Activities

PFI Global Fund is involved in the following activities:

• Care and Support Services
  

• Capacity Building
  

• Advocacy
  

• Operations Research / Special Studies
  

• Monitoring and Evaluation

Based on the experiences and strengths of Indian Network for People Living with HIV/AIDS (INP+) and Freedom Foundation, the care and support model for The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) – HIV/AIDS Round 4 project was worked through a consultative process. The care and support will be provided through the following networks and centres –

District Level Networks (DLNs)

District Level Networks is the key intervention for providing care and support services. 102 District Level Networks (DLNs) of PLHAs will be set up in 138 districts in the six high prevalence states. Some of the neighboring smaller districts will be clubbed together with the larger districts.  The main activities of DLNs are to provide counselling, refer PLHAs to other service delivery points, conduct support group meetings, provide care and support to PLHAs through treatment education and linkages with other service providers and support of PLHAs on ART to adhere to treatment through Peer Treatment Educators. 

Peer Education Strategy

The main focus of Peer Education is on Treatment Adherence.  The peer educators are the paid volunteers for the program. The staff of the DLN identify peer educators during counselling and Support Group Meetings. The District Network Officer/ Social Worker does the follow-up of the peer educators. Each DLN trains 20-30 peer educators. These peer educators will support 5 to 10 PLHAs on ART for treatment adherence.

Treatment Counselling Centre (TCC):

PLHAs on ART in particular need continuous counselling at various stages and social support in order to adhere to the life long treatment. The NGOs will set up Treatment Counselling Centre (TCC) at the public tertiary/district institutions providing ART. These centres will strengthen the counselling services provided at the public institutions; provide treatment education, individual/group counselling, family counselling etc. These centres prepare clients to accept their status, motivate them and build social support for them and refer them to the respective DLNs.  In the project 50 TCCs will be established and 20 TCCs will be set up in the first phase by INP+.

Positive Living Centre (PLC)

Experiences in India has shown that in districts where the prevalence is very high, there is a need to further strengthen health monitoring systems, financial empowerment and create social support for families. These activities could be carried out through Positive Living Centre (PLC), a model that has been tried in Namakkal district in Tamil Nadu. These PLCs will provide prevention to care and support services for PLHAs through outreach interventions, and by building linkages with existing services and programs.  Health services include counselling, health monitoring for PLHAs, diagnosis and treatment of STD/RTI and OIs.  Outreach services include IEC/BCC, advocacy and networking. Economic and legal needs of the infected, affected and vulnerable women will be addressed by organizing them into self-help groups (SHGs).  The SHGs will be included in legal literacy workshops and in trainings provided by government for income generation. PLCs will also provide care and support services for children infected and affected by HIV/AIDS and address the needs of children vulnerable to HIV/AIDS.  This includes educational, nutritional and psychosocial support, medical care, life skills education, and school and college awareness programs. PLCs will serve as advocates for PLHA and increase the capacity of members and staff. Linkages will be established with institutions, NGOs, state government, private doctors etc.  Both electronic media through local TV channels and print media through local newspapers are used for advocacy.

It also provides a space to watch television programs; interact with other friends living with HIV and staff; have refreshments like tea/nutrition mix; help staff in their work and avail free IEC resources and open to add any other preferred services by clients.

Comprehensive Care and Support Centres

It is estimated that about 10% of the PLHAs will be terminally ill and will require palliative care.  Many of families of such PLHAs are unable to provide such care at home. Many families are rejecting terminally ill patients and this is more so with HIV/AIDS. PLHAs in such stages will be cared for at the Comprehensive Care and Support Centres (CCSCs). These are tested models in the state of Karnataka and Andhra Pradesh. CCSCs will be 50 bedded care centres with both inpatient and outpatient facilities. Palliative and intensive care service facilities will be made available with Oxygen, Nebulizer, drip-feeding, pain management etc and referrals will be made for specialized clinical services to other centres as and when required. Laboratory services will be available for microbiological investigations of blood, urine and sputum. For advanced diagnostic test like CT Scan, CD4 / CD8, the patients will be referred to other laboratories providing these services. Pre and post-test counselling services will be provided by trained Counsellor which is the key to the comprehensive care and support for HIV/AIDS.

ART services at corporate sector health facilities

CII will set up 4 Corporate Sector Health Care facilities, 2 in year 1 and 2 in year 2, to provide quality ART services in the 6 high prevalent states.

Health Smart Card

CII is also responsible for development of the Health Smart card and testing its feasibility. The Health Smart Card has been named as a Health Smart Card instead of HIV/AIDS card to maintain confidentiality and social acceptance. Smart cards are credit card–sized plastic cards with an embedded microchip and secure medium for identification, authentication and encryption. The card consists of photograph and address of the client with other details like date of birth, Reg No., age, blood group and information of family members on the backside of the card. As a part of the security mechanism, after the card is inserted into the card reader, the doctor and the patient need to authenticate which enables to get general information of the patient. The card enables to get the detailed information of the patient by the thumb impression of the patient through a thumb reader system. The information is not stored in the card but is accessible through the system on authentication. A CPU (with card reader) and a small screen are needed for smart cards. The small screen reduces the cost as well as the power consumption of the system. A data entry operator is needed to key in the data at each centre.

This portable medical record is particularly useful in the fight against HIV/AIDS, where

§         Much of the affected population is mobile

§         Monitoring of treatment to ensure adherence to treatment plan is essential to prevent the patient from being drug resistant

§         The patient’s information has to be kept confidential given the current prejudices regarding the disease

Capacity Building

EngenderHealth Society will be responsible for capacity building of peers, counsellors, social workers and health care providers of the NGO sector

The project also requires building adequate capacities of field staff from 100 NGOs from the 6 high prevalence states to provide home and community based care.  A team of 3 staff per NGO would be trained. 22 master trainers, 619 counsellors, social workers, health care providers and field staff employed at the TCCs, DLNs, PLCs and CCSCs in the project and NGO sector will be trained. In addition 3340 peer treatment educators (including master trainers) will be also trained at the district level. 2 NGO/private sector Continuing Education & Training Centres (CETCs) and one training base in 6 high prevalence states will be established for conducting these training programmes. This approach ensures that core strengths are enhanced at the institutional level and also covers the complete gamut of providers across the NGO sectors.

3 sets of manuals and 2 sets of job aids will be developed. The package will address a broad range of provider skills, attitudes and practices that together will improve quality, access, and utilization of treatment, care, and support services.  All materials will be field tested before being introduced as part of the basic training in counselling and communication skills.

Advocacy

CII is responsible for conducting advocacy with corporates.  CII conducts advocacy through conferences to identify corporates who are interested in setting up the ART centres.  Focus group discussions are conducted with the interested corporates to discuss in depth the processes for setting up the ART centres. Small group meetings are held with the corporates to have more detailed discussions to finalise the establishment of the centre.

Operations Research / Special Studies

The goal of operations research (OR) is to increase efficiency; effectiveness and quality of services delivered by various service delivery points. These studies will provide insights for the program and help the program mangers and decision makers to effectively improve the implementation of the program. The Operation Research studies carried out in the first year is as under:

Operation Research 1: 

Assessing PLWHAs expectations about quality of care and support services with a view to strengthen the capacity of District Level Networks

Operation Research 2:

Understanding support group meetings of people living with HIV AIDS

Operation Research 3:

Setting up standard guidelines for providing care and support services including palliative care

Operation Research 4:

Documentation of various training models in HIV/AIDS in select states of India


Monitoring and Evaluation

Monitoring and Evaluation system is developed with the aim to

• Collect evidence of activities and results
• Determine program effectiveness in reaching predetermined objectives and
• Identify and address problems

The monitoring and evaluation framework gives a picture of the data sources, indicators and the Monitoring and Evaluation approach that need to be followed for the monitoring of the indicators. The regular monitoring system focuses on processes and output indicators.

Management Information Systems (MIS) is a part of the monitoring systems, which enables each of the sub recipients to assess their accomplishments and measure the progress of their activities. It also encourages managers to identify issues that need attention and suggest corrective steps/solutions. The MIS consists of registers for each of the service delivery points, monthly and quarterly progress reports at different levels (service delivery point level, state level and Core Sub Grantee level). These systems will also enable to ensure the quality of services provided at the grass root level.

Evaluation 

The main objective of evaluation is to review or evaluate the progress of the program with respect to the processes, quality implementation, coverage, coordination and linkages with various stake holders and evaluate whether the progress of the activities are achieved as per the predetermined plan of the program. The results of the evaluation study will identify gaps and suggest specific corrective measures for the program, provide immediate recommendations for year2 planning and offer inputs for phase 2 planning.