
years (NACO 2011). program in 2006. Until recently, pre-ART clients
were only traced through the activities of the link
The “transfer” category—meant to maintain workers and the integrated positive prevention and
coverage when a patient moved permanently or care drop-in center outreach workers. However, in
traveled temporarily to another district—proved 2010-2011, some ART centers started adding pre-
more difficult. When a patient traveled to another ART clients with a CD4 count < 350 cells/mm3 to
district, a Samastha link worker helped write a the list of clients to be traced.
8 AIDSTAR-One | July 2012
9. AIDSTAR-One | CASE STUDY SERIES
What Worked Well The state level, district, and visited ART centers
reported stable numbers of LFU clients. This
suggests that the majority of missing clients are
Linkages and local support for
being retrieved before they qualify as LFU.
adherence: In many areas where Samastha
worked, the linkages between PLHIV and existing
Enhanced relationships and trust:
government schemes were successful—though,
Samastha built trust with ICTC counselors by
unfortunately, their effect on adherence cannot be
referring clients to them, including pre- and
quantified. Nevertheless, it is likely that Samastha’s
postnatal women and their infants, and by
linking strategies contributed substantially to patient
organizing testing “camps” with ICTCs. Camps
adherence to ART and care. The link workers’
provided opportunities for ICTCs to educate
activities also increased local understanding of
and establish contacts with people who wanted
HIV and helped to spur community initiatives to
testing, and enhanced the relationship between
assist PLHIV, some of which directly supported
ICTC staff and communities. Finally, Samastha’s
adherence.
role in strengthening the connections between
Improved documentation: The combination DAPCU and local NGOs helped to build trust and
of Samastha’s efforts, including mapping villages, collaboration between government and community-
standardizing and coordinating documentation, and based organizations at the district and state levels.
facilitating tracking, significantly improved the ability
of government agencies and NGOs to identify,
recover, and retain PLHIV who needed care and Challenges
treatment.
Stigma: Though Samastha’s link workers
Improved tracking: It seems clear that
improved local understanding of HIV, stigma
Samastha’s work significantly improved efforts to
remained a major challenge with particular
track down rural clients who needed HIV services
relevance for adherence to treatment. While the
and increased the capacity of PLHIV to adhere
proportion of people who provided the correct
to their treatment regimes. Also, while the project
address for home visits increased considerably
linked PLHIV with various types of resources, the
(from an estimated 10 percent at the start of the
linkages maintained the confidentiality of PLHIV
project to an estimated 30 to 40 percent in later
and, with few exceptions, facilitated communication
years), a large number of people still did not want
of each patient’s wishes regarding contacts with
to be contacted at home. In other areas (e.g.,
support services.
Mysore rural), an estimated 70 percent provided the
Samastha may have influenced state-level correct address, while in areas like Bagalkot, where
statistics on LFU clients. During the project KHPT had been active well before the start of the
period, the number of people who were receiving Samastha project, the proportion of PLHIV who
ART increased from about 3,000 to over 83,000 were open to home visits was estimated at around
statewide. In Karnataka overall, the proportion of 90 percent.
PLHIV who were LFU began to decrease soon
after Samastha started, dropping from 5.4 percent Expansion: District-level DAPCUs need support
in spring 2008 to 3.4 percent in late 2010 (NACO in managing and coordinating the activities that
2011). were implemented in Samastha-supported districts.
Linking Resources for Antiretroviral Therapy Adherence: The Samastha Project in Karnataka, India 9
10. AIDSTAR-One | CASE STUDY SERIES
The large numbers of PLHIV who need follow-up, Refine systems to safeguard
and the considerable number of local organizations confidentiality: Samastha link workers
whose activities need to be coordinated, make it earned the confidence of ICTC counselors and
very challenging for DAPCUs to expand this kind other government HIV service providers through
of program without intensive support. At the end of careful implementation of a well-designed system.
the project, Samastha used considerable resources Individuals’ confidentiality requests should be
for its activities in fewer than half of the districts carefully documented, communicated to all
in Karnataka. A wider scale-up would require concerned, and respected. Programs should
additional resources. systematically look for any negative side effects of
shared confidentiality, especially if it is extended to
Understanding adherence: Training link a wider cadre of health care workers.
workers to recognize adherence problems was
not always easy. Adherence issues are likely to Ensure adherence management at a
be underestimated for several reasons. Samastha sufficient level of authority: Intensive
recognized that the three-day recall was not reliable adherence monitoring work needs to be guided by
and changed their assessment method. The pill a skilled manager who is capable of bringing all
count however, requires considerably more calculus concerned parties together at regular intervals and
skills and may cause a lack of confidence among motivate them to do a thorough review and compare
link workers to use the method or to correctly lists of clients. In Karnataka, this task was taken
assess adherence problems. Data from the link on by the DAPCU directors, most of whom proved
workers’ adherence assessment show that almost to have sufficient levels of authority to manage this
100 percent of their clients on ART achieve greater process. Senior Samastha staff stressed that it is
than 95 percent adherence. However, checks of the important that whoever takes on this coordinating
Green Books of clients encountered during village role should have the authority to make the system
meetings (and comparing the dates of antiretroviral work.
drug pickups with the number of tablets received)
showed that roughly one out of six had adherence Develop adherence procedures for
issues that would rate them below 95 percent migratory PLHIV: Special attention may be
adherence. required to guarantee continuity of services for
migratory laborers, especially those who migrate for
long periods of time and those who migrate across
state borders.
Recommendations
Make sure that outreach workers can
Samastha’s multipronged approach to adherence identify adherence problems: Supervision of
monitoring and improvement is promising. The link workers should regularly focus on adherence
combination of interventions to prevent, identify, assessment. Supervisors can improve link workers’
and remedy adherence problems has the potential assessment skills by observing adherence
for maximum impact. The scale at which Samastha assessments, double-checking the link worker’s
implemented the interventions required the assessments, and performing assessments
organization of a large support and supervision along with the link worker. Whenever link workers
network, and the project showed that this can be overestimate adherence or fail to recognize
done. The following are some recommendations to adherence problems, opportunities for patient
consider when implementing similar interventions. education and adherence support are missed. g
10 AIDSTAR-One | July 2012
11. AIDSTAR-One | CASE STUDY SERIES
REFERENCES National Institute of Health and Family Welfare and
National AIDS Control Organisation. 2007. Annual
Becker, M. L., B. M. Ramesh, R. G. Washington, HIV Sentinel Surveillance Country Report 2006.
S. Halli, J. F. Blanchard, and S. Moses. 2007. New Delhi, India: NACO.
Prevalence and Determinants of HIV Infection in
South India: A Heterogeneous, Rural Epidemic. National Institute of Medical Statistics and National
AIDS 21:739–747. AIDS Control Organization. 2010. Technical Report,
India HIV Estimates. Government of India.
Blanchard, J., J. O’Neil, B. M. Ramesh, P.
Bhattacharjee, T. Orchard, and S. Moses. 2005. National Rural Health Mission. n.d. Home Page.
Understanding the Social and Cultural Contexts Available at http://mohfw.nic.in/NRHM/asha.htm
of Female Sex Workers in Karnataka, India: (accessed January 2012)
Implications for Prevention of HIV Infection. The
Journal of Infectious Diseases 191(Suppl 1):S139– O’Neil, J., T. Orchard, R. C. Swarankar, J. F.
S146. Blanchard, K. Gurav, and S. Moses. 2004.
Dhandha, Dharma and Disease: Traditional Sex
Halli, S. S., B. M. Ramesh, J. O’Neil, S. Moses, and Work and HIV/AIDS in Rural India. Social Science &
J. F. Blanchard. 2006. The Role of Collectives in Medicine 59:851–860.
STI and HIV/AIDS Prevention Among Female Sex
Workers in Karnataka, India. AIDS Care 18(7):739– ACKNOWLEDGMENTS
749.
The author owes a debt of gratitude to the
Indian Council of Medical Research and Family leadership and staff of the Samastha project for
Health International. 2009. India Integrated their support in the development of this case study,
Behavioral and Biological Assessment, Round 1 as well as to Samastha’s partner organizations and
(2005-2007), National Summary Report. Pune, beneficiaries for sharing their experiences. Many
India: National AIDS Research Institute and Family thanks also to the leadership of the Karnataka
Health International. State AIDS Prevention Society for their input
and openness. Thanks also to the U.S. Agency
Karnataka Health Promotion Trust. 2008. “Our for International Development/India, especially
Projects.” Available at www.khpt.org/samastha.html Sangeeta Kaul and Anand Rudra, for their
(accessed June 2011) assistance, advice, and helpful feedback.
Karnataka Health Promotion Trust. 2011a. Annual
Progress Report of Samastha Project, 2011. RECOMMENDED CITATION
Karnataka Health Promotion Trust. 2011b. Building Willems, Herman. 2012. Linking Resources for
Capacity for Sustainability: Capacity Development Antiretroviral Therapy Adherence: The Samastha
Strategy for Samastha’s Care and Support Project in Karnataka, India. Arlington, VA: USAID’s
Initiatives. Bangalore, India: KHPT. AIDS Support and Technical Assistance Resources,
AIDSTAR-One, Task Order 1.
National AIDS Control Organisation. 2011. ART
Scale up in Karnataka: Best Practice Document.
Bangalore, India: KHPT.
Linking Resources for Antiretroviral Therapy Adherence: The Samastha Project in Karnataka, India 11
12. AIDSTAR-One’s Case Studies provide insight into innovative HIV programs and approaches
around the world. These engaging case studies are designed for HIV program planners and
implementers, documenting the steps from idea to intervention and from research to practice.
Please sign up at www.AIDSTAR-One.com to receive notification of HIV-related resources,
including additional case studies focused on emerging issues in HIV prevention, treatment,
testing and counseling, care and support, gender integration and more.