Link ART centres concept
-
Upload
drshruthi-pradeep -
Category
Documents
-
view
520 -
download
3
Transcript of Link ART centres concept
Link ART Centres Concept
Link ART Centres
Concept, Objectives, Structure,
Roles and responsibility
Link ART Centres Concept
Session Objectives
By the end of the session the participant will understand:
• The Concept and Rationale of Link ART Centres
• Objectives of Link ART Centres
• Role of Link ART Centres in National Health System Strengthening for HIV treatment and Care
• Infrastructure, Human Resources and Roles and Responsibilities
• LAC Plus scheme
2
Link ART Centres Concept
Access to ART: Current situation
• The ART roll out is mostly confined to:
1) Medical Colleges
2) Tertiary Hospitals
3) Some big District Hospitals
• As a result, many a times, patients have to travel long distances to get the treatment
3
Link ART Centres Concept
Link ART Centre: Rationale
• As the treatment is lifelong and drugs are provided once a month, this leads inconvenience and long travel
• May lead to missing of visits, particularly when patient is otherwise feeling healthy
• Monthly visits may also entail the patient’s stay in the city leading to escalation of costs in addition to travel cost
4
Link ART Centres Concept
Link ART Centre: Rationale
• At times, natural phenomenon like heavy rain, floods, landslides, extreme weather conditions make drug collections on scheduled visit dates almost impossible
• All these factors have been perceived as potential barriers to an optimal adherence for ART
5
Link ART Centres Concept
Link ART Centre: Rationale
• To minimise the travelling needs for the patients stable on ART and improve drug adherence , it was envisaged to set up LINK ART CENTRES
• The Scheme of Link ART Centres was initiated in 2007
• It is a low cost facility and expenditure is only on facility development, training and operational costs
6
Link ART Centres Concept
• To integrate ART services with the Primary / Secondary Health Care system
• To build capacity of the health care staff at the Primary Health Care Level in ART treatment
• To act as bridge between testing & treatment services
• Reduce the travel cost and travel time of PLHIV to increase access to HIV care services
• Improve quality of ART services by decongesting ART Centres
• To improve the adherence of PLHIV to HIV care & ART
Link ART Centre: Objectives
7
Link ART Centres Concept
Model of HIV treatment
service
Public Health Infrastructure
& HIV-Relevant Staff
HIV-Related Services
Medical College
ART Centre/ Link ART Centre
Link ART Centres
Community-Based HIV Screening
CCC / NGOs
Re
ferra
l District Hospital
Community Health Centre
Primary Health Centre (PHC)& 24/7 PHC
Sub-Centres & Anganwadi Centres
ICTC,Designated
Microscopy Centre
District with low Sero-positivity may have LAC only.
ART Centres +
tertiary level care
Centres of Excellence - alternate First line &
Second line ART
HIV Care in Integrated General Health System
8
Link ART Centres Concept
LAC
Back Referral to ART Centre
Screening of HIV-TB
Co infection
Psycho-Social Support
To PLHIVTreatment ofMinor OIs
Provide ARV Drugs to Stable PLHIV on ART
Adherence Counselling and
Monitoring PLHIV for side effects
Functions of LAC
9
Link ART Centres Concept
Main Responsibility of LAC
• Adherence counseling and monitoring
• Provide ART drugs to stable patients on ART linked out by Nodal ART Centre
• Identification of the critical side effects of ART / medication for Opportunistic Infections (OIs)
• Identification of symptoms suggestive of OIs, side effects of drugs
• Referral to the main ART centre at the earliest
Link ART center shall not initiate ART in any patient
10
Link ART Centres Concept
• Baseline analysis of the geographic distribution of the patients is required.
• Mapping of the PLHIV seeking ART at all the centres in the state to be done and then, we should identify the number of patients coming from the districts and identify the districts with at least:
– 50 patients on ART in plain and
– 25 patients on ART in hilly areas can be reduced to as low as 10 patients.
Link ART Centre: Site Selection
11
Link ART Centres Concept
• The Link ART Centre should ideally be opened at Integrated Counselling and Testing Centres (ICTC) in Government Hospitals including Rural / Taluk Hospitals (Block level) and CHCs
• Each LAC will be linked to the CLOSEST NODAL ART Centre
• Each LAC will have one Nodal ART Centre. However, one Nodal ART Centre may have more than one LAC
Link ART Centres: Ideal Sites
12
Link ART Centres Concept
• Two rooms about 10 X10 feet are minimally required
– One room for the drug storage, and
– Second room for the drug dispensing, record keeping and counseling.
• Rest of the infrastructure is adequately provided under the ICTC
• The Link ART centre will utilize the computers facility already available with the site (ICTC / CCC). The LAC shall get a broad band internet connection from the funds provided as per the LAC approved financial support
PLHIV will be attended in General OPD of the centre daily
Link ART Centres: Infrastructure
13
Link ART Centres Concept
Personnel at LAC (No additional Manpower is provided)
Doctor:
• The institute (ICTC in hospital setting) should identify 2-3 Doctors (at least 2) in such a way that the patient can be attended and examined on all working days.
• If this is not feasible (eg due to shortage of manpower) this should be done on at least on two to three days a week, but even if patient comes on days other than the scheduled days, care should not be denied.
• The senior most doctor amongst them (preferably a specialist physician) shall be the LAC In- charge and responsible for day to day activities and reporting to the Nodal ART centre.
14
Link ART Centres Concept
Personnel at LAC• Counsellor:
The ICTC counsellor shall bear the responsibility of ART counselling of PLHAs on ART.
• Nurse:
Institute should depute a nurse to assist the Doctor and the Counsellor. Computer literate nurses should be given preference for deputation in the LAC.
• Pharmacist:
The institutional pharmacist shall be the in charge of drug storage, dispensing and drug record keeping.
Note: Nurse and counsellor will assist in record keeping and reporting.
15
Link ART Centres Concept
Setting up of LAC
• Training of Staff of identified for LAC (Institutional & ICTC)
• Transfer of PLHIV on ART from the nodal ART Centres to LAC
• Transfer of ARV drugs
• Monthly reporting system to Nodal ART Centre
16
Link ART Centres Concept
Assessment of LAC
• By December 2010, 545 LACs were functioning
• Over 25,000 PLHIV are accessing ART services at LACs
• An assessment study was undertaken in four states: Gujarat, Maharashtra, Rajasthan & UP
• The study revealed that patient satisfaction had increased significantly and cost and time on travel to access ART had decreased
17
Link ART Centres Concept
Findings of LAC Assessment
• Time taken for travel reduced considerably (Median time taken: 60 minutes)
• The distance traversed also reduced (Median distance: 25 Km)
• 97 % of the patients were attending LAC regularly every month
• 95 % PLHIV reported that waiting time <30 minutes for availing counselling & collection of drugs
• Median expenditure on travel Rs. 40
• >90 % PLHIV were satisfied with services
18
Link ART Centres Concept
• The roll out of the revised scheme shall be initiated at existing LAC with a patient load of more than 75 PLHIV on ART and will be expanded in a phased manner after getting prior approval from NACO
• Manpower:
• The LAC will utilise the existing human resources of the facility
• Considering the additional functions of LAC, presently a staff nurse will be provided
Roll out of LAC Plus Scheme
19
Link ART Centres Concept
9
Monitoring of PLHIV on ART
Screening of HIV -TB Coinfection
Enrollment of PLHIVA in HIV Care
and basic investigations
Pre-ART Management
Treatment of OIs
Psycho–social Support to PLHIV
LAC
Back Referral
Roll out of LAC Plus Scheme
20
Link ART Centres Concept
Functions of LAC & LAC PlusLAC LAC Plus
ARV Drug distribution Enrolment of PLHIV into HIV care and ART Care
Monitoring of PLHIV on ARTPre-ART management including basic investigations and sample collection for CD4 count
Counselling on adherence, nutritional & positive prevention
Follow up of pre-ART patients not eligible for ART
Referral of eligible patients to Nodal ART Centre for ART initiation
Identification of side-effects Screening of HIV-TB co infection
Treatment of Minor OIs Monitoring of PLHIV on ART Drug distribution
Treatment of Minor OIs
Monitoring of side-effects of ARV drugs
Counselling on adherence, nutritional & positive prevention
Tracing of LFU and Missed Cases (Pre-ART & ART)
21
Link ART Centres Concept
Key Points• The Concept, Objectives and Rationale of Link ART
Centres were discussed
• The Role of LAC in the National Health System in providing HIV care services were discussed
•Method of site selection of LAC and the details of infrastructure and Human resources were provided
• Roles and responsibilities of LAC staff were discussed
• The extended LAC Plus scheme was described
• Standard operating Procedures of LAC will be considered in detail in a separate session
22