TANSACS LAC

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ART program in Tamil Nadu 26 December 2012 1

ART Program:

ART Program Started in April 2004 Currently 35 ART Centres 26 Old ART Centers and 9 more new ART Center Started JAN 09

ART Coverage:

ART Coverage Nos registered in 35 ART Centres- 121678 Nos started on ART – 52786 Alive and on ART- 35395

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Operational Guidelines for Link ART Centers in India NACO, April 2008 26 December 2012 4

Objectives of setting up the Link ART center:

Objectives of setting up the Link ART center To integrate ART services with the Primary / Secondary Health Care system. To build the capacity of the health care staff at the Primary Health Care Level in ART treatment. To increase the access of ART services to the PLHA. To improve the adherence of patients to ART. To reduce the travel cost and travel time of PLHA to access services. To reduce the load at the Nodal ART center 26 December 2012 5

Functions of Link ART Centre (LAC):

Functions of Link ART Centre (LAC) Medical Functions: To monitor the patients on ART in terms of OIs, Side effects, Adherence and Weight. Back referral to the ART centre, symptoms suggestive of OI, side effect of OI drugs, pregnancy and ANC care, etc. To Facilitate linkages between other service providers such as ICTCs, NGOs. 26 December 2012 6

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Psychological Functions: To provide psychological support to PLHA accessing the LAC To provide counselling for adherence to ARV drugs To educate PLHA on proper nutrition To advise for risk reduction behaviour including usage of condoms Social Functions: To facilitate PLHA to access available resources provided by Govt. and NGOs To facilitate linkages between other service providers and patients, like educational help for the children and IGP etc. 26 December 2012 7

Site for link ART centre:

Site for link ART centre The Link ART centre should ideally be opened at ICTC in a Hospital setting NACO will not be extending any additional support in form of Human Resources and infrastructure development cost. Facility expected to have minimum requirements (staff, space, computers & internet) in place. Space: Two 10’*10’ rooms are needed. One for drug storage and another one for drug dispensing, record keeping and counselling . 26 December 2012 8

Personnel for the Link ART center:

Personnel for the Link ART center Doctor: (LAC should identify 2-3 Doctors, senior most doctor amongst them (preferably a General physician) shall be the LAC In- charge and responsible for day to day activities and reporting to the Nodal ART centre) Counsellor : The ICTC counsellor shall bear the responsibility of counselling of PLHA on ART Staff Nurse : The institute should depute a nurse to assist the Doctor and the Counsellor Pharmacist : The existing pharmacist shall be in charge of drug dispensing and drug record keeping 26 December 2012 9

Training of Personnel at LAC:

Training of Personnel at LAC Training of the personnel will be imparted by NACO either at the identified training institute or the Nodal ART centre. Computers & Internet : The Link ART center will utilize the computers & Internet facility already available with the ICTC 26 December 2012 10

Responsibilities:

Responsibilities Link ART centre In-charge Overall responsibility of the functioning of the Link ART centre All administrative matters relating to the centre. Coordinate and develop referral system and linkages with Nodal ART centre, NGOs, and Positive Network Groups etc. Ensure adherence to the highest standards of quality. Ensure that PLHA are not discriminated in the hospital. Review and monitor the functioning of the Link ART centre every week and ensure submission of reports as required. Should ensure timely transfer of drugs from the Nodal ART centre by coordinating with MO/SMO of the Nodal ART centre. The LAC In charge shall also bear responsibilities of treating PLHIV 26 December 2012 11

Doctor at LAC :

Doctor at LAC Monitor the patients on ART & identify the Symptoms suggestive of OI, Side effect of ART / OI medication, Pregnancy and ANC care, etc. Inform the SMO/MO of the Nodal ART centre whenever the patient is referred to the Nodal ART centre Ensure that record keeping and reporting are carried out properly To facilitate linkages between other service providers Refer the cases to the Nodal ART centre if required Ensure drug adherence and counsel the patient towards safe sex, condom usage, proper nutrition and positive living Monitor the consumption and availability of ARVs, other medicines and to alert to ensure un-interrupted supply. the Nodal ART centre 26 December 2012 12

Counsellor at LAC:

Counsellor at LAC Address issues of stigma and discrimination and rights of PLHA. Address issues related to ARV treatment i.e. adherence and side effects Repeatedly stress on positive living, prevention and condom use and dispense condoms. Complete the required sections in the recording and reporting tools kept at the Link ART Center and maintain them on computer The counsellor plays a very important role as a member of ART team and his/her responsibilities are crucial for the success of the programme 26 December 2012 13

Pharmacist at LAC :

Pharmacist at LAC Dispense the ARV drugs Maintain drug stock register and drug dispensing register Ensure adequate stock of ARV drugs Inform the Nodal Officer of the Nodal ART center if there is a problem with the drug stock (e.g. Expiry, delay in release of drugs from Nodal ART center, improper package / damage) Advise the patients and family about importance of adherence during each visit. Advise the patients on possible drug toxicities and reporting of the same 26 December 2012 14

Nodal Officer – ART center (DHQH):

Nodal Officer – ART center (DHQH) The Nodal officer at the nodal ART center shall bear the responsibility of informing the in-charge at the LAC regarding the transfer of the PLHA through post, telephone and e-mail within three days of the transfer and make sure the drugs are transferred with in two weeks of the date of transfer of the patient to the LAC. 26 December 2012 15

Linkages and Referrals:

Linkages and Referrals Nodal ART Center: The counterpart staff at nodal ART center and LAC (i.e. doctors, counselors, nurses and pharmacists) should communicate regularly by phone and email for smooth functioning of the linkage. PLHA Networks: Ensure the ART drug adherence among the PLHA and follow up of PLHA not attending LAC regularly. NGOs To carry out home visits for the On-ART PLHA who are irregular on the treatment. 26 December 2012 16

Financial Assistance:

Financial Assistance One time contingency grant for furnishing of center = Rs. 15,000/- Cost of training of staff – to be borne by training institutes recurring grant : Internet connection @ Rs. 650/- p.m. x 12 = Rs. 7,800/- p.a. Cost of stationery, records and contingency = Rs. 10,000 p. a. Cost of travel for ORW and to main center = Rs.20, 000 p.a. A separate bank account shall be opened by LAC for maintenance of fund The two signatories of the account will be the Medical superintendent of the hospital and LAC In charge. 26 December 2012 17

Eligibility to transfer of Patients to LAC:

Eligibility to transfer of Patients to LAC PLHA stabilized on ART for minimum 6 months at the Nodal ART centre Those who have exhibited weight gain, and increase in CD4 count after 6 months after initiating ART Do not have any active OI Those who are willing to be transferred, once the above conditions are fulfilled . LAC shall not initiate any patient on ART 26 December 2012 18

Documents and Supplies:

Documents and Supplies The transferred patients should be given the following documents by ART Nodal Officer to take it to LAC. Xerox copy of the Patient’s white card Original Green Patient book LAC transfer out form One month drugs 26 December 2012 19

Transfer of Drugs:

Transfer of Drugs Drugs for 6 months will be sent by the nodal ART centre to LAC 26 December 2012 20

Patients at Link ART Centres:

Patients at Link ART Centres Once the patient reaches LAC, he/she is given a separate LAC Id.No. in the LAC register On monthly visits to the LAC, following patient parameters (WAAO) are recorded in the LAC register sheet and Patient’s Green Book: Weight of the patient. Adherence. Any Adverse Effects of ARV drugs. Any OI. 26 December 2012 21

Flow of patient at Link ART center :

Flow of patient at Link ART center Registration at the OPD counter Counsellor General OPD (to the trained Doctor) Pharmacy: Drug dispensing (by pharmacist / nurse) 26 December 2012 22

Referral of Patient from Link ART center to Nodal ART center:

Referral of Patient from Link ART center to Nodal ART center After every Six Months – for repeat CD4 Count and Clinical review Before Six months If any major OI is diagnosed If there are any major side effects of ARV Drugs he/ she should be given / have following documents for follow up at Nodal ART center : Xerox copy of his/her page in the LAC register. Green book of the patient. Transfer back form . 26 December 2012 23

Activities will be done at Nodal ART center on a routine 6 monthly basis: :

Activities will be done at Nodal ART center on a routine 6 monthly basis: CD4 Count and other investigations Clinical review of the patient Review / Modification of the drug regimen (only prescription and no dispensing. After first time of transfer, drugs will be given from LAC only) Filling up of the patient’s original white card from the Xerox copy of the Individual page of the patient from the LAC register and green book Refer back to LAC with next 6 months drugs to be transferred through Community Care coordinator Monthly report to NACO 26 December 2012 24

Record keeping and monthly reporting at LAC:

Record keeping and monthly reporting at LAC Registers to be maintained at Link ART center: LAC Register : To be filled by MO LAC Drug Stock Register. To be filled by Pharmacist / Nurse LAC Drug Dispensing Register. To be filled by Pharmacist / Nurse LAC Monthly Report format. To be filled by MO Transfer back forms are to be maintained at the Link ART center Monthly Reporting by Link ART center: Each LAC will create its own E mail id such as lac.kulithalai@gmail.com and will report to the Nodal ART center in the Monthly Reporting Format by 30 th of every month by email followed by a hard copy. The format of e mail should be as suggested. NO REPORTS FROM LAC WILL BE SENT TO SACS/NACO DIRECTLY 26 December 2012 25

Functioning of LAC:

Functioning of LAC The patients at LAC examined in the General OPD The ICTC shall not designate days for the dispensing of ART The upper limit of the Link ART centre is fixed to 150 . As the number of patients on ART reaches 100, the LAC In Charge and Nodal ART centre shall intimate NACO and SACS The patients diagnosed at ICTC based in Link ART centre should be referred to Nodal ART centre for registering in Pre ART care Only the patients from the designated Nodal ART centres will be dispensed ART at LAC The patients at LAC will remain the patients of nodal ART Center 26 December 2012 26

Formats for weekly communication:

Formats for weekly communication Sr.no . ART No. Name of the Patient Address Current regimen Reason for Transfer Next date of dispensing ART 1. Nodal ART center to LAC 26 December 2012 27

PowerPoint Presentation:

Sr.no . ART no. LAC no. Name of the Patient Address Reasons for Referral Next date of dispensing ART 2. LAC to Nodal ART center 26 December 2012 28

PowerPoint Presentation:

Transfer Out form (Form For transfer from Nodal ART center to Link ART center Date of Transfer Out: Name NODAL ART center , address _________________________________of the Transferring ART center. Name LINK ART center , address _____________________________of ART center where patient is transferred. Name of Patient: ART No. of the patient :______________________ Address Date of starting ART : (Date/Month/Year); Initial Clinical Stage – WHO Stage - ______, CD4 - ________ Current Clinical Stage – WHO Stage - ______, CD4 - ________ Next date of dispensing drug _______________________ Current Regime - _______________________, Reason for Transfer ________________________ Remarks – Date for CD4 count, when the patient is to be transferred back to Nodal ART center- Please find the following documents handed to the patient: ART Treatment Card (White Card) (Xerox) Patient ID card (Green card) Others, if any (mention) Name and Signature of SMO/MO Phone no. and E mail of SMO/MO: _________________________________ To be filled by the receiving of ART center and sent to the transferring ART center by post / email …………………………………………………… (Name of Patient) with ART No.___________, transferred by you on date …….. / ……. / ……. has reported and been registered with us on ………. / ………. / ……….. The documents sent by you have been received. Name and Signature of MO Phone no. with E mail of MO 26 December 2012 29

PowerPoint Presentation:

Sl. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Date of visit* Due Date of next visit Weight (kg) Height (cm) of child Func­tional Status WAB** WHO Clinical Stage Oppor­tunistic Infections (code) # Drugs prescribed for Opportunistic Infections Antiretroviral drugs and dose prescribed Adher. to ART ## (No. of doses missed) Any other medicine TB treat­ment Y/N ART Side effects - code $ Concurrent condition e.g. STI Pregnancy (y/n) or FP method*** Condoms given Y / N Remarks / Referrals Staff Signa­ture Prophylaxis (Dosage) R x CTX Other 1 2 3 4 LAC Register (The register should have one page per patient enrolled at LAC) Name of Patient :________________ Link ART ID :______________ Nodal ART ID :________________ Date of Registration at LAC: __/__/__ Date of Registration at LAC: __/__/____ 26 December 2012 30

PowerPoint Presentation:

Transfer back form (Form for transfer from LAC to Nodal ART center) Date of Transfer Back Name LINK ART center , address _____________________________of ART center where patient is transferred. Name NODAL ART center , address ____________________________of the Transferring ART center. Name of Patient: Link Art Id.No.________________ Address Current Clinical Stage – WHO Stage - ______, CD4 - ____________ Next date of dispensing drug: Current Regime – Reason for Transfer back : Routine 6 monthly Follow up / major OI / major SE / Others (Please Specify) Remarks – Please find the following documents handed to the patient: Xerox copy of the Patients Page from LAC Register. Patient ID card (Green Card) Others, if any (mention) Name and Signature of M.O of Link ART center Phone no. and E mail of M.O of Link ART center _________________________________________________________________ To be filled by the receiving of ART center and sent to the transferring ART center by post / email …………………………………………………… (Name of Patient), with Link ART Id No. _____________ referred by you on date …….. / ……. / ……. Has reported to us on ………. / ………. / ……….. The documents sent by you have been received. Name and Signature of SMO/MO Phone no. with E mail of SMO/MO 26 December 2012 31

PowerPoint Presentation:

Thank You 26 December 2012 32

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