Spruha :

Background:

During the period prior to the National AIDS Control Programme- III, i.e. before 2007, several HIV care homes were being run in the country independently. The basic objective of these centres was to serve as hospices, to provide shelter and terminal care to PLHIV. Many of the inmates had been deserted by their families, due to HIV. These centres were stand alone centres and served as long stay homes for PLHIV.

With the introduction of Antiretroviral Therapy (ART), PLHIVs are able to regain their health and live a normal life while taking ART, lifelong. However, adhering to ART was a challenge and non adherence became a major reason for treatment failures and recurrent illness in PLHIV.

In a bid to improve the adherence levels amongst PLHIVs, an experiment in the Govt Hospital of Thoracic Medicine, at Tambhram was conducted which was the first step toward transforming the role played by the care centres. In this experiment, it was realised that if people were provided with appropriate and intense counselling at the initiation of ART, the likelihood of them being adherent was much higher. This meant that more people could lead a healthy life and be a part of India’s productive force. It also meant that fewer PLHIV would feel the need for second line ART which was 10 times more expensive than First Line ART, thus having a direct impact on the financial burden for the HIV programme.

The CCC concept was then scaled up through a proposal by NACO to GFATM in the round 6 applications, which resulted in the roll out of the CCC program under NACP-3 in its new form with revised guidelines. The CCC was envisaged as a link between home based care and the tertiary care unit.  It was transformed from a stand-alone permanent hospice to a place where PLHIV could stay for a short while. The CCCs would complement the work of the ART centres by reinforcing the counselling provided at the ART centre on positive prevention, drug adherence, nutrition counselling etc. It would also work closely with the ART centre to educate and monitor the client for ART side effects, minor OIs, monitoring and follow-up of CD4 counts. Since the CCCs were also staffed with outreach workers, they could follow up the clients at their homes and help follow up on clients who were not taking their treatment regularly. These centres would also provide the PLHIV with a safe space where their psycho-social needs could be addressed.

Goal of the Project:

An increased number of PLHIV have access to better quality of life and reduced vulnerability through improved clinical and care services, linking with relevant social services and community responses.

Objectives:

• To expand the coverage of and access to services for PLHIV.
• To expand the scope of services provided to PLHIV.
• To ensure PLHIV receive various services in an environment without stigma, discrimination and denial.

Focus:

• Ensuring availability and accessibility of quality services by PLHIV.
• Ensuring psychological care, social interventions and nutrition is provided to PLHIV along with medical services.
• Ensuring ART adherence and bringing down the defaulter cases.
• Establishing linkages and co-ordination systems between project services and relevant government or private services to ensure a continuum of care. 
• Developing of standard operating procedures, modules, manuals and materials for quality HIV care.
• Ensuring that the CCC team provides the range of medical & psychosocial services either directly or through strong linkages with relevant identified service providers such as ART centre, ICTC, DOTS, TI programs, Tertiary level hospitals, orphanages, destitute homes, vocational rehabilitations centres, legal support centres in the respective districts.
• Supportive supervision and monitoring of services to PLHIV.

Services available at the CCC:

• OPD and IPD services for clients
• Nursing care for 24 hours for clients
• Medicines on OPD and IPD basis for clients
• Basic routine laboratory diagnostic services
• Counseling services for clients and care givers
• Transport for clients and care givers.
• Accompanied referrals from ART centre
• Accompanied referrals to ART centre or any other tertiary care unit or social services
• Accommodation for care givers during client’s IP days
• Food for clients during IP days

Reach:

As on 1st April 2012, under Spruha project, 58 CCCs are functional across 2 states (31 CCCs in Maharashtra and 27 CCCs in Karnataka) effectively reaching out to around 1 Lakh (104232) PLHIVs.