Transcript Role of Pharmacists in HIV Care under NACP III

Role of Pharmacists in HIV Care
under NACP III
Tamilnadu State AIDS Control Society
HIV/AIDS Epidemic in India (2007)
• National India
0.48 %
Districts by category:
A – 141
B – 46
• State
C – 309
Tamilnadu
0.25 %
Tamilnadu
D – 114
Categorization of districts
Category of Districts

More than 1% ANC/ PPTCT prevalence in district in any time in any
of the sites in the last 3 years
A

Less than 1% ANC/PPTCT prevalence in all the sites during last 3
years Associated with More than 5% prevalence in any HRG group
(STD/ FSW/ MSM/ IDU)
B

Less than 1% in ANC prevalence and Less than 5% in all STD clinic
attendees or any HRG WITH KNOWN HOT SPOTS (Migrants,
Truckers, Large aggregation of, Factory workers, Tourist etc)
C

Less than 1% in ANC prevalence in all sites during last 3 years with
Less than 5% in all STD clinic attendees or any HRG OR No or
Poor HIV Data With No Known Hot Spots/ Unknown
D
National AIDS Control Program
Phase III
GOAL
To reverse the epidemic in India over the next 5
years through integration of prevention &
treatment programs.
• Objectives




Prevention of new infections in high risk groups and vulnerable
populations through
a) Saturation of coverage of high risk groups with Targeted
Interventions (TI)
b) Scaled up interventions in other vulnerable populations
Increasing the proportion of persons living with HIV/AIDS
receiving care and treatment
Strengthening the infrastructure, systems and human resources
in prevention and treatment programs at the district, state and
national levels
Establishing nation wide strategic planning, programme
management, monitoring and evaluation system.
Key features
•
•
•
•
•
Prevention
Up-scaling of activities
Classification of districts by risk category
TIs more focused approach on HRGs
Empowering and capacity strengthening of CBOs
to
manage TIs
• Introduction of Link Workers in A and B districts (more
focus on IPC)
• Focused efforts on women, youth and children
Key features ....
• Emphasis on quality of care
• Increased access to ART, including resistance surveillance
• Increased focus of pediatric ART care
• Special efforts to address GIPA, impact mitigation
• Mainstreaming and partnerships with private sector
• Leveraging resources for sustainable response
• Performance Oriented Programme Management
Guiding principles
• Three Ones



one agreed action framework;
one National HIV/ AIDS coordinating authority,
one agreed National Monitoring & Evaluation system
• Equity
• Respect for the rights of the PLHA
• Civil society representation and participation
• Creation of enabling environment
• Improved access to services
• Effective HRD strategy
• Evidence based and result oriented programme
implementation
CST component under NACP III
Care, Support and Treatment


To ensured access to OI treatment including free drugs.
First line ART is to be provided to eligible PLHA free of cost.

Ensuring adherence and monitoring ART drug resistance.
Through e.g.: medical colleges, district hospitals with fully
functional medicine department.

Community outreach for home based care and livelihood
support.

PCP prophylaxis, nutritional advice and treatment of TB

The national target for first line ART is 2,00,000
Care, Support and Treatment
 Improved treatment access for OIs
 There would be a referral system for appropriate
management
 Supply of major OI drugs under government hospitals free
of cost
 Doctors in private sector will have access to training and
referral linkages
 Development of guidelines on OI management for
different levels of service delivery and referral linkages
 Development of guidelines and capacities for establishing
standards of care
 Establishment linkages with DOTS programme for HIV/TB
co-infection
Care, Support ...
 Increased Number of PLWHA on ART
 More ART centres and link ART centres
 Arrangements for CD4 testing either through direct provision or
linkages with central units
 Identification of referral centres and orientation of doctors
 Identification of NGOs to provide community outreach, home
based care and psycho social support
 Establishment of facilities for paediatric ART, including viral load
testing facilities and procurement of paediatric drug formulations
 Assessing the need for and setting up community care and
support centres
 Improve public private partnership to achieved specific targets
every year.
Care, Support ...
 Expansion of VCTC, PPTCT and PEP programs
 Integration of VCTC and PPTCT centres (and if feasible blood
bank and STI services also). If loads permit it, the programmes
can share counseling and testing services.
 Long term follow up of mother and child for OI and ART and
facilitate access to RCH services
 States with poor testing load need to ascertain reasons for poor
use and take remedial measures.
 Establish district model ICTCs as training and referral centres
 Staggered approach to scale up based on identified need and
capacity over the project period
 (Capacity building) Set up EQAS for ICTC testing and quality
assurance systems for counselling services
Care, Support ...
Community care and support programs
 Identify and develop partnership with NGOs/CBOs
 Community care centres where needed
Integration of prevention and treatment measures and linkages
 Linkages established between ART centres, PLHA networks and
TIs/Workplace interventions
 Prevention education for positive persons
 Risk reduction strategies for PLHA and their partners
 Prevention case management integrated into OI and ART
 Partner referrals through counselling
 Screening for TB/STI of PLHA
 Capacity building of PLHA networks to participate in prevention
programmes (IEC, Advocacy, Workplace, School AIDS programme,
Youth friendly services)
 Strengthening positive prevention programmes
Care, Support ...
 Collaboration with PLHA networks
 Facilitating the formation of PLHA CBOs/networks
 Capacity building of PLHA
 Advocacy and technical support for policy changes to enable GIPA
 Development and implementation of policies to create an enabling
environment to enhance the involvement of PLHA and affected people at
all levels
 Linking livelihood support
 Advocacy with government and private sector to support PLHA,
 Through membership of SHGs, savings fund, corpus fund, vocational
trainings for IGP
 Capacity building of PLHA to advocate for livelihood support, design and
manage micro credit/ IGP
 Reducing stigma and discrimination
 Advocacy for enactment of State-specific anti discriminatory laws
 Providing and supporting community based programs especially in the
workplace
 Supporting formation of PLHA networks at district levels
Centres of support under the CST
component in the State
Programs
Anti Retero viral centres
PPP Anti Retero viral centres
Link Anti Retero viral centres
Integrated Counselling & testing centres
Mobile
Community Care Centres
Child focussed Community Care Centres
Drop in Centres
Number of
facilities
37
1
46 ( target 90)
783
11
40 + 1
5
37
HIV prevalence – Tamil Nadu
Krishnagiri
ANC prevalence
0.25%
Salem
Estimated PLHIV –
1.84 lakhs
Namakkal
Trichy
Theni
HIV Prevalence - ANC (%)
1.2
1
1.13
1
Percent
0.87
0.8
0.75
0.65
0.6
0.5
0.4
0.375
0.25
0.2
0
2000 2001 2002 2003 2004 2005 2006 2007
Year
Role of Pharmacists
Prevention
Care & treatment
Prevention
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•
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Promotion of safe and healthy sexual behaviour
Improve the management and control of STIs
Reduce parental transmission
Provide appropriate post exposure prophylaxis
Care & Treatment
• Provide treatment, care & support services in health facilities
– Supply of appropriate drugs for OI management and HIV related
infections
– Budgeting and forecasting the demands for dispensing
– Advise on rational drug usage
•
•
•
•
•
•
Nutrition
Antibiotics
ART
TB drugs
Prophylaxis
Anti fungal drugs
– ART
•
•
•
•
Adherence
Resistance
Efficacy
Side effects
– Help in referral services
• Provide adequate treatment, care and support services in
communities – since their public interaction is more, vital information
can be spread
Role of Pharmacist in Institutional DOT Provider
• Check the TB identity card for CPT prescription
• Provide monthly supply of CPT to the HIV-infected TB
patients, who have been prescribed CPT by the attending MO
and record the date of delivering on the TB treatment card.
• Encourage the HIV-infected TB patients, during their monthly
visit to PHI for collecting CPT, to meet the Medical Officer for
routine examination
• Ensure confidentiality of HIV status of the TB patients remains
confidential with in the health system
• Monthly basis indent (from MO-TC) and maintain stock of
Cotrimoxazole for the HIV-infected
• TB patients prescribed CPT for the entire duration of their TB
treatment