NACO Calls Proposals for HIV/AIDS Component of GFATM Round 7

[Guest guest]

Dear FORUM,

NACO has called for proposal to be submitted for Global Fund round 7.

One of the core activities of the NACP-III strategy is saturation of

the high risk group population namely - sex workers, Injectable Drug

Users (IDUs), Men having sex with Men (MSM), truck drivers and

cleaners and short stay migrant workers in urban and semi-urban

areas. NACO has identified the following areas of NACP-III for support under

Round 7

(a) Strengthening capacity of training institutes relating to

counseling and nursing care;

( Implementation of a Link Workers scheme ' to provide an array of

preventive/BCC services, through development of multi-sectoral

linkages in A & B category districts; and

© Implementation of workplace policy in private industries,

independently or in partnership with NACO.

However, the concept note it is not clear on the possibility of

NACO accepting proposals addressing other issues in HIV response

other than the needs of so called " high risk population groups "

The following is a text version of the NACO's concept note on

proposal for HIV/AIDS component of Global Fund Round 7. The detail

are available at the NACO web page at the following url.

http://www.nacoonline.org/concept_note.pdf

http://www.nacoonline.org/

___________________

Concept Note on Proposals for HIV/AIDS Component of GFATM Round 7

1. Preamble:

The intrinsic challenging nature of the virus and heterogeneous

socio – culture fabric of India has led the Government of India's

response to combat HIV infection with dynamism.

National AIDS Control Program (NACP) is being implemented across the

country since 1992. The activities are coordinated and monitored by

the State AIDS Control Societies established in all the states of the

country. The program lays specific focus on high-risk population,

local needs and nature of spread of the infection.

NACP has been evolving over the years and has gone through a process

of progress and expansion by cutting across several boundaries. The

response to HIV/AIDS could be seen through three phases of National

AIDS Control Program. NACP I (1992-99) focused on the awareness

generation, infrastructure development at states level and promoting

prevention program particularly blood safety. NACPII (2000-07) moved

on further scaling up of awareness building, prevention strategies

through Voluntary Counseling and Testing (VCT), Prevention of Parent

to Child Transmission (PPTCT), Targeted Interventions (TIs) for high

risk vulnerable groups, treatment of Opportunistic Infections (OIs),

Blood safety low cost strategies for care and support and

introduction of Anti-retroviral Treatment (ART).

NACP III (2007-12) aims at up-scaling above mentioned services,

decentralizing implementation up to district level, developing Public-

Private Partnerships in various interventions and mainstreaming

various activities with other sectors. It also focuses on

integration with National Rural Health Mission (NRHM) and other

National Health Programs notably the Reproductive and Child Health

(RCH) program and Revised National TB Control Program (RNTCP).

2. NACP-III Framework:

The commitment of Indian Government is reflected in the design of

NACP III with the following services provided within different

components:

Preventive Services Care Support and Treatment Services

1. Creating awareness about symptoms, spread,

prevention and treatment

2. Screening for STI and RTI and treatment

3. Condom promotion

4. Integrated Counseling and Testing (ICT)

5. Promotion of voluntary blood donation and

access to safe blood.

6. Prevention of Parent to Child Transmission

7. Promotion of safe practices and infection control

1. Management of Opportunistic Infections

2. Control of TB in PLHA (RNTCP)

3. Anti-retroviral Therapy

4. Outreach community/home based care

5. Reducing stigma and discrimination

Targeted Interventions for High Risk Groups

1. STI services

2. Condoms – free and social marketing

3. BCC through peer and outreach

4. Building enabling environment

5. Community organizing and ownership building

6. Linking HIV related care and support services

IDU (Additional components)

1. Detoxification, de-addiction and rehabilitation

2. Needle exchange

3. Substitution therapy

4. Abscess management & other health services

MSM (Additional components)

1. Lubricants and appropriate condoms

As per NACP III following are the persons having primary

responsibility of service delivery at different levels of health care

given below:

4. Areas for Support under GFATM Round 7

Following areas of NACP-III have been identified for support under

Round 7:

(a) Strengthening capacity of training institutes relating to

counseling and

nursing care;

( Implementation of a Link Workers scheme ' to provide an array of

preventive/BCC services, through development of multi-sectoral

linkages in

A & B category districts; and

© Implementation of workplace policy in private industries,

independently or in

partnership with NACO.

Levels of service Personnel delivering

Services

Type of Services

1 Community

1. ASHA (Accredited Social

Health Activities (NRHM states)

2. Community Associations

3. Religious leaders

4. SHG members

5. PRI functionaries

Referring pregnant women for test

Creating awareness of HIV

Promotion of voluntary blood

Reducing stigma and discrimination

2 Sub-centre

1. ANM (Auxiliary Nurse Midwife)

2. RMP (Registered Medical

Practitioner)

Referring pregnant women for testing,

condom promotion

3 PHC/Private

provider

1. PHC doctor/Private practitioner

2. Nurse

3. Lab Technician

4. Pharmacist/Dispenser

5. Record Keeper

STD control and condom promotion

AIDS case diagnosis and referral

treatment of OI

Antenatal care and counseling

Diagnosis of common STIs and OIs

4 CHC/NGO

Hospitals

1. CHC doctor/ Trust hospital

doctor

2. Counselor

3. Nurse

4. Lab Technician

5. Pharmacist/Dispenser

6. Record Keeper

STD control and condom promotion

AIDS case diagnosis and referral

Treatment of common OIs

Integrated health counselling/testing

PPTCT services

Diagnosis of common STIs and OIs

Dispensing of OI and STD medicines

Maintaining record

5 District Hospitals/

Teaching hospitals

1. Specialists

2. Doctors

3. Nurse

4. Counselors

5. Lab Technician

6. Manager Drugs and Supply

Chain

7. Community Care Coordinator

Management of complications of HIV

ART

Support care

Integrated counselling/testing

Diagnosis of STD and OI

PPTCT

Ensuring drug supply at district level

Facilitating access to care and support

6 NGO/CBO/FBO

1. NGO/CBO in administering

CCC and family support

centres

2. NGO/FBO/other managing TI

3. Outreach worker

Palliative care, treatment of minor OI,

STD treatment

Counseling, social service

Adherence monitoring

(a) Strengthening capacity of training institutes relating to

counseling and nursing care;

The Program envisages increasing accessibility to services. In order

to enhance coverage of the target population, NACO proposes to

develop capacity of available Nurses, Doctors and other health care

professional, para professionals such as Counselors working in

Testing Centres and community members from the target population.

Since the traditional curriculum of nursing training does not have

specific focus on care and treatment component for HIV, NACO plans,

to strengthen the competence of nurses and other paramedics to build

in systems and skills in care for scaling up the capacity to deal

with this public health problem at all levels of health care. Special

training packages will be prepared to train, motivate and

continuously support nurses for counseling, testing, community

preparation for palliative care, administering treatment and

monitoring drug adherence.

The continuum of services consists of a package ranging from

prevention, care, support and treatment in keeping with the

progression of the disease in the individual and for the

community as a whole. At each stage of the disease manifestation at

the level of the individual, the households or the community, there

is need for consistent counseling and education to prevent the onset

of the disease as well as for coping with the disease when it does

set in; for ensuring appropriate behaviour for optimizing efficacy of

the treatment being administered. In this role of prevention and

support, nurses are the first contact point for the community and the

individual patients with the providers of care. As the primary care

givers, be at the community level – either the primary health care

and CHCs, district hospitals or the medical colleges, in the out-

patients ward or for in-patient treatment, nurses bear at least half

of the burden of counseling and treating the persons living with

HIV/AIDS.

The shortage of nursing personnel adversely affects the policy to

provide access to essential services to women and in particular

pregnant women to ensure that HIV positive mothers do not pass their

infection to their babies. The nurses played a significant role in a

pilot project implemented in Andhra Pradesh, Nursing staff appointed

at the Primary Health Centres have proven to be able to provide

essential services such as in conducting safe delivery to HIV

pregnant women.

Keeping the above in view, the proposal under Round 7 seeks to

encourage schools imparting training in counseling and Nursing

Training Institutions in the public sector and the NGO not for profit

sector, to develop appropriate capacity for training, concurrent

monitoring and building capacities among nurses in the public and

private sector. This shall include both public health as well as

hospital based nurses in counseling, care and support system, at home

and community level for providing access to HIV prevention and

treatment among vulnerable groups. Therefore,

institutions/organizations interested in providing training to these

two categories of care givers and who have the institutional capacity

and skills to do so, but requiring additional support both in terms

of infrastructure and teaching faculty may apply in the prescribed

format.

The application can be either by an individual institution or a

consortium of institutions, which must have capacity to train a

minimum of 1000 nurses/counselors during the next five year period.

( Implementation of a Link Workers scheme ' to provide an array of

preventive/BCC services, through development of multi-sectoral

linkages in A & B category districts

One of the core activities of the NACP-III strategy is saturation of

the high risk group population namely - sex workers, Injectable Drug

Users (IDUs), Men having sex with Men (MSM), truck drivers and

cleaners and short stay migrant workers in urban and semi-urban

areas. For total saturation of these groups, the NACP-III envisages

the use of link workersresidents of villages/towns of not more than

5000 population. It is envisaged that these persons who would be in

the age group of 19-25 years would be allotted some 10-15 villages

depending on the geographical proximity in that area, where they will

identify high risk and highly vulnerable households and provide them

intensive prevention education to protect them from getting the

infection. Alongside, the link workers would also be expected to

actively work with the community and based on the mapping of civil

society resources available, mainstream HIV prevention messages with

the Panchayati Raj bodies, Mahila Mandals, self-help groups, youth

clubs, school children etc. The objective is to ensure that these

peripheral areas in high prevalence districts are protected from

HIV/AIDS.

Link workers will also be expected to encourage those they feel may

be least willing to undertake testing, provide psycho-social support

at the house-hold level to the HIV infected persons, develop an

enabling environment in the community which is non-discriminatory and

ensure that the HIV-infected get support of the community and also

access to critical services at all times. Since youth will be the

focus, the link workers will be expected to run youth clinics once a

week, where they can impart necessary information, clarify doubts and

help the youth to cope up with their vulnerability to the HIV

infection.

The NACP-III envisages the link workers scheme to be implemented in

186 districts which have high prevalence of HIV or a highly

vulnerable to HIV infection. The list of districts is annexed (Annex-

1).

NGOs, community based organizations, faith organizations, etc. having

a good capacity to implement such community based strategies and link

workers scheme could apply with the minimum unit eligibility of the

coverage being of one district.

© Implementation of workplace policy in private industries,

independently or in partnership with NACO.

The private sector in India is estimated to employ 8-10 million work

force. In addition, an estimated 4 million could be the population

that lives and sustains on the industry by providing support services

to those working in the industries. Workplace policy implies

having a non-stigmatizing and non-discriminatory policy against the

HIV infected; ensuring that all workers - white collar, blue collar,

manual, direct or informal, contractual or regular - are provided

information on HIV infection, counseled to change behaviour among

those prone to high risk behaviour practices and life styles and

motivate/encourage them to undertake testing to know their status for

not only preventing transmission of the infection to others but also

availing of treatment at an early stage of the onset of the infection

and having the systems in place to ensure that those who are HIV

positive and requiring treatment, have access to ART treatment and

monitor drug adherence. For such a work place policy, the industry

would need to develop IEC materials to educate their work force and

also have clinics or access to medical and para-medical services, to

provide continuum of care and services; and establish with

professional social marketing organizations continued supply of

condoms and other consumables required under this programme. As model

employers, industries are expected to institute such work place

policies in their organizations.

Those industries having a large work force, particularly, of a

migratory nature, are encouraged to apply. Since the private sector

industry is expected to contribute to the national efforts for

arresting this infectious disease, the Global Fund grant will

necessarily have to be on a shared basis on the proportion of 75:25

where the private sector industry will need to provide 75 percent of

the investment for a matching grant of 25 percent from the Global

Fund. The minimum number of work force to be covered under this will

be 5000 workers. The application could either be submitted from an

industry or from a consortium of industries or a professional

organization of industrialists.

Interested parties may apply as per relevant application formats

annexed with this document.

http://www.nacoonline.org/concept_note.pdf

http://www.nacoonline.org/