Appraising the DC on Dist. level

NACP-III activities.

DAPCU

NACP-III (2007 – 2012)

BackgroundNACP - I (1992 - 1999) : Programme was being managed centrally. Focus was on awareness and service delivery units were located at rare places.

NACP - II (1999 – 2006) : Programme management decentralized to SACS, service delivery units like TI, ICTC, ART Centre and STD Clinic were established increasingly.

NACP – III (2007 – 2012) : Programme implementation will be further decentralized to District and Sub-district levels.- Based on edidemiological / vulnerability criteria,

610 districts divided into 4 categories.- Differential package of services planned for each category.- Every A and B district will have DAPCU to implement

AIDS control and prevention strategies, synchronized with the public health infrastructure and programmes at that level.

NACP – III Organogram

GOALS AND OBJECTIVESTo halt and reverse the epidemic in India over the next five yearsObjectives : Prevention of new infections. Increased proportion of PLHA receiving Care, Support and Treatment. Strengthening capacities at district, state and national levels. Building Strategic information management systems.

Strategy for District PlanningComprehensive package of graded services covering the entire population of the district.

a) Saturating the coverage of three HRGs - FSW, IDU & MSM.b) Expanding the coverage of bridge populations – Truckers and Migrant workers.c) Prevention among highly vulnerable population – Women, Youth & Children.d) Prevention among the general population through mainstreaming

Strategy Strategy ::a) Formation of CBO and Peer led

interventions for saturating coverage of all HRGs in urban areas.

b) NGO led interventions in rural areas with 5000+ population.

c) Mainstreaming interventions in rural areas with <5000 population..will be done by Link Worker Scheme (LWS) by ActionAid.

d) Mainstreaming HIV/AIDS in all Govt. Depts. for environment building in small scattered villages.

Service delivery at district level (A category)Institutional Framework Public Health Infrastructure Services

DISTRICT HEALTH MISSION ICTC

PPTCT

STD, OI, ART

BLOOD BANK

MEDICAL COLLEGE

DISTRICT HOSPITAL

DOCTOR, COUNSELLOR, LT

BLOCK HEALTH MISSION

BLOCK HEALTH MISSION

ICTC

PPTCT

STD, OI, ART

CHC

DOCTOR, COUNSELLOR, LT

PRIVATE PRIVIDERS ICTC SERVICES, STD Control, OICondom Promotion

24 Hrs phc

Doctor, Nurse cum Counsellor, LT

VILLAGE HEALTHCOMMITTEE

Condom PromotionTesting Kit

Care & SupportIEC

SC, AWC

LW, ANM, MPW, ASHA

REFERRAL

DHH - All HIV related services will be made available under one roof. This will include ICT, PPTCT, STD,OI and ART with necessary linkages.CHC will provide: ICT,PPTCT, STD and OI with necessary linkages to prevention and care treatment services.PHC will be responsible for ICTC services, STD control, OI and condom promotion.

Mobile ICTC to service hard to reach areas.

ROLE OF DAPCU

The role of DAPCU is 3 fold.1) Implementation of NACP

strategies.2) Convergence with NRHM

activities.3) Intersectoral Convergence

2.Convergence with NRHMa)Village level Village Health Committee – Orientation- Prevention-

Treatment-Care-Support Village Health Plan – Household survey – HIV

parameter LW member of VHC Untied fund at SC – AIDS Agenda Orientation to ASHA, ANM, MPW MCHN Day - PPTCT services, nutritional support to

PLHA mother and newborn, condom supply, delivery kit, STI, TB other OIs, ART followup – mobile lab

Promote ANC and institutional deliveries IMNCI protocol – include special care for HIV +Ve

infants.

Contd….

B) Block level Block Health Mission – Hospital

management committee Committed to IPHS

- 24 hrs. PHC/CHC be upgraded to ICTC- Provision of LT & Counsellor at ICTC- Centrifuge, Refrigerator, Infantometer – NRHM- HIV/AIDS testing kits, delivery kits – SACS- Strengthening Referral Protocol

. PPCTC / TB / STD / OI ICTC- Monthly review meeting - Representative of TI, Supervisor + Counsellor (ICTC).

(c) DISTRICT LEVEL Under NRHM, the District Health Action

Plan comprises the following five parts:- Reproductive and Child Heath Programme Immunization NRHM Additionalities National Disease Control Programme Inter-sectoral convergence, including

AYUSH The District AIDS Action Plan will

become the sixth component of the omprehensive Framework.

W & CD AWW – work on PPTCT, detect discrimination.

SHG - to support PLHA

RRC – among girls.

PR All functionaries – Orientation, Advocacy, Discrimination.

Gram Sabha – discuss HIV.

Budgetary supplement to prevention and control programme.

RD SHG + RRC – work on PLHA (Female), Integrated IEC

YA & S Promote VBD, Condom, NSS Campaign for rural youth. Train NSS (P.O.) / NYK (Co.)/Students.

Social marketing of condoms.

TOURISM Tourist spot – Condom, IEC, surveillance

LABOUR/

MINES/

FISHERY

INDUSTRY

IEC, Condom, Services at ESI hospital. Trade union – Orientation, discrimination Prevention, Labor – HIV in all training

POLICE / JAIL Support – Identifying HRG, sympathetic dealing, condom promotion in jail.

EDUCATION HIV awareness in adult education, No discrimination.

TRANSPORT

BS / RSIEC, Condom vending machine, Migration route, Orientation.

REVENUE HIV in all Dept. training.

Municipal Corporation & normal local body.

Awareness, Support through NGO and TIs for PLHAs. Mapping of HRG, Condom vending machine

CIVIL SUPPLY Antyodaya Cards for PLHAs.

DSW Madhubabu Pension Yojana

3.Intersectoral ConvergenceDept. Convergence activity

EPIDEMIC STATUS

People living with HIV/AIDS 33.0 million

Adults living with HIV/AIDS 30.8 million (93.33 %)

Women living with HIV/AIDS 15.5 million (50.32 %)

Children living with HIV/AIDS 2.0 million (12.90 %)

People newly infected with HIV Per Year 2.7 million

Children newly infected with HIV Per Year 0.37 million

AIDS deaths Per Year 2.0 million

Child AIDS deaths Per Year 0.27 million

More than 25 million people have died of AIDS since 1981

A : WORLD

B : India

Prevalence rate of India is 0.34%. The immerging face of the Epidemic is increasingly young, feminine & rural. 43 % of Women have not heard about HIV/AIDS.

Male Female H.R.G.

1.52 mln

(61 %)

.95 mln

(38 %)

.025 mln

(1 %)

People Living with HIV/AIDS 2.5 Million

C : Orissa

Male Female Child Male Child Female

7927 (59.37 %)

4544

(34.03 %)

505

(3.78 %)

375

(2.80 %)

People living with HIV / AIDS in Orissa 13351 (OSACS)

Vulnerability factors :• Large scale migration to other states in regular intervals.

• Large scale developmental projects such as, Mining industries, Hydro Electric and Irrigation Projects.

• Low literacy level especially among women.

• Rapid urbanisation and industrialisation.

• Merely parroted knowledge.

Transmission through :Sexual 82.82 %

Blood / Blood Products 0.86 %

Infected syringes & Needles 2.72 %

ANC / PPTCT 8.80 %

Not specified 4.81 %

/1

60

74

11

8

2

3 6

17

115

122

Block wise HIV +Ve

5

1. Bolangir (FSW, MSM, Migration)

2. Titilagarh (MSM, FSW)

3. Tureikela (Migration)

D : Bolangir

Male Female Total

177

(81.56 %)

40

(18.43 %)217

People living with HIV / AIDS in Bolangir 217

2 3 13 2237

102

38

217

0

50

100

150

200

250

2003 2004 2005 2006 2007 2008 TillJune2009

Total

2003

2004

2005

2006

2007

2008

Till June 2009

Total

Year wise +Ve Cases

Death due to AIDS

35

Delivery of Services so far :ICTC WISE COUNSELLING & TESTING

COUNSELLING TESTING

Name of centre Male Female Total Male Female Total

ICTC - I 8887 6342 15229 5028 3196 8224

ICTC - II 2214 5486 7700 1560 4719 6279

TITILAGARH SDH 3939 3574 7513 2241 2077 4318

KANTABANJI CHC 2221 2825 5046 2152 2817 4969

PATNAGARH SDH 8679 4883 13562 180 156 336

TOTAL 25940 23110 49050 11161 12965 24126

77

9

73

15 3

177

4 10 224 0

40

81

19

95

193

217

0

50

100

150

200

250

M

F

Total

ICTC wise +Ve Cases

Link Worker Scheme

Mainstreaming Interventions in rural areas with <5000 population:

• In these villages, focus will be on creating general awareness about HIV/AIDS and STIs, and also providing referral services for STI treatment, VCT/PPTCT, care and support. Such interventions will be done through the link worker model

• To prevent transmission from HRG to vulnerable population i.e. women and children.

• In Bolangir 2 lacks population will be covered under this scheme.

Objective

Implementation

• Selection of Link Worker is on process in 6 blocks.

Bolangir, Deogaon, Belpara, Loisingha, Titilagarh, Gudvela.

• Village mapping has started in Loisingha & Gudvela.

NEW ICTC Counselling

BELPARA 365

CHUDAPALI 272

GHASIAN 238

AGALPUR 68

SAINTALA 98

SINDHEKELA 470

MURIBAHAL 186

GUDVELA 127

TOTAL (8) 1824

Testing not started.

Loisingha

Khaprakhol

Deogaon

Above three centres are newly opened but staff not joined and centre may be shifted.

New Centre established

NAME OF TI

AREA OF OPERATION

TARGET

GROUP

NO.

REFL

TESTED

+VE

STD TREATMEN

THOT SPOT AREA

CONDOM

DISTRIBUTED

SOCIAL MARKETING

RYS BOLANGIR MUNICIPALITY

AREA,

LOISINGHA, AGALPUR,

CHUDAPALI

FSW, MSM

250,

200

552 398 61 342 RAJMAHAL AREA, GANDHI NAGAR, HATISAL PARA

8837 25355

SAI TITILAGARH

PATNAGARH

KANTABANJI

MSM 250 170 134 17 298 DURLA

TENDAPADAR

GUDIGHAT

BANKEL

TANIA

BALIPATA

11950 700

SAHARA TITILAGARH

PATNAGARH

KANTABANJI

FSW 250 159 108 6 253 ULBA

BERHAMPURA

RAMPUR

19250 5560

RYS : Rajendra Yuva Sangha, Bolangir

SAI : Social Awareness Institution.

SAHARA : Social Association for Humanitarian Activities in Rural Areas.

ART Registration at Burla.

Male Female Total

Pre ART 34 19 53

On ART 25 5 30

Position of MBPY

No of cases sanctioned

No. of cases received

Not traceable

Death

140 36 19 19

1- To increase footfalls in ICTC

2- To ensure more no. of ART registration.

3- Convergence with NRHM and all line departments in activity & training.

4- Coverage of all HRGs in the district

5- To address out migration

6- Strengthening the referral system

7- Liquidation of advances pending with district

Challenges Ahead & support needed from dist. administration

THAN

‘Q’

ALL