Conditional Cash Transfer in PMTCT ManagementInnovations in Enhancing Access to Testing and Prophylaxis in PMTCT

A Project in In Collaboration with RSACS, NRHM, UNICEF & UoM

In Partnership of IHAT & IMPACTSupported by ViiV Healthcare-PACF

UPDATE April 2013 to Dec. 2014

Presented by:Priyamvada Singh, PhD, LLB, MBADevelopment Consultant, University of Manitoba (UoM), Winnipeg, Canada. Trustee, India Health Action Trust (IHAT)

Presentation Overview

Part-I: PPTCT Overview and Project Introduction

Part-II: Project Activities and Results

Part-III: Financial Update

Part-I PPTCT Overview and Project Introduction

Geographical Coverage

Legend: PPTCT coverage with PACF supportPPTCT Coverage with GFATM support

State ProfileAs per the Census (2011):

The largest state by area, covers 10.4% area of India ("Official site of the Ministry of Statistics and Programme Implementation, India).

Population: 68,621,012, Rank 8th

literacy rate: 67.06% (80.51% male and 52.66% female), below the national average of 74.04%, female literacy rate is the lowest in the country

attracted 14 percent of total foreign as well as domestic visitors during 20092010 which is the fourth highest among Indian states

In Rajasthan the estimated adult HIV prevalence (ANC) in 2008 was 0.19% and in 2010 its 0.38%, 0.17% in 2011 and 0.32% in the year 2012

In spite of low HIV prevalence, its a highly vulnerable state with certain districts/sub district pockets showing emerging epidemic (13/33 districts indicating

higher than previous HIV adult prevalence in 2010 (9 have more than state %) ;

having large number of PLHIV due to the large population size.

PPTCT: Some Facts In 2009, around 4 Lakh children (

Some Facts.....Cont....PMTCT services can be provided through existing public health systems, even in less resourced parts of the world; many countries have reached the 80% coverage target of antiretroviral for PPTCT.

This means addressing not just practical issues, but also social, cultural, gender dimensions, status of woman in the family and the individual factors.

People's attitudes towards HIV are central to the success or failure of PPTCT.

Strengthening of village level structures and involving those in to the comprehensive HIV response is critical to sustained efforts towards primary prevention of HIV amongst youth and an efficient PPTCT.

All districts and sub-districts still do not have enough PPTCT services and existing services are not reaching many of the local women in need.

To achieve wide coverage, PPTCT programmes must be integrated into existing public health systems, with services provided by all antenatal and delivery clinics (which is

being aimed now by convergence between NRHM, NACP and MoWCD).

These interventions are cost effective and deserve to be seen as a necessary part of maternal and child health.

The Project District Profile - PALI

Particulars Total Male Female

Population 2,038,533 1,025,895 1,012,638

Estimated Annual Pregnancies

(2012-13)51219 (HIV Testing target 18201, 35.53%)

Number of Villages 1050: (Source: http://pali.nic.in/basic.htm)

Sex Ratio 987

Literacy Rate 63.23 78.16 48.35

1. Blocks 102. Community Health Centre 173. Primary Health Centre 694. District Hospital 015. Sub division Hospital 016. City Dispensary 057. Sub Centre 4788. Identified Delivery Centre 659. # of ANMs 54910. # of ASHAs 125811. # of AWWs 1500

Project District Profile - DUNGARPUR

Particulars Total Male Female

Population 13,88,906 698,061 690,837

Estimated Annual Pregnancies

(2012-13)41979 (HIV Testing target 12105, 28.83%)

Number of Villages987 (Source: http://dungarpur.nic.in)

998: District Health Department

Sex Ratio 990

Literacy Rate 60.78 74.66 46.98

1. Blocks 05 2. Community Health Centre 113. Primary Health Centre 404. District Hospital 015. Sub division Hospital 016. City Dispensary 047. Sub Centre 3298. Identified Delivery Centre 409. # of ANMs 59910. # of ASHAs 150411. # of AWWs 2071

Project Summary

The project attempts to test the efficacy of two specific innovative strategies i.e. vulnerability assessment and conditional cash transfer in increasing the demand to PPTCT services by pregnant women living with HIV in Rajasthan

The project also assists to strengthen the existing government service delivery mechanism to improve the access to PPTCT services

Objectives of the Project

The objectives of the project are to:1. increase access to ICTC services by pregnant women;2. ensure all HIV+ mothers and newborns receive ARV prophylaxis as per NACO guidelines;3. ensure all babies born to HIV+ mothers are tested for HIV within 6 months and put on prophylaxis or treatment as indicated;4. demonstrate the effectiveness of conditional cash transfer in PPTCT management.

Impact and Outcomes

Impact

Improved pregnancy and newborn survival among HIV positive women

Improved government and community support to HIV positive pregnant women

Outcomes

Pregnant women vulnerable to HIV avail testing facilities

Pregnant HIV positive mothers opt for institutional deliveries

High Level Anticipated Results

90% of pregnant women motivated and referred for HIV counselling and testing (thru RCH-NACP integration)

90% of pregnant women identified with high vulnerability to HIV screened for HIV within 6 months of their pregnancy

95% of identified HIV+ pregnant women receive recommended ARV prophylaxis during pregnancy

80% babies born to HIV+ mothers are tested for HIV within the first 6 months

All HIV exposed babies receive recommended prophylaxis and treatment during follow up until 18 months

Government of Rajasthan adapts the project interventions for scale up in other districts

Main Strategies Engage NRHM and WCD cadres to improve PPTCT referrals for HIV counseling , testing &

services while having focused outreach and service linkage mechanism in place

Use Vulnerability Assessment Checklist to screen pregnant women with high vulnerability to HIV and refer them for testing (a short term solution to universal testing for HIV in pregnancy)

Reimburse travel and opportunity cost to pregnant women availing HIV counseling and testing after referral

Develop technology based MIS to minimize Loss of Follow Up (LFU)

Integrate RCH and PPTCT services, while building capacities of ANMs, ASHAs, AWWs, Counselors and Lab Technicians (in line with the spirits of MoHFW & NACOs joint circular-Aug. 2010).

Build capacities of PHC/CHC staff in Early Infant Diagnosis (EID)

Build community support mechanisms for pregnant women living with HIV to avail full package of PMTCT (as recommended by NACO)

Advocate with the government to ensure regular availability of supplies and quality counseling at PMTCT service delivery points

Advocate with the government for scale up of the project as per the efficacy assessment

Key Activities (1)

Enrol & train HIV infected women as peer educators through the

- focused outreach, service referrals

- follow up with HIV+ pregnant women during ANC, delivery, and PNC till babys attaining 18 months age.

Provide cash to support travel and opportunity cost to women availing referral for HIV testing for self and babies.

Introduce client tracking system using cell phone to ensure regular follow up for service delivery

Train ANMs, ASHAs and AWWs to screen pregnant women for HIV vulnerability and refer for testing and PPTCT counselling

Key Activities (2)

Ensure institutional delivery & ART Prophylaxis for all identified HIV+ mothers and the babies.

Train ICTC/PHC/CHC staff to collect, store and transport blood samples using DBS.

Evaluate the role of conditional cash transfer in PMTCT management

Document the learnings & experiences and share with the stakeholders informing/improving PPTCT programming

advocate with Government for scale up.

Advocate with government to facilitate cash incentive using untied NRHM funds for HIV testing in pregnancy and EID.

Project Duration and the Planned Coverage

Three YearsJanuary 2013 till December 2015

Two districts Pali & Dungarpur

Training of staff of all ICTC-PPPTCT, PHCs/CHCs in the project districts engaged in providing HIV related services (200)

Training of all ANMs (1100+)

Orientation of ASHAs and AWWs (6000+)

Motivate all pregnant women for HIV testing and counseling

Estimated 2000 pregnant women counseled and referred annualywith CCT for HIV testing, based on high vulnerability to HIV

All HIV+ve pregnant women are linked with PPTCT service package and followed up till 18 months (estimated 400)

Training and supervision of Peer Educators (28)

Part-II Project Activities and Results

PPTCT Project - Organogram

PPTCT Project

IMPACT

Technical Specialist

ConsultantMonitoring & Evaluation

Manager

India Health Action Trust (IHAT)

Project Director

Program Manager

District Coordinator Pali District

Peer Educators 19

District Coordinator Dungarpur District

Peer Educators 9

State Level Project Steering Committee

having Representatives of

RSACS, NRHM, UNICEF,

IMPACT & IHAT

Project Partners: Roles and ResponsibilitiesIHAT

Overall Leadership

Community Outreach & Service Linkages

Client Follow up and Peer Counseling

Stakeholder Coordination

ORW, ASHA, ANM, AWW Training Strengthening

ASHA, AWW Training & Strengthening

Conditional Cash Transfer (CCT)

IMPACT

Base Line and End line

ANM Training & Strengthening

Counselor & LT Training & Strengthening in EID

MIS & Reporting (including Cell Based MIS)

IEC

Documentation

Dissemination

ACTIVITY UPDATEProject team trained in project components in April & June 2013 and a refresher is done on the project & new MDR guidelines in August 2014. The training module is available at https://www.pacfonline.com/pg/file/ihatrajasthan/read/5614/training-of-outreach-works-and-the-front-line-workers-the-training-module-hindiA total of 4570 (72.56%) out of 6298 ASHAs/AWWs are trained by the IHAT teams; oorientation Kit is available at: https://www.pacfonline.com/pg/file/ihatrajasthan/read/5696/orientation-of-awws-ashas-the-pptct-orientation-kithindi 913 (79.53% of the total) ANMs have been trained by Bal SansarSanstha (an NGO operating in Rajasthan and outsourced by the MPACT for this assignment) covering 13 out of 15 blocks in Dungarpur and Palidistricts.https://www.pacfonline.com/pg/file/ihatrajasthan/read/5695/anm-training-module-pacf-pptct_ihat_bss_june-2013dpdf

REPORTING SYSTEMThe record keeping and reporting structure is as follows: Two registers are being maintained by each ORWs for their blocks and then these are feeding in to the district level Master Registers1) Entering all the referrals done for HIV counseling and testing in the Referral Register; if any client is found HIV positive then registering her in to the Client Service Tracking Register keep entering the mother-babys service access records till the baby attains 18 months of age.Daily Activity Register covers the routine activities of the ORWs which translates into the Monthly Progress Report Daily Output Register covers the main indicators of the project and serves as a daily tracking tool translating into a monthly progress report. The Cell based MIS is a CommCare application, designed into 4 modules i.e. Screening; Test Follow up; Pre-natal; and Post natal used by the ORWs (http://www.commcarehq.org) . The application can be accessed on the exchange as approved for the global sharing at the link: https://www.commcarehq.org/exchange/6e0b6600e6c1b2fe5272d0972a470309/info/

REFERRAL SLIP

Note: These orientations are being done through monthly sector meetings organized as part of system and are attended by the key govt. staff from the concerned blocks, involved in the PPTCT programme. The Orientation

Module can be accessed at: https://www.pacfonline.com/pg/file/ihatrajasthan/read/5696/orientation-of-awws-ashas-the-pptct-orientation-kithindi

UPDATE ON ASHA & AWWs ORIENTATION ON PPTCT:

DISTRICT DUNGARPUR (April 2013 to Dec 2014)

Sl.

No.

Name of the

Blocks

No. of

ASHAs

in the

Block

No. of

AWWs in

the Block

No. of

ASHAs

AWWs

Trained

1 Simalwara 353 529 489

2 Bichhiwara 397 509 491

3 Sagwara 291 400 381

4 Dungarpur 220 306 399

5 Aspur 243 327 389

TOTAL 1504 2071 2149

Total Trained: 60 % of the total # of 3575 ASHAs and AWWs

UPDATE ON ASHA & AWWs TRAINING ON PPTCT:

DISTRICT PALI (April 2013 to Dec 2014)

Sl.

No.

Name of the

Block

No. of

ASHAs

in the

Block

No. of

AWWs

in the

Block

No. of

ASHAs

AWWs

Trained

1 Pali 203

2 Rohat 117

3 Rani 170

4 Desuri 216

5 Bali 410

6 Sumerpur 162

7Marwad

(Kharchi) 176

8 Sojat 257

9 Raipur 100

10 Jaitaran 225

Total 1258 1500 2036

Total Trained: 74 % of the total # of 2758 ASHAs and AWWs

UPDATE ON ANM TRAINING ON PPTCT: DISTRICT

DUNGARPUR

S.No.Name of the

Blocks

No. of ANMs

in the Block

No. of ANMs

Trained

1 Simalwara 155 143

2 Bichhiwara 153 141

3 Sagwara 85 126

4 Dungarpur 83

5 Aspur 87

Total 563 410 (73%)

Note: These trainings were attended by the key

govt. staff from the concerned blocks, involved in

the PPTCT programme.

UPDATE ON ANM TRAINING ON PPTCT: DISTRICT PALI

S.No.Name of the

Block

No. of ANMs

in the Block

No. of ANMs

Trained

1 Pali 42 37

2 Rohat 49 44

3 Rani 42 39

4 Desuri 32 38

5 Bali 65 66

6 Sumerpur 53 46

7Marwad

(Kharchi) 70 62

8 Sojat 73 61

9 Raipur 60 59

10 Jaitaran 63 51

Total 549 503 (92%)

S.No.Name of the

Blocks

DISTRICT PALI:

Villages and Outreach Coverage

Total

Villages

Covered till Dec.

2014 Uncovered

Villages Coverage%

1 Pali 88 86 2 98

2 Rohat 80 76 4 95

3 Rani 77 77 0 100

4 Deshuri 81 81 0 100

5 Bali 113 111 2 98

6 Sumerpur 70 70 0 100

7 Marwad 157 153 4 97

8 Sojat 125 125 0 100

9 Raipur 141 137 4 97

10 Jaitaran 118 118 0 100

1050 1034 16 98

S.No.Name of the

Blocks

DISTRICT DUNGARPUR : Villages and Outreach Coverage

Total Villages

Covered till Dec 2014

Uncovered Coverag

e%

1 Dungarpur 184 168 1691%

2 Sagwara 184 184 0 100%

3 Simalwara 260 243 1793%

4 Bichhiwara 211 195 1692%

5 Aspur 159 149 10 94%Total 998 939 59 94%

PPTCT Project: Geographical Coverage (April 2013 to Dec. 2014) Pali Coverage Dungarpur Coverage Project Coverage

Total Villages # Covered % Covered Total Villages # Covered

% Covered Total Villages

# Covered

% Covered

1050 1034 98 998 939 94 2048 1973 96

Health Camps to Reach the UnreachedDungarpur-Health Camp Status: (Jan. to Dec 2014)

S.No.Name of the

Block Name of Facility

No Of

Health

Camps

No. of

Testing

No. Of

Cases

+ve

1 Bichhiwara

CHC GamdriAhara, PHC Talaiya, PHC Kanba 2

110 0

2 Simalwara

PHC Chitari, PHC Gariyta, Sub Center Ratdiya, CHC Dungarsaran, Sub Center Dariyati, PHC Jasela 7

415 0

3 Sagwara

PHC Bhasour, PHC-Ghata ka Gaon, CHC Buchiya bada, Sub Center Varda, PHC Biliya Badgama 5

388 0

4 Aaspur PHC Nithuwa 1 62 0

5 DungarpurPHC Antri, PHC Pohari Kahaturat 2

126 0

Total 17 1101 0

Pali-Health Camp Status: (Jan to Dec 2014)

S.No.Name of

the Block

Name of

Facility

No Of

Health

Camps

No. of

Testing

No. Of

Cases

+ve

1 Pali PHC Gundoj 1 70 0

2 Rohat PHC Jaitpur &

Chenda2 155 0

3 Rani

4 Desuri CHC Deshuri &

PHC Nadol 2 20 0

5 Bali PHC Falana &

Beda2 159 1

6Sumerpur

CHC-Koshelav Bikani, Novi

3 133 0

7Marwad

(Kharchi)

8 Sojat CHC Bagdi 1 63 0

9 Raipur

PHC Piplyakala & CHC

Khusalpura, Takhatgarh,

2 106 0

10 Jaitaran

PHC Aanand Pur Kalu, PHC

Ras, CHC Nimaj3 151 0

Total 16 875 1

Note: Out of 16 camps, 8 were Migrants camps by Govt. supported by the project Outreach

HIV TESTING FACILITY AND KITS AVAILABILITY STAUTS

Name of the

Blocks HIV Testing Sanctioned Facility

HIV Testing

Kits Not Available (As on Dec. 2014)

ICTC PPTCT CHC PHC ICTC PPTCT CHC PHC

Pali 1 1 - 5 - - - -

Rohat - - 1 3 - - -

Rani - - 1 4 - - _

Desuri - - 3 4 - - -

Bali 1 - 2 10 - - - 1

Sumerpur - - 3 7 - - - 1

Marwad - - 1 9 - - - -

Sojat 1 - 2 8 - - - 1

Raipur - - 2 6 - - - 2

Jaitaran - - 2 11 - - - 2

Total 3 1 17 67 0 0 _ 7

1. One of the crucial support areas is ensuring smooth HIV test kit supplies from the RSACS - CMHO - RCHO level.

2. There is no supply of DBS test kits for long and hence, EID is almost stopped.

3. The Project has arranged 2165 HIV Test kits enabling smooth testing services (at 19 Facilities and 8 Health Camps)

HIV TESTING FACILITY AND KITS AVAILABILITY STAUTS

PPTCT PROJECT - DISTRICT DUNGARPUR

S.No.Name of

the Blocks

HIV Testing Sanctioned

Facility

HIV Testing

Kits Not Available

ICTC PPTCT CHC PHC ICTC PPTCT CHC PHC

1Dungarpur

1 1 2 8 - - 2 3

2 Sagwara 1 - 3 9 - - 2 7

3 Simalwara - - 4 9 - - 1 8

4Bichhiwara

- - 3 9 - - 1 5

5 Aspur - - 3 6 - - 2 3

Total 2 1 15 41 - - 8 26

1. One of the crucial support areas is ensuring smooth HIV test kit supplies from the

RSACS - CMHO - RCHO level.

2. There is no supply of DBS test kits for long and hence, EID is almost stopped.

3. The Project has arranged 3090 HIV Test kits enabling smooth testing services (in 17

Camps and PHC/CHCs)

STATUS of REFERRALS OPTED HIV TESTING-PPTCT COUNSELING, & THE RESULTS

S.

No.

Name of the

Block

PALI District - April to Dec. 2013

Total

Referral

Total

VAC

used

Total HIV

Test

HIV

Positive

Male

HIV

Positve

Female

1 Rani 1434 1274 1220 0 5

2 Rohat 680 663 575 0 2

3 Sumerpur 1049 1024 1038 1 3

4 Sojat 1052 1005 1027 1 1

5 Desuri 1109 1035 1078 0 3

6 Marwar 627 604 606 0 0

7 Bali 1820 1608 1722 3 13

8 Raipur 395 351 383 0 0

9 Jaitaran 804 751 797 0 1

10 Pali 550 531 429 0 2

Total 9520 8846 8875 530

(0.32%)

S. No.Name of the

Block

Dungarpur District - April to Dec. 2013

Total

Referral

Total

VAC

used

Total

HIV

Test

HIV

Positve

Male

HIV

Positve

Female

1 Dungarpur 529 582 368 0 1

2 Sagwara 1569 1407 925 3 16

3 Bichhiwara 824 978 324 0 2

4 Aspur 957 1014 329 0 2

5 Simalwara 751 631 261 0 2

Total 4630 4612 2207 323

(0.45%)

Till Dec.2013, a total of 11,082 referrals opted for HIV counseling and testing (8875 in Pali and 2207 in Dungarpur), out of these, 39 (0.35%) pregnant women were found positive (29 +1 direct in Pali and 10 +13

direct in Dungarpur). All these 53 (39 + 14) +ve women are taken in to the PPTCT service-net & f-up.

In Pali: HIV Testing target 18201 (35.53% of estimated annual pregnancies) in Dungarpur: HIV Testing target 12105 (28.83%)

In the year-I, the project contribution to the RSACSs PPTCT annual testing target in the district was 49% in Pali & 18% in Dungarpur

STATUS of Block wise REFERRALS for HIV TESTING-PPTCT COUNSELING, & THE RESULTS

Jan. to Dec. 2014, a total of 19458 referrals opted for HIV counseling and testing (14045 in Pali and 5413 in Dungarpur), out of these,

44 (0.22%) pregnant women were found positive 36+24 direct in Pali and 8+8 in

Dungarpur), and all these 76 women are taken in to the PPTCT service-net & f-up.

S.No.

Name of

the

Blocks

JAN-DEC-2014

Total

Referral

Total

HIV Test

Total

VAC

used

HIV

Positve

Male

HIV Positve

Female

1 Rani 1990 1606 1003 0 6

2 Rohat 1258 1210 843 0 4

3 Sumerpur 1604 1520 470 0 10

4 Sojat 1285 1153 732 0 2

5 Desuri 1392 1299 675 0 11

6 Marwar 1336 1252 797 0 3

7 Bali 2718 2494 868 1 14

8 Raipur 1684 1540 1267 0 2

9 Jaitaran 1408 1327 762 0 1

10 Pali 699 644 419 0 7

Total 15374 14045 7836 1

60

(P36+G24)

(0.26%)

S.No.Name of the

Blocks

JAN-DEC-2014

Total

Referral

Total

HIV

Test

Total

VAC

used

HIV

Positve

Male

HIV

Positve

Female

1 Dungarpur 519 341 310 0 1

2 Sagwara 1685 1514 1274 0 13

3 Bichhiwara 1456 992 1166 0 0

4 Aspur 1284 1099 1118 0 1

5 Simalwara 1601 1283 1152 0 1

Total 6545 5229 5020 0

16,

(8+8)

(0.15%)

6870 5413 5322

Performance against the Key Indicators (Jan. To Dec. 2014)

Basic Project Indicators (January 2014-December 2014) Pali Dungarpur Total PercentageExpected Pregnancies in a Year (Jan to Dec) 47880 38879 86759Total Number of Women Contacted 15462 6883 22345 26%

Total Number of Contacted Pregnant Women where VAC was administered 7836 5322 13158 59%

Total Number of VAC Administered Pregnant Women found vulnerable through VAC 7192 2474 9666 73%

Percentage of pregnannt women with high vulnerability to HIV screened for HIV within 6 months of their pregnancy". 100% 100% 100% 100

Total Number of Contacted Pregnant Women Referred for Testing 15374 6870 22244 100%

Total Number of Referred Pregnant Women Tested 14045 5413 19458 87%

Total Number of Tested Pregnant Women Obtained Test Results 13941 5412 19353 99%Total Number of Tested Pregnant Women Found HIV+ (53 pregnant women were found HIV+ in 2013) 60 16 76 0.39%Total Number of HIV+ women delivered (of those identified HIV positive in 2014) (last year total delivered 39: 19 in Dungarpur, 20 in Pali) 51 15 66 87%Total Number of Institutional Deliveries (of those delivered so far in the project including 2013) (last year total Inst. deliveries 36: 18 in Dungarpur, 18 in Pali) 65 31 96 92%

Number of Referred Pregnant Women provided CCT for testing of self 3510 1709 5219 23%

Number of HIV+ women provided with CCT for testing of their babies 19 15 34 52%

Number of cases closed(10 cases closed in 2013) 14 7 21 28%

Number of Tested Pregnant Women whose husbands were referred for HIV testing 54 45 99 0%

Number of Babies referred to doctor for follow up (including 38 babies born in 2013) 36 12 48 46%

The Year & District Wise PPTCT Counselling &Testing ( and Positivity) and the PACF PPTCT Project Efforts

District year Sum of # tested Sum of # positive % positive

Dungarpur 2008 1604 10 0.62

Dungarpur 2009 1442 1 0.07

Dungarpur 2010 1355 5 0.37

Dungarpur 2011 4972 14 0.28

Dungarpur 2012 4939 17 0.34

Dungarpur April 2013 Dec. 14 15168 50 0.32

Total 2008 to 2014 29480 97 0.32

The PACF PPTCT Project Contribution

Dungarpur April 2013 to Dec 14

2207 (till Dec. 13)

5413 (Jan-Dec.14) 39 (10+8=18) 0.23%

7620 (April13 to Dec 2014)

District year Sum of # testedSum of #

positive% positive

Pali 2008 1485 6 0.4

Pali 2009 2728 1 0.04

Pali 2010 2636 13 0.49

Pali 2011 4156 13 0.31

Pali 2012 4439 18 0.41

Pali April 2013 Dec. 14 12901 42 0.32

Total 2008 to 2014 28345 93 0.32

The PACF PPTCT Project Contribution

Pali April 2013 to Dec. 14

8875 (till Dec. 13)

14045 (Jan-Dec.14) 90 (29+36 =65) 0.28%

22920 (April 2013 To Dec. 2014)

Note:

1. Data Source: RSACS for 2008 to 2014

2. PACF PPTCT Project results for April 2013 to Dec. 2014;

3. The data of RSACS for 2013 -14 includes the numbers tested and detected +ve through the project efforts but, not all the tested and

found +ve are entered in to the RSACS data (mainly due to the lack of reporting from FICTCs and synchronization).

From April 2013 till date, in 10 districts, IHAT ORWs have reached and followed up with 300 PPTCT cases linking the mother baby pair with the PPTT services

The year wise information on counselling and testing of pregnant women in the PPTCT (source: RSACS website)

Indicator 2004 2005 2006 2007 2008 2009 2010 2011 2012

Number registered - 77814 93184 154679 321676 376717 332223 420211 488665

Counselled at PPTCT - 34271 35523 86183 178303 262567 293482 388500 419986

Accepted HIV test 1557 2193 11284 52339 139034 225098 270923 368070 386067

HIV+ pregnant Women 6 23 33 107 250 351 371 411 367

% HIV +ve 0.38 1.04 0.29 0.20 0.1 0.16 0.13 0.11 0.09

% of MB pair received NVP - 22 40 28 43 54 65 75 91

The Challenges Huge Geography, less staff (originally proposed in different context)

Supply intervals in the HIV test kits

Non availability of DBS-PCR Testing facility (kits supply) and

The less number of facilities activated (staff trained in EID)

Issues of different types of reporting systems in PPTCT programme(un addressed synchronization needs)

The MDR introduced but still some pregnant women reporting receiving NVP (the issues related to govt. staff training and lack of update on MDR guidelines)

There is a greater need for supportive supervision and joint action at all levels by optimizing the govt. as well as the project resources

SUPPORT NEEDS Activation of all the planned HIV testing-counselling centres (block level ICTCs/PHC/CHCs)

Ensuring availability /regular HIV test-kit supplies (DBS-PCR)

Monthly sharing of the PPTCT programmes district wise reports, state MPR (thru e-mail)

ANMs and ASHAs to be encouraged/motivated for the improved PPTCT referrals (during their regular monthly meetings), should be asked for including the PPTCT referral data in their MPRs

Joint visits to the project fields by the IHAT-RSACS-NRHM officials, providing inputs in review, planning & implementation process, enabling a coordinated action

Regular State Project Steering Committee (SPSC) Meetings

The Plan of Action for 2015

Development of Block-Pool for Supportive Supervision (ASHA Coordinators Training-ToT)

Adaptation of ASHA Diary (bringing all formats in one; from the IHAT-TSU in Uttar Pradesh).

Reaching out to unreached villages so far/ more Health Camps

Advocacy with NHM to scale up (tested strategies)

Some film Clippings from the projectPPTCT PACF supported Project Album:

https://www.pacfonline.com/pg/profile/ihatrajasthanhttps://www.youtube.com/user/singhpriyamvadais

https://www.youtube.com/watch?v=n_5WMetWv1shttp://youtu.be/9AVr89IT3I0http://youtu.be/fql8_w6_40o

http://youtu.be/NB1O5RUBTvMhttp://youtu.be/Tp6CY9vKPY8

http://youtu.be/VcGQ4AXAoBshttp://youtu.be/mB7RRH6Jm0Mhttp://youtu.be/4jD0mFevPBw

http://youtu.be/6or2jj--u1chttp://youtu.be/ih79rT-zMcQhttp://youtu.be/H11suk6edhc

I am live..to tell the taleand for my baby http://youtu.be/fzGzONz1ra8

https://www.pacfonline.com/pg/photos/upload/3118/my-pptctpacf-album-pl-see-nine-video-clippings-uploaded-by-ihat-at-httpswwwyoutubecomusersinghpriyamvadais

The Resources (Developed by IHAT) REFERRAL STRATEGIES PROMOTING THE PREVENTION OF PARENT TO CHILD

TRANSMISSION (PPTCT) OF HIV

https://www.pacfonline.com/pg/file/ihatrajasthan/read/5817/cct-in-pptct-management_referral-strategies-of-the-project

Training Module is developed by IHAT, ORW induction training https://www.pacfonline.com/pg/file/ihatrajasthan/read/5614/training-of-outreach-works-and-the-front-line-workers-the-training-module-hindi

The ORW Training Module of IHAT was adapted /modified by BSS for the ANM trainings. https://www.pacfonline.com/pg/file/ihatrajasthan/read/5695/anm-training-module-pacf-pptct_ihat_bss_june-2013dpdf

Training Module for ASHA-AWWs orientations. https://www.pacfonline.com/pg/file/ihatrajasthan/read/5696/orientation-of-awws-ashas-the-pptct-orientation-kithindi

Training Material for the Staff orientation on the New MDR PPTCT Guidelines.

Thanks for your valued attention