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Program
Areas |
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HIV/AIDS Projects |
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PATHWAY |
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 The total number of HIV cases
throughout India is increasing each year (in 2005, NACO reported
5.1 million persons infected), and the prevalence rates in many
areas, are also increasing dramatically. Although the prevalence
rate among the general population is low in comparison to high
prevalence countries in Southern Africa, with one sixth of the
world’s population, the total number of HIV cases continues to
grow unrelentingly in India. According to most experts, the
window of time to effectively tackle the HIV/AIDS epidemic by
prevention as well as care and support in India is quickly
running out.
PCI India has been awarded a
four-year cooperative agreement by the Center for Disease
Control and Prevention (CDC), Atlanta under the Global AIDS
Program to implement a home-based care program for people
living with HIV/AIDS (referred to as the “PATHWAY” Project).
This project has been operational in Pune, Maharashtra since
2001.The same model project has been replicated and directly
implemented by PCI in Salem District of Tamilnadu. In September
2004, PCI initiated the PATHWAY+ Program, “Comprehensive
Community and Home-Based Care and Support for People Living with
HIV/AIDS (PLWHA) in India,” which was also funded by CDC.” The
five-year continuation program (September 1, 2004-August 31,
2009) was designed to implement an integrated community and
home-based care and support and HIV prevention in three sites in
the high prevalence states of Maharashtra, Tamil Nadu, and
Andhra Pradesh. Through supplemental funding from CDC, this
project was expanded to three additional project sites in the
northeastern states of Manipur (Churachandpur and Imphal) and
Nagaland (Dimapur).
PATHWAY has trained and
mobilized home-based care teams at the project sites. The
home-based care team assesses the magnitude of the epidemic at
the community level, identifies the probable beneficiaries,
conducts a needs assessment, and develops linkages with local
health practitioners and service providers. The program
activities begin with broad-based community sensitization and
rapport-building activities conducted in partnership with
community-based organizations, such as women’s and youth groups.
Once a client is registered,
health care and counseling services are provided through a
combination of the mobile clinic, home visits as needed by the
PATHWAY home-based care team (medical staff, counselors, social
workers, community health workers, and peer educators), and at a
community meeting center. Services are also provided through
referrals to a network of government and private hospitals,
clinics, and other providers which are sensitized and mobilized
to participate in the program’s referral network.
Health care services include:
prevention and treatment of opportunistic infections, concurrent
infections such as STI and reproductive track infections;
tuberculosis screening and provision of directly observed
therapy short course (DOTS); prophylaxis, anti-retroviral
therapy monitoring; care and treatment, self care skills
training; care giving skills training; and nutritional support.
As part of the ‘continuum of care’ approach, PATHWAY+ sites also
carry out prevention activities for the general population,
which include general community awareness programs. PLWHA
support groups and networks are formed or existing ones are
strengthened and local leaders are sensitized to provide
community support for PLWHAs and their family members. Focused
capacity building sessions for local community-based
organizations, non-governmental organizations and other private
and government institutions to deliver prevention and care and
treatment services for the PLWHAs are also activities of the
PATHWAY+ program.
The highlight of the PATHWAY
project is that the project model of care has been expanded and
is operational in five high prevalence states of India with ten
implementing partners. Lessons learned were presented at the “
in June, under
XVI International Conference in Toronto in August 2006. PATHWAY
has provided over 11,453 people with voluntary counseling and
testing services and over 6,356 PLWHA have received care and
support services. The project employs PLWHAs as frontline
workers as part of the HBC team, thus ensuring greater
involvement and empowerment of PLWHAs. |
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PEDIATRIC AIDS INITIATIVE |
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 In April 2004, the Government
of India initiated its free anti-retroviral therapy roll out
scheme. As of March 2006, the scheme has catered to around
37,000 individuals through public, private, and non-governmental
organization supported anti-retroviral therapy centers (NACO
2006). Currently, there are 5.7 million (NACO 2006) people
living with HIV in India, mainly found in six high prevalence
Indian states: Karnataka, Tamil Nadu, Andhra Pradesh,
Maharashtra, Manipur, and Nagaland.
Based on the Government of
India’s advice to provide care and treatment for children in
India, NACO will be supported by the Clinton HIV/AIDS Initiative
in implementing a comprehensive pediatric initiative, so that a
greater number of children living with HIV/AIDS can benefit from
the program.
Majority of the children who
were being treated were above the age of five, as pediatric
formulations to treat children below the age of five were not
widely available through the Government of India’s free
anti-retroviral therapy scheme. The situation is further
compounded for children below 18 months as relevant diagnostics
are available only in select government establishments.
The rationale of Clinton
HIV/AIDS Initiative’s pediatric initiative is to ensure that the
majority of the children living with HIV in India are
beneficiaries of the comprehensive, child friendly HIV/AIDS care
and treatment package.
The comprehensive care and
treatment package will include psycho-social, nutritional,
medical, and transportation support. Clinton HIV/AIDS Initiative
role will include forecasting and procuring the pediatric ARVs
for 10,000 children, linking of children living with HIV/AIDS to
the nearest anti-retroviral therapy centers, and partnering with
non-governmental organizations providing home based care and
support to children living with HIV/AIDS. PCI was selected in
April 2007 as one of the lead partners through which the care
and support components will be rolled out. PCI has been selected
as it is currently implementing the home and community based
HIV/AIDS care and support programs in Andhra Pradesh,
Maharashtra, Manipur, and Tamil Nadu. Nagaland has extensive
experience in implementing the home and community based care and
support programs with a special focus on children.
PCI’s role is to map
non-governmental organizations working with children living with
HIV/AIDS and partner with them. PCI is building their capacity
on care and support and linking them to the government
anti-retroviral therapy centers.
PCI has consolidated care and
support in the target areas by building upon and integrating the
project with its existing care and support projects.
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HEALTH HIGHWAYS |
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 India has one of the largest
road networks in the world and an estimated 2 to 5 million
long-distance truck drivers and helpers. Truckers are high at
risk of HIV due to their mobility and tendency to frequent
commercial sex workers, yet have little knowledge about HIV and
other STIs, and generally do not use condoms.
In 1999, Project Concern
International (PCI) initiated the Healthy Highway Project
to bring about healthier attitudes and sexual behaviors among
truckers, crewmembers and the community along the trucking
routes. The project was initially funded by the Britain’s
Department for International Development, but is now by the
Rajasthan State AIDS Control Society.
At rest-stops along a major
highway in Rajasthan, PCI peer educators engage truckers in
discussions about HIV/AIDS and STIs. Rest-stop staff, petrol
pump workers, mechanics and local private health practitioners
are trained as informal peer educators to reinforce the work of
formal peer educators.
The program has reached thousands of truckers and transport
workers with vitally-needed information, access to condoms and
STI treatment, and has succeeded in creating peer-support for
more responsible sexual behavior. The project that began on a
30-kilometer stretch now manages a 145-kilometer stretch of
national highway |
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HELP |
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Demographically, India has
become a young country where more than 70 percent of the
population is now under the age of 35. Out of this 33.8 percent
are age 15-34. The number of adolescents alone (10-19) is over
230 million. Thus, every second Indian is a young Indian, but
young women and men are steadily emerging as the epicenter of
the HIV/AIDS epidemic. A substantial segment of this critical
sub population are sexually active, marry early, migrate for
work in vulnerable situations, and are exposed to negative peer
pressure and a risky environment. Nearly 33 percent of reported
AIDS cases in India are in the age group of 15-29 years, yet HIV
programs for youth are scarce.
In October 2005, PCI initiated
the Health Education and Life skills
Program (HELP), a project on youth HIV Prevention in
Pune Schools and Colleges. The project is funded by Zensar
Foundation to reduce the vulnerability of children and young
people by ensuring both girls and boys access to HIV/AIDS
prevention education services. The objective is to raise the
level of knowledge, awareness and skills of adolescents and
youth about HIV/AIDS prevention among 8th and 9th
grade students and students enrolled in Pune colleges during a
two-year period.
The program also contacts and
sensitizes the heads of education departments, schools and
colleges. PCI uses interactive methodology to conduct life
skills education, including HIV education, and sessions are
evaluated using appropriately designed pre and post session
questionnaires.
There has been a significant
increase in students’ knowledge and awareness levels on HIV,
pubertal changes and the importance of physical hygiene. This
project marks the success of PCI’s partnerships with the
corporate sector in the area of youth health and development.
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MASBOOT |
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The new state Jharkhand,
created in 2000, suffers from a whole range of socio-economic
limitations that may intensify the devastating effect of the
HIV/AIDS pandemic within the state. Factors include a lack of
public health infrastructure, the paucity of the
grassroots-level non-governmental/community-based/faith-based
Organizations trained in HIV/AIDS, and large tribal and
marginalized sectors of the population.
In response to the need for
building and strengthening the capacity of the health care
delivery system in Jharkhand, in September 2005, the Center for
Disease Control and Prevention (CDC GAP) in Atlanta awarded
Child in Need Institution (CINI) and Project Concern
International/India (PCI/India) the project named Making
AIDS Services Stronger By Enhancing Organizational
Outreach (MASBOOT, meaning STRONG in Hindi).
PCI is implementing the program in Ranchi and Hazaribagh
districts of Jharkhand in order to train and build the capacity
of government and non-government stakeholders in the provision
of HIV/AIDS services and to improve the quality of those
services in Jharkhand.
The project conducts needs
assessments, designs training modules, and conducts need based
capacity building programs for medical, paramedical and social
health care providers. The MASBOOT Project has developed modules
of cascading level of training and a pool of trainers which
includes people living with HIV/AIDS. |
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CONTINUUM OF CARE PROJECTS IN
TAMIL NADU |
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PCI has undertaken projects to
complete the continuum of care through linkages with relevant
projects in Tamil Nadu, thus providing holistic care and support
with PLWHAs. The projects include:
Community Care Center
The Community Care Center is a
project implemented by PCI with support from Tamil Nadu State
AIDS Control Society (TANSACS). It is a short term inpatient
nursing care facility, acting as a bridge between hospital and
home care. The main objective of the care center is to deliver a
continuum of care. This involves the promotion of early
detection of HIV, focus on the effective treatment of
opportunistic infections, reduce mother-to-child transmission of
HIV and strengthen the referral services to enable PLWHA to
avail specialized services like CD4 testing and Anti retroviral
therapy when needed.
The Community Care Centre
provides 24 hours medical care, nutrition support, counseling
support, behavior modification programs, training for
caregivers, recreational activities and referral services.
The Community Care Centre has
been playing an essential role in the provision of comprehensive
care and support to the PLWHA in and around the district of
Salem. With the Care Centre becoming an anti-retroviral therapy
initiation centre in December 2005, much of the activities at
the Care Centre revolves around the referrals, initiation and
follows up of the anti-retroviral therapy for the PLWHAs in
collaboration with that of the Department at the Salem
Government Hospital.
The Bill and Melinda
Gates Foundation-AVAHAN-VHS-TAI
PCI is implementing a
community driven prevention program in Salem district reaching
female sex workers and their clients. The project is a Bill and
Melinda Gates Foundation supported AVAHAN initiative that is
funded by the Tamil Nadu AIDS Initiative. It aims to promote
behavior change and reinforce safer sexual practices among
female sex workers as well their clients, and refers those
suspected to be infected to the PATHWAY program for home-based
care.
The
PCI-GFATM-TANSACS-PPTCT
The project identifies and
mobilizes antenatal mothers for counseling and testing,
providing anti-retroviral therapy to positive mothers and
children, follow-up services for safe institutional delivery,
and nutritional support. Pregnant women are referred to the
Integrated Voluntary Counseling Centre. If a patient is found
positive, follow up activities are pursued.
GFATM III/HIV-TB
The GFATM III is a TNSACS
funded initiative through which the state of Tamilnadu
aims to increase the demand for prevention, care and support for
HIV and TB through community mobilization and partnership
building. PCI operates this program in the district of Salem
through outreach workers, some of whom are to be placed in the
STD (Sexually Transmitted Disease) department and Integrated
Voluntary Counseling Centre of Salem and Mettur Government
Hospital, while others coordinate in the field.
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