DR A.K.

GUPTA , ADDITIONAL PROJECT DIRECTOR

DELHI STATE AIDS CONTROL SOCIETY

 HOLISTIC APPROACH
Views a patient as a whole person, not as just a
disease or a collection of symptoms :
•health,
•economic,
•social, emotional and spiritual
•the nutritional, environmental and lifestyle
factors that many contribute to an illness
AIDS Cumu 2000 2001 2002 2 2004 2 2 2 Cu
DEATHS/CASE lative 003 005 006 007 mul
S till ativ
1999 e
till
May
Cumulative 200
deaths 118 142 169 201 230 237 283 363 526 8602

Cumulative 4 6 6
Cases 359 498 656 762 881 956 2421 346 409 976

32.86 28.51 26.1 11.6 8 8 8

% of Deaths 9 425.76 26.38 124.79 9 .35 .21 .63
 Status Of AIDS Cases In
Delhi
TOTAL HIV POSITIVE CASES REGISTERED AT 9
ART CENTRES (TILL JUNE 2008): 15,970
75% OF TOTAL CASES SHARED BY 3 ART
CENTRES (RML, LNH & AIIMS)
ADULTS: 92.6%, CHILDREN: 7.4%
44% STARTED ON TREATMENT.
65% ARE ALIVE & CONTINUING TREATMENT
35% LFU, DIED OR TRANSERRED OUT TO ART
CENTRES OF OTHER STATES.
 OBJECTIVES OF ART CENTERS
Objective: To provide comprehensive package of services to eligible
persons with HIV/AIDS.
• Identify eligible persons with HIV/AIDS requiring ART through
laboratory services (HIV testing, CD4 Count & other required
investigations to rule out/detect any underlying OI).
• Provide free ARV & O.I. drugs to eligible persons with HIV/AIDS
continuously with provision of counseling services before & during
treatment for ensuring drug adherence.
3. Educate persons & escorts on nutritional requirements. hygiene
& measures to prevent transmission of Infection.
4. Refer patients requiring specialized services or admission.
5. ART centers are linked to CCC for short duration inpatient care.
Presently the ARV drugs are being provided on monthly basis.
6. Provide condoms
 ART CENTERS IN
BSAH
DELHI
GTBH

LNH
DDUH

KSCH

RMLH

AIIMS

LRS
SJH
 FUNCTIONS OF ART CENTRES
1. MEDICAL FUNCTION:
B. DIAGNOSIS & TREATMENT OF O.I.
C. SCREEN PLHA FOR ELIGIBILITY TO START ART
D. MONITOR PATIENTS ON ART & MANAGE SIDE EFFECTS
E. PROVIDE IN-PATIENT CARE WHEN NECESSARY
F. FACILITATE LINKAGE BETWEEN OTRHER SERVICE PROVIDERS
G. FACILITATE EASY ACCESS TO SPECIALIT’S CARE AS NECESSARY
• PSYCHOLIOCAL FUNCTIONS:
I. PROVIDE PSYCOLOGICAL SUPPORT TO PLHAs
J. PROVIDE COUNSELING FOR DRUG ADHERENCE
K. EDUCATE PLHA ON PROPER NUTRITION
L. ADVISE FOR RISK REDUCTION BEHAVIOUR & USE OF CONDOMS
• SOCIAL FUNCTIONS:
N. FACILITATE PLHA TO ACCESS AVAIALBLE GOVT & NGO RESOURCES
O. FACILITATE LINKAGE BETWEEN OTHER SERVICE PROVIDERS LIKE
EDUICATIONAL HELP FOR CHILDREN & INCOME GENERATION
PROGRAMMES.
 CD4 TESTING
• 9 ART CENTRES
• CD4 TEST FACILITY AVAILABLE IN 4 CENTRES
• OTHER CENTERS : CLEAR LINKAGE TO NEAREST ART
CENTRE FOR CONDUCTING REGULAR UNITERRUPTED CD4
COUNTS
• DONE FREE TO A MAX OF 2 TESTS/YEAR UNLESS
DESIRED SO BY THE PHYSICIAN. ON PATIENT’S DEMAND
ADDITIONAL TEST AT Rs 250/-
• REAGENTS /KITS PROVIDED BY NACO
 ANTIRETROVIRAL IMPLEMENTATION STATUS OF STATE TILL JUNE 2008
S.No. ARTC REGISTERED STARTED ART NOT ON ART B/O ON ART

ADULT CHILD TOTAL ADUL CHIL TOTA ADUL CHIL TOTA ADUL CHIL TOTA
T D L T D L T D L
1 RML 4357 465 4822 2164 235 2399 869 91 960 1295 144 1439

2 LNH 2493 142 2635 1226 50 1276 401 11 412 825 39 864

3 AIIMS 3481 238 3719 1357 141 1498 595 59 654 762 82 844

4 LRS 471 19 490 248 11 259 81 2 83 167 9 176

5 DDU 1132 60 1192 447 13 460 94 4 98 353 9 362

6 GTBH 1283 73 1356 481 16 497 145 2 147 336 14 350
7 SJH 863 34 897 314 4 318 91 0 91 227 4 231

8 KSCH 112 112 50 50 10 10 40 40

9 BSAH 716 31 747 255 1 256 58 1 59 197 0 197

TOTAL 14796 1174 15970 6492 521 7013 2334 180 2514 4162 341 4503

No of Patient On OI treatment

894
Medicines for Opportunistic Infections
(OIs)

DSCAS is providing funds to the hospitals treating

HIV/AIDS Cases for procurement of drugs for the
treatment of Opportunistic infections.

 NACO is procuring drugs for OIs

COMMUNITY CARE CENTRES FOR
COMMUNITY BASED CARE
S. No. Name of the Address District
Centre

1. AKANKSHYA East
CARE AND B - 17/4, Nagar,
SUPPORT Shahadara,
HOME
2 BHARTIYA H.NO 3 ,DAROGA NORTH
PARIVARDHAN MARKETS WALI
SANSTHA GALI,BURARI CHOWK,
3 MULTIPURPOSE NORTH
CHILD COMMUNITY WEST
SURVIVAL CENTRE,VILLAGE KHERA
KHURD,
4 ASHRAYA South
Multi Purpose Community West
HOLISTIC CARE
Centre, Village Rajokari
CENTRE
 Community Care Centers
Delhi has presently 4 CCCs to provide
• Treatment for minor Opportunistic Infections & psychosocial support through
sustained counseling.
• To function as a bridge between hospital & home care.
• The introduction of ART has brought about a change in the role played by CCCs.
The
CCCs are being transformed from a standalone short stay home to playing a
critical role in enabling PLHAs to access ART by providing Holistic care to
PLHAs through:
• Monitoring, follow-up, counseling support to those who are initiated on ART,
• Positive prevention, drug adherence, nutritional counseling,
• Out -patient & inpatient treatment. All patients started on ART are required to be
admitted in a CCC for a minimum of 5 days inpatient care.
b. Make referral to PPTCTC for care of HIV positive pregnant women, pediatric HIV
services, ART centers for CD4 or other tests and DOTS for treatment of TB.
Care at Community Care
Centre
 DROP IN CENTRE
 
Jagriti HIV/AIDS organization (support
group)
WZC – 28, Om Vihar, Uttam Nagar, New Delhi
-110059
 DROP-IN CENTERS
•DSACS is supporting currently one DIC with following
objectives:
2.To promote positive living and build capacity & skills among
People Living with HIV/AIDS cope with infections.
3.To create an enabling environment for PLHAs
4.To establish linkages with existing health services, NGOs &
CBOs and
5.To protect & promote the rights of the infected individuals
• In 2008-09 DSACS is establishing 4 more DICs in consultation
with positive networks.
 COMMUNITY CARE & DROP-IN CENTERS IN
DELHI
CSI BPS
CCC CCC
CHELSEA
CCC

JAGRI
TI DIC

ACTION
INDIA
CCC
 JANUARY 2008 - JUNE 2008 CCC DATA
(i) Details Attendance and Registration
Values in Numbers
Parameters Children Children
Male Female TS/RG Total
Male Female
On ART 219 85 1 10 1 316
New PLWA Registered &
Attended (Out patient) Not On
295 226 4 33 25 583
ART
On ART 472 460 1 82 57 1072
Old Registered PLHA
attended(Out patient) Not On
598 587 12 127 50 1374
ART
On ART 147 43 1 7 1 199
New PLHA admitted (In-
patient) Not On
110 60 4 4 1 179
ART
On ART 150 42 1 7 2 202
Old Registered PLHA
admitted(In-patient) Not On
83 60 1 11 6 161
ART
On ART 18 3 0 2 0 23
No. of deaths among PLHA
(other than in-patient) Not On
8 9 0 0 0 17
ART
On ART 4 0 0 0 0 4
No. of deaths among admitted
PLHA (In Patient) Not On
2 2 1 0 0 5
ART
 Details of Opportunistic Infections Treated January 08- June
08 at CCCs
Type of OI Male Female Total Type of OI Male Female total
1. Tuberculosis 318
233 85 7. Cryptococcal Meningitis 5 1 6
(9%)
2. Candidiasis 405
226 179 0 0 0
(11.5%) 8. Toxoplasmosis
3. Chronic 1023 21
545 478 17 4
Diarrhea (29%) 9. CMV Retinitis (0.6%)
11
3 4 7 (0.2%) 10. MAC 7 4
4. PCP (0.3%)
28
5. Herpes Zoster 18 10 11. Other 234 115 349
(0.79%)
6. Bacterial
1202
Infections 620 582 12. Other 99 62 161
(34%)
(Respiratory)

Total : 3531 OIs

 DROP IN CENTRES DATA JANUARY 08 TO JUNE 08
MALE FEMALE CHILDREN TOTAL
CUMULATIVE NO OF PLHA REGISTERSINCE 199 179 47 425
INCEPTION
1
NO OF SUPPORT GROUP MEETING CONDUCTED FOR 6
PLHA
2
CUMMULATIVE NO OF PLHA PARTICIPATE IN EACH
SUPPORT GROUP MEETING
3 0 0 0 0
NO OF PLHA COUNSELLED 54 80 0 134
4
NO OF PLHA FAMILY MEMBER COUNSELLED 21 41 0 62
5
NO OF SPOUSE /FAMILY MEMBER REFERRED TO 15 16 0 31
VCTC
6
NO OF PLHA MEMBER REFERRED FROM NGO'S 0 8 0 8
7
NO OF PLHA REFFED FROM VCTC 2 2 0 4
8
NO OF PLHA REFFED TO CCC 30 34 5 69

NO OF PLHA REFERRED TO ART 14 10 1 25

9
NO OF PHA REFERRED TO CD 4 COUNT 22 38 5 65
10
ROLE OF POSTIVE NET
WORKS
 DNP+: TRACKING HIV +VE CLIENTS,
PREGNANT FEMALES, ENSURING AVAILABILITY
OF HIV TEST KITS, NVP & OTHER LOGISTICS
AT ICTCs & ARV DRUGS AT ART CENTRES.
 DWPN+ : TRYING FOR
1. WIDOW PENSION, WIDOW REMARRIAGE &
2. SUBMITTED PROPSAL FOR OPENIENG D.I.C
 LOVE LIFE SOCIETY: SUBMITTED PROPSAL
FOR OPENIENG D.I.C
 JAGRITI SOCIETY : RUNNING D.I.C
Other Activities Under
Holistic Care
 MISSIONARIES OF CHARITY (MOTHER
TERESSA), MAJNU KA TILA-NIRMAL HRIDAY-
PROVIDING CARE & SUPPORT SERVICES TO
ABANDONED PLHAs AND IS LINKED TO ART
CENTRE L.N.HOSPITAL.
 WEAKNESSES IN ART SERVICES OF
DELHI
 LOST TO FOLLOW -UP PROBLEM
 POOR REPORTING OF OIs & NON AVAILABILITY OF MANY OI
DRUGS
 CD 4 TESTING FACILITY NOT AVAILABLE IN ALL ART CENTRES
(LINKED SERVICE ) THERE IS A DELAY IN DELIVERY OF
REPORTS TO CLIENTS.
 NO FINANCIAL ASSISTANCE BEING PROVIDED TO PLHAs FOR
CHILD EDUCATION & IMPROVING NUTRITIONAL STATUS
 POOR LINKAGE WITH CCCs: THE NEW GUIDELINE OF 5 DAYS
ADMISSION NOT YET IMPLEMENTED
 LOW INSTITUTIONAL DELIVERY RATE OF HIV +VE ANC CASES.
SO DATA ON ARV PROPHYLAXIS FOR NON INSTITUTIONAL HIV +
VE DELIVERIES NOT AVAILABLE.
 STEPS TO IMPROVE ART SERVICES
IN DELHI
INFRASTRUCTURE & MANPOWER
ASSESSMENT FOR IMPROVEMENT : FOR
ADEQUATE SPACE, WAITING AREA, BASIC
AMINITIES (TOILET , DRINKING WATER FACILITY),
AUDIOVISUAL IEC, DRUG STORAGE ,
RML, LNH: RELOCATION TO BLOCKS IN PROCESS
STAFF :TO ENSURE ALL POSITIONS FILLED AS
PER NACO GUIDELINES
OUT REACH WORKER DEPLOYED IN ICTCs OF
ALL A.R.T. CENTERS TO TRACK LFUs/ANC HIV +VE
CASES
SUPERVISORY VISITS BY DSACS & NACO
TIMELY RELEASE OF ANNUAL RECURRING
 STEPS TO IMPROVE ART SERVICES IN
DELHI (contd.)
DECONGESTION OF ART CENTRES
A THIRD OF PLHAs AVAILING ART SERVICES
IN DELHI ARE MIGRANTS FROM NEIGHBOURING
STATES OF HARYANA,
RAJASTHAN,PUNJAB,UP,BIHAR & UTTRAKHAND
ROLLING OUT LINK ART CENTRES IN EXISTING
ICTCs IN NCR BORDERING AREAS
TRANSFER OUT TO OTHER STATES: IF THE
PLHA SHIFTS TO HIS NATIVE STATE FOR
EMPLOYMENT
 MEETING OF CCCs WITH ART CENTRE IN-
CHARGES
STEPS TO IMPROVE ART SERVICES IN
DELHI (contd.)
FINANCIAL IMPROVEMENT OF PLHAs
PREFERENCE IN JOBS UNDER NACP WITH
RELAXATION OF QUALIFICATION FOR THE
POSTS OF
 COUNSLELOR,
 ICTC OUT REACH WORKERS,
 COMMUNITY CARE COORDINATOR AT ART
CENTRES
 STEPS TO IMPROVE ART SERVICES IN
DELHI (contd.)
Steps to Scale up ICTC Coverage in 2008-09 by
Gap Analysis
 Estimated Sexually Active Population in the State (40%)- 66
Lakhs
 Estimated Risky Behavior Population (6%) in the state- 3.96
Lakhs
 Number counseled & testesd in 2007- 1.26 Lakhs
 Gap for Risky Behavior population- 2.70 Lakhs
 Estimated Total Antenatal Cases annually in the state- 3.0
Lakhs
 Gap of ANC cases- Total estimated ANC – Testing done in
2007-08 = 3.0 – 0.66 Lakhs= 2.34 Lakhs
 STEPS TO IMPROVE ART
SERVICES IN DELHI (contd.)
Steps to Scale up ICTC Coverage in
2008-09 by Gap Analysis
2008-09 Target of counseling & HIV testing of
risky behavior population- 2.5 Lakhs
 2008-09 Target of counseling & HIV testing of
ANC population- 2.5 Lakhs
 26 New ICTCs -2008-09 (in M & CW centers,
maternity homes, dispensaries, hospitals,
chest clinics, etc ), Two ICTCs in 24 hours
PHCs & 10 under Public Pvt partnership with
Pvt Clinics/Hospitals/Diagnostic Centers.
 EXISTING LOAD FOR CARE, SUPPORT &
SERVICES
INDIAN Vs DELHI SCENARIO

INDIAN SCENARIO DELHI SCENARIO

ESTIMATES: 2.5 MILLION PLHAs 32,000 PLHAs
(2007 Provisional Data)
PREVELANCE: 0.36% 0.22%
FIRST CASE– 1986 1988

HIV +ve regtd. at ART-4,65,500

15,970
AIDS CASES ON ART- 1,55,000 4503
09
NO. OF ART CENTRES: 174
04
NO. OF CCCs : 157
 NEW HIV POSITIVES EXPECTED TO BE IDENTIFIED IN 2008-09
GROUP NUMBER TO BE % HIV +VE EXPECETED NUMBER NEW
COUNSELED & TREND IN HIV POSITIVE= TOTAL
TESTED IN 2008-09 2007-08 EXPECETD HIV +VE MINUS
PREVIOUS YRS EXPECETD
HIV +VE
SEX WORKERS 47,500 2.04% 950 -724=206
MSMs 18,000 11.73% 2111 -1467=644
IDUs 12,000 10.2% 1224 -740=504
STI PATIENTS 45,548 4.38% 1995 -1144=849

RISKY BEHAVIOR 2,50,000 4.9% 12250- 6125=6125

POPULATION

ANC POPULATION 2,50,000 0.22% 550- 143=407

TOTAL 6,23,048 8735 ( 3843 i.e. 44% MAY
NEED ART)
 HIV POSITIVITY RATES & TARGETS FOR 2008-09 FOR
DELHI
GROUP COVERAGE IN 2007-08 ( TARGET FOR 2008-09
% HIV POSITIVE)
SEX WORKERS 35,526 (2.04%) 47,500

MSMs 12,512 (11.73%) 18,000

IDUs 7258 (10.2%) 12,000

STI PATIENTS 26135 (4.38%) 45,548

RISKY BEHAVIOR 1,25,944 (4.9%) 2,50,000

POPULATION

ANC POPULATION 65,867 (0.22%) 2,50,000

PLHAs ON ART 4503 (TILL JUNE 08) 9500
 Prevention of Parent To Child Transmission
Targets of HIV Exposed Babies 2008-09

PROGRAMME BEING IMPLEMENTED IN 16

MAJOR GOVT HOSPITALS OF DELHI
 ESTIMATED 3.0 LAKH DELIVERIES PER YEAR
 HIV POSITIVITY IN ANTENATAL MOTHERS
SENTINEL SURVEILLANCE( 2007) - 0.22%
RATE OF VERTICAL TRANSMISSION – 30%
ESTIMATES : 198 HIV EXPOSED NEWBORNS
BORN PER YEAR IN DELHI
 Proposed Service Outlets in 2008-09
under Care, Support, Treatment
Service outlets Existing Proposed (08-09) Total

ART Centers 9 0 09

Community Care Centers 4 6 10

Link ART Centre (Subject to 0 18 18

approval from NACO)

Drop In Centre 1 4 05

Centre for Excellence for 0 1 01

ART

TOTAL 14 29 43
 SOCIO-ECONOMIC PROFILING OF
PLHAs
A STUDY WAS UNDERATKEN IN COLLABORATION WITH ILO AT TWO ART
CENTRTERS (RML & LNH)
SALIENT FEATURES:
SAMPLE SIZE: 1171 PLHAs (816 MALES, 333 FEMALES & 22 TS/TG
LNH: 584 PLHAs, RML:587 PLHAs
90.9% PLHAs BELONG TO 16-45 YRS AGE GROUP
SEX COMPOSITION: MALES 70%, FEMALES-28%, TS/TG-2%
MARITAL STATUS: MARRIED-72%, WIDOW-12%, SINGLE-16%
STATUS OF RESIDENCE: 62% FROM DELHI, 38% ARE MIGRANTS
(UP,HARYANA)
EDUCATIONAL STATUS: MAJORITY (61%)- LOW EDUCATION STATUS:
25%-ILLITERATE, 36% PRIMARY SCHOOL. ONLY 29%-SEC SCHOOL &
10% COLLLEGE GRADIATE
EMPLOYMENT STATUS: > 51% -UNEMPLOYED (90% WOMEN, 50%
TS/TG & 35% MEN); 12% DAILY WAGE, 37% REGULAR EMPLOYMENT
OCCUPATIONAL BREAKUP: SELF EMPLOYED/BUISENSS-34%, PVT
SECTOR-35%, GOVT -8%, LABOUR-14%, FARMER-5%, HAWKERS-4%
MONTHLY HOUSLEHOLD INCOME: 46.9% < RS. 2000/PM; 79.2% < RS.
4000/PM; 18.2% BETWEEN 4000-10,000/PM; 2.6% . > RS. 10,000/PM
RECOMMENDATIONS FROM THE
STUDY
 INCOME GENERATION PROGRAMME
FOR WIDOW WOMEN: PREFERENCE IN
JOBS,
 A WELL STRUCTURED PROGRAMME
FOR NUTRITIONAL SUPPORT TO
PLHAs
 MAINSTREAM HIV/AIDS
INTERVENTION IN UNORGANISED &
PVT SECTOR ON TOP PRIORITY&
STRUCTURE OF WORK PLACE POLICY IN
EACH SECTOR
THANK YOU