APAC initiated efforts to scale up response for providing HIV care in public sector setting. As a pilot, Salem- a high prevalence  district was selected and training provided for all health care service providers/ functionaries in PHC, Taluq- hospitals and District headquarters hospitals. The training of the doctors, nurses, lab-technicians, ANM, VHN and other health-network staff was envisioned to facilitate early recognition and referral for appropriate care at the primary point of contact between medical services and the community.

The main objectives of the program were:

• To provide training & build capacity of Health care providers in the government sector medical institutions

• To create a non stigmatizing and non discriminatory approach in the continuum of care services provided to PLHA by the HCP in the Government sector

• To improve the health seeking behavior of the PLHA & care givers

• To establish linkages with the NGOs/CBOs/Network for effective continuum of care in the government sector

SAATHII (Solidarity and Action Against the HIV Infection in India) was selected as the nodal agency for mainstreaming and strengthening government health system in a selected district for providing HIV /AIDS care and support services at home, community and institutional levels.

SAATHII is a non-government organization initiated in 2000 by a collective of professionals from public health, biomedical, social science, education and media fields. It works to build the capacity of agencies from both government and civil society that are on the frontlines of the response to HIV/AIDS in India. SAATHII implements programs in the following areas:

• Training and Technical Assistance to strengthen and expand HIV/AIDS prevention, care, support and treatment services

• Information Dissemination to bridge knowledge gaps and provide time-sensitive updates to service providers

• Networking to bring people from multiple sectors together and foster collaborations

• Advocacy for increased attention and political commitment on HIV/AIDS

Training

• 4 day residential training of trainers for doctors in District Headquarters

• 4 day residential training of trainers for nurses, labtechs, ANM, VHN in District Headquarters

• 3 day Taluk-level training for doctors( including exposure visit)(250 members)

• 3 day Taluk-level training for lab-techs,VHN, nurses etc.( including exposure visit) (750 members)

• 1 day refresher training of trainers for doctors in District Headquarters

• 1 day refresher training of trainers for nurses, labtechs, ANM, VHN in District Headquarters

Onsite support for PHC, taluk HQ & district HQ hospital staff

Coordination meetings

• Planning Meeting among HCP and TA Team at Dt HQ

• Coordination Meeting among HCP and TA Team at Taluk Hospital

• District-Coordination Meeting at Dt. HQ

Resource mobilization for PHC

Training

• Trained 1050government sector medical & paramedical staff in Salem district

Onsite support

• Fortnightly visits to PHC, THQ hospitals

• Better collaboration among the various PHC

• Developed a uniform system of reporting HIV cases to the SACS

Resource mobilization

• Mobilize resources for the PHC in the form of BP apparatus, weighing machines, wheel chairs, needle destroyers, etc

Linkages

• Development of linkages with the PHC , NGOs & the local stakeholders for providing a continuum of care service

• The project was entirely handed over to the district health authorities for continuation.

This model had given clarity in the concept of mainstreaming HIV/AIDS care in the government sector. The concept of training followed by onsite support had given a confidence for the primary care physicians to manage OI at their PHC level. Involvement of the local stakeholders had led to very good community mobilization & advocacy for this disease.

This model of mainstreaming proved to be a cost effective one and could be replicated in other districts of India.

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