SCHEME FOR

PEDIATRIC CENTRES OF EXCELLENCE IN HIV care

National AIDS Control Organisation Ministry of Health & Family Welfare Government of India November !""

1.

BACKGROUND

India has the third highest estimated number of individuals infected by HIV/AIDS in the world after Nigeria and South Africa - an estimated 2 ! million "#$HA %National AIDS &ontrol 'rgani(ation and )NAIDS* 2+,+- &urrently there are an estimated ,,.*+++ children under the age of ,. years who are HIV infected %)NAIDS* 2++/- 0he National AIDS &ontrol 'rgani(ation launched National "aediatric Initiative in November 2++1 to ra2idly scale u2 access to care* su22ort* and treatment for 2aediatric 2atients across the country 22*6.6 are on treatment across the country %NA&' &7IS 5e2ort* December 2+,+In addition* the "revention of "arent to &hild 0ransmission %""0&0- 2rogramme has e32anded to over .+++ integrated counseling and testing centres offering ""0&0 services However* ""0&0 u2ta8e is still limited amongst HIV 2ositive women and there are an additional estimated 2+*+++ infants infected yearly through 7other to &hild 0ransmission %70&0- %NA&'* 2++/- NA&'9s recent launch of :arly Infant Diagnosis for children and infants u2 to ,6 months of age using DNA "&5 testing and ra2id scale u2 of the same is a huge ste2 in addressing the disease* as these efforts will result in the identification of many more HIV 2ositive children and an associated rise in the number of children re;uiring A50 0he limited number of children currently enrolled into care* as well as the antici2ated influ3 of newly identified 2ositive infants into the health care system means there is an urgent need to both evaluate current 2ractices in 2aediatric HIV care and treatment and 2lan for the scaling u2 of services to reach all HIV 2ositive children Additionally* as HIV 2ositive children survive longer* treatment strategies im2rove and second line drugs become available* there is an increasing level of com2le3ity in clinical management* necessitating ongoing training of clinicians entrusted with the care of these 2atients $ith the e3ce2tion of a few e3clusively "aediatric &entres* the ma<ority of A50 centres are not staffed by 2aediatricians and often rely on a general 2aediatric de2artment to 2rovide 2aediatric e32ertise when needed 0his referral system is de2endent on the recognition that such e32ertise is re;uired Due to the relatively low burden of 2aediatric HIV in India* many general 2aediatricians have not develo2ed com2etency in dealing with HIV s2ecific com2lications 2 &urrently* a22ro3imately 4/*4,/ of HIV infected children have been registered at an A50 &entre and

including recognition of HIV sym2toms and the need for early testing and enrolment Hence* it is a felt need to have Paediatric Centres of Excellence (PCoE) in !" care# that are model treatment and referral centres and at the same time im2art ;uality training to other 2eo2le involved in caring for 2aediatric HIV 2atients 0hese centres should be the 2rimary sites for underta8ing research* including o2erational research on a large scale "&o:s are e32ected to conduct high ;uality research relating to different as2ects of "aediatric HIV care and treatment =or this they need to actively see8 collaborations with other de2artments and institutions

$.

BR!E% PROGRA&&E DE'CR!P(!ON

0o ensure 2rovision of high ;uality "aediatric HIV care and ca2acity building activities in "aediatric HIV across the country* it is 2ro2osed that ) re2uted centres that are currently nominated as Re*ional Paediatric Centres (RPCs) would be develo2ed and strengthened as Paediatric Centres of Excellence (PCoE). 0hese centres will focus on building their own ca2acity in 2roviding high ;uality care in "aediatric HIV and subse;uently su22ort the necessary ca2acity building related to "aediatric HIV for the staff being recruited for the A50 scale u2 >y e;ui22ing these centres for training and research* it is e32ected that the faculty from these "&o:s will carry out 2eriodic site visits to the different A50 centres to assess ;uality of care? monitor ;uality of care through a commonly agreed u2on set of ;uality of care indicators for 2aediatric HIV? encourage o2erational research on 2aediatric HIV and related issues? su22ort 2ublication of research 2a2ers in re2uted <ournals and 2resent 2a2ers at research conferences and disseminate research findings to the different teaching medical institutions etc It is believed that by 2roviding incentives such as a 2ositive wor8 environment* in addition to the ca2acity and sco2e for research etc * the 2rogrammes can attract some of the most talented to wor8 in the 2rogramme In establishing such "aediatric &entres of :3cellence the stigma and discrimination that e3ists among the medical faculty in both the 2ublic and 2rivate sectors towards "#HA is e32ected to be bro8en down* as these centres will increase recognition that 2aediatric HIV 2atients re;uire s2eciali(ed care* su22ort and follow u2

0he goal of these institutions is to ma8e all services essential to the 2ac8age of com2rehensive care of &hildren living with HIV/AIDS %&#HA- available under one roof* without the 2atient having to rely on referrals or travel from one centre to another +. RA(!ONA,E %OR PAED!A(R!C CEN(RE' O% E-CE,,ENCE (PCOE')

0he Re*ional Paediatric Centres (RPCs) were established with the vision of 2roviding ;uality HIV care and treatment at tertiary level to su22ort the A50 centres in the region as 2art of National "aediatric Initiative in 2++1 As 2art of NA&" III midterm review* 5"&s were evaluated 0he 8ey findings and recommendations included@ 7ost A50 &entres were not staffed by 2aediatricians or s2ecialists in 2aediatric HIV? thus* a shift to an integrated 2atient management a22roach with the referral 2aediatric de2artments within each hos2ital is re;uired &onstant training and u2grading of 8nowledge and s8ills among 2roviders is re;uired to address the need for s8illed healthcare 2roviders on ;uality 2aediatric HIV care* including 8nowledge of issues surrounding long term treatment adherence and HIV drug resistance "aediatric &entres should 2rovide vision* leadershi2 and strategic direction on "aediatric HIV care A treatment for National 2rogramme

In 2++1* ) Re*ional Paediatric Centres (RPCs) were selected by NA&' with the e32ectation that they would directly 2rovide ;uality care to HIV 2ositive children and also wor8 towards building ca2acity in their res2ective regions 0hese ) RPCs were selected in states with either high numbers of HIV 2ositive children enrolled into care and/or 2aediatric e32ertise in the field of HIV medicine It is these ) RPCs which are being u2graded to be Paediatric Centres of Excellence (PCoEs) as a 2art of this 2ro2osed scheme@
'l. No , 'tates lin0ed for Ca1acit2 B3ildin* and &entorin* Carnata8a Cerala 0amil Nadu "ondicherry Andaman A Nicobar 7aharashtra Bu<arat* Boa Daman A Diu 7adhya "radesh Dadra Nagar A Haveli

Na.e of t/e PCoE Indira Bandhi Institute of &hild Health %IBI&H-* >angalore* Carnata8a Institute of &hild Health %I&H-* &hennai* 0amil Nadu #o8manya 0ila8 7unici2al Beneral Hos2ital %Sion-* 7umbai* 7aharashtra , 2 ! D . 1 4 6 / ,+ ,,

'l. No D

Na.e of t/e PCoE &alcutta 7edical &ollege %&7&-* Col8ata* $est >engal ,2 ,! ,D ,. ,1 ,4 ,6 ,/ 2+ 2, 22 2! 2D 2. 21 24 26 2/ !+ !, !2 !!

. 1

Niloufer &hildren9s Hos2ital* Hyderabad* Andhra "radesh Calawati Saran &hildren9s Hos2ital #ady Hardinge 7edical &ollege* Delhi

'tates lin0ed for Ca1acit2 B3ildin* and &entorin* $est >engal 'rissa Assam >ihar &hhattisgarh Ehar8hand Si88im Andhra "radesh Delhi )ttar "radesh "un<ab Himachal "radesh Haryana &handigarh 5a<asthan Eammu A Cashmir )ttara8hand 7ani2ur 7i(oram Arunachal "radesh Nagaland 0ri2ura

Eawaharlal Nehru Hos2ital %EN-* Im2hal* 7ani2ur

Note: These linkages are dynamic and subject to change as more PCoEs are identified (after approval of NAC ! In addition to these 4 5"&s chosen to become "aediatric &o:s* it is recognised that there are additional 5egional "aediatric &entres with 2aediatricians highly trained in 2aediatric HIV care and with large numbers &#HA enrolled in care and treatment However* a definitive decision on recognition as a "aediatric &entre of :3cellence will de2end on an assessment* which will loo8 at the centre in it9s entirety to determine ;ualification =or e3am2le* such an assessment would consider the staff9s commitment to and 8nowledge of 2aediatric HIV care and treatment* the e3isting infrastructure in 2lace* and the ;uality of care 2rovided to 2atients* in addition to other as2ects Should additional institutions meet the re;uirements set out during the evaluation and assessment 2eriod* they may be considered for recognition as a "aediatric &entre of :3cellence "eriodic assessment for all e3isting "&o:s would be conducted by an inde2endent 2anel using standardised indicators to determine if they are continuing to u2hold their e32ected roles* and meet the minimum standards as "&o:s 0he ongoing status and su22ort would therefore be sub<ect to the 2erformance of "&o:s .

4.

CR!(ER!A %OR 'E,EC(!NG PAED!A(R!C CEN(RE O% E-CE,,ENCE

0he e32ectations for a "aediatric &o: are as follows@ 0he ability to demonstrate ;uality care in the following areas %see A22endi3 A for further details in each area-@ o Beneral "aediatric &are o HIV Awareness/Sensitivity/Stigma 5eduction o HIV Diagnosis in &hildren %including clinical stagingo HIV :32osed Infant &are o "aediatric &ounselling o "aediatric A50 7anagement o "aediatric 2nd line o 7anagement of "aediatric 'I9s/0> o 7onitoring and :valuation/"aediatric &ohort Analysis o HIV and Nutrition 0he ca2acity for "aediatric &are* which includes s2ecialty faculty* strong lin8ages across de2artments and a lac8 of stigma in wards/de2artments with regards to treating &#HA 0he s2ace needed to create a child friendly* dedicated A50 &entre? as well as the ability to 2rovide 2rimary A50 care to 2arents of &#HAs 0he 2otential to be a referral centre for tertiar2 care in 2aediatric HIV care su22ort and treatment in the region A strong academic inclination/trac8 record of carrying out analysis and 2ublications? in addition to a strong research tradition - basic and o2erational 0he laboratory facilities necessary for routine investigations and the diagnosis of o22ortunistic infections Dedicated and e32erienced faculty with a commitment to 2roviding high ;uality services to children affected* infected* or e32osed by/to HIV and willingness to continually im2rove care through a 2rocess of ;uality monitoring and o2erational research A commitment to 2roviding the essential 2ac8age of com2rehensive services 0he ca2acity and commitment needed to develo2 effective lin8ages with the other institutions e g for the training of medical and 2ara-medical staff in the region 0he willingness to be re2ositories of information related to care and su22ort for 2aediatric HIV 0he commitment to scaling u2 ca2acity in "ediatric HIV by actively engaging in training and mentoring activities within their regions

5.

RE'OURCE' A( ( 5.1 Human 5esources6

PAED!A(R!C CEN(RE' O% E-CE,,ENCE

Faculty members/ residents of the institution and the ART center staff will support the functioning of the CoE. Additional staff for the functioning of the CoE will be provided by NAC . Steering Committee A !teering Committee shall be constituted at C E headed by the head of the institution and consisting of "rogramme #irector$ #eputy #irector$ A"#/%# &C!T' of concerned !AC! and a NAC representative &RC to represent NAC in case NAC official cannot participate'. This committee shall meet once in ( months for review of functioning of "C E / to sort out any issues related to its functioning. ne "rogramme #irector and one #eputy #irector of the C E will be identified from the faculty at the institution. )n the e*isting "CoEs$ the Nodal fficer will be re+ designated as "rogram #irector$ CoE. The "rogram #eputy #irector will be selected by the "rogramme #irector in consultation with the ,ead of the )nstitution and NAC . )n newly designated CoEs$ preference for the position of "rogramme #irector will be given to faculty associated with the ,)- program and in consultation with the ,ead of the )nstitution and NAC .

Programme Director PCoE %e3isting Nodal 'fficer redesignated* who is already a faculty of the Institution- to oversee activities of the "&o: 0his a22ointment will be the res2onsibility of the Head of the Institution "rogramme Director "&o:9s duties are to@ o o o o "rovide strategic direction to the 2lans and activities of the &o:? Set u2 the &o: as 2er NA&' guidelines/ NA&' a22roved "&o: scheme? Devise wor8-2lans and timelines for moving activities forward? :nsure timely im2lementation of all activities related to &o: and A50 centre including@ &om2rehensive HIV care? 0raining* mentoring* and research? 'ther ca2acity building activities 4

7a8e fre;uent visits to the lin8ed A50 centres and 2rovide feedbac8 to the "&o: members based on the observations during the visits so that the action 2lan may be modified as re;uired? :nsure concrete results for the successful im2lementation of the "&o: activities? :nsure contacts with A50 centre 2ersonnel to elicit their coo2eration and convergence with the "&o: activities? 7anage all administrative issues related to "&o: and A50 centre? >e the focal 2erson for all communication and corres2ondence related to functioning and activities of &o:? 'versee monthly re2orts on "&o: activities* training and other critical issues* etc? 7aintain financial control and monitors "&o: budgets on a 2eriodic basis to ma8e sure that budgets are s2ent according to a22roved allocation

o o o o o o

#rogram De$%ty Dire&tor Co'( S/he will@ >e in charge of training and mentoring >e a member of the SA&:" De2uti(e the "rogramme Director in his/her absence

A50 Staff as 2er NA&' A50 '2erational Buidelines % SMO/MO Nurse, Counsellor, Data Entry O erator, P!armacist, "a# tec!nician, Care Coordinator - Number of A50 Staff de2ends on load of the centre Nutritionist 2ost under 5egional "aediatric &entre will continue

Additional Staff under "&o: Scheme@ Contractual appointments for the C E will be carried out by the !teering Committee. The procedure for the selection of contractual staff for ART centres should be followed for " CoE staff selection.

One M$E and %esearc! Officer& 0o analyse data* coordinate research activities* 2rovide necessary technical assistance to 7entoring team on the 2erformance of the A50 &entres and ;uality of "aediatric care in the region 0his 2osition will@ 6

Design and u2date the monitoring system* which includes drafting instructions for com2leting forms/formats and 2re2aring com2uterised re2orting formats? &ontribute to 2lanning and 2re2aring research 2rotocols? >e involved in all other research activities of the "&o:? =acilitate and monitor 2rogress of the "&o: research 2ro<ects? "artici2ate in training* mentoring and other ca2acity building activities of the "&o:? "erform analysis of monthly re2orts and other data* as re;uired of the A50 centres? &om2ile &o: re2orts for NA&'? Assist in conducting surveys* formative research* needs assessment and analysis of data generated within the "&o:? 7a8e monitoring visits to A50 centres as directed by the Director "&o:? >e involved in ;uality assurance of research 2ro<ects? &arry out data ;uality chec8s? Assist in 2erformance analysis and assist in 2resentation of findings to the other members of the "&o: team? >e involved in managing the "&o: networ8 website? Assist in data com2ilation* analysis and 2re2aration of 2resentations and 2ublications under the su2ervision of the Director "&o:? Su22ort the im2act evaluation of the 2ro<ects underta8en by the "&o:?

o o o o o o o

o o o o

o o

Su22ort the analysis of all ;uantitative and ;ualitative data from 2ro<ects underta8en at the "&o:? "erform any other <ob related to "&o: activities* as assigned by Director "&o:

One PCoE Programme Coordinator& &oordination of training* financial account 8ee2ing* and relationshi2 management 0his 2osition will@ o o o o o o o o o &oordinate all training activities* 2re-training 2re2arations and logistics for trainings of "&o:? &oordinate mentoring and 2ost-mentoring activities and logistics for mentoring? Assist the Director "&o: in managing and maintaining the relationshi2s and communications within the "&o: team* as well as the A50 centre 2ersonnel? Assist the Director "&o: in managing corres2ondence related to the functioning and activities of &o:? Assist in maintaining documentation and communication materials with res2ect to the "&o: activities? Assist the Director "&o: in timely im2lementation of training* mentoring* research and other ca2acity building activities? Assist in trac8ing budgets and s2end on "&o: activities? 7a8e site visits to A50 centres as directed by the Director "&o:? "erform any other <ob related to "&o: activities as assigned by Director "&o:

In addition* it is e32ected from the "&o: that there would be@ Involvement and contribution of faculty from "aediatric sub-s2eciality de2artments within the institution on "aediatric HIV &are? Identified "aediatric e32erts as mentors for their region %regional lin8ages to be s2ecified by NA&'-? Involvement of "ostgraduate fellows 0he 2ost graduate students should be regularly 2osted to assist the functioning of the A50 centre 0hesis relating to "aediatric HIV care by 2ost graduate students should also be encouraged at these centres Staff of the institution should be trained and/or sensitised in 2aediatric HIV service delivery as well as to reduce stigma and discrimination ,+

. 2 Infrastructure at "&o:6 0hese "&o:s should have ade;uate accommodations for an A50 centre* as 2rescribed by NA&' guidelines* which outline the need for ade;uate s2ace* 2rivacy* a waiting area* counselling rooms* a 2harmacy* AV aids* dedicated drin8ing water and well maintained toilet facilities etc 0he facility should 2rovide a child-friendly s2ace* including toys and a 2lay area In addition* as the institution is a teaching facility* the centre should 2rovide auditorium/lecture facilities %including AV :;ui2ment-* a conference area/meeting room* I0 e;ui2ment for data analysis and teleconferencing* an #&D 2ro<ector and la2to2 com2uter for outreach activities and a library with internet facilities and access to 8ey 2aediatric <ournals/te3tboo8s =inally* the centre should have ade;uate s2ace/facilities with signs in :nglish and the local language for the following services listed below@ 5.$.1 'acilities at Paediatric 'riendly (%) Centre at PCoE&
Essential 2 e3amination rooms 2 counselling rooms , sam2le collection room , 2harmacy cum store , Se2arate room for data entry and documentation , nursing station , "lay area A 2lay rac8 with toys for children 2 wash rooms %one male* one female, $aiting area for 2+ 2atients , "atient education area for AV/I:&/ info dis2lay Hygienic s2ace-water dis2ensing %away from wash room *ood to !a+e #ut not essential "antry %can be used for demonstrating low cost high nutrition food 2re2aration to mothersSome e3tra seating s2ace near the 2harmacy* registration* 7's rooms etc 7ore storage s2ace for documents / registers / I:& / nutrition / drugs etc 5ooms connected by intercom facility

Ade;uate infrastructure %furniture A e;ui2ments- has been 2rovided to 4 Institutions under the 5"& scheme and attention must be 2aid to the maintenance and u28ee2 of these facilities 0hus* s2ecial attention should be 2aid to ensure a22ro2riate flooring* 2ainting* lighting* and ventilation is maintained* as u28ee2 of the facility enhances the safety* functionality and aesthetic a22eal of the centre 5.$.$ Essential 'acilities (ccessi#le to t!e PCoE ,it!in t!e -nstitution& 2 rooms for "&o: staff ,,

 5.$.+

, room for documentation , 7ini / 7a3i Auditorium with re;uired AV facilities AV conference room with internet facility for tele/video conference activities E.ui ments to #e O,ned #y PCoE&

0he "&o: will 2urchase and maintain the following e;ui2ments for e3clusive use for "aediatric HIV care and treatment 2rogramme o 2 Des8to2 &om2uters o 2 #a2to2s , "ortable #&D 2ro<ector with screen

It is e32ected that the "&o: has 2ortable AV e;ui2ment to fulfill its training mandate in the region as re;uired 0he centre should have ade;uate I0 e;ui2ment for data analysis* internet access* and teleconferencing abilities with the A50 &entres A library* with subscri2tions to 8ey "aediatric HIV related <ournals/te3tboo8s* should also be maintained

7.

'ER"!CE' A( (

PAED!A(R!C CEN(RE' O% E-CE,,ENCE

7.1 #in8ages to Diagnostic Services6 0he "&o: is e32ected to !a+e #asic la#oratory ser+ices, including microbiology* 2athology* haematology* bio chemistry* serology* radiology* F-ray* ultrasonogra2hy* &0 and 75I %wherever available- 0he microbiological lab services should include diagnostics for 0uberculosis* &ry2tococcal meningitis* &ry2tos2oridial and other 2arasitic diarrhoea* &NS mass lesions li8e to3o2lasmosis* and common fungal infections in immune-su22ressed hosts* etc 0he "&o: needs to ensure efficient access to &DD testing* DNA-"&5* and 5NA-"&5 through well established lin8ages with nearest 5eference #aboratories identified by NA&' 0he "&o: is also e32ected to treat any cases of '22otunistic Infections or side effects of A50 and diagnostic facilities for the same should also be available with the "&o: If the "&o: cannot treat these* then it should refer these cases for treatment Additional diagnostics* li8e viral load measurements* can be reviewed on a case by case basis? if indicated* contingency funds can be used with the a22roval of the "rogramme Director of the "&o:

,2

7.$ #in8ages and 5eferrals for S2ecialised &are@ 0here should be a22ro2riate adult and 2aediatric lin8ages and referral for care* including inpatient care" with all other s2ecialty de2artments #in8ages and referrals to 2aediatric subs2ecialty care should be em2hasised and includes lin8ages to child 2sychology* dentistry* intensive care* 2athology* 2aediatric surgery* 2ulmonology* cardiology* hematology and neurology Adult referral level care should be available in those centres where adult services are not available =ormal lin8ages should also be established to ""0&0 services* I&0& services* 5N0&" services* community-based su22ort services* social wor8 de2artment/organisations* nutritional rehabilitation services and "#HA networ8s 7.+ "harmacy at the "&o:6 0he centres will be 2rovided with an essential list of drugs to be maintained* as well as stoc8s of the same 0he "harmacy at the "&o: will stoc8 and dis2ense s2ecialised "aediatric and adult formulations of A50* both first line and second line treatment regimens* "aediatric and adult formulations of cotrimo3a(ole and 2aediatric formulations 'I drugs 'n a case by case basis* with the a22roval of the "rogramme Director* the "&o: can authorise use of contingency funds for the 2urchase of drugs which are not included in the NA&' a22roved list 7.4 Additional Services for &ontingency6 A small contingency fund of IN5 , la8h 2er annum will be set aside for contingencies related to s2ecialised investigations* 2harmaceuticals and other incidental e32enses* which will be considered on a case by case basis It is e32ected that the "rogramme Director of the "&o: will 8ee2 clear written notes of each case* which will detail the case and e32lain the decisions reached Additional local su22ort can be solicited by each "&o: should the need arise

,!

).

RO,E' AND RE'PON'!B!,!(!E' O% PCOE ).1 =amily &entric and &om2rehensive 7anagement of HIV %"re A50 and A50-6 :ach institution will have trained* com2etent faculty to diagnose and facilitate the management of &#HA who come to these centres* in addition to those who are referred from other A50 facilities in the region 0he centre will also facilitate lin8ages for referral and care of adult care givers Areas of e3cellence for "&o: and hos2ital staff would include@ Beneral "aediatric &are HIV Awareness/Sensitivity/Non Stigmatising behaviour HIV Diagnosis in &hildren %including clinical stagingHIV e32osed Infant &are "aediatric &ounselling "sychosocial Su22ort "aediatric A50 7anagement including 2nd line management 7anagement of "aediatric '22ortunistic Infections/0> treatment and lin8ages Nutrition management of SA7 and 7A7 #in8ages with social 2rotection and welfare schemes

As "aediatric centres of e3cellence* these centres should e32ect to receive &#HA who are very ill with com2lications or who are not res2onding to A5V medications for various reasons 0o ensure effective management of such 2roblems* these centres of e3cellence will need to admit and treat these 2atients in wards that are 2ro2erly e;ui22ed and staffed and where they are at minimum ris8 of ac;uiring additional diseases* es2ecially nosocomial infections ).$ &a2acity >uilding and 7entoring6 Due to trans2ort costs/distance* it is not feasible for every child within a region to travel to the "aediatric &': for routine care 0herefore* it is necessary that the "aediatric &entres 2lay an active role in building ca2acity amongst health care wor8ers so that every child ,D

has access to ;uality medical and 2sychosocial care 0hese ca2acity building activities will serve to increase 8nowledge and s8ill in "aediatric HIV care within their res2ective institutions* as well as other relevant medical and community-based institutions within their region ).$.1 Mentoring

7entoring can be defined as Ga sustained" collaborative relationship in #hich a highly e$perienced health care provider guides improvement in the %uality of care delivered by other providers and the health care systems in #hich they #ork H 7entoring will be both 2rogrammatic and clinical 0he "&o: should be able to 2lan* organise and carry out all mentoring activities* both 2rogrammatic and clinical A core grou2 of mentors will be identified and will be trained as mentors 7entoring will be for A50 centres lin8ed to the "&o: and* also* for the trainees from the same institute and other facilities >y maintaining this e32ertise and develo2ing a strong ca2acity building 2rogramme* the mentors will serve as resources for 2roviding technical su22ort and trainers for all as2ects of the NA&' and SA&S training networ8 0he "&o: should establish a Core Ca1acit2 B3ildin* (ea. (CCB() com2rised of a "aediatrician* 7icrobiologist* "athologist* 'bstetrician* &ommunity 7edicine s2ecialist* Nutritionist* counsellor* and 7A: e32ert under the leadershi2 of "rogramme Director "&o: 0he members for &&>0 will be selected based on his/her technical e32ertise in the res2ective field* training s8ills* related facilitation s8ills and availability 0he &&>0 must be trained and committed in the res2ective areas of e32ertise defined above and res2onsible for carrying out all training and mentoring related activities 0hese &&>0 members will underta8e field visits to A50 &entres* have regular case discussions %through 2hone or web based mediaand mentor the trainees 0he &&>0 will networ8 and contribute regularly to the construction* revision and u2dating of training curricula and =AIs for "aediatric HIV* with an aim to ,.

broaden the s8ill and 8nowledge base of the "&o: 2ersonnel 0his will be done under the su2ervision and a22roval of NA&' 0his will include Beneral "aediatric &are* HIV awareness/sensitivity/non-stigmatising behaviour* HIV diagnosis in children %including clinical staging-* HIV e32osed infant care* 2aediatric counselling* 2sychosocial su22ort* 2aediatric A50 management* including 2nd line management* management of 2aediatric '22ortunistic Infections/0> treatment and lin8ages* nutrition management of SA7 and 7A7* lin8ages with social 2rotection and welfare schemes* and management of A50 side effects 0he "&o: will thereby underta8e the following activities towards strengthening "aediatric HIV care and treatment services in the region* with funding and coordination su22ort from res2ective SA&S 7entoring of A50 &entres towards ;uality "aediatric care will include@ "roviding &7:s for "aediatricians and S7'/7's of the A50 centres in the region* to be conducted by the "rogramme Director of the "&o: and one other e32ert 2aediatrician identified by the "&o:? &onducting review meetings to monitor and im2rove the ;uality of "aediatric care J this will be convened by the res2ective 5egional &oordinator %A50* NA&'-* chaired by the "rogramme Director of the "&o:? 'rganising regional wor8sho2s/conferences J this will be conducted by the "&o: under the overall su2ervision of the "rogramme Director* and with funding and coordination su22ort from the SA&S? &ontinuous mentoring of selected A50 centres J the 5egional &oordinator and the "rogramme Director will wor8 closely in this 2rocess* with the 5& leading the coordination of the 2rocess from the A50 centres9 end* vi( scheduling of mentoring visits* coordination between the 5esource "erson and the I&0& and A50 centre scheduled for this will be drawn u2 under the overall leadershi2 of the 5egional &oordinator* 7aintaining the involvement of )B and "Bs fellows in "aediatric HIV care It is e32ected that each "aediatric &': will have a defined geogra2hic area* and the 2aediatric HIV care and treatment service delivery 2oints in that geogra2hic ,1

areas should be lin8ed to the res2ective "aediatric &': for trainings* technical assistance and mentoring "aediatric &':s should conduct ;uarterly regional meetings in coordination with their regional SA&S to discuss &S0 and ""0&0 issues %include SA&S* 2artners* other A50 &entres etc- and how to address them 0he "aediatric &': should communicate regularly with NA&' and share notes from these meetings ).+ &a2acity >uilding of &&>06 NA&' will design and im2lement the ca2acity building of &&>0* as re;uired with the su22ort of e32erts "&o:s will continuously im2rove u2on their s8ills and stay u2 to date on the latest information relating to "aediatric HIV %in the form of <ournal clubs* online &7: activities** $eb- based learning/distance learning %e g I-0:&H runs a 2rogramme for adult &':s-* etc - 0hey will also u2date the A50 &entres in their region regularly 'n rotational basis* and under the leadershi2 of NA&'* individual "&o:s will identify articles and electronically send them to all "&o:s in the form of a newsletter ).4 &a2acity >uilding of A50 &entres6 Identifying and filling of ga2s in s8ills for all cadres of staff 0his will be done by &&>0 through a 2rocess that includes training and mentoring sessions at each A50 &entre* which will wor8 towards develo2ing com2etencies in s2ecific areas related to ;uality 2aediatric HIV care 0he "&o:s will underta8e regular ;uality im2rovement e3ercises with SA&S and A50 &entres* which will include reviewing agreed u2on ;uality of care indicators %Anne3 ,-* identifying 2roblem areas* generating a 2lan to im2rove 2roblem areas* and following-u2 on interventions and their results "&o:s will conduct sensitisation trainings for hos2ital staff to decrease stigma "&o:s will also train on I7N&I-HIV/S"5I0 to increase referrals for testing 0he schedule for training and mentoring visits by "&o:s to A50 &entres will be defined by each "&o:s* SA&S and NA&' 0he &&>0 team will be res2onsible for this As information management and communication im2roves* each "&o: can use monthly ;uality scorecards to ,4

target centres that need more hel2 'ver a 2eriod of a year* "&o:s should continue monitoring ;uality at centres that have been visited to ensure that e32ertise is maintained ).5 2SA&:"6 p!ACE" will be constituted in the "CoEs based on the patient load $ after approval of NAC The p!ACE" will consists of K K K "rogramme #irector of "C E/ Nodal fficer of ART centre E*ternal ART e*pert &panel to be formed by NAC $ preferably not from the same ART centre' Regional Coordinator/%oint #irector &C!T' / Consultant &C!T' at !AC!

)he f%n&tions of $SAC'# *ill in&l%de . K Reviewing and deciding on paediatric cases referred by the referring ART centres for second+line ART provision / both for eligibility for viral load testing and initiation of second line ART Reviewing referred paediatric cases for alternative first line ART Reviewing cases every fi*ed wee0day &for e.g. Tuesday' or ne*t wor0ing day &in case the fi*ed day being a holiday'. This is to ensure that there is no delay in review /and processing of the case referred for review of suspected treatment failure. A ma*imum of 12+34 patients shall be reviewed at each meeting &old and new'. ,owever$ if there are very few patients$ the meeting may be deferred to the ne*t wee0. 5entoring and ensuring high 6uality case management of the "7,)- on second+ line ART by the referring ART centre #ocumenting the registration and monitoring progress of all patients sent for !ACE" review

K K

K K

8.

&ON!(OR!NG (

9UA,!(: O% PAED!A(R!C

!" CARE !N (

REG!ON

:ach institution should be able to demonstrate measurable ;uality im2rovement through the use of a set of ;uality of care indicators % Detailed in Anne3 ,-* which will be calculated on a regular basis and disseminated to 8ey sta8eholders* including SA&S* NA&' and other A50 centres ,6

Iuarterly analysis of a set of ;uality indicators will allow "&o:s to ob<ectively assess the care that is 2rovided >y instituting a 2rogramme for ;uality im2rovement* "&o:s should be able to maintain a high standard of care* while wor8ing towards continuous im2rovement In addition* "&o:s will serve as an e32ert resource for 2aediatric referral level care %i e treatment failure/second line* com2licated 'I management- for other centres within their res2ective regions SA&S will facilitate "&o:s to collect all &#HA data from A50 centres* including monthly &7IS re2orts 0he "&o:s will underta8e the res2onsibility of analysing core indicators for all A50 centres within their regions and share findings with res2ective A50 &entres* SA&S and NA&' networ8 of "&o:s can be created with defined communication lin8ages %web-based* hotline* elearning- to 2rovide ongoing su22ort across regions $ith in2uts from the e32ert 2aediatricians in the country* including members of the "aediatric 0echnical 5esource Brou2 %05B-* NA&' will design the 7A: to trac8 the s8ill and 8nowledge u2grade affected by this initiative "&':s will develo2 ;3alit2 indicators for 1aediatric care to review their own function as well as functioning of attached A50 centres A "rogramme Steering &ommittee will be formed for reviewing the 2rogress 2eriodically A "rogramme Steering &ommittee com2osed of 2ermanent re2resentatives from NA&'* SA&S* )NI&:=* &HAI* and $H' is 2ro2osed and would be set u2 under the guidance of NA&' 0his &ommittee would be res2onsible for monitoring and 2roviding overall management guidance for the im2lementation of the 2rogramme* as 2er NA&'9s a22roval Additionally* ,-2 rotating re2resentatives from each of the "&o:ss are also 2ro2osed to be included in the committee for holistic steering and to hel2 incor2orate each " &o:9s 2ers2ective for ca2acity building 0his committee of 1 to ,+ individuals will meet on a ;uarterly basis and will be res2onsible for guiding and monitoring the 2rogress of the ca2acity building 2rogramme and ensuring that lessons learned and best 2ractices are shared between the different "&o:s <. RE'EARC

As e32ert resources in the field of "ediatric HIV* the "&o:s should be res2onsible for conducting and coordinating o2erational research to guide care and treatment decisions on an institutional as well as national* scale NA&' will hel2 build the ca2acities of the "&o:s to conduct clinical trials* such as the evaluation of new drugs* drug regimens* 2harmaco8inetics* etc &ollaborative ,/

research with other "&o:s will be encouraged by NA&' wherever 2ossible :ach "&o: should develo2 detailed research im2lementation 2lans* which would include their 2ro2osal* local Institutional 5eview >oard %I5>- clearance* and a22rovals from NA&' )ltimately* the final research and findings should be submitted / 2resented to NA&' 0he o2erational research conducted should address the im2ending needs of the National 2rogramme* and should maintain high ;uality and standards* so as to be hel2ful in formulating or modifying National 2olicies 0he "&o:s should be a member of a networ8 of 5esearch Institutions Additionally* the "&o:s would assist the NA&" in &onducting in de2th analysis of data of various services including A50 centres* 7aintaining a re2ository of information related to 2aediatric HIV/AIDS * 7onitoring and evaluation of "aediatric &ohort Analysis and "aediatric "harmacovigilance activities

2+

1=.

NACO %!NANC!A, A''!'(ANCE (O PCOE'

2,

No.

A. NON RECURR!NG GRAN( B3d*et !te. A.o3nt , "hysical Infrastructure 5s !+*++*+++ %0hirty #a8hs2 :;ui2ments 5s .*++*+++ %=ive #a8hs-

Details Includes refurbishment / new construction? 2ro2er furniture? ade;uate sitting arrangements at the seminar halls etc based on need K 0wo Des8 to2 &om2uters A K 0wo "rinters K 0wo la2to2s K 'ne #&D 2ro<ector K 'ne "hotoco2ier A Scanner

B. RECURR!NG GRAN( > No. , 3.an Reso3rce 7A: and 5esearch 'fficer J ,

K 'ne 5efrigerator (capacity &'' litres! U&AN RE'OURCE' Ran*e of A.o3nt Per 'alar2 1er Essential 93alifications Ann3. .ont/

Rs.3(444+ 38444 Rs.32444+ 384449

Rs 3$:;$444 Rs ($(;$4449

5 !c &any one of the 7ife !cience <ranches' 9Candidate with "h # 6ualification gets higher salary

&andidates with medical ;ualification can also be a22ointed for the this 2ost =or 7D candidates* remuneration range will be same as A50 S7' =or 7>>S candidates* remuneration range same as A50 7' "&o: &oordinator - ,

Rs 11244 / 12324

Rs 1$(8$444

5s ,,.++5s ,*!6*+++ ,.2.+ C. RECURR!NG GRAN( > OPERA(!ONA, E-PEN'E' No B3d*et !te. A.o3nt Per Ann3. , Subscri2tion for <ournals 5s ,*++*+++ 2 '2erational 5esearch 5s D*++*+++ ! D . 1 4 6 / 7aintainence of e;ui2ments &onsumables* including )niversal "recautions 0esting Cits =unds for travel to other A50 centres 0raining and 7entoring in the region 5s 2*++*+++ 5s 2*++*+++ =rom NA&' 5s ,*++*+++

Nutritionist -,

A graduate in any disci2line* 2referably social sciences* or related to Human 5esource develo2ment with at least of 2 years of 2rogramme management e32erience 7 Sc with =ood Science A Nutrition/>iochemistry Details 7inimum one research re;uired by each "&o: 2er year &an be used in ne3t year if not com2letely utilised In addition to the su22ort to the A50 centre

=or use for travel of &&>0 0eam only

&an be carried over to be used in subse;uent year if needed

&7: / wor8sho2s %for other hos2itals- 2er 5s !*++*+++ year Sensitisation trainings for the institutes and 22 5s ,*++*+++ other hos2itals in the state &ontingency 5s ,*++*+++

=or needful 2atients / s2ecialised investigations needed for

2!