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  1. 1. By:-Jageshwar Dayal kori -Ishan Sanodia -Gabriel Daske Integrated Counseling & Testing Centre (ICTC) Visit. Mahatma Gandhi Memorial Medical College Hospital, Indore. Guided By:- Dr. Sanjay Dixit Dr. Veena Yesikar
  2. 2. Introduction An individual who is infected with the human immunodeficiency virus (HIV) will not develop the acquired immunodeficiency syndrome (AIDS) immediately. It is important that an individual who is HIV-infected is aware of his/her status as otherwise he/she could unknowingly transmit the virus to others. The only way to the presence of HIV and get timely treatment is through a simple blood test. HIV counselling and testing services were started in India in the year 1997. Under NACP-III, Voluntary Counselling and Testing Centres (VCTC) and facilities providing Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) services are remodelled as a hub or ‘Integrated Counselling and Testing Centre’ (ICTC) to provide services to all clients under one roof..
  3. 3. Overview: National AIDS Control Program • 1992: National AIDS Control Program Initiated • 1997: VCT services started in the country • 1999: NACP II Initiated (99-06) • 2000/2001: 11 centers of excellence conduct PPTCT • 2001: Operational guidelines for PPTCT and VCT (revised in ’04 & ’07) • 2002: PPTCT services started throughout the country • 2003: GFATM : support to PPTCT • 2004: GFATM : support to HIV-TB coordination • 2006: NACP-III framework designed, Integration of VCT and PPTCT as ICTC • 2007: Provider Initiated testing for ANC mothers, TB patients, STI patients, HRG population. • 2014 : NACP-IV launched for 5 years(2012-2017).
  4. 4. Problem status of HIV in INDIA Source:- NACP-IV Strategy Document India has demonstrated an overall reduction of 57% in estimated annual new HIV infections (among adult population) from 2.74 lakhs in 2000 to 1.16 lakhs in 2011 The challenge before us is to make all HIV-infected people in the country aware of their status so that they adopt healthy lifestyles and prevent the transmission of HIV to others, and access life- saving care and treatment. S. No. year HIV Prevalence Annual New HIV infections Population infected with HIV 1 2000 - 2.74 lakhs 2 2001 0.41 % 3 2006 0.35 % 4 2011 0.27 % 1.16 lakhs 20.9 lakhs
  5. 5. Packages of services under NACP-IV : • Prevention services • Care, Support, and treatment services Goals & Objectives Objective 1: Reduce new infections by 50% (2007 Baseline of NACP III) Objective 2: Comprehensive care, support and treatment to all persons living with HIV/AIDS
  6. 6. Components • Component 1: Intensifying and Consolidating Prevention services with a focus on HRG and vulnerable populations • Component 2: Expanding IEC services for (a) general population and (b) high risk groups with a focus on behavior change and demand generation • Component 3: Comprehensive Care, Support and Treatment • Component 4: Strengthening institutional capacities • Component 5: Strategic Information Management Systems (SIMS)
  7. 7. What is an Integrated Counselling and Testing Centre? An integrated counselling and testing centre is a place where a person is counselled and tested for HIV, on his own free will or as advised by a medical provider.
  8. 8. Who needs to be tested in an ICTC? Subpopulations who are more vulnerable or practice high-risk behaviour like 1. sex workers and their clients, 2. men who have sex with men (MSM), 3. transgenders, 4. injecting drug users (IDUs), 5. truckers, 6. migrant workers, 7. spouses and children of men who are prone to risky behaviour.
  9. 9. ROLE OF AN ICTC •Early detection of HIV. •Provision of basic information on modes of transmission and prevention of HIV/AIDS •Promoting behavioural change and reducing vulnerability. •Link people with other HIV prevention, care and treatment services.
  10. 10. GATHER Approach G = Greet the client A = Ask about the problem Active listener Assess degree of risk behavior Show respect and tolerance Enable patient or client to express freely Determine access to support and help in family and community T = Tell the client about specific information that he or she desires H = Help them to make decisions E = Explain any myths or misconceptions(also known as INFORMED DECISION MAKING) R = Return for follow up or Referral
  11. 11. -An ICTC is located in health facilities owned by the government, in the private/notfor- profit sector, in public sector organizations/other government departments such as the Railways, Employees' State Insurance Department (ESID) in sectors where nongovernmental organizations (NGOs) have a presence. -In the health facility, the ICTC should be well coordinated with the Department of Medicine, Microbiology, Obstetrics and Gynaecology, Paediatrics, Psychiatry, Dermatology, Preventive and Social Medicine. -In MGMMC, ICTC is located in Microbiology Department. Where can an ICTC be located?
  12. 12. Different types of ICTCs ICTCs can be classified into two types: 1. Fixed-facility ICTCs • Stand-alone • Facility-integrated 2. Mobile ICTCs A mobile ICTC will consist of a  van with a room to conduct a general examination and counselling  a space for the collection and processing of blood samples, etc. There are 4,537 stand-alone Integrated Counseling and Testing Centres (ICTCs), 9,196 Facility Integrated ICTCs and 1,805 under Public and Private Partnership model.
  13. 13. Physical Infrastructure required for an ICTC In a facility, the ICTC should be located in a place that is easily accessible and visible to the public. • The counselling room • Blood collection and testing room— Refrigerator, Centrifuge, Needle destroyer, Micropipette, Colour-coded waste disposal bins. • CD4 count room
  14. 14. Human resources for an ICTC The ICTC requires a team of skilled persons consisting of the manager (medical officer), counsellor and LT. 1. ICTC manager (medical officer)-- The administrative head of the facility where the ICTC is located must identify and nominate a medical officer as manager in- charge of the ICTC. duties:- • Administrative • Demand generation • Quality assurance • Supply and logistics • Monitoring and supervision
  15. 15. 2. Counsellors--The counsellor should be a graduate in Psychology/Social Work/Sociology/Anthropology/ Human Development or hold a diploma in Nursing with a minimum of 3–5 years of experience in the field of HIV/AIDS. duties:- • Preventive and health education--provided pre-test information/counselling, post-test counselling and follow-up counselling. • Psychosocial support • Referrals and linkages—Maintain effective coordination with the RCH and TB programmes as well as with the antiretroviral therapy (ART) programme,
  16. 16. 3.Laboratory technician-- The LT should hold a Diploma in Medical Laboratory Technology (DMLT) from an institution which is approved by the state government. duties:- • HIV testing according to standard laboratory procedure. • Keep the facility neat and clean at all times. • Keep a record of HIV test results and stock of rapid HIV diagnostic kits. Follow universal safety precautions and strictly adhere to hospital waste management guidelines. 4. Outreach workers– Mobilize & Follow up Patients. Follow up the mother–baby pair till 18 months after delivery.
  17. 17. HIV COUNSELLING HIV/AIDS counselling/education is a confidential dialogue between a client and a counsellor aimed at providing information on HIV/AIDS and bringing about behaviour change in the client. It is also aimed at enabling the client to take a decision regarding HIV testing and to understand the implications of the test results. Steps:- 1. HIV pre-test counselling/information 2. HIV post-test counselling 3. Follow-up counselling -- In follow-up counselling there is a re-emphasis on adoption of safe behaviours to prevent transmission of HIV infection to others. Follow-up counselling also includes establishing linkages and referrals to services for care and support including ART, nutrition, home-based care and legal support.
  20. 20. KITS USED FOR TESTING 1) SD BIOLINE HIV-1/2 3.0 test -is an immunochromatographic(rapid) test for qualitative detection of antibodies specific to HIV-1 and HIV-2 in plasma/serum/whole blood. -Manufactured by SD BIO STANDARD DIAGNOSTICS PVT. LTD. - sensitivity=100% -specificity=99.8%
  21. 21. SD BIOLINE HIV-1/2 3.0 test
  22. 22. SD BIOLINE HIV-1/2 3.0 test
  23. 23. 2) HIV-1/2 TRISPOT TEST KIT: -it is a rapid Trispot test to detect antibodies to HIV-1 & HIV-2 in human serum/plasma. -Manufactured by BHAT BIO-TECH INDIA(P) LTD. -sensitivity=100% -specificity=99.7%
  24. 24. HIV-1/2 TRISPOT TEST KIT
  25. 25. HIV-1/2 TRISPOT TEST KIT
  26. 26. 3) COMBAIDS –RS Advantage-ST:HIV 1+2 immunodot test kit: -It is for the detection of antibody to HIV 1 and/or HIV 2 in whole blood /serum /plasma. -Manufactured by Span Diagnostics Ltd. -sensitivity=100% -specificity=100%
  29. 29. STRATEGY 3 For individual Dx of patients ,ICTC uses STRATEGY 3 which is as follows: -All samples are tested with one rapid test.(SD BIOLINE HIV-1/2 3.0 test). -If test result is NON-REACTIVE:final report NEGATIVE. -If test result is REACTIVE then sample is tested again by different systems(TRI- DOT &BI-DOT tests). -Results can be REACTIVE or NON-REACTIVE. -If result is REACTIVE with 2nd & 3rd antigen test then report is POSITIVE. -If result is NON-REACTIVE with either 2nd or 3rd antigen test ,then report is INTERMEDIATE. -If result is NON-REACTIVE with 2nd & 3rd antigen test then report is NEGATIVE.
  30. 30. Three Tests Done:
  31. 31. Testing Algorithm
  32. 32. Summary of the month(JUNE 2016) :Status
  33. 33. Fig a:Positivity 322 165 487 23 0 23 0 100 200 300 400 500 600 ICTC Client(Excluding Pregnant women) ICTC Client: Pregnant/BF mothers Total ICTC Clients 4)No. of clients provided post test counseling & given result 5)No. of clients diagnosed positive for HIV(after 3 specific tests)
  34. 34. Fig b:Co-infection(HIV+TB) 27 0 7 0 0 5 10 15 20 25 30 ICTC Client(Excluding Pregnant women) ICTC Client:Pregnant/BF mothers 7)No. of ICTC client referred to RNTCP (microscopic centre) 8)No. of HIV infected TB patients(CO- INFECTION.
  35. 35. Fig c:Direct & Referred Patients 1 328 329 0 23 23 0 50 100 150 200 250 300 350 Client Initiated(DIRECT) Provider Initiated(Referred) TOTAL 2)Tested for HIV 4)Were diagnosed HIV+(after 3 specified tests)
  36. 36. Fig f:Category wise Positivity 21 1 0 0 1 0 23 0 5 10 15 20 25 1)Heterosexual 2)Homosexual 3)Blood/Blood product 4)Infected syringe/Needles 5)Parent to child 6)Not specified/unknown 7)Total Total Total
  37. 37. THANK YOU