About Link ART+ Center
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It has been observed that nearly 25-30% of persons detected HIV positive at ICTC are not accessing care, support & treatment services. Reasons for this could be many including persons being asymptomatic at the time of detection and long distances to reach the ART centre for registration and basic investigations which may lead them to postpone/delay their visit to ART Centres till they become symptomatic. It has also been observed that nearly 20% patients reach ART Centres at a very late stage (CD4 count <50), when the risk of mortality is nearly 2-3 times higher.
In view of the above facts, the scope and functions of select Link ART Centre have been expanded to include Pre-ART registration and HIV care at LAC itself. The LAC, which shall perform Pre-ART management also, shall be designated as “LAC plus” This shall help to bridge the gap between ICTC (Counseling & Testing services) and CST (Care, Support & Treatment) services and also reduce the travel cost and travel time of PLHIV in accessing ART services. These patients shall be followed up at LAC plus till they become eligible for ART or referred to ART Centre for any other reason.
Objectives of LAC plus Scheme:
- To reduce the travel cost and travel time in accessing ART services
- To increase the access to HIV care for the PLHIV.
- To improve the drug adherence of patients on ART
- To bridge the gap between counseling & testing services and Care, Support & Treatment services
- To integrate HIV Care, Support & Treatment services with the Primary / Secondary Health Care system (NRHM).
- To build the capacity of the health care providers at the Primary/secondary Health Care Level for Care, Support and Treatment services for sustainability of services. (Integration with NRHM)
Functions of LAC plus:
In addition to the functions mentioned in LAC, the LAC plus shall also perform following functions:
Pre – ART Care
The patient detected HIV positive at ICTC would be referred to nearest LAC plus/ ART Centre as per patient‟s convenience for registration in HIV care, baseline investigations and further follow up. The blood sample for CD4 testing for PLHIV registered at LAC plus shall be collected at LAC plus itself on a pre-fixed day and sent to nodal ART Centre. Pre-ART follow up shall be done at LAC plus till the time PLHIV becomes eligible for ART or has a major OI. Once the PLHIV becomes eligible for ART, he/she would be referred to Nodal ART Centre. LAC plus shall also identify & treat minor Ois in pre-ART patients and provide in-patient care, whenever required. Depending upon the capacity including diagnostic facilities and drugs, the facility may provide treatment of other Ois as well. The PLHIV shall also be referred to nodal centre for any other illness that cannot be managed adequately at LAC plus.
Screening of PLHIV for TB symptoms:
All PLHIV should be screened for TB and all patients with symptoms of TB should be referred to the nearest RNTCP unit for diagnosis and treatment of TB and to nodal ART Centre for initiation of ART. Intensified case finding for TB should be undertaken by LAC plus as per guidelines. The LAC plus shall have same HIV/TB tools as maintained at ART centre. However, they shall send the information of completed line list to their nodal ART Centre only where it shall be compiled and sent to SACS as per established procedure. No LAC plus shall send HIV- TB report directly to SACS.
Tracing MIS/ LFU (Pre-ART) cases
CD4 due list for Pre-ART PLHIV shall be maintained by LAC plus. The Missed/ LFU cases shall be traced by nurse & counselor through phone and outreach. Concerned ICTC, Link Workers, DLN and other outreach workers shall also be involved in tracing of MIS/ LFU cases.