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Improving access to care and treatment services for children affected by HIV/AIDS in Andhra Pradesh, India. Ajay Kumar Reddy Technical Manager – Monitoring & Evaluation Balasahayoga. Context. India 0.34% prevalence with an estimated 2.31 Million PLHIV (HSS 2007)

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Improving access to care and treatment services for children affected by HIV/AIDS in Andhra Pradesh, India

Ajay Kumar Reddy

Technical Manager – Monitoring & Evaluation

Balasahayoga

context
Context

India

0.34% prevalence with an estimated 2.31 Million PLHIV (HSS 2007)

3.5% of PLHIV (80,000) constitute the age-group <15 years (HSS 2007)

0.49% prevalence among ANC attendees (Annual Report 2009-10, NACO)

Low knowledge on HIV / AIDS among general population (17% women and 33% men – NFHS-3)

High prevalence in southern states (Andhra Pradesh, Maharashtra, Tamilnadu and Karnataka) and the North-East

context1
Context
  • Andhra Pradesh
    • 0.5 Million PLHIV (HSS 2007) constituting 22% of the HIV burden of the Country
    • 1.22% prevalence among ANC attendees (pregnant women)
    • 17,000 infected children (HSS 2007) and 150,000 affected children (Program Data)
    • Low awareness levels on HIV / AIDS among general population (13.7% women and 32% men – NFHS-3)
issues
Issues
  • Issues effecting access to care and treatment for HIV affected children
    • Prevention and Treatment focused on adults (Ped ART introduced in 2006 and Early Infant Diagnosis in 2010)
    • Facilities not treating ‘Family’ as a unit thereby resulting in low identification of infected Children and Partners
    • Low knowledge on existing HIV care, treatment and support services
    • Absence of Continuum of Care approach and lack of follow-up resulting in high drop-out from care and treatment services
    • Delayed testing and identification leading to high mortality rates. (Out of the total children dead, only 37% have been tested whereas 87% were with Mothers HIV Positive)
balasahayoga the program
Balasahayoga – the program
  • Objective: Improve the Quality of Life of Children through access to treatment, care and support services.
  • Duration: 5 Year program supported by Children’s Investment Fund Foundation (CIFF) and Elton John AIDS Foundation and implemented by FHI, Clinton Foundation and CARE.
  • Coverage: 68,000 children and their families affected by HIV/AIDS in 11 districts of Andhra Pradesh, India
  • Interventions in domains of Health, Education, Nutrition, Psycho-social support and Safety Nets
  • Works at Community and Facility levels to generate demand for services as well as improve response at facilities.
the approach
The Approach
  • Family case management (FCMs) approach where FCMs (outreach workers) make home visits, provide care, counsel parents on available services and make accompanied referrals to facility-based services;
  • Data sharing with Facilities to identify and minimize Loss-to-follow-up between services
  • Develop and Use simple set of tools (algorithms, flip books, etc) for FCMs to screen for eligibility of VCT, ART and other key services
  • Work with facilities to improve patient flow, availability of pediatric ART/OI medication, quality of care and child counseling
  • Local Coordination Committees to ensure community level and key stakeholder participation and support
  • Demonstrate and Advocate with Government to provide access to support services like safety-nets and livelihood promotion activities.
lesson s learnt
Lesson’s Learnt
  • The continuum of care approach has resulted in significant improvements in access to services and retention in care
    • Identification and registration of 46,000 children and 48,000 adults (infected and affected) from 28,000 Families.
    • HIV testing rates among eligible children increased from 19% to 58%;
    • Enrollment in treatment services increased from 42% to 78% for children and 18% to 66% for adults;
    • Loss-to-follow up from ART treatment reduced to <2% among children and <5% among adults;
    • Improvement in Food Security Levels of Households through access to Safety Nets and Livelihood Enhancement Initiatives.
    • Overall retention of children in care is 93%, with 6.3% lost due to migration and 0.34% due to death.
next steps
Next Steps
  • Partner with state and national government to adapt this continuum of care approach to other HIV affected areas of India.
  • Successfully Pilot the Children Affected By AIDS (CABA) Scheme for scale-up in all the high-prevalence districts in the Country.
  • Demonstrate a cost-effective and replicable model for adoption and scale-up by Government to other districts and states.