Andhra Pradesh AIDS Consortium (APAIDSCON)

Andhra Pradesh AIDS Consortium (APAIDSCON) is consortium of private medical colleges for promoting HIV service delivery in the private sector including prevention, diagnosis, care, treatment, follow-up and related aspects. It also provides systems strengthening and technical assistance to private sector in clinical care. APAIDSCON draws a partnership between 20 private medical colleges across 16 districts in the state of A.P.

The overall Goal of the consortium is to encourage private medical colleges to open their doors to HIV/AIDS patients for providing treatment and care without fear, stigma and discrimination. Specifically APAIDSCON aims to

  1. To organize a consortium of all the private medical colleges in Andhra Pradesh for provision of HIV/AIDS services as per NACP by 2010
  2. To develop capacities of Health care providers on HIV/AIDS services as per NACP guidelines in all private medical colleges in Andhra Pradesh by 2010.
  3. To foster public private partnerships for HIV/AIDS services under NACP in the Private Medical Colleges and Nursing Homes by 2010.

In order to accomplish the above objectives, SHARE INDIA - APAIDSCON is conducting the following core activities which are broadly classified in to:

A. Strengthening Human resources for health
To build capacity of the healthcare staff for providing comprehensive care and treatment to people living with HIV/AIDS, SHARE INDIA- APAIDSCON is conducting various training programs for all the strata of health care providers that includes doctors, nurses, lab technicians, counsellors and outreach workers working in government and non-government agencies. Overview of Training Programmes conducted by the consortium

1. Training of nurses:
1409 nurses from the private medical colleges and private maternity nursing homes were trained through 47 nurses' "sensitization training program", 64 nurses from the state funded community care centres(CCC) and temporary hospitalization wards (THWs) were trained through two "clinical nursing training program" and 27 nurses from private medical colleges were trained through "training of trainers program" on HIV medicine.

2. Training of physicians:
368 doctors from departments of general medicine, TB/Chest, Dermatology, Paediatrics and STI in private medical colleges and 39 doctors from state funded community care centres(CCC) and temporary hospitalization wards (THWs),24 doctors working in the prisons of Andhra Pradesh were trained on HIV medicine through 13 four days "advanced clinical hands on training program"(ACT), 1682 were trained on HIV medicine through 54 "doctors sensitization training programs", and 25 doctors from private medical colleges were trained through "training of trainers program" on HIV medicine.

3. Training of Obstetricians and Gynaecologists (OBGYN):
220 obstetricians and gynaecologists from private medical colleges and private maternity hospitals were trained on HIV medicine pertaining to prevention of parent to child transmission (PPTCT) through six "Obstetricians and Gynaecologists training programs".

4. Training of Medical post graduates:
This program was started in October 2009.Till date 151 medical post graduates from various departments across 20 medical colleges were trained through 5 two day "post graduate training program" on HIV medicine.

5. Training of Interns:
This program was started in October 2009.Till date 1102 medical interns/house surgeons across 20 medical colleges were trained through 35 two day Interns training program called "Linking Learning to Life" on HIV medicine.

6. Training of Microbiologists: 18 Microbiologists / lab managers of the private medical colleges were trained on HIV and OI diagnosis to support care of PLHIV in their institutions. This program was conducted in October 2009.

7. Training on laboratory quality assurance:
23 lab managers and lab technicians working across 15 Integrated Counseling and Testing Centres in private medical colleges were trained on laboratory quality assurance in October 2009.

8. Training of ICTC lab technicians:
34 lab technicians from state funded community care centres and temporary hospitalization wards were trained on basics of HIV medicine and laboratory testing in April 2009.

9. Training of ICTC Counsellors:
15 counsellors from 15 ICTCs in private medical colleges were trained on the various counselling aspects of HIV through 3 refresher training programs from October 2006 – July 2010.24 counsellors from various prisons across Andhra Pradesh were trained on HIV counselling in August 2009.

10. Training of peer counsellors: 15 peer counsellors were trained on basics of HIV, various aspects of outreach activity, recording and reporting the data from the field through 2 induction and 9 refresher training programs from October 2007 to July 2010.

11. Sensitization programs of housekeeping staff:
1275 housekeeping staff from 16 private medical colleges was trained on basic of HIV, Universal safety precautions and biomedical waste management through 42 sensitization training programs from October 2006 to September 2009.

12. Training of project coordinators:
18 project coordinators from AP state funded community care centres were trained on the management of community care centres in terms of managing human resources, maintenance of infrastructure, documentation and reporting in May 2009.

B. Care, support and treatment
Community Care Centres play a critical role in providing treatment, care and support to people living with HIV/AIDS (PLHA).Under NACP-III these centres are attached to ART centres and ensure that PLHA are provided: (a) counselling for ARV drug adherence, nutrition and prevention (b) treatment of opportunistic infection (c) referral and outreach services for follow up and (d) social support services. Andhra Pradesh State AIDS Control Society (APSACS), allocated three NACO supported CCCs to SHARE India. Among the three two were established in two partnering private medical colleges, i.e. GSL Medical College, East Godavari, Kamineni Institute of Medical Sciences, Narketpally and one to SHARE INDIA in 2008.All these three CCC are assigned to work as per the national guidelines and are closely monitored by SHARE INDIA-APAIDSCON.

1. Building Linkages for CCCs
Under the national program CCCs established work under difficult conditions like having inadequate staff (especially doctors) or lack of trained doctors. These gaps are being addressed with the partnering institutes taking the leadership role in providing trained manpower to provide services. 5 partnering institutes have built the linkages and trained doctors are providing services in these CCCs. The linkages that were established are as follows:

  1. St. Joseph Care and support centre – Mamata Medical College, Khammam
  2. Rotary Abhaya care and support center– Maharaja Institute of Medical Sciences (MIMS),Vizianagaram
  3. Lodi care and support centre– Chalmeda Ananda Rao Institute of Medical Sciences, Karimnagar
  4. Asha Jyothi care and support center – Mediciti Institute of Medical Sciences, Ghanpur
  5. Desire society care and support center – MNR Medical College, Sangareddy, Medak
Universal availability and access of to HIV patients by providing OI treatment through IP and OP care has been core of care and support activity of the project. These services are being provided at partner institutions.

Overall, 5,567 (2,521 in Oct09-July10) episodes of OIs were treated at OPD (1,245) and IPD (1,276) of the PIs.

2. Supporting public sector through consultant at Andhra Pradesh Chest Hospital:
With an objective to address the gaps in care, treatment and training interventions that currently exist, under the Public-Private Partnership, APAIDSCON provided support to AP chest hospital by placing a medical officer as a consultant, to become a nodal center of training, diagnosis, care, treatment and support in HIV/AIDS in Andhra Pradesh. This strengthened and streamlined the State level HIV/AIDS and related programs & trainings for Medical Doctors, Nurses, paramedical staff, Laboratory technicians, Pharmacists, Field staff and others.

C. Counseling and testing
Under the Private Public Partnership (PPP) with APSACS, 15 of the present partnering institutions of APAIDSCON have been allotted standalone Integrated Counseling and Testing Centres (ICTCs). These ICTC centres are being coordinated and monitored by SHARE INDIA –APAIDSCON/APAIDSCON. 5 Facility Integrated ICTCS (F-ICTCs) with in the Private Medical Colleges and 45F-ICTCs in private Nursing Hospitals have also been established. A total of 298894 individuals were counselled and tested at these centres of which 1, 28, 811 were pregnant women.

1. Facility Integrated Counseling and Testing Centres:
SHARE INDIA –APAIDSCON in collaboration with APSACS established the Facility Integrated - Integrated Counseling and Testing Centres (FI-ICTCs) in the 5Private Medical Colleges,
1. PES Institute of Medical Sciences, Kuppam
2. Shantiram Medical College, Nandyala
3. Narayana Medical College, Nellore
4. Pratima Institute of Medical Sciences, Karimnagar
5. Dr.VRK Women's Medical College, Moinabad
and 45 Private Maternity Nursing Homes, Multi specialty Hospitals and Private Laboratories across 4 districts – East Godavari, Vizianagaram, Rangareddy and Hyderabad of Andhra Pradesh as a part of Public private Partnership to make ICTC services more accessible and these would eventually also be included under EQUAS like the existing ICTCs

2. Peer counsellors for PPTCT
APAIDSCON has initiated the concept of peer education by appointing peer counselors in 15 partnering institutes. Each peer counselor sends a monthly report to APAIDSCON office. The activities of peer counsellors are as follows:
Voluntary counselling and testing services for pregnant, non-pregnant women and children
Facilitation and conducting institutional deliveries for HIV infected pregnant women Nevaripine (NVP) prophylaxis for HIV infected pregnant woman & child Counselling for safe infant feeding practices and nutritional support for infected pregnant women and children
Follow up of infected children until the serostatus is known
Universal Cotrimoxazole prophylaxis to exposed children.8.Follow up of child for routine immunization
Referral and follow up of HIV infected pregnant, non-pregnant women and children to Anti-Retroviral Treatment (ART) centres and CD4 count facilities D.Laboratory services The consortium offered subsidized laboratory services to the positive individuals as well as offered a quality assurance programme to strengthen the testing practices in the private sector.

1. Subsidized CD4 testing facilities:
Lab support – subsidized CD4 Testing Facility - As a part of the goal of the consortium, SHARE INDIA –APAIDSCON/APAIDSCON built the capacity of the partnering medical colleges to give care to PLHIV. But the partnering institutes which are located in semi urban and rural areas do not have the facilities of CD4 testing which is required for a standardized care. To fill this gap, with support from CDC and Mediciti Hospitals had initiated CD4 testing facility at subsidized rates. The cost to the patient being referred by the Partnering Institutions will be only Rs. 200/-, the rest will be subsidized by SHARE INDIA and Mediciti Hospital. This is being done through an advanced State-of-the-Art Flow Cytometer (BD Facs Caliber). A total of 4165 PLHIV accessed subsidized CD4 testing.
2. Lab quality assurance program:
The provision of quality laboratory services and the reliable diagnostic testing are integral to the success of surveillance programmes, as well as programmes for prevention, care, support and treatment of disease including HIV. Adherence to good laboratory practices to promote reliable and accurate results, contribute to good patient care, and promote a positive attitude towards testing from a patient's perspective. In order to understand the current scenario of the HIV testing labs in our state, APSACS in collaboration with SHARE INDIA – APAIDSCON has set off a quick review of HIV testing practices in 133 private laboratories of Hyderabad.The review examined adherence to the national guidelines for testing, counselling and informed consent.SHARE INDIA –APAIDSCON in consultation with APSACS designed quality assurance program for the ICTCs with in its 15 partnering private medical colleges as a pilot program to assess all the quality parameters for rapid HIV Testing and counselling. The ICTC assessment process has drawn the strength and spirit from the national guidelines developed by NACO. SHARE INDIA-APAIDSCON along with SRL and NRL accreditation team members in consultation with APSACS carried outcome assessment in the ICTCs of 15 partnering private medical colleges. The final results were presented to APSACS.