ICTC

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What is Integreted Counselling and Testing

Integrated Counselling and testing is a combination of two activities – counselling and testing . HIV testing has generated interest not only among medical community but also amongst the general public. Testing for HIV involves ethical, human and legal dimensions apart from mere biological testing.

In India, HIV testing carried out on a voluntary basis with appropriate pre-test and post-test counselling is considered to be a better strategy and is in line with the National HIV Testing Policy as well as the WHO guidelines.

Objective of ICT

To make HIV testing facility easily available at a cheaper cost with proper pre and post-test counselling to all individuals who are willing to get tested/ referred for testing by Health Care Institutions such as TB Clinic, Blood Bank, ANC Clinics & STD Clinics.

Role of ICT Centre

To identify individuals with HIV infection for diagnosis or voluntary testing purposes. Persons can come Voluntarily for testing if they have performed risk behaviour or if someone suspects/feels that he/she may have HIV/AIDS.
To provide pre-test and post test counselling.
To provide testing facility to cases referred by other doctors, STD Clinics, ANC Clinics etc.

 

Because ICTC is adaptable to clients’ needs, testing and counselling can be done for individuals and couples, for people of all ages and of all backgrounds. Counseling services, with or without testing, can and should be tailored to the needs of particular client groups, some of which have very different needs.

These groups include:

 

Women (regardless of their HIV status), who are or who want to become pregnant.
Couples who agree to attend sessions together before and after testing.
Children, including those living with HIV/AIDS, or who are part of a family in which one or both of the parents are either infected with the virus or have died of AIDS.
Young people, both in and out of school.
Injecting Drug Users (including those who are young people).
Sex Workers (including those who are young people).
Other socially marginalized or vulnerable groups such as Homosexuals, migrants, etc.

At present there are 50 ICTC�s in Madhya Pradesh.

Background

Parent-to-child transmission (PPTCT) of HIV, or perinatal transmission, accounts for 2.72 percent of the total HIV infection load in the country. Parent-To Child Transmission (PPTCT) of HIV can occur during pregnancy, at the time of delivery or through breastfeeding. If an HIV positive woman becomes pregnant, there is a 25-30% chance that the baby will also be infected. More than 27 million women, including over 92,000 HIV infected women, give birth in India every year. The number of HIV-positive women is increasing, and with it, the number of babies with HIV infection. Fortunately, Parent-to-Child Transmission (PPTCT) can be prevented with a combination of low-cost, short-term preventive drug treatment, safe delivery practices, counseling and support, and safe infant-feeding methods.

Vision

To ensure that all women in India may remain free of HIV infection, and have access to the services & support needed to protect their children from becoming infected with HIV.

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Elements of the PPTCT programme:

� Primary prevention of HIV infection in young people & women of child bearing age through promotion and provision of free, subsidized or commercially marketed condoms, provide diagnosis for treatment of sexually transmitted diseases, and behaviour change communication efforts to reduce behaviour that place individuals at risk, and information about risks of PTCT during pregnancy, delivery, breastfeeding & encouragement to see ict counselor or health provider for information on how to prevent HIV/AIDS among infants & young children.

� Prevention of unintended pregnancies in HIV positive women through reproductive health services, which include family planning.

� Prevention of transmission from an HIV positive women to her infant through anti-retroviral (ARV) prophylaxis and safer delivery practices

� Care and support services to HIV-infected women who are enrolled with the programme and to their children and families, including counselling on infant feeding.

Providing PPTCT services

M.P. State AIDS Control Society provied this service through 5 Medical Colleges namely Gandhi Medical College Bhopal, Mahatma Gandhi Memorial Medical College Indore, Shyam Shah Medical College Rewa, Netaji Subhash Chandra Bose Medical College Jabalpur, Gajra Raje Medical College Gwalior. These centres have provided support in the scale up of PPTCT services in Mahdya Pradesh.
Implementing of PPTCT

The PPTCT services are provided in the antenatal clinics of all the medical college hospitals.

The Road ahead

We need to focus on early completion of :

� Adapting & disseminating in local languages the guidelines on counselling for infant feeding and HIV
� Sensitising health care providers to eschew all stigma and discrimination vis a vis clients
� Providing specific training to service providers to improve counselling skills
� Sensitising communities to create a more caring & supportive environment for HIV affected families
� Increasing awareness and comprehension abour the importance & benefits of preventing HIV transmission from Parent to child..

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�Anti retroviral Drugs(ART)

About two decades have passed since the HIV/AIDS has entered the medical horizon. As yet, no curative treatment has been found. However, 4 years after the virus was discovered, first drug for treatment of HIV infection was discovered by the scientists. The scientists discovered agents which act somewhere in the life cycle of the virus in the body, that will stop the replication of the virus. The first drug, which was discovered in 1987, acted on the reverse transcriptase enzyme so that pro virus DNA would not be formed. Since then, various drugs acting on the reverse transcriptase have been discovered. Two groups of drugs: 1) Nucleoside Analogue and 2) Non-nucleoside analogue was discovered till 1998. In 1998, another group of drugs was discovered and announced in the World Congress of AIDS in Vancouver . These were the drugs, which acted on the enzyme protease, which helped in the maturation of m-RNA to mature virions. These drugs were known as protease inhibitors. So, the anti retroviral drugs, which acts on the various stages of the life cycle of the virus in the human body stop the replication of the virus but does not get the virus out of the human cell where they are firmly integrated. These drugs, though most of them are available in India , are very costly and the government of India does not support the treatment by these drugs in the program, as, inspite of the reduction of the cost per patient cost of treatment of these drugs is about Rs. 11,000 – Rs 15,000 per month. However, in the training programs the physicians are apprised about the utility of these drugs as well as their side effects.

 

The drugs available in India are as follows

1.      Reverse transcriptase inhibitors

i.            Nucleoside analogue
AZT (azidothymidine, zidovudine) – 100 mg. each tablet
DDC (zalcitadine) – 75 mg. Tablet each
Stavudine – 100 mg. Tablet each
Lamivudine – 150 mg. Tablet each

ii.            Non-nucleoside analogue
Nevirapine – 200 mg. Tablet each

2.      Protease inhibitors

i.            Saquinavir

ii.            Ritonavir

iii.            Indinavir

(VI) Post exposure prophylaxis

The following drugs are only used for post exposure prophylaxis and supported by the Government of India

Zidovudine – 300 mg. twice daily for 4 weeks
Lamivudine – 150 mg. twice daily for a period of 4 weeks
Indinavir – 800mg. Thrice daily (only when indicated as part of expanded regime)

Detailed guidelines have been issued to all DACS for further dissemination to all hospitals in Public, Private and voluntary sectors. MPSACS has provided funds to all District AIDS Control Societies for this purpose with the direction that the above drugs should be made available in all Government Hospitals who are admitting patients with HIV/AIDS.

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