Anti Retroviral Therapy (ART):
In Maharashtra currently, there are 73 ART Centers (excluding Mumbai) which are providing free of cost medicines.These ART centers are located at Medical colleges
District Hospital & Sub District Hospital level. Out of the 73 ART Centers,6 ART Center are functional under Public Private Partnership (PPP) model.With no vaccine available,
to HIV. Prevention of Transmission and Lifelong ART medicines are the measures which ensure that viral suppression happens in the large community.
Treat All Policy :
From May-2017 under Treat All Policy irrespective of CD-4 count, all HIV positive clients will be provided lifelong free ARV medicines.
When there is a failure of first-line ART given to any person living with HIV then second line Anti- Retroviral therapy is given. Initially,
all patients in the state in second-line ART had to come to JJH (Centre of Excellence) ARTC, Mumbai, but for the convenience of the patients;
ART plus centers have been established in 11 regional places from the month of February 2016.To increase the ART Adherence, minimize the time and cost of travel.
Maharashtra State AIDS Control Society under NACO, New Delhi,has established 177 Link ART Centers in 34 districts in the state where Patients on ART are provided with medicines.
ART Performance (Excluding Mumbai)
|
Activities |
2008 |
2009 |
2010 |
2011 |
2012 |
2013 |
2014 |
2015 |
2016 |
2017 |
2018 (UptoMay 2018) |
|
ART Centers |
29 |
44 |
52 |
54 |
59 |
60 |
70 |
72 |
73 |
73 |
73 |
|
Link ART Centers |
32 |
95 |
113 |
123 |
114 |
136 |
157 |
174 |
177 |
177 |
177 |
|
Care Support Centre |
|
|
|
|
|
33 CSC Project started by NACO under Vihaan from 1st April 2013 |
|
49 |
49 |
49 |
49 |
|
Pre ART Registration |
137541 |
187073 |
253099 |
302170 |
355947 |
344145 Transferred out have been subtracted from this figure |
326112 |
349273 |
371268 |
397641 |
400806 |
|
Ever started on ART |
6,890 |
99854 |
139197 |
173580 |
217906 |
204330 Transferred out have been subtracted from this figure |
206137 |
235191 |
259946 |
301467 |
305542 |
|
Alive & On ART |
48458 |
69925 |
93415 |
112342 |
138180 |
144562 |
150532 |
166826 |
180450 |
201359 |
203089 |
|
On 2nd line ART |
89 |
311 |
773 |
1,083 |
1403 |
1737 |
3650 |
4834 |
5534 |
7666 |
8131 |
Care Support Centers (CST):
Vihaan” program is being implemented under Global Fund Round IV and RCC Phase II by Alliance India and NMP plus in collaboration with
MSACS and MDACS. At the district level, 49 CSC organizations in Maharashtra and 5 organizations in Mumbai have been selected to provide
Care and Support services to PLHIVs on 1st June 2013. Situation Analysis for all the districts is completed. The main aim of this Project is
to provide support Care & treatment to HIV patients
Following services are being provided under Care Support Centers:
- Counseling at CSC
- Periodic meetings with various groups:
- Outreach through home visits for bringing back Lost to follow up cases back on Treatment.
- Advocacy
- Social Welfare Schemes
- Other Activities
1. Organizing support group meetings – for special groups or “buddy groups”
2. Setting up of “discrimination response teams”
ARTc,LAC and CSC facilities :
|
District |
Sr. No. |
Name of ART Center |
No. of ART Centre |
No. of Care & Support Centres |
No. of Link ART Centre |
|
Ahmadnagar |
1 |
Ahmadnagar |
2 |
2 |
13 |
|
2 |
Pravara -PPP |
||||
|
Akola |
3 |
Akola |
2 |
1 |
6 |
|
4 |
Lady Hardinge Hospital-Corp. Hospital |
||||
|
Amravati |
5 |
Amravati DH |
1 |
1 |
8 |
|
Aurangabad |
6 |
Aurangabad |
3 |
2 |
5 |
|
7 |
SDH Vaijapur |
||||
|
8 |
Paithan, Aurangabad |
||||
|
Beed CH |
9 |
SRTR Ambejogai,Beed |
2 |
2 |
5 |
|
10 |
Beed CH |
||||
|
Bhandara |
11 |
Bhandara |
1 |
1 |
5 |
|
Buldhana DH |
12 |
Buldhana DH |
1 |
1 |
5 |
|
Chandrapur |
13 |
Chandrapur |
3 |
1 |
5 |
|
14 |
BILT,Chandrapur |
||||
|
15 |
SDH Warora |
||||
|
Dhule |
16 |
Dhule |
2 |
1 |
2 |
|
17 |
Shirpur, Dhule |
||||
|
Gadchiroli DH |
18 |
Gadchiroli DH |
1 |
1 |
0 |
|
Gondia - DH |
19 |
Gondia - DH |
1 |
1 |
0 |
|
Hingoli - DH |
20 |
Hingoli - DH |
1 |
1 |
3 |
|
Jalgaon |
21 |
Jalgaon |
2 |
1 |
9 |
|
22 |
Amalner, Jalgaon |
||||
|
Jalna - DH |
23 |
Jalna - DH |
1 |
1 |
3 |
|
Kolhapur |
24 |
Kolhapur RCSM |
4 |
3 |
4 |
|
25 |
Gadhinglaj - SDH |
||||
|
26 |
Ichalkaranji |
||||
|
27 |
Savitribai Phule |
||||
|
28 |
Lotus Foundation,Kolhapur |
||||
|
Latur |
29 |
Latur |
2 |
1 |
3 |
|
30 |
Udgir, latur |
||||
|
Nagpur |
31 |
Nagpur GMC |
3 |
2 |
7 |
|
32 |
Kamthi |
||||
|
33 |
IGMC, Nagpur |
||||
|
Nanded |
34 |
Nanded |
1 |
1 |
6 |
|
Nandurbar DH |
35 |
Nandurbar DH |
1 |
1 |
1 |
|
Nashik |
36 |
Nashik |
2 |
2 |
6 |
|
37 |
Malegaon - CH |
||||
|
Osmanabad |
38 |
Osmanabad |
2 |
1 |
5 |
|
39 |
Sastur, Osmanabad |
||||
|
Parbhani |
40 |
Parbhani |
1 |
1 |
5 |
|
Pune |
41 |
Sasoon G H Pune |
7 |
3 |
14 |
|
42 |
AFMC,Pune |
||||
|
43 |
Nari Pune |
||||
|
44 |
Baramati |
||||
|
45 |
Yerwada, Pune |
||||
|
46 |
Aundh, Pune |
||||
|
47 |
YCM, Pune |
||||
|
Raigad |
48 |
Alibag CH |
2 |
1 |
11 |
|
49 |
Reliance, Raigad |
||||
|
Ratnagiri |
50 |
Ratnagiri |
1 |
1 |
6 |
|
Sangli |
51 |
PVPG Sangli |
4 |
3 |
6 |
|
52 |
GMC Miraj |
||||
|
53 |
Islampursangli |
||||
|
54 |
Bharti Vidyapith, Sangli |
||||
|
Satara |
55 |
Satara |
3 |
2 |
11 |
|
56 |
Karad - SDH |
||||
|
57 |
Phaltan |
||||
|
Sindhudurg CH |
58 |
Sindhudurg CH |
1 |
1 |
0 |
|
Solapur |
59 |
Solapur |
3 |
2 |
7 |
|
60 |
Pandharpur -SDH |
||||
|
61 |
Barshi-solapur |
||||
|
Thane |
62 |
Thane |
8 |
3 |
4 |
|
63 |
NMMC Vashi, Thane |
||||
|
64 |
Ulhasnagar - CH |
||||
|
65 |
Kalva Thane |
||||
|
66 |
Bhiwandi |
||||
|
67 |
Corporation Hospital, Bhyander, Thane |
||||
|
68 |
Kalyan Rukminibai, Thane |
||||
|
69 |
Dombivali, Shastri nagar, Thane |
||||
|
Wardha |
70 |
Wardha |
1 |
1 |
3 |
|
Washim - DH |
71 |
Washim - DH |
1 |
1 |
4 |
|
Yavatmal |
72 |
Yavatmal |
2 |
2 |
5 |
|
73 |
Pusad |
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ART Plus:
It has been decided by NACO that patients who are stable on second-line ART at COE for 6 months & have undergone 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
- Staff Nurse
- Data Entry Operator
- Pharmacist
- Lab Technician
- Counselor
- 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 a 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 centers:
To minimize the need for the patients stable on ART, it is envisaged to have identified 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 a 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 (1 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 the purchase of thermal role paper for printing, hypochlorite solution, micro tips, gloves, stationery etc. as per workload 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 a 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).
The rationale for Centers of Excellence:
- The 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 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.
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