GLOBAL HEALTH ADVOCATES INDIA ALONG WITH INP +, (INDIA'S LARGEST NETWORK OF PEOPLE LIVING WITH HIV/AIDS) HANDS OVER RECOMMENDATIONS FOR THE NEXT PHASE OF THE NATIONAL AIDS CONTROL PROGRAMME (NACP-IV) TO NACO (NATIONAL AIDS CONTROL ORGANISATION)
RECOMMENDATIONS BASED ON A COUNTRY WIDE CONSULTATION INCLUDE A RANGE OF SPECIAL FOCUS AGENDA POINTS ON TACKLING THE HIV-TB CO-INFECTION
GHA India (Global Health Advocates, India) along with INP +(INP+ has over 2,75,000 members in 26 states and 282 districts) has prepared a list of recommendations for the Government of India to consider while planning the next phase of National AIDS Control Programme(NACP IV) which will run from 2012 to 2017. NACO is expected to examine these recommendations while drawing up the National Strategic Plan in September 2011 for NACP IV for 2012-2017. INP + is a part of the working groups on Care and Support, Stigma and Greater Involvement of People Living with HIV set up by the National AIDS Control Organisation (NACO) to develop these recommendations.
The recommendations, developed from 7 regional nation-wide consultations( in Orissa, Calcutta, Pune, Imphal, Chennai, Lucknow and Delhi), cover three main areas: prevention of TB among PLHIV, improved ART treatment and early checking for resistance to first line of ARTs for people living with HIV/AIDS as well as with the TB-HIV co -infection and mainstreaming HIV into the health system.
TB is the leading cause of death for PLHIV in India contributing to more than half the deaths.
Among the major recommendations of TB/HIV consultation include a call for early scale up and availability of better and faster TB testing technology. These include the roll out of the molecular based NAAT (Nucleic Acid Amplification Test) tests which provides early diagnosis of pulmonary TB and Extra Pulmonary TB. The Stop TB partnership in its global plan to stop TB for 2011-2015 has listed a specific plan for saving a million lives by 2015 through scale up in testing for TB among PLHIV , earlier ART treatment and early and regular TB treatment. Stop TB targets an 80 percent detection and treatment rate for TB among PLHIV by 2015, currently less than 5 percent of PLHIV in India are automatically tested for TB.
K. K. Abraham, President of Indian Network for People Living with HIV/AIDS (INP+), pointed out that," These tests in future will also help to bypass the reluctance of health care provider in taking samples inform of pus/blood or Cerebrospinal Fluid (CSF) fluid in the case of Extra Pulmonary TB . Apart from these INP + has three top recommendations which can help save lives. These are to ensure a better quality diagnosis for early detection of first line treatment failure cases . This will save lives of PLHA waiting to get second line of ART. Other recommendations are Alternate Drugs (Tenofovier based) for first line ART and involving the PLHIV community in monitoring and evaluation".
These recommendations are based on a national consultation among all stakeholders including civil society, PLHIV and funding agencies. INP+ with technical assistance from GHA India has done 7 Regional consultations ( in Orissa, Calcutta, Pune, Imphal, Chennai, Lucknow and Delhi) where over 700 number of representatives from 21 states came together to discuss the gaps in the program specific to TB-HIV co-infection and develop the recommendations for that.
Outlining the set of points that emerged from the national consultations with regard to TB/HIV co-infection, Global Health Advocates India, Advocacy Coordinator, Mamta Jacob said, "Steps should be taken to introduce Isoniazid Preventive Treatment (IPT) for those PLHIV who are eligible. People living with HIV who are routinely exposed to TB should be protected against becoming ill with TB. Such protection is cheap and simple—a daily dose of isoniazid would help in preventing an HIV positive person who has latent TB infection from developing life threatening active TB."However Mamta Jacob added that in order to do that better TB diagnostic tools like molecular based NAAT (Nucleic Acid Amplification Test) tests, which are faster and accurate are needed in the future to correctly test for TB in HIV positive people.
She also pointed out that," there should also be wide spread and free of cost ( for HIV positive people) availability at the district hospital level of diagnostic methods like CT scans, Ultrasounds and MRI. These methods which are very important in diagnosing extra pulmonary TB in PLHIV are currently available only in 267 medical colleges nationally and are not free for HIV positive people. Jacob also pointed out the importance of infection control measures in ART (Anti retro viral Treatment) centres like safe disposal of sputum to prevent and reduce cross-infections of TB among PLHIV."
A final set of recommendations outline a plan for improving case findings for TB/HIV co-infection by targeting training of partners who work in affected networks like MSM and drug users; establishing a higher number of integrated centres where testing for both HIV and TB can take place and strengthening referrals and reporting between ART centres and TB testing centres( Link Plus and DMCs).
BACKGROUND TO THE CONSULTATION
NACO Consultation Process
To give specific inputs into the NACP phase IV plan, 15 Working Groups ( with 20+ sub-groups), with representation from different stake holders including Government departments, Civil Society, Development Partners and Private Sector have been set up. INP+ is part of the working groups on Care and Support, Stigma, Greater Involvement of People Living with HIV.
Integration of the TB and HIV/AIDS national programs
Under the joint initiative of NACO & RNTCP (Revised National TB Control Programme), the ‘National Framework for Joint HIV/TB Collaborative Activities' was revised for strengthening HIV-TB collaborative activities across the country. The National Technical Working Group for HIV/TB — comprising of key officials from NACO and the Central TB Division — regularly monitor the programme through a system for line listing. The Technical Working Group ensures: 1) fast tracking of patients co-infected with HIV and TB; 2) adherence to treatment Guidelines; 3) appropriate training of medical officers posted at ART centres on TB diagnosis and treatment. The intensified HIV/TB package of activities includes routine offer of HIV counseling and testing for all TB patients and linking all the identified HIV/TB patients to CST including treatment for TB, other OI and ART.
Source : India Country Report (2009-2010) : UNAIDS
ABOUT INP+ and Global Health Advocates India
INP + is an ISO 9001:2000 certified Community Based Organization – The Indian Network for People Living with HIV/AIDS (INP+) is a national network for people living with HIV/AIDS. INP+ is a social movement by and for People Living with HIV/AIDS (PLHIV) in enforcing the recognition for Human Rights of PLHIV in India. INP+ has waged a long and intensive struggle against fear, ignorance, prejudice and despair born out of the epidemic and stood to represent courage, insight, acceptance and hope to hundreds and thousands of People Living with HIV/AIDS.
Global Health Advocates (GHA) India is a non-governmental organization that focuses on engaging all sections of society to fight diseases that disproportionately affect people living in poverty, and are also causes of people living in poverty. In particular, Global Health Advocates India works towards the formulation and implementation of effective public policies to fight disease and ill health in India. GHA India runs The Advocacy to Control Tuberculosis Internationally (ACTION) project, an international partnership of advocates working in 7 countries to mobilize political will and resources to treat and prevent the spread of tuberculosis (TB), a global disease that kills one person every 20 seconds.