ICTC

Integrated Counselling & Testing Centre (ICTC)

1. Integrated Counselling & Testing Centre (ICTC) 1

2. Introduction HIV counselling and testing services were started in India in 1997. The main functions of an ICTC are: Conducting HIV diagnostic tests. Link people with other HIV prevention, care and treatment services. 2

3. Overview: National AIDS Control Program 1992: National AIDS Control Program Initiated 1997: VCTC services started in the country (voluntary counseling & testing centers) 1999: NACP II Initiated (99-06) 2000/2001: 11 centers of excellence conduct PPTCT ( Prevention of parent to child transmission) 2001: Operational guidelines for PPTCT and VCT (revised in ’04 & ’07) 2002: PPTCT services started throughout the country 2003: GFATM : support to PPTCT 2004: GFATM : support to HIV-TB coordination 2006: NACP-III framework designed, Integration of VCTC and PPTCT as ICTC 2007: Provider Initiated testing for ANC mothers, TB patients, STI patients, HRG population. 2014 : NACP-IV launched for 5 years(2012-2017). 3

4. HIV Stats Among the States/UTs, in 2015, Manipur has shown the highest estimated adult HIV prevalence of 1.15%, followed by Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh & Telangana (0.66%), Karnataka (0.45%), Gujarat (0.42%) and Goa (0.40%). Besides these States, Maharashtra, Chandigarh, Tripura and Tamil Nadu have shown estimated adult HIV prevalence greater than the national prevalence (0.26%), while Odisha, Bihar, Sikkim, Delhi, Rajasthan and West Bengal have shown an estimated adult HIV prevalence in the range of 0.21– 0.25%. 4

5. NACP III Component 1: Intensifying and Consolidating Prevention services with a focus on HRG and vulnerable populations TI (Targeted interventions) for HRG & intervention among low-risk population ICTC (VCTC + PPTCT) 5

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7. What is an Integrated Counselling and Testing Centre? Under NACP-III, Voluntary Counselling and Testing Centres (VCTC) and facilities providing Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) services are remodelled as a hub or ‘Integrated Counselling and Testing Centre’ (ICTC) to provide services to all clients under one roof.. 7

8. Who needs to be tested in an ICTC? Subpopulations who are more vulnerable or practice high-risk behaviour like Female sex workers (FSW) Injectible drug users (IDUs) high risk group (HRG) M en who have sex with men (MSM) Clients of FSW Truckers Bridge population M igrant workers S pouses and children of men who are prone to risky behaviour (vulnerable population) 8

9. ROLE OF AN ICTC Early detection of HIV. Promoting behavioral change and reducing vulnerability. 9

10. GATHER Approach G = Greet the client A = Ask about the problem Active listener Assess degree of risk behavior Show respect and tolerance Enable patient or client to express freely Determine access to support and help in family and community T = Tell the client about specific information that he or she desires H = Help them to make decisions E = Explain any myths or misconceptions(also known as INFORMED DECISION MAKING) R = Return for follow up or Referral 10

11. Where can an ICTC be located? An ICTC is located in In public sector organizations/other government departments such as the Railways, Employees' State Insurance Department (ESID) in sectors where nongovernmental organizations (NGOs) have a presence. In the health facility, the ICTC should be well coordinated with the Department of Medicine, Microbiology, Obstetrics and Gynecology, Paediatrics, Psychiatry, Dermatology, Preventive and Social Medicine. 11

12. Different types of ICTCs 12 1805 4537 9196

13. Level of HIV counseling and Testing services in India 13 SA-ICTC SA- ICTC F -ICTC MOBILE ICTC Reaching HRG, Unreachable population

14. Physical Infrastructure required for an ICTC The counselling room Blood collection and testing room- refrigerator,centrifuge,needle destroyer,micropipette,colour coded waste disposal bins CD4 count room 14

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16. Human resources for an ICTC The ICTC requires a team of skilled persons consisting of the manager (medical officer), counsellor and LT. 1. ICTC manager (medical officer)-- The administrative head of the facility where the ICTC is located must identify and nominate a medical officer as manager in-charge of the ICTC. Counsellors- -The counsellor should be a graduate in Psychology/Social Work/Sociology/Anthropology/ Human Development or hold a diploma in Nursing with a minimum of 3–5 years of experience in the field of HIV/AIDS. 4. Laboratory technician- - The LT should hold a Diploma in Medical Laboratory Technology (DMLT) from an institution which is approved by the state government 5. Outreach workers – Mobilize & Follow up Patients. Follow up the mother–baby pair till 18 months after delivery. 16

17. KITS USED FOR TESTING SD BIOLINE HIV test is an immunochromatographic (rapid) test for qualitative detection of antibodies specific to HIV-1 and HIV-2 in plasma/serum/whole blood. Manufactured by SD BIO STANDARD DIAGNOSTICS PVT. LTD. - sensitivity=100% -specificity=99.8% 17

18. 18 SD BIOLINE HIV test

19. HIV TRISPOT TEST KIT: It is a rapid Trispot test to detect antibodies to HIV-1 & HIV-2 in human serum/plasma. Manufactured by BHAT BIO-TECH INDIA(P) LTD. -sensitivity=100% -specificity=99.7% 19

20. 20 HIV TRISPOT TEST KIT

21. COMBAIDS –HIV immunodot test kit: It is for the detection of antibody to HIV 1 and/or HIV 2 in whole blood /serum /plasma. Manufactured by Span Diagnostics Ltd. -sensitivity=100% -specificity=100% 21

22. COMBAIDS HIV-1/2 IMMUNODOT TEST KIT 22

23. STRATEGY 3 For individual diagnosis of patients ,ICTC uses STRATEGY 3 which is as follows: All samples are tested with one rapid test.(SD BIOLINE HIV-1/2 3.0 test). If test result is NON-REACTIVE : final report NEGATIVE. If test result is REACTIVE then sample is tested again by different systems (TRIDOT &BI-DOT tests). Results can be REACTIVE or NON-REACTIVE. If result is REACTIVE with 2 nd & 3 rd antigen test then report is POSITIVE. If result is NON-REACTIVE with either 2nd or 3 rd antigen test ,then report is INTERMEDIATE. If result is NON-REACTIVE with 2 nd & 3 rd antigen test then report is NEGATIVE. 23

24. When is ART (Anti-retroviral therapy) initiated?   Criteria for ART If CD4 is between 200-250, this should be repeated in four weeks and treatment to be considered in asymptomatic patients Adherence to ART regimen is vital in treatment. Any irregularity in following the prescribed regimen can lead to resistance to HIV drugs, and therefore can weaken or negate its effect. ART centres are located in medical colleges, district hospitals and non-profit charitable institutions providing care, support and treatment services to PLHIV.   24

25. PREVENTION OF PARENT TO CHILD TRANSMISSION ( PPTCT) The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme was launched in the country in the year 2002 following a feasibility study in 11 major hospitals in the five high HIV prevalence states. The PPTCT programme aims to prevent the perinatal transmission of HIV from an HIV infected pregnant mother to her newborn baby. The programme entails counselling and testing of pregnant women in the ICTCs. Currently, there are more than 15000 Integrated Counselling and Testing Centres (ICTCs) in the country, most of these in government hospitals, which offer PPTCT services. Of these ICTCs, nearly 550 are located in Obstetrics and Gynaecology Departments and in Maternity Homes where the client load is predominantly comprised of pregnant women.   25

26. Services to Pregnant Women Offer HIV counselling and testing. Moving from ANC centric to Family Centric ART to all HIV pregnant women regardless of CD4 count and who staging. Preferred regimen is TDF(TENOFOVIR)+ 3TC(LAMIVUDINE)+EFV(EFAVIRENZ) Promoting institutional delivery Provision of care for associated conditions. Counselling for exclusive breastfeeding up to 6 months 26

27. Services to HIV exposed infants(HEI ) Exclusive breastfeeding up to 6 months ARV prophylaxis up to 6 weeks with Nevirapine syrup which can extend to 12 weeks if duration of ART of mother is less than 24 weeks CPT ( clotrimoxazole prophylactic therapy) initiated after 6 weeks . Confirmatory test done at 6 months, 9 months, and 12 months after cessation of breast feeding. Lifelong ART at the earliest if confirmed HIV positive . 27

28. Comprehensive management given to minimize the risk of infection following potential exposure to blood-borne pathogens e.g. HIV. This includes: 1. First aid 2. Counseling 3. Risk assessment 4. Relevant laboratory investigations based on informed consent of the exposed person. 5. Depending on the risk assessment, the provision of short term (4 weeks) of ART. 6. Follow up and support 28 POSTEXPOSURE PROPHYLAXIS

29. HIV COUNSELLING HIV/AIDS counselling/education is a confidential dialogue between a client and a counsellor aimed at providing information on HIV/AIDS and bringing about behaviour change in the client. It is also aimed at enabling the client to take a decision regarding HIV testing and to understand the implications of the test results. Steps:- 1. HIV pre-test counselling/information 2. HIV post-test counselling 3. Follow-up counselling 29

30. Objectives 1. Facilitating decision to undergo HIV test 2. Providing psychological, social and emotional support for • People who have contracted the virus and • Others affected by the virus. 3. Preventing transmission of HIV by • Providing information about risk behaviours (such as unsafe sex or needle-sharing) • Motivating people to take good care of their health, • Assisting them to develop personal skills necessary for behaviour change, • Adopting and negotiating safe sexual practices. 4. Ensuring effective use of treatment programmes by • Establishing treatment goals and • Ensuring regular follow-up. 30

31. PRE- TEST COUNSELLING Information should be simple and up to date. Pre test counseling helps a person to understand the possible results of an HIV test. It may be positive, negative or equivocal. The counselor must explain the meaning of each such test result. This should be utilized as an opportunity to assess the likely reaction of the client to a positive or negative test result. 31

32. POST-TEST Counselling Test Result? 32

33. WHAT IF NEGATIVE RESULT 33

34. WHAT IF POSITIVE RESULT 34

35. WHAT IF EQUIVOCAL RESULT 35

36. FOLLOW-UP counselling 36 In follow-up counselling there is a re-emphasis on adoption of safe behaviors to prevent transmission of HIV infection to others. Follow-up counselling also includes establishing linkages and referrals to services for care and support including ART, nutrition, home-based care and legal support.

37. Issues to be addressed by HIV/AIDS counselling HIV/AIDS counselling is intended to address the physical, social, psychological and spiritual needs of the client. Besides, the following issues should also be addressed: • Problems related to infection and illness • Death, bereavement • Social discrimination • Sexuality • Lifestyle • Prevention of transmission 37

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39. In order to adopt an appropriate strategy for prevention and control, we need to detect the spread of the disease in the country That is we need an area specific targeted intervention and best practice approach. So we have various surveillances; HIV sentinel surveillance HIV sero surveillance AIDs case surveillance STD surveillance Behavioral surveillance Integration with surveillance of other diseases like TB 39

40. HIV Sentinel surveillance Determine the level of HIV infection among general population and high risk groups. To understand the trends of HIV epidemic again in general population and high risk groups To understand geographical spread of HIV infection and to identify emerging pockets To estimate HIV prevalence and HIV burden in the country 40

41. Annual cross sectional survey of the risk groups In the same place for over a few years by unlinked anonymous serological testing procedures. 41

42. THANK YOU 42