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ART

 

  • Anti Retroviral Therapy Centre
  • MSACS has established ART Centre in Government Medical Colleges, District Hospitals and certain Sub District Hospitals of Maharashtra. As per AAP 2011-12, Maharashtra had a target to open 3 new ART centres - which was sanctioned by NACO (DH Sindhudurg, GMC Miraj-Sangli, DH Beed). Currently 48 ART centre in Maharashtra excluding Mumbai. Out of which 39 NACO funded ART Centres. Now 30 districts of category A have at least one ART Centrs and 2 more ART Centres in Category C district excluding Sindhudurg District. 10 big districts have more than one ART Centres.
  • Maharashtra has 190083 PLHA registered and 107886 patients ever started On ART of which 73605 patients alive on ART upto 2010 Dec end excluding Mumbai. In addition to this 773 patients are receiving Second line ART as per Dec 2010 data. The updated ART Cumulative data is as below.

 

Activities 2008 2009 2010 2011 2012 2013 2014 Till March 2015
Art Centers 27 36 50 43 48 60 70 72
Link Art Centers 40 98 112 121 125 136 156 157/td>
Registreation in HIV care
Total
66260 111019 156241 202336 280414 287364 305236 329750
Ever Registered on ART 29351 55337 78671 115826 177457 176909 189520 216137
Alive & On ART 22231 40962 60230 78802 113940 133728 141643 156836

 

ART to RNTCP referrals

Indicator 2012-13 2013-14 2014-15(till Feb.2015)
Number of patients attending ART center (Footfalls) 1166626 1462561 13,94,111
ART Clients referred to RNTCP 45,071 56569 57,740
% of ART Clients referred to RNTCP 3.80 3.86 4.14
Total diagnosed as TB. 6,076 5,919 5,320
Percentage 13.48 10.46 9.21

 

ART Plus:

It has been decided by NACO that patients who are stable on second line ART at COE for 6 months & have under gone repeat viral load test at 6 months may be referred back to the referring ART Centres by SACEP after considering the capacity of the referring Centres. Therefore NACO upgraded 3 ART Centres as ART plus Centres in Maharashtra.

 

Staff Details at ART Centres:

Out of 48 ART Centres of Maharashtra, 452 staff is working at ART Centres excluding Mumbai.

In charge: Nodal Officer (Govt. Employee)

Senior Medical Officer

Medical officer

  1. Staff Nurse
  2. Data Entry Operator
  3. Pharmacist
  4. Lab Technician
  5. Counselor
  6. Community Care Coordinator

 

Functions of ART centers:

The main objective of Anti-retroviral Therapy (ART) is to provide comprehensive services to eligible persons with HIV/AIDS. The specific objectives of an ART center are to:

  • Identify eligible persons with HIV/AIDS requiring ART through laboratory services
  • (HIV testing, CD4 Count and other required investigations)
  • Provide free ARV drugs to eligible persons with HIV/AIDS continuously
  • Provide counseling services before and during treatment for ensuring drug Adherence
  • Educate persons and escorts on nutritional requirements, hygiene and measures to
    • prevent transmission of infection
    • Refer patients requiring specialized services or admission.
  • Provide comprehensive package of services including.

 

Medical Functions:

  • To diagnose and treat Opportunistic Infections
  • To screen PLHA for eligibility to initiate ART
  • To monitor patients on ART and manage side-effects, if any
  • To provide in-patient care as and when required.

 

Psychological Functions:

  • To provide psychological support to PLHA accessing the ART center
  • To provide counseling for adherence to ARV drugs
  • To educate PLHA on proper nutrition
  • To advise for risk reduction behavior including usage of condoms

 

Social Functions:

  • To facilitate PLHA to access available resources provided by government and NGO agencies.
  • To facilitate linkages between other service providers and patients, like educational help for the children and Income generation Programmes.

 

Link ART centres:

To minimize the need for the patients stable on ART, it is envisaged to have identify and designate Link ART Centers (LAC) for distribution of ARV drugs and monitoring of drug adherence in stabilized patients. This center will be like an extension facility to the main ART center. LAC will be set up where patient load is high (>1000 PLHAs on ART) and there are minimum of 50 PLHAs on ART from the catchment area of LAC. Patients stabilized on ART for 6 months minimum and who are willing to be transferred will pick up ARV from LAC.

There will be no additional human resource that shall be provided by NACO. Job-oriented training will be imparted to Doctor, Nurse, Counselor and Pharmacist (one each) in these facilities on the additional responsibility of ARV dispensing.

As per AAP 2010-11, Maharashtra target is 38 of which 29 LACs were sanctioned by NACO. Currently 123 LACs are sanctioned by NACO and 4424 PLHA linked out from Nodal ART Centre to LAC Centres. Up till now MSACS opened LAC in 28 Category A districts & 1 LAC in Category C District.

 

LAC Plus:

The existing LACs is upgraded to LAC Plus based on their patient load that is when these centres threshold 70 people alive on ART. In addition to this NACO decided to appoint one Staff Nurse at LAC plus Centres. In Maharashtara currently 16 LACs crossed 70 patients registered & alive on ART and MSACS recruited 17 nurses in these LAC plus Centres.


CD4 Machines:

In Maharashtra, total 35 CD 4 labs are functional excluding Mumbai and 3 more will come up this year (including PPP Centres). Operational Cost @90,000 per FACS Calibur Sites of 5 ART Centres, Cost @50,000 per FACS Count Sites of 20 ART Centres and Cost @25,000 per Parte Sites of 8 ART Centres. CD4 Labs would need contingency grant for purchase of thermal role paper for printing, hypochlorite solution, micro tips, gloves, stationary etc. as per work load and these funding are only applicable for NACO funded ART Centres.

 

Centre Of Excellence (COE):

The HIV/AIDS epidemic has, over the past decade, evolved into a more complex one necessitating operational research. There is need for medical institutions which deliver high quality of care, treatment and support to People Living With HIV/AIDS (PLHA). Complex treatment schedules and patient management require constant training and upgrading of skills among providers. At the same time, being a lifelong therapy, it requires a comprehensive care approach that meets the range of needs of PLHA as well as high levels of drug adherence for anti retroviral treatment.

For focusing on both training and operational research, NACO has envisaged that 10 reputed centers that are currently providing training in ART would be developed and strengthened as Centers of Excellence (COE).

 

Rationale for Centers of Excellence:

  • Requirement of a shift to chronic patient management approach.
  • Issues surrounding long term adherence and HIV drug resistance require constant training and upgrading of knowledge and skills among providers.
  • To address the need for capacity building of good quality, skilled and knowledgeable healthcare providers.
  • Serve as models in HIV/AIDS care and support.

As per the approved Annual Action plan for year 2011-12, proposed to release the recurring for Coe (Recurring – Personnel, Research, Training, consumables, TA/DA & oper, Costs, Stationery etc.  Non-recurring- Renovation Furnishing, Equipment.)  Funds required for running an ART Centre are provided to each ART Center for utilization as per guidelines