CARE SUPPORT & TREATMENT (CST)
The Care, Support and Treatment (CST) component of the National AIDS Control Programme aims to improve the survival and quality of life of Person Living with HIV (PLHIV) with Universal access to Comprehensive HIV care. The treatment, care and support for a PLHIV is lifelong. As the programme progressed, HIV treatment, care and support services are increasingly shifting their focus on early treatment initiation and retention in treatment and care.
These centres provide support and linkages to various social sector schemes, LFU tracking, providing peer and psychosocial counselling, treatment literacy/adherence, home visits, stigma reduction, advocacy with other departments to increase access, partner testing, local resource mobilisation, and intensive case finding for TB. Family testing, especially of spouse and children, has been a part of CSC initiative.
Treatment services offer free Antiretroviral Treatment (ART) as well as comprehensive management of HIV infected people with respect to treatment and prevention of opportunistic infections. ‘Test and Treat’ policy has been adopted to enhance the uptake of treatment services by all irrespective of CD4+ counts. Single window delivery of TB and HIV services has also been initiated across all ART centers. Molecular diagnosis/testing (e.g. CBNAAT) is being offered to people living with HIV (PLHIV) identified as presumptive Tuberculosis (TB) cases for early diagnosis of TB.
Standardized Antiretroviral Therapy:
Antiretroviral therapy is provided to all PLHIV irrespective of CD4 count and WHO clinical stage, after counseling and preparing client for lifelong therapy. The National programme provides standardized, quality assured, fixed dose combinations of drugs free of cost. The treatment is provided after ensuring proper management/prophylaxis of opportunistic infections and preparedness of client for lifelong therapy.
Services available at
FACILITY INTEGRATED ANTIRETROVIRAL THERAPY CENTER (FI- ART)
- ANACS has 1 no. of Facility Integrated Antiretroviral Therapy (FI- ART) at GB Pant Hospital (Room No. 52), CD4 testing done at ICMR.
- ART drugs provided by NACO through GHTM Tambaram.
- Registration at Antiretroviral Therapy (ART) center
- Basic Clinical Investigation
- CD4 Testing
- Treatment Preparedness and Adherence counselling
- Management and Treatment of Opportunistic Infection
- Co-trimoxazol Preventive Therapy and IPT
- Free Antiretroviral Therapy (ART) (Adult & Pediatric)
- Anti TB Treatment (ATT)
- Post Exposure Prophylaxis (PEP)
- Condom Distribution
- Nutritional Counselling
- Viral Load Testing
- Linkage to Social Welfare schemes
- Information on other Benefits available for People Living with HIV (PLHIV)
- Support for Healthy and Positive Living
In Andaman & Nicobar Islands
- Care and support treatment provided through FI-ART (Facility Integrated Antiretroviral Therapy) Centre located at Room No. 52, G.B. Pant Hospital, Port Blair.
- To initiate treatment after the declaration of positive status the PLHIV has to get registered at FI-ART Centre. Treatment and all services are given free here.
- 268 HIV(+)ve have been registered since 2011 in FI-ART Centre, G. B. Pant Hospital, Port Blair by the end of March 2021..
- As on March 2021, 127 patients HIV (+)ve patients are on ART in Andaman & Nicobar Islands. Out of 127 PLHIV, 02 Male & 01 Female is Co-infected with HIV-TB.
ART at the doorsteps during the COVID -19 pandemic.
During the Lockdown period the ART Drugs were distributed to the PLHIV at their door steps. For North & Middle Andaman District the ART Drugs was sent by bus and in Shaheed Dweep & Swaraj Dweep it was sent by boat. In South Andaman area ART drugs were sent to doorsteps by road.
EARLY INFANT DIAGNOSIS (EID)
Early Infant Diagnosis of HIV is a National HIV/ AIDS care and treatment program in India with the objective to diagnose HIV-1 infection in infants and children <18 months. Currently, there are 6 EID referral laboratories.
The HIV exposed baby is initiated on Cotrimoxazole prophylaxis at 6 weeks and is tested for HIV DNA-PCR at 6 weeks by DBS (Dry Blood Spot) sample. If the DBS sample is positive for HIV DNA -PCR, then a repeat DBS sample is tested for HIV DNA-PCR. The HIV exposed baby is then initiated on lifelong ART at the earliest if confirmed HIV positive in the second DNA PCR test.
NEW INITIATIVES IN CARE SUPPORT AND TREATMENT
FAST TRACK TARGET (90-90-90)UNAIDS had proposed the ambitious Fast-Track (‘90-90-90’) treatment targets, where, by 2020,
- 90 % of PLHIV knows their Status, of which
- 90 % of PLHIV are on ART, of which
- 90 % of PLHIV (ie, 73% of all PLWH) should be virally suppressed, as a means to eliminate HIV as a public health threat by 2030.
Globally, at the end of 2020 the targets (90–90–90) achieved:UNAIDS had proposed the ambitious Fast-Track (‘90-90-90’) treatment targets, where, by 2020,
- 84% [68– >98%] of people living with HIV knew their HIV status.
- Among people who knew their status, 87% [67– >98%] were accessing treatment.
- And among people accessing treatment, 90% [70– >98%] were virally suppressed.
- Of all people living with HIV, 84% [68– >98%] knew their status, 73% [57–88%] were accessing treatment and 66% [53–79%] were virally suppressed in 2020.
TEST AND TREAT POLICY :
NACO has adopted a ‘Test and Treat’ policy for PLHIV towards attainment of End of AIDS epidemic as a public health threat and to improve quality of life of PLHIV. The Guidelines on when to start ART has been changing over the years as newer evidence became available from time to time. NACO has revised its policy regarding ART based on WHO recommendations, scientific evidences and TRG recommendations.
Guidelines have changed from ART initiation at CD4 200 in 2004 to CD4 500 in 2016 to Treat All, policy in Feb-2017. Moving from CD cut off 500 to Treat All is a major way to reduce new HIV infections, reduce progression to AIDS and prevent TB among PLHIV. To ensure optimum benefit of the policy, all ART centers have been instructed to actively follow up clients under “Pre-ART care” and initiate ART in these clients. As soon as a person is tested and found positive, he will be initiated with Antiretroviral Therapy (ART) irrespective of his CD 4 counts or clinical stage. This is for all men, women, adolescents and children who have been diagnosed as HIV (+) ve.
VIRAL LOAD TESTING:“Viral Load test is of immense importance to monitor the effectiveness of treatment of patients taking lifelong Antiretroviral Therapy”. NACO has introduced routine VL monitoring of all patients on ART in a phased manner.
Broadly there are 2 strategies as below:1) PPP model by engaging Metropolis started in phased manner: since 8/2/2018
2) Scale up of in-house VL laboratories: To strengthen country’s capacity, NACO has procured VL machines to meet the demand of VL tests for more than 10 lakhs per year.
MISSION SAMPARK:To extend the benefit of test and treat policy and reach out to all those “who are aware of their HIV positive status” but “are not on ART” have to be linked back for HIV care, for which Govt. of India took the initiative in the form of “Mission SAMPARK”, launched on 1st December, 2017.
Objective: To eradicate HIV/AIDS by 2030
Main aim of launching this new mission SAMPARK under the National Strategic Plan 2017-24:
Now, the main task is to find out those who though are HIV positive (PLHIVs), but are left from the services and bring them all back to HIV care. We need to raise more awareness about this syndrome and bring them forward by accepting the situation they are in and try to come out of it and not ignore it. The syndrome has to be eradicated not just from India but from the world by 2030 as it is a global issue and we cannot lose more lives due to carelessness.