You are on page 1of 132

SECTION FOUR

Annexures
Annexures
Annexure 1 Baseline Assessment 334
Annexure 2 Quick Reference Steps In using a Maleand a Female Condom 337
Annexure 3 Referral Linkage Organogram 339
Annexure 4 Disinfection of Needles and Syringes with Bleach 340
Annexure 5 Hand Hygiene Checklist 341
Annexure 6 Guidelines for Disposal of Used Disposable Needles and Syringes 342
Annexure 7 Guidelines for Disinfection and Sterilization 343
Annexure 8 Situational Guide - Cleaning up a Blood Spill on the Floor 344
Annexure 9 Situational Guide - Care of the Body after Death of a PLHIV 346
Annexure 10 NACO PEP Policy: Procedure to be followed after an Accidental Exposure to HIV
Infectious Fluid 347
Annexure 11 STI Syndrome Flowchart Management Urethral Discharge & Burning micturation 359
Annexure 12 STI Syndrome Flowchart Management of Scrotal swelling 360
Annexure 13 STI Syndrome Flowchart Management of Inguinal Bubo 361
Annexure 14 STI Syndrome Flowchart Management of Genital Ulcers 362
Annexure 15 STI Syndrome Flowchart Management of Vaginal Discharge 363
Annexure 16 STI Syndrome Flowchart Management of Lower Abdominal pain in females 364
Annexure 17 STI Syndrome Flowchart Management of Oral & Anal STIs 365
Annexure 18 STI Syndrome Flowchart Management of Molluscum and Ectoparastic infestation 367
Annexure 19 STI Syndrome Flowchart-Management of Ophthalmic Neonatorum 370
Annexure 20 Guide to Common Symptoms and Possible Aetiologies 370
Annexure 21 What a Nurse needs to know about Dementia and Delirium 372
Annexure 22 Comprehensive laboratory evaluation in HIV/AIDS 374
Annexure 23(a) Diagnosis of HIV infection among infants and children below 18 months 375
Annexure 23(b) Specimen Collection (by heel prick) and handling procedure
for HIV DNA PCR testing by Dried Blood Spot (DBS) sample collection 377
Annexure 24 Monitoring and follow up patients on ART: Recommendations in the National
Programme 382
Annexure 25 4 Prong NACO PPTCT Strategy 384
Annexure 26 PPTCT True or False Statements and Answers 388
Annexure 27 PPTCT: Three Safe Infant Feeding Options Some Important Points
You Could Keep In Mind When Counselling Mothers On Feeding Options 389
Annexure 28 Replacement Feeding Checklist 391
Annexure 29 Questions and Issues that must be assessed by the Nurse to Aid In
Preparing the Child And Family For ARV 392
Annexure 30 Ways to Promote ART Adherence in Children 393
Annexure 31 WHO Growth Monitoring Charts 394
Annexure 32 Dosing Schedule For Infants and children below 18 months 396
Annexure 33 Antiretroviral Therapy For TB patients 397
Annexure 34 Assuming the quality /amount of PTH 399
Annexure 35 Music Therapy 400
Annexure 36 National AIDS Control Organization (Phase III) 402
Annexure 37 List Of State AIDS Control Societies (SACs) 403
Annexure 38 List Of ART Centres 406
Annexure 39 List Of Community Care Centres (CCCs) 413
Annexure 40 Ice Breakers & Energizers 435
Annexure 41 Role Of Nurse at ART & CCCs 438
Annexure 42 Patient Treatment CardART White Card 439
Annexure 43 Counselling Checklists 448

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexures Page 333
ANNEXURE 1: BASELINE ASSESSMENT

BASELINE ASSESSMENT:
Focus on information that is significant to HIV care. Approach the assessment in a systematic, organized
manner using the information below as a guide.

Baseline assessment: Presented below is a checklist , one could use when assessing a patient
Focus on information that is significant to HIV care. Approach the assessment in a systematic, organized
manner using the information below as a guide.

I. FACTOR DETAILS

Name (Optional)
Age
Gender
Address (Optional)
Contact Details
Care Givers Contact Details
Entry Point (Services referring the patient for HIV care) :
(ICTC/ RNTCP/ Outpatient/ Inpatient/ Pediatric/ PPTCT
Centre/ STI Clinic/ ART Centre/ IDU outreach/
Sex Worker Outreach/ PLHIV Network/ MSM/
Private Practitioner/Self Referred
Employed (Y/N)
Occupation
For Pediatric Patients (under 15 yrs.):
Staying with (Own Family/ In a centre -
No family contact/In a centre - family
contact
Guardian /Caregivers Education
Date of admission or clinic visit

II. HIV status


Risk Factor for HIV: Heterosexual/MSM/ IDU/Mother to
child/Blood Transfusion/ Unsafe injection/Unknown
For IDUs: Substitution Therapy (Y/N)
When was the patient diagnosed with HIV?
Any complications (e.g. OIs)
What does patient know about HIV/AIDS?
Is patient being tested for HIV
If yes, is report available
HIV Status
If positive, any complication
If No, Check for window period
Repeat test if required
Has patient received counselling or medical care?

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 334 Section Four: Annexure-1
I. FACTOR DETAILS
III. Chief complaint
What is the main reason for which the patient
was hospitalised or came to clinic?
Significant presenting symptoms, complaints

IV. Significant recent medical history


Malaria, TB, STIs? HBV/ HCV/ Diabetes/
Hypertension/ Cardiovascular/ Other diseases?
Co existing Conditions
Is patient taking any medications?
ART Treatment History (Received-Y/N; Initial
CD4 Count/Drugs & duration
Prophylactic medications? Traditional remedies?
Any allergies
History of mental illness? Depression?
Previous hospitalisations? Surgery?
History of Alcohol use
History of smoking/ Substance use
For women:
LMP (Last Menstrual Period), pregnancy,
RTIs,Surgeries, Contraception and
Gynaecologic history?
For Pediatric Patients (under 15 yrs. of age):
Birth History Normal/ Caesarean/ Vacuum/Forceps)
Birth Weight
Neonatal Complications
Infant Feeding (Breast Feeding; till when/
Replacement Feed/Mixed)
DNA PCR Results
Neurodevelopment
Immunization Record

V. Relevant social history


Primary language
Family structure? Married, no of children?
Family income? Financial status?
Employment? Living situation?
Educational status/ literate?
Is anyone else in the family ill?
What is the partner spouse status
Have HIV? Spouse status
Who is the decision- maker in the family?
What is the Childrens status
Does anyone else know of patients HIV status?
Their reaction to the clients HIV status
Can the patient identify family member
community, faith based organization group
where they may receive support?
Does the patient use alcohol/drugs/cigarettes?

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-1 Page 335
I. FACTOR DETAILS
VI. Relevant sexual history
Nature and status of current sexual relationship(s) -
currently sexually active with spouse or one
significant partner or with multiple partners?
Men, women or both?
Current sexual practices vaginal, anal, oral sex?
Exchanging sex for money, drugs or other?
Use of condoms?
Other safe practises Eg. Mutual masturbation
VIII.Patient Self Appraisal
How is s/he feeling?
Change in weight - current weight and previous
weight if available
Mood changes
Weakness or fatigue
Respiratory symptoms (cough, breathlessness, chest pain)
GI symptoms (nausea, vomiting, loss of
appetite, diarrhoea, thrush)
Neurological symptoms (memory loss, headaches,
visual changes, neurological deficit)
GU symptoms (genital itching, sores, dysuria, incontinence)
Dermatological (rash, itching)
Pain (assess using the visual analogue pain scale)
Other
VIII. Significant physical exam findings
Significant vital signs at presentation
Weight, height, including assessment of wasting
& severity of dehydration
Note general appearance
Head & neck, including mouth & oral cavity
(Candidiasis, Hairy cell Leukoplakia)
Lymph nodes
Examination of eyes for jaundice, anaemia, etc
Examination of genitals for sores, rash, discharge
Examination of skin and mucous membrane for
rashes, common skin infections (fungal
infections, dermatitis, KS, HZV)
Examination of mental status: appearance,
behaviour, orientation and memory
IX. Significant results of lab and other investigations
If needed, confirmatory HIV test
CD4 count
Hemogram (CBC)
Full chemistry panel
Sputum AFB
TST (Mantoux) chest x-ray
Others, if needed
Current diagnosis or multiple diagnoses if available
Some questions to answer:
What is the WHO clinical stage of this patient?
Is this patient eligible for ART?

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 336 Section Four: Annexure-1
Annexure 2: Quick Reference Steps in Using a Male and
Female Condom

Steps in Using a Male Condom

Do Dont

Check expiry date Re-use condoms


Use condom correctly and consistently Store condoms in the sun
Use each condom only once Use the teeth or nails to tear the condom packet
Use water based lubricants Use oil-based lubricant
Think of dual protection Use condoms made with natural products
like lambskin as these are not protective
against HIV
Use the male and female condom together

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-2 Page 337
Steps in Using the Female Condom

Behaviour change communication: HIV transmission

1. 2.
OPEN END (Outer ring): Covers the HOW TO HOLD THE POUCH: Hold
area around the opening of the vagina. inner ring between thumb and middle
INNER RING used for insertion. Helps finger. Put index finger on pouch
hold the pouch in place. between other two fingers.

3. 4.
HOW TO INSERT IT: Squeeze the MAKE SURE PLACEMENT IS
inner ring. Insert the pouch as far as CORRECT: The pouch should not be
possible into the vagina. Make sure the twisted. Outer ring should be outside
inner ring is past the public bone. the vagina.

Fig. 2.7 How to use a female condom for vaginal sex

Proper use of the female condom (vaginal sex)


It is advisable to decide on the use of a condom with your partner beforehand as you may forget in
the heat of the moment.
Always check the expiry or manufacture date on the condom package to make sure it has not expired.
Make sure it is not more than 4 years old.
Using your fingers, carefully open the condom at the indicated place. Make sure your fingernails do not
damage the condom. DO NOT use sharp objects, such a scissors or a razor as they may cut the
condom.
Inspect the condom to make sure it is intact.
Rub the outside of the condom to evenly spread the lubricant inside the condom. Add the lubricant as
desired.
Find a comfortable position for inserting the condom.
Hold the condom at its closed end. Squeeze the inner ring (the ring at the closed end of the condom)
between the thumb and the middle finger with the forefinger between the two.
Spread the vaginal lips with the other hand, and insert the condom in the vagina.
Use your forefinger to push the inner ring all the way up in the vagina until you feel the pubic bone
with your finger.
Make sure the outer ring (at the open side of the condom) lies against the outer lips.
Guide and insert the penis inside the condom. Make sure the penis does not go underneath or beside
the condom.
If during intercourse the penis does not move freely, there is a sound, or the condom is moving in and
out with the penis, add lubricant (to the penis or inside the condom).
If the outer ring is pushed in the vagina or the penis goes beneath or to the side of the condom, stop
and put on a new condom.
Keep the condom on during intercourse. After ejaculation and after the penis is pulled out, squeeze and
twist the outer ring to avoid spilling semen and pulling the condom out of the vagina.
Wrap the condom in toilet paper and, as soon as possible, throw it away out of reach of others. Do
NOT flush the condom down the toilet.
NEVER reuse the condom.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 338 Section Four: Annexure-2
Annexure 3: Referral Linkage Organogram

Annexure 3: Referral Linkage Organogram

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-3 Page 339
Annexure 4: Disinfection of Needles and Syringes with Bleach

Injecting drug users often do not have access to a steady supply of disposable syringes, and re-use/share
needles with other IDUs. The procedure below can be taught to them to minimize the risk of HIV transmission
under such circumstances. Remember, where available disposable, unshared needles are always the first
choice.

Procedure:
It will probably take 5-10 minutes to follow the recommended procedures for
cleaning and disinfecting.
Fill the needle and syringe completely with clean water
Shake vigorously for 30 seconds, and shoot out the water into the sink or
onto the ground
Repeat the process
Then, completely fill the needle and syringe (to the top) with full-strength (not
diluted) liquid household bleach several times.
Keep the bleach for at least 30 seconds
Shoot out the bleach and repeat
Rinse the syringe and needle by completely filling several times with CLEAN
water.

Remember:
Cleaning and disinfecting should be done at two points of timeonce
immediately after use and again just before re-use of needles and syringes.
ALL used solutions should be disposed of (e.g. by placing in a waste container
or pouring down a sink or toilet or on the ground). DO NOT REUSE.
Every time the cleansing process is repeated, the more likely HIV and other
blood borne pathogens will be inactivated
Taking the syringe apart by removing the plunger may also improve the
cleaning/disinfection of parts that might be hard to reach (e.g., behind the
plunger).
Although it is important to follow all steps in the bleach disinfection procedures
to ensure maximum effectiveness, drug users who indicate they may be
unable to do so should be encouraged to perform as much of the process
as possible.
The more steps done, the more effective the disinfection process is likely to
be in reducing risk of HIV transmission.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 340 Section Four: Annexure-4
Annexure 5: Hand Hygiene Checklist

Procedure Done

Ensure short finger nails


Ensure water supply/ alcohol hand - rub solution
Remove accessories from hands
Pour soap solution / alcohol rub into hand or apply soap uniformly on the hand
Scrub both hands
Scrub palms and fingers
Scrub back of hands
Scrub fingers and knuckles
Scrub thumbs
Scrub finger tips and nails
Scrub wrists and up to elbows if needed
Wash hands ensuring removal of soap from all applied areas / if using
alcohol rub, rub all surfaces till dry (Do not wash with water)
Air dry or dry using clean towels

Keeping the above points in mind, think about what resources are required for regular efficient hand
hygiene and make a mental note to check if these are available at your centre.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-5 Page 341
Annexure 6: Guidelines for Disposal of Used Disposable
Needles and Syringes

No. Steps / Stages

Sever needles from disposable syringe immediately after administering injection using a needle
cutter/hub-cutter that removes the needle from disposable syringes or cuts plastic hub of
syringe from AD syringes
The cut needles get collected in the puncture proof container of the needle cutter/hub-cutter.
The container should contain an appropriate disinfectant and the cut needles should be completely
immersed in the disinfectant
Segregate and store syringes and unbroken (but discarded) vials in a red bag or container.
Send the collected materials to the common bio-medical waste treatment facilities. If such
facilities do not exist, then go to the next step.
Treat the collected material in an autoclave. If this is unavailable, treat the waste in 1%
hypochlorite solution or boil in water for at least 10 minutes. It shall be ensured that these
treatments ensure disinfection
Dispose the autoclaved waste as follows: (i) Dispose the needles and broken vials in a pit /
tank, (ii) Send the syringes and unbroken vials for recycling or landfill.
Wash the containers properly for reuse
Make a proper record of generation, treatment and disposal of waste

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 342 Section Four: Annexure-6
Annexure 7: Guidelines for Disinfection and Sterilization

Device Classification Devices Examples Type of Process Process Examples

High Risk Implants, scalpels, Sterilisation Steam under pressure,


Enters sterile tissue needles, other (cycle time per Dry heat, Ethylene oxide gas,
or vascular system, surgical instruments manufacturer) Chemical gas sterilizers
includes dental and Endoscopic
instruments accessories
Intermediate Risk Flexible Endoscopes, High-level Glutaraldehyde based
Touches mucous Laryngoscopes, disinfection formulations (2%) Stabilized
membranes or Endotracheal Tubes, (exposure time Hydrogen Peroxide (6%)
broken skin Respiratory Therapy 20 minutes) Household bleach (Sodium
and Anaesthesia Hypochlorite 5.25%
equipment, Diaphragm 1,000 ppm available
fitting rings, and other Chlorine = 1:50 dilution)
similar devices.
Thermometers Intermediate-level Ethyl or Isopropyl Alcohol
(oral or rectal) disinfection (70% to 90%)
(exposure time (do not mix oral and Rectal
> 10 minutes) Thermometers)
Smooth, hard Intermediate-level Ethyl or Isopropyl Alcohol
surfaces such as disinfection (70 to 90%) Phenolic
Hydrotherapy tanks (exposure time detergent (dilute per label)
> 10 minutes) Iodophor detergent (dilute
per label) Household bleach
(Sodium Hypochlorite 5.25%
1,000 ppm available
chlorine = 1:50 dilution)
Low Risk Stethoscopes, Low level Ethyl or Isopropyl Alcohol
Touches intact skin Tabletops, floors, disinfection (70 to 90%) Phenolic
Bedpans, (exposure time detergent (dilute per label)
Furniture, etc. > 10 minutes) Iodophor detergent (dilute
per label) Household bleach
(Sodium Hypochlorite 5.25%
100ppm available
chlorine = 1:500 dilution)

Copyright 1996 The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) 1016
Sixteenth Street NW, Sixth Floor, Washington, DC 20036
202-296-2742 Fax 202-296-5645 E-mail APICinfo@apic.org

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-7 Page 343
Annexure 8: Situational Guide - Cleaning up a Blood Spill on
the Floor

Instruct the hospital worker or cleaner to wear appropriate personal protective equipment: plastic
apron, shoes and disposable gloves.
Put a towel / gauze / cotton over the spill area to cover it completely.
Pour hypochlorite solution 10% over the covered cloth to soak it completely.
Leave the solution on the cloth for another 30 minutes without disturbance.
Carefully lift the cloth from the floor, mopping the whole spill onto the cloth and dispose into the
yellow bin.
Using a routine mop and soap water solution swipe the area and wash the mop and hang it out to
dry.
Remove gloves and dispose into red bin.
Wash hands under running water with soap and dry hands.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 344 Section Four: Annexure-8
HIV/AIDS and ART Training for Nurses Facilitator Guide
Section Four: Annexure-8 Page 345
Annexure 9: Situational Guide - Care of the Body after Death
of a PLHIV

HIV can survive in cadavers for a considerable amount of time (up to 16 days after death if stored at 2C.
Viable HIV has also been isolated from bone fragments, spleen, brain, bone marrow, and lymph nodes at
autopsy 6 days post-mortem.

Do Dont

Protect self by using PPE and avoiding Give bath to the dead body.
injuries Embalming bodies, especially when infected
Gloves, especially if the body has many with hepatitis B, hepatitis C, HIV or rabies as
wounds. it involves the extraction of infected material
Wear other PPE only if large quantities of from body as well as further exposure of
splashes of blood are anticipated. infected tissues and cant be guaranteed to
Bodies that need to be handled especially eliminate the risk of infection from the body.
directly from emergency rooms or after (If absolutely essential, use all PPE)
resuscitation procedures may contain
needles or other sharps. Care should
be taken to avoid needle stick and
sharps injuries.
Enclose the body in double plastic
sheet/bag to avoid contamination and
spread of infection
Remove PPE after the procedure
Discard PPE into linen bin for laundering or
dispose appropriately.
Wash hands after removing PPE.
A shower should be taken before leaving
the room.
Disinfect the environment and any other place
or item that is contaminated with body
secretions with 1% hypochlorite solution.
Educate relatives of deceased about
a. Body to be kept enclosed in the double
plastic sheet/bag with seal.
b. Need for burial or cremation as early
as possible,
c. Sealing the coffin is not required.
Disinfecting if needed and then washing
patients clothing, bed linen, and other
personal items.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 346 Section Four: Annexure-9
Annexure 10 : NACO PEP Policy: Procedure to be followed
after an Accidental Exposure to HIV Infectious Fluid

Do Do Not

Remove gloves, if appropriate Do not panic


Wash the exposed site thoroughly with Do not put pricked finger in mouth
running water
Irrigate with water or saline if exposure sites Do not squeeze wound to bleed it
are eyes or mouth
Wash skin with soap and water Do not use Bleach, Chlorine, Alcohol, Betadine,
Iodine or other antiseptics/detergents on
the wound

** Do - Consult the designated physician immediately as per institutional guidelines for


management of the occupational exposure **

Step 1: Management of Exposure Site First Aid


For skin if the skin is broken after a needle-stick or sharp instrument:
Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub.
Do not use antiseptics or skin washes (Bleach, Chlorine, Alcohol, Betadine)
After a splash of blood or body fluids:
To unbroken skin:
Wash the area immediately
Do not use antiseptics
For the eye :
Irrigate exposed eye immediately with water or normal saline
Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye.
If wearing contact lens, leave them in place while irrigating, as they form a barrier over the eye and
will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal
manner. This will make them safe to wear again
Do not use soap or disinfectant on the eye.
For mouth :
Spit fluid out immediately
Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times
Do not use soap or disinfectant in the mouth
Consult the designated physician of the institution for Management of the Exposure immediately.

Step 2: Risk assessment


The HIV sero-conversion rate of 0.3% after an AEB (for Percutaneous Exposure) is an average rate. The
real risk of transmission depends on the amount of HIV transmitted ( amount of contaminated fluid and the
viral load).
A designated person/trained doctor must assess the risk of HIV and HBV transmission following an AEB.
This evaluation must be made rapidly, so as to start any treatment as soon as possible after the accident

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 347
(Ideally within 2 hours but certainly within 72 hours). This assessment must be made thoroughly (because
not every AEB requires prophylactic treatment).

PEP must be initiated as soon as possible, preferably within 2 hours

Two main factors determine the risk of infection: the nature of exposure and the status of the source patient.

Step 2 (a): Assessing the nature of Exposure and Risk of Transmission


Three categories of exposure can be described based on the amount of blood/fluid involved and the entry
port. These categories are intended to help in assessing the severity of the exposure but may not cover
all possibilities.

Categories of exposure

Category Definition and example

Mild exposure: Mucous membrane/non-intact skin with small volumes


E.g. : a superficial wound (erosion of the epidermis) with a plain or low
calibre needle, or contact with the eyes or mucous membranes,
subcutaneous injections following small-bore needles
Moderate exposure: Mucous membrane/non intact skin with large volumes OR
Percutaneous superficial exposure with solid needle
E.g.: a cut or needle stick injury penetrating gloves.
Severe exposure: Percutaneous with large volume e.g.:
An accident with a high calibre needle (>=18 G) visibly
contaminated with blood;
A deep wound (haemorrhagic wound and/or very painful);
Transmission of a significant volume of blood;
An accident with material that has previously been used
intravenously or intra-arterially.

The wearing of gloves during any of these accidents constitutes a protective factor.
Note: In case of an AEB with material such as discarded sharps/needles, contaminated for over 48 hours,
the risk of infection becomes negligible for HIV, but still remains significant for HBV. HBV survives longer
than HIV outside the body.

Step 2 (b): Assessment of the Exposed individual


The exposed individual should have confidential counselling and assessment by an experience physician.
The exposed individual should be assessed for pre-existing HIV infection as PEP is intended for people
who are HIV negative at the time of their potential exposure to HIV. Exposed individuals who are known
or discovered to be HIV positive should not receive PEP. They should be offered counselling and information
on prevention of transmission and referred to clinical and laboratory assessment to determine eligibility for
antiretroviral therapy (ART). Besides the medical assessment, counselling of the exposed HCP is essential
to allay fear and start PEP (if required) at the earliest.

Step 2(c): Assessing the HIV status of the source of exposure


PEP needs to be started as soon as possible after the exposure and within 72 hours. In animal studies,
initiating PEP within 12, 24 or 36 hours of exposure was more effective than initiating PEP 48 hours or 72
hours following exposure. PEP is not effective when given more than 72 hours after exposure.
A baseline Rapid HIV testing should be done before starting PEP.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 348 Section Four: Annexure-10
Initiation of PEP where indicated should not be delayed while waiting for the results of HIV testing of the
source of exposure. Informed consent should be obtained before testing of the source as per national HIV
testing guidelines.

Categories of situations depending on results of the source

Source HIV Status Definition of risk in source

HIV negative Source is not HIV infected but consider HBV and HCV
Low risk HIV positive and clinically asymptomatic
High risk HIV positive and clinically symptomatic (see WHO clinical staging)
Unknown Status of the patient is unknown, and neither the patient nor his/her blood
is available for testing (e.g. injury during medical waste management the
source patient might be unknown). The risk assessment will be based only
upon the exposure (HIV prevalence in the locality can be considered).

HIV infection is not detected during the primary infection period by routine-use HIV tests. During the
window period , which lasts for approximately 6 weeks, the antibody level is still too low for detection
but infected persons can still have a high viral load. This implies that a positive HIV test result can help
in taking the decision to start PEP, but a negative test result does not exclude HIV infection. In countries
or population groups with a high HIV prevalence, a higher proportion of HIV-infected individuals are found
in the window period. In these situations, a negative result has even less value for decision-making on PEP.

Step 3: Informed consent from exposed person


Exposed persons (clients) should receive appropriate information about what PEP is about and the risk and
benefits of PEP in order to provided informed consent. It should be clear that PEP is not mandatory.

Key information to provide informed consent to the client after occupational exposure

Key information to Exposed Person (Client) Specific Details include

The risk of acquiring HIV infection from Ask client for understanding of HIV
the specific exposure transmission risk after exposure
The risk of getting HIV infection from a
person known to be HIV positive is estimated
to be
Sharps injury: 3 in 1000 exposures (0.3%)
Mucous membrane splash: 1 in 1000
exposures (0.1%)
the risk is increased with large exposure e.g.
needle-stick from hollow bore needles with
visible blood, from artery or vein and from
source patients with high viral load
(usually very sick persons with OIs)
What is known about PEP efficacy Ask Clients understanding of PEP
PEP is provided to prevent potential
transmission of HIV
PEP is not 100% effective and should be
given within 72 hours (ideally as soon as
possible, if eligible).
Balance risk and benefits of PEP: PEP may
prevent HIV transmission, versus possible
risk of side effects

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 349
Key information to Exposed Person (Client) Specific Details include

Information about clients risk of HIV Clients possibility of prior HIV infection
infection based upon a risk assessment should be assessed
(if s/he has not had a recent HIV test) Counsel for HIV testing and follow-up
The importance of being tested and psychosocial support where possible rapid
receiving appropriate post-test counselling testing should be used based on national
(although HIV testing can be delayed testing guidelines
if needed) Inform if the Baseline HIV test is positive,
PEP medicines will be discontinued then the PEP will be discontinued
if their initial (baseline) HIV test is positive Arrange referral to ART centres for
assessment if found HIV positive

Importance of adhering to medication Discuss dosing of the PEP medicine e.g.


once started Pill should be taken twice a day for 28 days,
Duration of the course of medicine once in the morning and once in the evening
(4 weeks) Depending on the nature and risk of exposure,
2 drugs or 3 drugs may be used
Side effects may be important with use of 3 drugs
Expert opinion/consultation by phone or
referral may be needed with a HIV specialist
if 3rd drug is to be used
Arrange for special leave from work
(2 weeks initially)

Common side effects that may be Discuss possible side effects of the PEP
experienced medicines e.g. Nausea, Fatigue, Headache
(depending on which drugs given)
Side effects often improve over time. It is
often minor and do not need specialised
supervision.
Symptomatic relief can also be given by
using other drugs

They can stop at any time but will Animal studies suggest that taking less than
not get the benefit of PEP if the source 4 weeks of PEP does not work
is HIV positive If client decides to stop at any time, s/he
needs to contact the physician before
stopping the medications
Arrange for follow-up visit and decide further
course of action/follow-up

Prevention during the PEP period e.g. After any AEB, the exposed person should
sexual intercourse and unplanned pregnancy not have unprotected sexual intercourse until
it is confirmed, 3 months after the exposure,
that s/he is not HIV infected.
It is also advised to avoid pregnancy.
Use of condoms is essential

If Client is pregnant she can still take The PEP drugs used are safe for pregnancy
PEP during pregnancy If the client gets HIV during the pregnancy
due to the exposure, the baby will have
some risk of becoming HIV infected

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 350 Section Four: Annexure-10
Key information to exposed person (client) Specific Details include

Safety of PEP if the client is breastfeeding The PEP drugs used are safe during
breast-feeding
May consider stopping breastfeeding if
PEP is indicated.

Educate client on the possible signs and Signs and symptoms of early HIV sero-
symptoms of early HIV sero-conversion conversation: Fever, Rash, Oral Ulcers,
Pharyngitis, Malaise, Fatigue, Joint Pains,
Weight loss, Myalgia, headache
(similar to Flu-like symptoms)

Risk of acquiring Hepatitis B and C from Risk of Hepatitis B is 9-30% from a Needle
a specific exposure and availability of Stick Exposure the client can be given
prophylaxis for this vaccinations
Risk of Hepatitis is 1-10% after Needle Stick
Exposure there are no vaccinations for this.

* Provider should correct misconceptions at all times during the counselling sessions

Psychological support:
Many people will feel anxious after exposure. Every exposed person needs to be informed about the risks
and the measures that can be taken. This will help to relieve part of the anxiety, but some may require
further specialised psychological support.
Documentation on record is essential. Special leave from work should be considered for a period of time
e.g. 2 weeks (initially) then, as required based on assessment of the exposed persons mental state, side
effects and requirements.

Practical application in the clinical settings:


Once Prophylactic treatment has begun, the exposed person must sign form A1.
Informed consent also means that if the exposed person has been advised PEP, but refuses to start
it, s/he should sign Form A1. This document should be kept by the designated officer for PEP.
An information sheet covering the PEP and the biological follow-up after any AEB may be given to the
person under treatment. However, this sheet cannot replace verbal explanations.
Arrange for follow-up visit and leave from work.

Step 4: Deciding on PEP Medications/Regimen

Deciding on therapy
There are two types of regimens:
a) Basic regimen: 2-drug combination
b) Expanded regimen: 3-drug combination
The decision to initiate the type of regimen depends on the type of exposure and HIV serostatus of the
source person. See Table 6.

HIV Post-exposure Prophylaxis Evaluation

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 351
Exposure Status of source
HIV+ and HIV+ and Clinically HIV status unknown
asymptomatic symptomatic

Mild Consider 2-drug PEP Start 2- drug PEP Usually no PEP or consider 2-drug PEP
Moderate Start 2-drug PEP Start 3-drug PEP Usually no PEP or consider 2-drug PEP
Severe Start 3-drug PEP Start 3-drug PEP Usually no PEP or consider 2-drug PEP

HIV testing of the source patient should not delay the decision about whether or not to start PEP. Start
2-drugs first if required, then send for consultation or refer.
In the case of a high risk exposure from a source patient who has been exposed to or is taking
Antiretroviral medications, consult an expert to choose the PEP regimen, as the risk of drug resistance
is high. Refer/consult expert physician. Start 2 drug regimens first.

Expert opinion may be obtained for the following situations:


(Refer to list of PEP experts on www.nacoonline.org)
Delay in reporting exposure (> 72 hours)
Unknown source: Use of PEP to be decided on case to case basis after considering the severity of
exposure and the Epidemiologic likelihood of HIV transmission. Do not delay PEP initiation if indicated
Known or suspected pregnancy: Do not delay PEP, if indicated
Breastfeeding issues in the exposed person: Do not delay PEP if indicated. Consider stopping breast
feeding, if PEP is indicated.
Source patient is on ART or possibly has HIV Drug resistance : Refer/Consult as soon as possible
Major toxicity of PEP regimen: minor side effects may be managed symptomatically. Refer to expert
if non-tolerance or non-adherence
Refer/ consult if in doubt or complicated cases (e.g. major psychological problem)

Step 5: Starting PEP


Various animal studies done over the years have provided encouraging evidence of post exposure
chemoprophylactic efficacy. Studies have also shown that delaying initiation, shortening the duration or
decreasing the antiretroviral dose of PEP, individually or in combination, decreased its prophylactic efficacy.
In a retrospective case control study of HCP, it was demonstrated that use of Zidovudine as PEP was
associated with a reduction in the risk of HIV infection by approximately 81%. Also the experience in HIV
infected patients has shown that combination of different antiretroviral agents is superior to monotherapy
regimen, so a combination of two or three drugs in PEP regimen should be more beneficial than a single
drug. One needs to consider toxicity of a combination regimen vis--vis risk of transmission.

PEP must be initiated as soon as possible, preferably within 2 hours

Initiate HIV Chemoprophylaxis


Because Post-Exposure Prophylaxis (PEP) has its greatest effect, if begun within 2 hours of exposure, it
is essential to act immediately. There is little benefit if >72 hours later. The prophylaxis needs to be
continued for 4 weeks.
Report exposure immediately to appropriate authority.
Fill in the medical form
Never delay start of therapy due to debate over regimen. Begin with basic 2-drug regimen, and once
expert advice is obtained, change as required.
The 3rd drug can be added after consultation with an expert.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 352 Section Four: Annexure-10
Dosages of the Drugs for PEP

Medication 2-drug regimen 3-drug regimen

Zidovudine (AZT) 300 mg twice a day 300 mg twice a day


Lamivudine (3TC) 150 mg twice a day 150 mg twice a day
1st choice : Lopinavir/Ritonavir (LPV/r)
400/100 mg twice a day or 800/200 mg
once daily with meals
Protease Inhibitors 2nd choice : Nelfinavir (NLF)1250 mg
twice a day or 750 mg three times a
day with empty stomach
3rd choice : Indinavir (IND)800 mg
every 8 hours and drink 6-8 litres
of water daily
Note: If Protease Inhibitor is not available and the 3rd drug is indicated, one can consider using Efavirenz
(EFV 600 mg once daily). Monitoring should be instituted for side effects of this drug e.g. CNS toxicity
such as Nightmares, Insomnia etc.

* Fixed Dose Combination (FDC) are preferred, if available. Ritonavir requires refrigeration.

PEP regimens to be prescribed by health centres:

Preferred Alternative

2-drug regimen 1st choice: 2nd choice:


(basic PEP regimen) Zidovudine (AZT) + Stavudine (d4T) +
Lamivudine (3TC) Lamivudine (3TC)
3-drug regimen (expanded PEP regimen) consult expert opinion for starting 3rd drug e.g.
LPV/r, NLF or IND
Not recommended ddI + d4T combination
NNRTI such as Nevirapine should not be used in PEP

More information on alternative schedules is available in the latest update USPHS guidelines issued 30
September 2005. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm) or www.who.int
Selection of the PEP regimen when the source patient is known to be on ART: The physician should
consider the comparative risk represented by the exposure and information about the exposure source,
including history of and response to antiretroviral therapy based on clinical response, CD4 cell counts, Viral
load measurements (if available), and current disease stage (WHO clinical staging and history). When the
source persons virus is known or suspected to be resistant to one or more of the drugs considered for the
PEP regimen, the selection of drugs to which the source persons virus is unlikely to be resistant is
recommended. Refer for expert opinion.
If this information is not immediately available, initiation of PEP, if indicated, should not be delayed.
Give the 2 drug (basic) regimen. Changes in the PEP regimen can be made after PEP has been started,
as appropriate. Re-evaluation of the exposed person should be considered within 72 hours Post-Exposure,
especially as additional information about the exposure or source person becomes available.

Antiretroviral Drugs during Pregnancy


If the Exposed person is pregnant, the evaluation of risk of infection and need for PEP should be approached
as with any other person who has had an HIV exposure. However, the decision to use any Antiretroviral

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 353
drug during pregnancy should involve discussion between the woman and her Health-Care Provider(s)
regarding the potential benefits and risks to her and her fetus.
Data regarding the potential effects of Antiretroviral drugs on the developing fetus or neonate are limited.
There is a clear contraindication for Efavirenz during entire pregnancy) instead use of Nevrapine is adviced
similarly, Indinavir is contraindicated during Pre-hatal record.
In conclusion, for a female HCP considering PEP, a pregnancy test is recommended if there is any chance
that she may be pregnant. Pregnant HCP are recommended to begin the basic 2-drug regimen, and if a
third drug is needed, Nelfinavir is the drug of choice.

Side-effects and Adherence to PEP


Studies of HCP taking PEP have reported more side effects than PLHIV taking ART, most commonly
Nausea and Fatigue. Possible side-effects occur mainly at the beginning of the treatment and include
Nausea, Diarrhoea, Muscular pain and Headache. The person taking the treatment should be informed that
these may occur and should be dissuaded from stopping the treatment as most side-effects are mild
and transient, though possibly uncomfortable. Anaemia and/or leucopoenia and/or thrombocytopenia may
occur during the month of treatment. A complete blood count and liver function tests (transaminases) may
be performed at the beginning of treatment (as baseline) and after 4 weeks.
In practice and from HCP studies, many HCP did not complete the full course of PEP because of side
effects. Side effects can be reduced by prescribing regimens that do not Include a Protease Inhibitor (PI),
by giving medications to reduce Nausea and Gastritis and by educating clients about how to reduce side
effects e.g. taking PEP medications with food. It is important that side effects should be explained before
initiating PEP so that the symptoms are not confused with symptoms of Seroconversion to HIV.
Adherence information is essential with psychological support. More than 95% adherence is important in
order to maximise the efficacy of the medication in PEP.

Management of Minor ARV drug side effects

Signs or symptoms Management at health facility

Nausea Take with food. If on AZT, reassure that this is common, usually self-limited.
Treat symptomatically.
Headache Give Paracetamol. Assess for Meningitis. If on AZT or EFV, reassure that
this is common and usually self-limited. If persists more than 2 weeks,
call for advice or refer.
Diarrhoea Hydrate. Follow diarrhoea guidelines. Reassure patient that if due to ARV,
this will improve in a few weeks. Follow up in 2 weeks. If not improved,
call for advice or refer.
Fatigue This commonly lasts 4 to 6 weeks especially when starting AZT. Give
sick leave from work. If severe or longer than this, call for advice or refer.
CNS side effects: This may be due to EFV. Take EFV at night before sleeping; counsel
Anxiety, nightmares, and support (usually lasts < 3 weeks). Initial difficult time can be managed
psychosis, depression with amitriptyline at bedtime.Call for advice or refer if severe depression
or suicidal tendencies or psychosis. (Stop EFV).
Blue /black nails Reassure. It is a non-threatening side effect, common with AZT
Rash If on EFV, assess carefully. Is it a dry or wet lesion? Call for advice.
If generalised or peeling, stop drugs and refer for expert opinion.
Fever Assess clinically for Hepatitis or if this could be Primary (acute) HIV
infection or other non-HIV related infections e.g. concurrent common cold.
Call for advice or refer.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 354 Section Four: Annexure-10
Signs or symptoms Management at health facility
Jaundice or Stop drugs. Call for advice or refer.
abdominal or (Abdominal pain may be pancreatitis from d4T.) If jaundice or liver
flank pain tenderness, send for ALT test and stop ART. Call for advice or refer.
Pallor Measure Haemoglobin. Refer if sever pallor or symptoms of anaemia or
very low haemoglobin (<8 grams). This may be due to AZT.
Tingling, numbers If new or worse on treatment, call for advice or refer. Patient on d4T/3TC
or painful feet/legs should have the d4T discontinued substitute AZT if no anaemia
(check haemoglobin).

Amount of medication to dispense for PEP


All clients starting on PEP must take 4 weeks (28 days) of medication. In all cases, the first dose of PEP
should be offered as soon as possible, once the decision to give PEP is made. HIV testing or results of
the source HIV test can come later. As usage of PEP drugs is not frequent and the shelf life is 1 to 1.5
years, it is proposed that:
Starter packs for 7 days can be put in the Emergency Department with instructions to go to a
designated clinic/officer within 1-3 days for a complete risk assessment, HIV counselling and testing
and dispensing of the rest of the medications and management. At least 3 such kits are provided in
the casualty department.
It is important to monitor and regularly follow-up the person once PEP is started.

Post-Exposure Measures against Hepatitis B and C 20

HEPATITIS B
All health staff should be vaccinated against Hepatitis B. The vaccination for Hepatitis B consists of 3
doses: initial, 1 month, and 6 months. Sero-conversion after completing the full course is 99%.

HBV vaccination after an AEB:

HBV vaccination status of Exposed Person Action after AEB

* Anti-HbS level > 10 IU/L No action


* Anti-HbS level <10 IU/L Hep B Vaccine Booster
Vaccinated, anti-HbS not known Hep B Vaccine Booster
Vaccinated more than 5 years ago Hep B Vaccine Booster
Never vaccinated Give complete hepatitis B vaccine series

* Antibody test (anti-HbS level), if available, is not necessary.

HEPATITIS C
There is presently no prophylaxis available against hepatitis C. There is no evidence that Interferon,
pegalated or not, with or without Ribavirin is more effective when given at this time than when given
at the time of disease. Post-Exposure management for HCV is based on early identification of chronic
HCV disease and referral to a specialist for management.

Step 6: Follow up of an exposed person


Whether PEP prophylaxis has been started or not, follow up to monitor possible infections, and psychological
support are indicated.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 355
Laboratory follow-up

Laboratory tests after AEB

Timing In persons taking PEP In persons not taking PEP


(standard regimen)

Baseline HIV-Ab, anti-HCV, HBsAg * HIV-Ab, anti-HCV, HBsAg *


(within 8 days after AEB) Complete blood count
Transaminases
Week 2 and 4 Transaminases ** clinical monitoring for hepatitis
Complete blood count ***
Week 6 HIV-Ab HIV-Ab
Month 3 HIV-Ab, anti-HCV, HBsAg HIV-Ab, anti-HCV, HBsAg
Transaminases**
Month 6 HIV-Ab, anti-HCV, HBsAg HIV-Ab, anti-HCV, HBsAg
Transaminases**

*HIV, HBV and HCV testing of exposed staff within 8 days of an AEB is required (baseline serostatus).
Offer an HIV test in case of an AEB, as a positive HIV status may indicate the need to discontinue
PEP. The decision on whether to test for HIV or not should be based on informed consent of the exposed
person.
** Transaminases should be checked at week 2 and 4 to detect hepatitis in case the exposed person
contracted HBV from the AEB.
*** For persons started on AZT-containing PEP regimens

Clinical follow-up
In addition, in the weeks following an AEB, the exposed person must be monitored for the eventual
appearance of signs indicating an HIV seroconversion: Acute Fever Generalised Lymphadenopathy,
Cutaneous Eruption, Pharyngitis, non-specific Flu symptoms and Ulcers of the mouth or Genital area.
These symptoms appear in 50%-70% of individuals with an HIV primary (acute) infection and almost always
within 3 to 6 weeks after exposure. When a primary (acute) infection is suspected, referral to an ART centre
or for expert opinion should be arranged rapidly.
An exposed person should be advised to use precautions (e.g., avoid Blood or tissue Tonations, Breastfeeding,
Unprotected sexual relations or Pregnancy) to prevent secondary transmission, especially during the first
6-12 weeks following exposure. Condom use is essential.
Adherence and side effect counseling should be provided and reinforced at every follow-up visit. Psychological
support and mental health counseling is often required.

Follow-up HIV testing:


Exposed persons should have post-PEP HIV tests. Testing at the completion of PEP may give an initial
indication of seroconversion outcome if the available antibody test is very sensitive. However, testing at 4-
6 weeks may not be enough as use of PEP may prolong the time to seroconversion; and there is not
enough time to diagnose all persons who seroconvert. Therefore, testing at 3 months and again at 6
months is recommended. Very few cases of seroconversion after 6 months have been reported. Hence,
no further testing is recommended if the HIV test at 6 months is negative.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 356 Section Four: Annexure-10
Flow chart: Management of an AEB and PEP

Steps Actions timing

Accidental exposure to blood 0 h 0 min

Step 1 Immediate first aid

Step 2 Risk assessment by a medical doctor As soon as possible

Step 3 Decision on therapy (medical doctor and exposed person)


Counselling and information
Offer of psychological support
Special leave from work/duty

Step 4Step 5 Prophylactic treatment against HIV Infection


and HBV vaccinations as required
  Ideally within
2 hours but
certainly
Yes No within 72 hr
  
Step 5 Offer follow-up &
Start 2-drug Start 3-drug counselling as required

Step 6 Monitor and follow-up of HIV, HBV and HCV status 6 months

Access and Availability to PEP at a Health Care Facility


In order to ensure that an exposed person has access to prophylactic therapy in a timely manner, it is
recommended that PEP drugs be kept available round-the-clock in any one location where a doctor is on call
24-hours a day (e.g. casualty, ICU). All health staff should know through in-house trainings where to get PEP
as required.
For the full course of drugs, this can be purchased locally to complete 4 weeks of drugs or refer to nearest ART
centre. In case these drugs are not available on site at the healthcare facility, the hospital can purchase.
It locally and it shall be reimbursed by SACS.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-10 Page 357
Drug stock at the Health care Facility

Level of health Designated person/team Minimum drug stock of PEP


care facility in charge of PEP exposure-response kits*
Tertiary hospitals Team: Infection control officer, 3 kits of 7 days supply
and medical Physician, Casualty officer i.e. FDC (AZT/3TC) 2 tabs/day
colleges Where ART centers are within the x 7 days x 3 kits = 42 tabs
same institution, the ART nodal officer If ART centre available, to link for
should be the reference person for PEP supply and referrals
Secondary Team: infection control officer, 3 kits of 5 days supply
district, taluk casualty officer i.e. FDC (AZT/3TC) 2 tabs/day
The district/Taluk physician (internal x 5 days x 3 kits = 30 tabs
medicine) should be the reference If ART centre available, to link for
person for PEP supply and referrals
Primary CHC The medical officer of the CHC is the 2 kits of 3 days supply
reference person for PEP i.e. FDC (AZT/3TC) 2 tabs/day x 3
days x 2 kits = 12 tabs
Primary Health The PHC medical officer is in-charge Link to CHC or district level
centers (PHC) of referring for PEP to CHC or for PEP
district level

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 358 Section Four: Annexure-10
Annexure 11: STI Flowchart For management Urethral
Discharge & Burning micturation

Causative Organisms
Syndrome Urethral discharge in Males
Neisseria Gonorrhoea
Chlamydia trachomatis
Trichomonas vaginalis

RTs STIs Gonohorrhea, Chlamydial Infection, Trichomoniasis

Laboratory investigations (if


History of Examination Look for available)
Urethral discharge Redness and swelling of the Gram stain examination of the urethral
Pain or burning while urethral meatus smear will show gram-negative intra
passing urine, increased Urethral discharge. If discharge cellular diplococci in case of gonorrhea
frequency ofurination is not seen, then gently massage In non-gonococcal urethritis, more
Sexual exposure of the urethra from the ventral part of than 5 neutrophils per oil immersion
either partner including the penis towards the meatusand field (1000X) in the urethral smear
high risk practices look for a thick, creamygreenish- or more than 10 neutrophils per high
likeoro-genital sex yellow or mucoid discharge power field in the sediment of the
first void urine are observed

Treatment
As dual infection is common, the treatment for urethral discharge should adequately cover therapy for both gonorrhoea
and chlamydial infections.
Recommended regimen for uncomplicated gonorrhoea + chlamydia Uncomplicated infections indicate that the disease is
limited to the anogenital region (anterior urethritis and proctitis).
Tab. Cefixime 400 mg orally, single dose Plus
Tab Azithromycin 1 gram orally single dose under supervision
Ensure patient takes medication under your direct observation
Advise the client to return after 7 days of start of therapy
When symptoms persist after adequate treatment for gonorrhoea and chlamydia in the index client and partner(s), they
should be treated for Trichomonasvaginalis.If discharge or only dysuria persists after 7 days
Tab. Secnidazole 2 gm orally, single dose (to treat for T.vaginalis)
If the symptoms still persist
Refer to a higher centre as early as possible

Management of pregnant partner


Syndrome-specific guidelines for Pregnant partners of male clients with urethral discharge should be
partnermanagement examined by doing a per speculum as well as per vaginal
Treat all recent partners examination, and treated for gonococcal as well as chlamydial
Treat female partners (for gonorrhoea and infections.
chlamydia) on the same lines after ruling out Cephalosporins to cover gonococcal infection are safe and
pregnancy and history of allergies effective inpregnancy
Advise sexual abstinence, and if not acceptable, Tab. Cefixime 400 mg orally, single dose OR
advise consistent condom usageduring the course Ceftriaxone 125 mg by intramuscular injection
of treatment +
Provide condoms, educate about correct and Tab. Erythromycin 500 mg orally four times a day for
consistent use seven days OR
Refer for voluntary counseling and testing for Cap Amoxicillin 500 mg orally, three times a day for seven
HIV, Syphilis and Hepatitis B days to cover chlamydial infection
Schedule return visit after 7 Quinolones (like ofloxacin, ciprofloxacin), doxycyclineare
contraindicated in pregnant women.

Follow up After seven days


To see reports of tests done for HIV, syphilis and Hepatitis B
If symptoms persist, to assess whether it is due to treatment failure or re-infection or prompt referral if required

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-11 Page 359
Annexure 12 : STI Flow Chart for Management of Scrotal swelling

Syndrome Scrotal swelling

Neisseria Gonorrhoea
Chlamydia trachomatis

RTIs/ STIs Gonorrhea, Chalamial


Infection
Laboratory Investigations
Examination (If available)
History of Look for Gram stain examination of
Swelling and pain in scrotal Scrotal swelling the urethral smear will show
region Redness and edema of the gram-negative intracellular
overlying skin diplococci in case of
Pain or burning while Tenderness of the complicated gonocoocal
passing urine epididymis and vas deferens infection
Systemic ymptoms like Associated urethral In non-gonococcal urethritis
malaise, fever discharge/genital ulcer/ more than 5 neutrophils per
Sexual exposure of either inguinal lymph nodes and oil immersion field in the
partner to high risk practices if present refer to the urethral smear or more than
including oro-genital sex respective flowchart 10 neutrophils per high
A tranillumination test to power field in the sediment
rule out hydrocoele should of the first void urine are
be done. observed

Treatment:
Treat for both gonococcal & chlamydial infections Tab Cefixime 400mg orally BD for 7 days Plus
Cap Doxycycline 100mg BD for 14 days & refer to hihercentre as soon as possible since complicated
gonococcal infection needs parental & longer duration of treatment.
Sopportivetherapyto reduce pain (bed rest, scrotal elevation with T bandage and analgesics

Differential diagnosis( Non RTIs /STIs) Infections Causing Scrotal Swelling Tuberculosis,Filariasis,
Coliforms. Pseudomonas,Mumpsvirus infection.
NonInfectious causes:
Trauma, Hernia, Hydrocoel,Testicular torsion & Testicular tumors

Management of protocolin case the


Syndrome Specific Guidelines for
partner is pregnant
Partner management
Depending on the clinical findingsin the pregnant
Partner needs to be treated depending on Partner (wether vaginal discharge or endocervical
the clinical findings discharge or PID is present) the drug
regimens should be used

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 360 Section Four: Annexure-12
Annexure 13 : STI Flow Chart management of Inguinal Bubo

Causative Organism
Bacteria Haemophilus ducreyi
Calymmatobacterium granulomatis
(Klebsiella granulomatis)
Chlamydia trachomatis

Laboratory investigations
Examination Diagnosis is on clinical grounds
History Look for
Swelling in inguinal region Localized enlargement of
which may be painful lymphnodes in groin which Differential diagnosis
Preceding history of genital may betender and fluctuant
ulcer or discharge Mycobacterium tuberculosis,
Inflammation of skin over filariasis
Sexual exposure of either the swelling
partner including high risk Any acute infection of skin of
Presence of multiple sinuses pubic area, genitals, buttocks,
practices like oro-genital sex Edema of genitals and
etc anus and lower limbs can also
lower limbs cause inguinal swelling.
Systemic symptoms like Presence of genital ulcer or
malaise, fever If malignancy or tuberculosis
urethral discharge, if present, is suspected refer to a higher
refer to respective flowchart centre for biopsy.

Note:
TREATMENT A bubo should never be incised and drained at the
Start Cap Doxycycline 100mg orally twice primary Designated STI Clinic, even if it is fluctuant,
dailyfor 21 days (To cover LGV) Plus as there is a high risk of fistula formation and
Tab Azithromycin 1gm orally single dose chronicity. If bubo becomes fluctuant always refer for
OR aspiration to a higher centre.
Tab Ciprofloxacin 500mg orally, twice daily In severe cases with vulval edema in females,
for 3 day to cover chancroid. surgical intervention in the form of vulvectomy
Refer to higher centre as early as possible. may be required for which they should be referred to
a higher centre.

Syndrome specific guidelines for partner


management Management of pregnant partner
Treat all partners whoare in contact with Quinolones (like ofloxacin, ciprofloxacin), doxycycline,
the client in last 3 months sulfonamides are contraindicated in pregnant women.
Partners should be treated for
Pregnant and lactating women should be treated with
chancroid & LGV
Tab Azithromycin 1gm orally single the erythromycin regimen and consideration should
dose to cover chancroid be given to the addition of a parenteral amino
Cap Doxycycline 100mg, twice daily glycoside (e.g., gentamicin)
for 21 days to cover LGV (Erythromycin estolate is contraindicated in pregnancy
Advise Abstinence during treatment due to hepatotoxicity. Erythromycin base or
Provide condoms, educate for erythromycin ethyl succinate should be given)
correct & consistent use

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-13 Page 361
Annexure 14 : STI Flow chart for management of Genital ulcers

Granuloma Inguinale Syphilis Chancroid Herpes Genitalis

Causative Organisms: LGV


BacteriumTreponemapallidum.
(Syphilis)
Bacteria Haemophilus ducreyi (Chancroid)
Herpes Simplex Virus (Herpes Genitalis)
Calymmatobacterium granulomatis (Granuloma Inguinale)
Chlamydia trachomatis (Lympho Granuloma Venerium) LGV

History Examination or multiple-Herpes simplex Lab


Genital ulcer/ Presence of vesicles Painless ulcer with shotty lymph Investigations:
vesicles Presence of genital ulcer, nodes - Syphilis
Burning sensation in single or multiple RPR Test
Painless ulcer with inguinal lymph
the genital region Associated inguinal lymph nodes - Granuloma inguinale and for Syphilis
Sexual exposure of node swelling and if present LGV Refer to
either partner including refer to espective flowchart Painful ulcer usually single sores - higher centre
high risk practices Ulcer characteristics: Chancroid associated with painful for
like oro-genital sex Painful vesicles/ulcers, single bubo further tests

Treatment: Doxycycline 100mg BD for 14 days


If vesicles or multiple painful ulcers are present treat for Tab Azithromycin 1gm orally single dose OR Tab
herpes with Tab. Acyclovir 400mg orally, thrice a day for 7 Ciprofloxacin 500mg BD for 3 days to cover Chancroid.
days. Treatment should be extended to 7 days if ulcers have not
If vesicles are not seen and only ulcer is seen, treat for epithelialized i.e. formed a new layer of skin over the sore.
syphilis and chancroid and counsel on herpes genitalis. Refer to higher centre
To cover syphilis give Inj. Benzathine penicillin 24 million If not responding to treatment
IUIM after Test daose in two divided doses (with Genital ulcers coexist with HIV
emergency tray ready) In patients allergic to Penecillin, Recurrent lesions

Management of Pregnant Women


Quinolones (like ofloxacin, ciprofloxacin), doxycycline, sulfonamides are contra indicated in
Syndrome specific pregnant women.
guidelines for partner Pregnant women who test positive for RPR should be considered infected unless adequate
management treatment is documented in the medical records and sequential serologic antibody titers have declined.
Treat all partners who are InjBenzathine penicillin 2.4 million IU IM after test dose (with emergency tray ready).
in contact with client A second dose of benzathine penicillin 2.4 million units IM should be administered 1 week after
during last 3 months the initial dose for women who have primary, secondary, or early latent syphilis.
Pregnant women who are allergic to penicillin should be treated withErythomycin and the neonate
Partners should be treated
should be treated for syphilis after delivery.
for Syphilis &chancroid
Tab. Erythromycin 500mg orally 4 times daily for 15days
Advise Abstinence during (Note: Erythromycin estolate is contraindicated in pregnancy because of drug related hepatotoxicity.
treatment Only Erythromycin base or erythromycin ethyl succinate should be used in pregnancy).
Provide condoms, educate All pregnant women should be asked history of genital herpes and examined carefully for herpetic
for correct & consistent use lesions.
Ref to ICTC for HIV Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally.
testing Women with genital herpetic lesions at the onset of labour should be delivered by caesarean
Follow up after 7 section to prevent neonatal herpes.
Acyclovir may be administered orally to pregnant women with first episode of genital herpes or
severe recurrent herpes.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 362 Section Four: Annexure-14
Annexure 15 : STI Flow Chart for management of Vaginal Discharge

Vaginitis Trichomoniasis Cervical Herpes Cervicitis

Causative Organisms Vaginitis Causative Organisms Cervicitis


Trichomonasvaginalis(TV) Neisseria gonorrheae
Candida albicans Chlamydia trachomatis
Gardnerellavaginalis, Mycoplasma causing
Trichomonasvaginalis
bacterial vaginosis (BV)
Herpes simplex virus

History Examination Laboratoryinvestigations


Menstrual history to rule out Per speculum examination to differentiate between (ifavailable)
pregnancy vaginitis and cervicitis. Wet mount microscopy of
Nature and type of a) Vaginitis: the discharge for
discharge (amount, smell, Trichomoniasis-greenish frothy discharge Trichomonas
color, consistency) Candidiasis - curdy whitedischarge vaginalisand clue cells
Genital itching Bacterial vaginosis adherentdischarge 10% KOH preparation for
Burning while passing urine, Mixed infections may present with Atypical discharge with Candida albicans
increased frequency fishy odour Gram stain of vaginal
Presence of any ulcer, b) Cervicitis: smear for
swelling on the vulval or Cervical erosion /cervical ulcer/ mucopurulent cervical clue cells seen in
inguinal region discharge bacterialvaginosis
Genital complaints in sexual Bimanual pelvic examination to rule out pelvic Gram stain of
partners inflammatory disease endocervical smear
Low backache If speculum examination is not Possible or client is to detect gonococci
hesitant, treat both for vaginitis and cervicitis

Treatment Treatment for cervical infection (chlamydia and gonorrhea)


Vaginitis (TV+BV+Candida) Tab Cefixim 400 mg orally, single dose
Tab. Secnidazole 2 gm orally, single doseORTab. Tinidazole
500 mg orally, twice daily for 5 days PLUS Azithromnycin 1 gram, 1 hour before lunch. If
vomiting within 1 hour, give anti-emetic and repeat
Tab. Metoclopropramide taken 30 minutes before Tab. o If vaginitis and cervicitis are present, treat for both
Secnidazole, to prevent gastric intolerance
o Instruct client to avoid douching
Treat for candidiasis with Tab Fluconazole 150 mg orally o Pregnancy, diabetes, HIV may also be influencing factors
single dose OR and should be considered in recurrent infections
localClotrimazole500 mg vaginal pessaries once o Follow up after one week

Management in pregnant women Specific guidelines for partnermanagement


Per speculum examination should be done to rule out
pregnancy complications such as abortion, premature
rupture of membranes Treat current partner only if no improvement after
Treatment for vaginitis (TV+BV+Candida) initial treatment
In first trimester of pregnancy If partner is symptomatic, treat client and partner
Local treatment with Clotrimazole vaginalpessary/ cream only using above protocols
for candidiasis. Oral Flucanozole is contraindicated in Advise sexual abstinence during the course of
pregnancy. treatment
Metronidazole pessaries or cream intravaginally if Provide condoms, educate about correct and
trichomoniasis or BV is suspected.
consistent use
In second and third trimester, oral Metronidazole can
be given Schedule return visit after 7 days
Tab. Secnidazole 2 gm orally, single dose or Treat the partner/s of women with cervical
Tab. Tinidazole 500 mg orally, twice daily for 5days discharge for gonorrhoea and chlamydia
Tab. Metoclopropramide taken 30 minutes before
Tab. Metronidazole, to prevent gastric intolerance

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-15 Page 363
Annexure 16 : STI Flow Chart for Management of Lower
Abdominal pain in females

Causative Organisms
Neisseria gonorrheae
Chlamydia trachomatis
Mycoplasma Gardnerella Anaerobic
bacteria(BacteroisSp, Gram positive cocci)

History Examination
Laboratory Investigations
Lower abdominal pain if available
General examination: Temperature, Pulse, Wet smear examination
Fever Blood pressure
Vaginal discharge Gram stain for gonorrhea
Per Speculum examination: vaginal/ cervical
Menstural irregularities Complete Blood count & ESR
discharge, congestion or ulcers
like heavy, irregular
Per abdominal examination: lower abdominal Urine microscopy for pus cell
vaginal bleeding
Dysmenorrhoea tenderness or guarding
Differential Diagnosis
Dyspareunia Pelvic examination: uterine/ adnexal Ectopic Pregnancy
Dysuria,tenesmus tenderness, cervical movement tenderness. Twisted Ovarian cyst
Low backache Note: A urine pregnancy test should be done Ovarian tumor
Contraceptive use like in all women suspected of having PID to Appendicitis
IUD rule out ectopic pregnancy. Abdominal tuberculosis

Treatment(out client treatment)


In mild or moderate PID(In the absence of Tubo ovarian abscess), out client
Syndrome specific guidelines for
treatment can be given. Therapy is required to cover Neisseria
partner management
gonorrheaeChlamydia trachomatis and anerobes.
Treat all partners in past 2 months
Tab. Cefixim 400 mg orally BD for 7 days Tab. Metronidazole 400 mg orally,
Treat male partners for urethral
twice daily for 14 days
discharge (gonorrhea and chlamydia)
Doxycycline, 100 mg orally, twice a day for 2 weeks (to treat chlamydial
Advise sexual abstinence during the
infection)
course of treatment
Tab. Ibuprofen 400 mg orally, three times a day for 3-5 days
Provide condoms, educate on correct
Tab Ranitidine 150 mg orally, twice daily to prevent gastritis
and consistent use
Remove intra uterine device, if present, under antibiotic cover of 24-48 hours
Refer to voluntary counseling and
Advise abstinence during course of treatment and educate on correct and
testing for HIV, Syphilis and
consistent use of condoms
Hepatitis B
Observe for 3 days. If no improvement (ie. Absence of fever, reduction in
Inform about the complications if left
abdominal tenderness, reduction in cervical movement, uterine tenderness) or
untreated and sequelae
if symptoms worsen, refer for inClient treatment.
Schedule return visit after 3days, 7
Caution PID can be a serious infection. Refer the client to the hospital if
days and 14 days to ensure
she does not respond to treatment within 3 days and even earlier if her
compliance
condition worsens.

Hospitalization of clients with acute PID should be seriously


Management of Pregnant Women considered when
Though PID is rare in pregnancy,
Any pregnant woman suspected to have PID should The diagnosis is uncertain
be referred to district hospital for hospitalization and Surgical emergencies eg. Appendicitis or ectopic pregnancy
treated with a parenteral regimen which would be cannot be excluded
safe in pregnancy.
A pelvic abscess is suspected
Doxycycline is contraindicated in pregnancy
Severe illness precludes management on an out Client basis
Note: Metronidazole is generally not recommended
The woman is pregnant
during the first three months of pregnancy. However,
it should not be withheld for a severely acute PID, The client is unable to follow or tolerate an out Client
which represents an emergency. regimen
The client has failed to respond to out Client therapy.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 364 Section Four: Annexure-16
Annexure 17 : STI Flow Chart for management of Oral & Anal
STIS

Causative Organisms Haemophilus ducreyi (chancroid)


Neisseria gonorrhoeae Klebsiella granulomatis (granuloma
Chlamydia trachomatis inguinale)
Treponema pallidum (syphilis) Herpes simplex (genital herpes)

History of Examination
Unprotected oral sex Look for Laboratory
with Oral ulceration, redness, pharyngeal Investigations
pharyngitis. inflammation RPR/VDRL for syphilis
Unprotected anal sex Genital or anorectal ulcers single or Gram stain examination
with anal discharge or multiple of rectal swab will
tenesmus, diarrhea, Presence of vesicles show gram negative
blood in stool, Rectal pus intracellular diplococcic
abdominal cramping, Any other STI syndrome in case of gonorrhea.
nausea, bloating (Do proctoscopy for rectal
examination if available)

Management of Oral /Anal STIs


Pharyngitis with history of unprotected oral sex
Or Genital or anorectal ulcers seen Diarrhoea, blood in stools,
Anal discharge, tenesmus bloating with history of Or abdominal cramping, nausea,
unprotected anal sex Vesicles seen or history of bloating with history of
Or recurrent vesicular eruptions unprotected anal sex.
Rectal pus or bloating with history of
unprotected oral

Tab. Azithromycin 1 gm
Follow flowchart Follow flowchart Tab. Cefixime 400 mg
urethral discharge genital ulcer (Follow urethral discharge syndrome flowchart)
syndrome and treat syndrome Anti-diarrheal medicines as needed
accordingly &
Refer to higher facility

Refer to relevant STI Syndromic


Any other STI syndrome
flow chart

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-17 Page 365
Annexure 17 : STI Flow Chart for management of Oral & Anal
STIS

Causative Organism
Virus: Human Papilloma Virus (HPV)
Clinical Features
Single or multiple soft, painless, pink in colour, cauliflower like growths which appear around the
anus, vulvo-vaginal area, penis, urethra and peri-neum.
Warts could appear in other forms such as papules which may be keratinized.
Diagnosis
Presumptive diagnosis by history of exposure followed by signs and symptoms.
Differential diagnosis
i. Condyloma lata of syphilis
ii. Moluscum contagiousm
Treatment
Recommended regimens:
Penile and Perianal warts
20% Podophyllin in compound tincture of benzoin applied to the warts, while carefully
protecting the surrounding area with Vaseline, to be washed after 3 hours. It should not be used
on extensive areas per session.
Treatment should be repeated weekly till the lesions resolve completely.

Note: Podophyllin is contraindicated in pregnancy. Treatment should be given under medical


supervision. Client
Should be warned against self medication
Cervical warts
Podophyllin is contra-indicated.
Biopsy of warts to rule out malignant change.
Cryo cauterization is the treatment of choice.
Cervical cytology should be done in the sexual partner(s) of men with genital warts.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 366 Section Four: Annexure-17
Annexure 18 : Management of Molluscum and Ectoparasitic
infestation

Causative Organism
Pox virus
Clinical features
Multiple, smooth, glistening, globular papules of carrying size from a
pinhead to a split pea can appear anywhere on the body. Sexually
transmitted lesions on or around genitals can be seen. The lesions are not
painful except when secondary infection sets in. When the lesions are
squeezed, a cheesy material comes out.
Diagnosis
Diagnosis is based on the above clinical features.
Treatment
Individual lesions usually regress without treatment in 9-12 months.
Each lesion should be thoroughly opened with a fine needle or scalpel. The contents should be exposed
and the inner wall touched with 25% phenol solution or 30% trichloracetic acid.
Pediculosis pubis
Causative Organism
Lice-Phthirus pubis
Clinical features
There may be small red papules with a tiny central clot caused by lice irritation.
General or local urticaria with skin thickening may or may not be present.
Treatment
Recommended regimen:
Permethrin 1% crme rinse applied to affected areas and wash off after 10 minutes
Special instructions
Retreatment is indicated after 7 days if lice are found or eggs observed at the hair-skin junction.
Clothing or bed linen that may have been contaminated by the client should be washed and well dried
or dry cleaned.
Sexual partner must also be treated along the same lines.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-18 Page 367
Annexure 18 : Management of Molluscum and Ectoparasitic
infestation

Scabies
Causative Organism
Mite-Sarcoptes Scabiei
Clinical features
Severe pruritis (itching) is experienced by the client which becomes worse at night.
Other members of family also affected (apart from sexual transmission to the partner,
other members may get infected through contact with infected clothes, linen or
towels).
Complications
Eczematization with or without secondary infection
Urticaria
Glomerulonephritis
Contact dermatitis to antiscabetic drug
Diagnosis
The burrow is the diagnostic sign. It can be seen as a slightly elevated grayish dotted line in the skin, best seen in the
soft part of the skin.
Treatment
Recommended regimens:
Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8 to 14 hours
Benzyl benzoate 25% lotion, to be applied all over the body, below the neck, after a bath, for two consecutive nights.
Client should
bathe in the morning, and have a change of clothing. Bed linen is to be disinfected.
Special instructions
Clothing or bed linen that have been used by the client should be thoroughly washed and well dried or dry cleaned.
Sexual partner must also be treated along the same lines at the same time.
Partner management
Timely partner management serves following purpose:
Prevention of re-infection
Prevention of transmission from infected partners and
Help in detection of asymptomatic individuals, who do not seek treatment.
Critical issues on partner management
Confidentiality Partners should be assured of confidentiality. Many times partners do not seek services, as they
perceive confidentiality as a serious problem. Respecting dignity of client and ensuring confidentiality will promote
partner management.
Voluntary reporting Providers must not impose any pre-conditions giving treatment to the index client. Providers may
need to counsel client several times to emphasize the importance of client initiated referral of the partners.
Client initiated partner management Providers should understand that because of prevailing gender inequalities,
women may not be in a position always to communicate to their partners regarding need for partner management. Such
client imitated partner management may not work in some relationships and may also put women at the risk of
violence. Hence alternative approaches should be considered in such situations.
Availability of services RTI/STI diagnostic and treatment services should be available to all partners. This may mean
finding ways to avoid long waiting times. This is important because many asymptomatic partners are reluctant to wait
or pay for services when they feel healthy.
Approaches for partner management
Date: There are two approaches to partner management:
Please attend the following centers along i. Referral by index client
with the card In this approach, index client informs the partner/s of possible infection.
Stamp of the Facility This appears to be a feasible approach, because it does not involve extra
Timings: personnel, is inexpensive and does not require any identification of partners.
A partner notification card with relevant diagnostic code should be given
Diagnostic Code:
to each index client where partner management is indicated. This approach
may also include use of client initiated therapy for all contacts.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 368 Section Four: Annexure-18
Annexure 18 : Management of Molluscum and Ectoparasitic
infestation

ii. Referral by providers


In this approach, service provider contacts clients partners through issuing appropriate partner notification card. This
information provided by the client is used confidentially to trace and contact partners directly. This approach needs
extra staff and is expensive
Coupon for a free examination
General principles for partner management
In general, partners should be treated for the same STI as the index xlient,
whether or not they have symptoms or signs of infection.
Health care providers should be as sure as possible about the presence of an STI before informing and treating the
partner, and should remember that other explanations are possible for most RTI symptoms like vaginal discharge.
Special care is required in notifying partners of women with lower abdominal pain who are being treated for possible
pelvic inflammatory disease. Because of the serious potential complications of PID (infertility, ectopic pregnancy),
partners should be treated to prevent possible re-infection. It should be recognized, however, that the diagnosis of PID
on clinical grounds is inaccurate, and the couple should be adequately counseled about this uncertainty. It is usually
better to offer treatment as a precaution to preserve future fertility than to mislabel someone as having an STI when
they may not have one.
Follow up visits
Follow up visits should be advised
To see reports of tests done for HIV, Syphilis and Hepatitis B.
If symptoms persist, advise clients to come back for follow up after 7 days. In case of PED, follow up should be done
after 2 to 3
days. Management of treatment failure and re infection
When clients with RTI/STI do not respond to treatment, it is usually because of either treatment failure or re-infection.
Ask the following questions to ascertain the cause:
To probe treatment failure
Did you take all your medicines as directed
Did you share your medicines with anyone, or stop taking medicines after feeling some improvement
Was treatment based on the national treatment guidelines. Also consider the possibility of drug resistance if cases of
treatment failure are showing an increasing trend.
To probe for re infection
Did your partner(s) come for treatment
Did you use condoms or abstain from sex after starting treatment
For treatment failure
All cases of treatment failure should be referred to higher health facility.
For re infection
Consider re-treatment with same antibiotics.
Refer to higher health facility if symptoms persist.
Screening for Asymptomatic Clients
It is well known that most RTIs/STIs are asymptomatic, especially amongst the women. The case finding is a process
of opportunistic screening at the time when an individual presents to a health facility, regardless of presence of symptoms.
Case findings opportunities are most commonly seen while providing services for contraception. Providers should use
opportunities for potential contraceptive clients to screen for RTIs/STIs. The National Guidelines for IUD, Oral Pills,
National Sterilization Services provide detailed guidelines regarding screening of RTIs/STIs.
Similar opportunities exist in pregnancy care settings. Most common screening programmes worldwide are those for
detecting syphilis in pregnant women. Untreated syphilis in pregnant female is associated with number of adverse
outcomes such as pregnancy loss, stillbirths and congenital syphilis. Providers are recommended to follow Government
of Indias following guidelines while providing services to pregnant women:
1. Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers, 2005.
2. Guidelines for Ante-Natal Care and Skilled Attendance at Birth by ANMs and LHVs, 2006.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-18 Page 369
Annexure 19 : STI Flowchart-Management of Ophthalmic
Neonatorum

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 370 Section Four: Annexure-19
Annexure 20 : Guide to Common Symptoms and Possible
Aetiologies

Symptoms Possible Aetiologies


Requiring
Attention

Dyspnoea Pulmonary infection (e.g., Pneumonia-bacterial or fungal)


Invasive Pulmonary disease (e.g. Pulmonary)
Obstructive Airway Disease, Emphysema
Severe anaemia
New Fever or Central nervous system (CNS) mass lesion-often accompanied by Headache
Change in Meningitis
Fever Pattern Sinusitis
Oesophagitis
Lymphoma
Fungal infections-often caused by characterized by Hepatomegaly;
If respiratory, characterized by Cough
Mycobacterium Avium Complex (MAC) - often accompanied by chronic
Diarrhoea and Abdominal pain
Bacterial parasites - Clostridium difficile, cytomegalovirus (CMV),
accompanied by Diarrhoea
Pneumonia - often accompanied by Dyspnoea , Tuberculosis - often
accompanied by Dyspnoea
Pneumocystis - often accompanied by cough
Drug reactions
Advanced HIV disease
New or Persistent Medications
Headache CNS lymphoma
Cryptococcus Meningitis, Toxoplasmosis
Altered Mental State AIDS dementia
Complex CNS infection
Tumours
Seizures or Loss CNS lymphoma
of Consciousness Medications
AIDS dementia
Toxoplasmosis
Peripheral Medications
Neuropathy HIV infection
CMV
Herpes Zoster
Visual Changes CMV retinitis (most common)
VZV, HSV, Toxoplasmosis
Syphilis
New or Persistent Medications, Diet
Diarrhoea Bacterial infections - Salmonella, Shigella, Campylobacter, C. difficile
Invasive diseases affecting the bowel - M. avium- intracellular, lymphoma,
CMV, Wasting syndrome

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-20 Page 371
Symptoms Possible Aetiologies
Requiring
Attention
Gastrointestinal Herpes simplex, CMV, Candidiasis
Bleeding Kaposis sarcoma, Lymphoma
Cryptosporidium
Salmonella, C. difficile

Dysphagia and Candidiasis


Odynophagia Herpes simplex
CMV
Neurologic impairment

Oedema Obstruction of venous or lymphatic vessels (e.g., from Kaposis sarcoma,


venous thrombosis, lymphoma)
Hypoalbuminemia
Renal failure, Congestive heart failure
Liver disease

Nauseous and Medications


Vomiting Infections, Massive disease of GI tract
CNS disease
Adrenal insufficiency

Inadequate Anorexia
Oral Intake Nauseous and vomiting
Dysphagia
Odynophagia
Inadequate access to food
Altered nutrition

Skin, Mucous Drug reactions


Membrane lesions Dry skin
Viral infections - Molluscum, herpes simplex or zoster
Bacterial infections - Bacillary angiomatosis, folliculitis, Impetigo, ecthyma,
abscesses
Fungal infections - Tinea, candida
Malignancy - Kaposis sarcoma
Pressure ulcers

Source: Adapted from Kirton, C. Talotto, D. & Zwolski, K. (2001) Handbook of HIV/AIDS Nursing

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 372 Section Four: Annexure-20
Annexure 21 : What a Nurse needs to know about Dementia
and Delirium

Dementia
Definition:
An organic mental disorder characterised by loss of intellectual abilities of sufficient severity to interfere with
social or occupational functioning. HIV-associated dementia is known as AIDS Dementia Complex (ADC)
Patients may present with ambulation/gait problems, mania, panic, psychosis, withdrawal or anxiety. Dementia
is progressive with a variable course. Patients with HIV-related dementia are often acutely aware of their
deterioration, which may lead to an adjustment disorder with profound fear, anxiety or depression.

Aetiology
HIV associated dementia HIV directly invades the brain tissue shortly after infection-was the most frequently
seen single neurologic complication of AIDS before the HAART era in the U.S.
Drug withdrawal
Pain

Clinical Manifestations of Dementia


Early manifestations:
Memory loss, Impaired concentration
Depressed mood, Apathy
Motor weakness, Tremor, poor handwriting
Irritability, Agitation
Personality change
Late manifestations:
Global Cognitive Dysfunction
Amnesiac features
Organic Hallucinations
Parkinsonism
Vegetative state
Mutism, Aphasia, Spasticity, Ataxia
Assessment
Screening tool for Dementia
Thorough physical examination to determine potential reversible causes:
Toxoplasmosis, Cryptococcoma, MAI, Lymphoma, CMV ventriculitis or Encephalitis, or Meningitis
associated with Syphilis, TB, or Cryptococcus Neoformans.
Neurologic Exam
CT scan or MRI to check for Cortical Atrophy, Ventricular Enlargement, or Masses
Labs: Thyroid function, RPR, LFTs, Bio-chemistry, Haemogram
Nursing Interventions
Educate patient and family.
Teach behavioural management strategies so patient with early manifestations of dementia can live
with some degree of independence, yet be safe in the home environment. (E.g. establishing a daily
routine and sticking to it).
Memory aids such as Notes, Calendars, Alarm Clocks, etc

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-21 Page 373
Referral to Home care Agency, may need 24 hour supervision
Because disease is frightening and may be progressive, the patient and family need assistance to plan
for the future.
Pharmacologic: ART, SSRI for Depression, Anti-psychotics for agitation and Hallucinations

Delirium

Definition:
Characterized by disturbance of consciousness and a change in cognition that develops over a period of
time and is caused by the direct physiologic consequences of a medical condition. Delirium is the most
common neuron-psychiatric complication in hospitalised AIDS patients.
Risk factors for Delirium in AIDS patients:
Advanced stage of immuno-suppression
History of OIs, especially affecting CNS
Substance use
Head or brain injury
Episodes of delirium or dementia

Aetiology May be single or multiple


Infectious: Cryptococcal or Toxoplasmosis Encephalitis

Assessment
Sudden change in mental status
Level of alertness may vary from agitation to lethargy, stupor or coma. Patients are usually drowsy and
may require repeated explanations from caregivers and examiners. Early signs of delirium may be
inaccurately attributed to anxiety.
Abrupt disturbances in sleep patterns or changes in level of activity should raise suspicion.
Interview caregiver and observe patient to assess functional status

Clinical Manifestations
Impaired memory, orientation: difficulty with abstractions, difficulty with sequential thinking, impaired
temporal memory, impaired judgment
Disturbances in thought and language with decreased verbal frequency
Disturbances in perception: visual hallucinations, paranoid delusions
Disturbances in psychomotor function: hypoactive, hyperactive or mixed
Disturbances in sleep-wake cycle with daytime lethargy, night time agitation
Affective lability: rapidly changes from one emotional state to another
Neurologic abnormalities: Tremors, Myoclonus, Nystagmus, Ataxia, Cranial Nerve Palsies, and Cerebellar
signs

Nursing Interventions
Address underlying condition such as metabolic abnormalities, sepsis, anaemia, CNS infections and
Malignancies, Antiretroviral therapy, Opioids, and Illicit substance use
Provide safe and consistent environment and increase supervision of patient as indicated
Communicate in clear simple terms to avoid misconceptions
Educate patient and family regarding care and procedures, medications, expected outcomes, and need
to orient patient to person, time, place, and situation
Ensure patients activities of daily living are met
Pharmacologic: Low doses of Neuroleptics (Haldol or Risperdal) to treat confusion or agitation

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 374 Section Four: Annexure-21
Annexure 22: Comprehensive Laboratory Evaluation in
HIV/AIDS

The purpose of the baseline laboratory evaluation is to 1) stage the HIV disease, 2) rule out concomitant
infections and 3) determine baseline safety parameters. The following tests are recommended

Essential Optional

Confirm HIV infection: HIV status must be Fasting lipid profile: May be recommended
documented. Refer to ICTC if in doubt. in patients with established coronary disease
risk factors or if Stavudine, Efavirenz, Protease
Inhibitor (PI) use is contemplated.
Specific investigations to rule out OIs Pregnancy test: EFV is contraindicated in
depending on the clinical need pregnancy
CD4 counts: all patients should have a Anti-HCV Screening: The prevalence of HCV is
baseline screening low in HIV infected patients except, such as in
north-eastern states of India where injection drug
use is a risk factor. It is also recommended in
HIV infected haemophiliacs and thalassaemics.
CBC: Hb, TLC, DLC, ESR, GBP Chest X-ray : To rule out TB or other pulmonary
infection
LFTs: Necessary to find evidence of hepatitis, Plasma viral load (PVL): A baseline PVL may
particularly when NVP use is contemplated. not be necessary. With optimum adherence and
a potent regimen, undetectable levels at 6 months
after ART initiation should be achieved.
Urine routine: To evaluate proteinuria and
sugar (necessitate estimation of blood glucose)
HBsAg: To rule out concomitant hepatitis B
infection as this can influence choice of ARV
regimen. Additionally, abrupt stopping of anti-HBV
drugs like Lamivudine and Tenofovir is not
recommended in patients with chronic Hepatitis B
co-infection since it may result in Hepatitis B
flare-up. This screening is mandatory for IDUs
and transfusion-associated HIV infection
HCV screening: mandatory for IDU and
transfusion- associated HIV infection
VDRL/TPHA (syphilis screening): especially
with persons of high risk behaviour group, history
of STIs and/or suggestive symptoms of syphilis
Pap smear : Helps in earlier diagnosis of
cervical intraepithelial neoplasia (CIN)

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-22 Page 375
Annexure 23 (a): Diagnosis of HIV Infection in Infants/
Children below 18 months

Diagnosis of HIV status in infants/children is very important in order to plan their care, support and treatment.
HIV DNA-PCR would provide testing for HIV-exposed infants and children < 18 months. Serology for HIV
antibodies, which is the gold standard for diagnosis in adults cannot be used for children below 18 months
due to false positive results because of presence of maternal HIV antibodies in the infants blood which
cross react.
In order to establish if the infant/child has acquired HIV infection, the DNA of the virus has to be detected
in the infants blood through the Polymerase Chain Reaction (PCR). The test specimen for DNA PCR can
be collected in two ways:
1. Dried Blood Spot (DBS): Infant/childs blood is collected on filter paper by heel/finger/ toe prick and
this specimen is sent to the laboratory, where the DNA PCR test is performed.
2. Whole Blood (WB): Infant/childs blood is collected in a microtainer/vacutainer and this specimen is
sent within a few hours to the laboratory where the actual DNA PCR test is performed.
Plan for HIV diagnosis among HIV exposed infants/children below 18 months
In infants between 6 weeks to 6 months of age:
Perform DNA PCR on DBS specimen collected at ICTC
If DNA PCR shows not detected follow up at ICTC
If DNA PCR shows detected refer to ART Centre for testing on WB specimen
Perform DNA PCR on WB specimen at ART Centre
If DNA detected on WB specimen at ART Centre, register and follow up at the ART Centre as per national
paediatric ART guidelines
If DNA not detected on the WB specimen at ART Centre, collect fresh WB specimen
Use the result of this specimen for further management
In infants/children between 6 months to 18 months of age:
Perform antibody test at ICTC
If antibody test is negative, follow up at ICTC.
If antibody test is positive proceed for DNA PCR
Perform DNA PCR on DBS specimen collected at ICTC if antibody test is positive
If DNA PCR not detected on DBS follow up at ICTC
If DNA PCR detected refer to ART Centre
Perform DNA PCR on WB specimen at ART Centre
If DNA detected on WB specimen at ART Centre, register and follow up at the ART Centre as per national
paediatric ART guidelines.
If DNA not detected on the WB specimen at ART Centre, collect fresh WB specimen.
Use the result of this specimen for further management
The HIV DNA-PCR results will be communicated from the reference lab to ICTC/ART collection centre
whichever applicable
Infants/children showing uninfected must continue to be followed up at the ICTC till 18 months as
per algorithm
Ensure definitive diagnosis of all infants/children by antibody tests at 18 months
All 3 antibody tests are to be used at 18 months for confirmatory HIV diagnosis, irrespective of the
first test results

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 376 Section Four: Annexure-23(a)
Annexure 23(b) : Specimen Collection (by heel prick) and
handling procedure for HIV DNA PCR testing by
Dried Blood Spot (DBS) sample collection

Introduction
Pediatric HIV infection is an evolving entity and continues to be a challenge for the medical community. The
standard diagnostic tool for HIV infection in adults, testing for antibodies to HIV antigens, has limited utility
in infants less than 18 months of age because of the transplacental transfer of maternal antibodies. An
essential priority in caring for HIV-infected children is accurate and early diagnosis of HIV.
The diagnosis of HIV in infants under eighteen months of age must therefore be conducted by direct
detection of the virus-specific genetic material. The assay can be conducted successfully on DBS specimens.
Use of DBS facilitates access to DNA PCR testing given its high sample stability and low biohazard, which
facilitate sample handling and transport from the clinic to the laboratory. This sample type, which can be
taken from a heel prick, requires a reasonably small amount of blood and is therefore well suited for routine
testing in infants, where blood volumes are small and blood draws are challenging. The use of DBS with
this assay is a strong advantage and is the preferred method of sample collection.
This describes a procedure for collection, packaging and transport of a dried blood spot (DBS) sample from
an infant below 18 months of age. A correct performance of the DBS collection using the aseptic technique
is critical to ensure the safety of the procedure and to assure the quality of the test results obtained thereof.
An optimal sample collection also contributes significantly to the comfort and satisfaction of the donors thus
encouraging retesting as and when required
Dried blood spots (DBS) should be made only by nursing personnel who have been appropriately trained
in both the making of dried blood spots and in universal blood and fluid precautions

Material Required
Sterile disposable Lancet with tip less than 2.4mm
Sterile Alcohol preparation ( 70% isopropanolol)
Sterile Gauze pad
Soft cloth
Blood collection form
DBS card[ specially formulated commercially available absorbent filter paper( Schleicher & Schuell 903
or Whatman BFC 180); (do not use ordinary filter paper)]
Gloves( powderless)
Discard jar with 5% Sodium Hypochlorite

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-23(b) Page 377
Preparation
Observe Universal Precautions at all times by wearing gloves, lab coat and safety glasses.
Put down a clean paper towel.
Lay out all the supplies you will need

Method

1. Obtain proper written informed consent from the parent/ guardian with appropriate
pre test counselling

2. Complete ALL information on the collection/ test requisition form. Write patient identification
information on a new clean filter paper card

3. Select the 4. Warm site with


appropriate site for soft cloth, moistened
puncture. Hatched with warm water
area indicates safe up to 41C, for
areas for puncture three to five
site. minutes.

5. Cleanse site with 6. Puncture heel. Wipe


alcohol preparation. away first blood drop
Wipe DRY with with sterile gauze pad.
sterile gauze pad. Allow another LARGE
blood drop to form.
Discard the lancet
safely into the discard
jar for sharps containing
5% freshly prepared
sodium Hypochlorite solution

7. Lightly touch filter paper 8. Fill remaining circles in


to LARGE blood drop. the same manner as
Allow blood to soak step 7, with successive
through and completely blood drops. If blood
fill circle with SINGLE flow is diminished,
application to LARGE repeat steps 5 through
blood drop. 7. Once the required
(To enhance blood amount of sample has
flow, VERY GENTLE been collected,
intermittent pressure pressure must be
may be applied to area applied gently at the
surrounding puncture site). Apply blood to one puncture site with a sterile gauze ensure
side of filter paper only (the side with printing). that there is no further bleeding from the
Do not contaminate filter paper circles by site following which the skin puncture site
allowing the circles to come in contact with should be dressed and protected with an
spillage or by touching before or after occlusive bandage.
blood collection

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 378 Section Four: Annexure-23(b)
9. Dry blood spots on a dry, clean, flat non-absorbent
surface for a minimum of four hours. Avoid touching
the part of the card where blood has been applied
to see of the blood has dried. As the blood dries
on the filter paper it will change from a bright red
color to a darker red-brown color, also the paper
will buckle slightly. Once dry, send completed form
to testing laboratory within 24 hours of collection

10. This figure below shows how an acceptable good quality DBS should appear. ID information
should be placed on the card. Each printed circle should have been filled with blood
Acceptable Sample

11. A figure demonstrating an unacceptable sample is also shown below.


Unacceptable Sample

Documentation
Document and maintain all consent forms
All necessary documentation and pertinent information of every sample collected and dispatched to the
lab for testing must be made in the designated register / computer
All samples sent to the lab for testing must be accompanied by the test requisition forms and a compiled
delivery checklist that carries a list and pertinent information of all the samples being dispatched from
the collection site to the testing laboratory
Record of failed attempts at taking a heel prick sample must be recorded .

Packaging and transport of samples to the testing laboratory

Material Required
Plastic ziplock storage packs
Dessicant packs
Humidity indicators
Biohazard labels
Glassine paper
Paper envelopes
Padded envelopes
Stapler
Gloves( powderless)

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-23(b) Page 379
Preparation
Observe Universal Precautions at all times by wearing gloves and lab coat .
Lay out all the supplies you will need
Ensure that all the DBS samples are of acceptable quality and well dried

Method

Packaging and storing DBS

1. When packaging DBS into zip lock bags,


separate each card with a sheet of
weight/glassine paper.

2. You can store up to 15 cards in a single 3. Place DBS cards inside the storage
zip-lock bag. bag gently

4. Add 5-10 Silica packets per zip-lock bag and


push the Silica packets to the bottom of the bag.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 380 Section Four: Annexure-23(b)
5.
Add a humidity indicator card.
Push as much air out of the bag as possible.
Double check that the bag is sealed completely.
Apply a Biohazard sticker to the outside of this
zip lock bag
If refrigeration is available use this to store DBS or
send it to testing Lab.
When ever possible avoid exposing the DBS to sunlight
and high temperatures (try to avoid leaving DBS in
your vehicle in the hot sun). If storage is being done
store the entire package of samples in a refrigerator
(4C) or freezer (-20C).

Transportation

1. Place the zip-lock bag containing the DBS


inside an envelope.

2.
Place the previous envelope inside a padded labelled
envelope to avoid damage to the DBS during postage/
courier transportation.
Place the test requisition forms and the compiled
delivery checklist in a separate zip lock bag and
place it in this padded envelope
Staple the envelope shut.
Place another biohazard sticker on the side carrying
the address of the testing site

3. Use a reliable and tested courier/ mailing system for transportation of the sample packages

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-23(b) Page 381
Annexure 24 : Monitoring and follow up patients on ART -
Recommendations in the National Programme

Day 0
(baseline) At At 1 At 2 At Every As needed
Before or at 15 days month month 3 month 6 month (symptom-
start of ART Directed)

Clinical and      
adherence
counselling
Weight      
Hb      
(if on AZT) (if on AZT)
ALT*    * * 
(if on NVP) (if on NVP)
Urinalysis  
(if on TDF)
Lipid profile   
(if on EFV (if on d4T,
and PI) EFV or PI)
Random  
Blood sugar (if on PI)
CD4  
Pregnancy  
testing for (if planning
women with for EFV)
pregnancy
potential
Plasma Viral  
Load**

Notes:
* For HBV and/or HCV co-infected patients, 3-monthly screening of Liver Function is recommended.
** Plasma Viral Load (PVL): The national programme does recommend routine viral load monitoring as part
of the programme. Viral load measurement is not recommended for decision-making on initiation or regular
monitoring of ART in resource-limited settings (WHO 2006). It may be considered for making diagnosis of
early treatment failure or to assess discordant clinical and CD4 findings in patients suspected of failing ART.
Scheduled follow up during the initial months of ART is necessary to diagnose and efficiently manage acute
adverse events, work with the patient on adherence issues, and diagnose clinical conditions like IRS and
new episodes of OIs.

Estimation of CD4 count for patients receiving ART:


Is recommended at 6 months to document immunological improvement on ART. After initiation of a NVP
based regimen, ALT measurement is recommended in the first month to detect drug-induced Hepatitis. With
an AZT- based regimen, it is important to monitor CBC for earlier detection of Haematological Toxicity. The

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 382 Section Four: Annexure-24
prevalence of Lipid abnormalities is significant on ART, particularly if a patient is on d4T, EFV or Lipid PIs.
In these patients and in patients with significant risk factors for Coronary Artery Disease a fasting lipid
profile should be done at 6 months, otherwise yearly estimations suffice. Random Blood sugar (RBS) is
recommended in the baseline screening of all patients to be started on ART, as currently one of the major
causes of morbidity in India is diabetes and hence screening should be done for pre-morbid status.

Questions to be asked During History Taking

History taking 2 1st 3rd 6th 9th Every 3-6


weeks month months months months months
thereafter

HIV related diseases    


incl. TB
Cough > 2 weeks    
Fever    
Weight loss    
Diarrhoea    
Other symptoms    
as GI,CNS,
neurology, skin rash
Other medicationstaken    

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-24 Page 383
Annexure 25 : 4 Prong NACO PPTCT Strategies

Prong 1 of the PPTCT Strategy: Primary prevention of HIV infection

This prong focuses on the parents-to-be. HIV infection cannot be passed on to children if their parents are not
infected with HIV. This consists of promoting safer and responsible sexual behaviours which include, where
appropriate, delaying the onset of sexual activity, practising sexual abstinence, reducing the number of sexual
partners and using condoms. The strategies here include condom provision, early diagnosis and treatment of
STIs, HIV counselling and testing , and suitable counselling for the uninfected so that they remain HIV negative.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 384 Section Four: Annexure-25
Prong 2 of the PPTCT Strategy: Prevention of unintended pregnancies among HIV-infected women

This prong looks at the family planning needs of the HIV infected women. With appropriate support, women
who are aware of being sero-positive can plan their pregnancy and therefore reduce the possibility of passing
the virusto their future children. They can also take measures to protect their own health. The strategies here
include high-quality reproductive health counselling and providing effective family planning measures such as
effective contraception, and early and safe abortion in case the womandecides to end the pregnancy. At the
ICTC, post-test counselling should cover this information if the client is in a position to absorb it, namely inform
sero-positive clients that they are capable of transmitting the HIV to others including their spouses and in the
case of women, to the children theymight bear. They should be informed that a counselling personnel can
explain to them how to reduce the risk of transmission and invite them to come back for more information
whenever they feel the need.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-25 Page 385
Prong 3 of the PPTCT Strategy: Prevention of HIV transmission from HIV-infected women to their
infants

Specific interventions to reduce transmission from a woman living with HIV to her child include HIV counselling
and testing, ARV prophylaxis and treatment, safe delivery practices, and safer infant feeding practices.
Specifically this involves:
Decreasing viral load Monitoring and treating infections
Supporting optimal nutrition
Avoiding premature rupture of membrane and invasive delivery techniques
Treating infections such as STIs
Promoting safer infant feeding
When an ARV drug is given to prevent transmission from the mother to the infant, it is referred to as ARV
prophylaxis. This is different from ARV treatment for the mother the mother which is used to treat her HIV
disease.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 386 Section Four: Annexure-25
Prong 4 of the PPTCT Strategy: Provision of care and support to HIV-infected women, their infants and
their families

Medical care and social support are necessary to help the woman living with HIV to address and manage her
worries about her own health and that of her family. If she is assured of receiving adequate care for herself and
her loved ones, she is more likely to undergo HIV testing, and also adhere to the treatment.
The service elements here include prevention and treatment of OIs, ARV treatment, palliative (pain-reducing)
and non-ARV care, nutritional support, reproductive health care and psychosocial support.
Thus, a comprehensive PPTCT programme provides a continuum of care for the mother and the child. The
continuum begins with educating adolescent women about primary prevention of infection and continues
through treatment, care and support to HIV-positive women and families. It ensures that women receive education
and services to reduce the risk of mother-to-child-transmission throughout pregnancy, labour and childbirth,
and infant feeding. It also provides support for both mother and child, especially during the crucial years of
childhood growth and development. This comprehensive approach ultimately provides linkages to existing
community services to address the complex needs and issues involved in HIV prevention, treatment and
management.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-25 Page 387
Annexure 26 : PPTCT True or False Statements and Answers

1. Pregnancy makes HIV disease worse.


False - Pregnancy does not accelerate the progression of HIV disease.

2. HIV-infected sperm can directly infect the infant even if the mother does not have HIV infection.
False- Although there is HIV in male semen, there is no HIV in the sperm. Therefore, the mother could get
HIV infection from the male semen but the foetus could not get HIV infection from the males sperm. The
foetus can only acquire HIV infection from exposure to the mothers blood or vaginal/cervical secretions
during pregnancy, birth, or breast milk during breast feeding. Remember that about 70% of time, the foetus
will not get HIV infection at all.

3. If a woman is HIV+, there are medications she can take to reduce the likelihood of passing the
virus to her infant
True- If a woman is HIV+, she can be prescribed ART depending on clinical criteria either during her
pregnancy. She should be given ART during labour, and the baby must be given ART within 72 hours of
birth. Details of ART to prevent mother to child transmission will be dealt with in this unit. If she is on ART
and her viral load is suppressed, her risk of transmission is very low, about 1 or 2%

4. If both parents are HIV +, using condoms during pregnancy isnt necessary
False - One partner may transmit a resistant virus to the other through sexual intercourse so it is essential
that the couple practice safe sex with use of condoms.

5. If a woman is HIV positive, all her babies will be HIV-infected because they share the same
blood.
False - The mother and baby do not share the same blood. The mothers blood is filtered by the placenta
so the baby gets oxygen and nutrients without exchange of blood. The baby can only become infected if
she/he is exposed to the mothers blood. This may happen from an infection in the placenta, a maternal
abruption or abdominal trauma causing bleeding into the amniotic sac, or during birth. It is also important
to note that even with exposure to the mothers blood during pregnancy and birth, there is only about a
30% chance of the baby becoming infected.

6. Procedures during delivery that may cause exposure of the newborn to maternal body fluids
should be avoided whenever possible
True - This includes artificial rupture of membranes, forceps or vacuum delivery, episiotomy, or vigorous
suctioning of the infant.

7. If an HIV positive woman has a Caesarean section (C/S), her risk of having a baby with HIV
is 0%.
False - Although in some cases, when the womans virus is not suppressed or she has advanced HIV
disease, a C/S may reduce the risk of infection, it will never reduce it to 0%. The actual risk depends on
the severity of disease and the actual viral load. When a woman is on ART and her viral load is fully
suppressed, there does not appear to be an advantage to C/S. Also, there is a higher risk of maternal
infection and mortality with C/s and the higher cost to consider.

8. Giving Nevirapine to babies after they are born is like giving a nurse post-exposure prophylaxis
after a needlestick injury.
True. Giving Nevirapine is like giving PEP to a nurse after a needle stick injury.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 388 Section Four: Annexure-26
Annexure 27 : PPTCT: Three Safe Infant Feeding Options
Some Important Points You Could Keep In Mind When
Counselling Mothers On Feeding Options

No Breastfeeding Breastfeed Exclusively Continue breastfeeding


at all Providing For 6 Months if at 6 months
Cows/Tinned milk Stopping Abruptly replacement feed is not
Switching to acceptable, affordable,
Weaning Foods feasible, safe and
sustainable with
complementary foods

Advantages Breast milk increases Breastfeeding provides infants with optimal nutrition,
PTCT risk by up to 20%. reduces morbidity and mortality associated with
Not breastfeeding at infections other than HIV, and delays the mothers
all eliminates this risk return to fertility.
completely Baby would have received all the anti-infective
available in breast milk
Bonding between the mother and baby is better
The babys gut is safe from any mucosal injury
reducing the chance of infection
It is economical and considerably more safe to breast
feed than to bottle or spoon feed the baby
At 6 months of age, breast milk alone may not be
enough to meet the nutritional needs of the baby,
hence complementary or weaning foods could be
introduced

Disadvantages Infant gets no colostrum Baby is exposed to Baby is exposed to virus


It is an expensive option virus in breast milk in breast milk
In India the chance of Colostrum along with Colostrum along with its
baby dying due to its advantages is also advantages is also
gastroenteritis (because considered to be considered to be highly
of poor hygienic highly infectious infectious
practices, ignorance of The longer the duration
mother about sterilizing of the breast feeding
feeding bottles, etc.) the higher the risk of
is higher than it dying transmission
of HIV!
Risk of over dilution of
formula could result in
malnutrition of the baby
Microscopic mucosal
injury of the gut is very
high with formula feeds
Social stigma if mother
does not breastfeed

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-27 Page 389
No Breastfeeding Breastfeed Exclusively Continue breastfeeding
at all Providing For 6 Months if at 6 months
Cows/Tinned milk Stopping Abruptly replacement feed is not
Switching to acceptable, affordable,
Weaning Foods feasible, safe and
sustainable with
complementary foods

What to Formula feeding will be Formula feed is All under second option
Assess to acceptable considered to be plus
Help Mother affordable expensive If socio-economic
Decide Option feasible unsustainable over situation is such that
safe the long term safe and sustainable
sustainable unsafe exclusive alternate feeds
cause for social cannot be provided
problems even after 6 months
risk for mixed feeds
unacceptable

Additional Why never to give Teach mothers how to express breast milk and give
Information mixed feeding. it safely if there is risk for cracked nipples, mastitis
to Provide With formula feeds that could increase the risk of HIV transmission
to Mothers microscopic mucosal Reinforce feeding hygiene if expressed breast
injury to gut is high milk is given
If mixed feeds (i.e. Good breast feeding practices: position of the mother
breast milk and other and the baby as well as breast hygiene
milk such as cows How to stop breast-feeding abruptly - it is important
milk) are given the if mother has been feeding directly to teach mother
chance of HIV to enter how to express breast milk at least two weeks
the increases risk of before stopping abruptly.
HIV transmission. Baby gets used to feeding with a cup/spoon/ palada
Infant feeding hygiene. Amount of breast milk supply reduces
Preparation of formula To practice safer sex while breastfeeding to
milk prevent reinfection and higher viral load
References to NGOs/
support centres which
may provide free/
subsidized alternate
feeds

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 390 Section Four: Annexure-27
Annexure 28 : Replacement Feeding Checklist

Yes No

Can she afford to buy enough milk/milk powder?


Does she have access to clean water?
Can she prepare milk safely?
Boil the water
Make the correct concentration of milk if
using the tin milk
Can she clean and sterilize the feeding articles?
Will she have enough support from significant
others in the family?
Does she know how much of milk the baby can
be given
each time
for a day
how often

If answers are No, see what patient education/ linkages can be provided to support replacement feeding
OR advise safe breastfeeding.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-28 Page 391
Annexure 29 : Questions and Issues that must be assessed
by the Nurse to Aid In Preparing the Child And Family
For ARV

What does the child understand about HIV?


Does the child know about his/her own HIV diagnosis?
If so, has the child felt any difference in treatment from family members, school authorities (stigma)?

Does the child (if old enough) understand the need to take ARVs?
How will ARVs fit into childs daily activities?
How will ARVs fit into the childs going to school?
Does the child know that ART is to be taken life long?
Is the child aware of how to store the medication?
Is the child aware of the side effects?
Is the child aware of toxicities?

Is the parent alive?


If yes (i.e. parent alive),
Is the parent sick/unable to administer ARVs?
Has the parent had any prior negative experience with ARVs?
Is the parent adherent himself or herself?
Does the parent know the implications of ART (life long, non adherence, administration
and toxicities, storage)?
If no (i.e. parent not alive), who is the support person for the child?
Does the support person know the importance of taking ARV?
Does the support person know the implications of ART
(life long, non adherence, administration and toxicities, storage)?

How did the parent cope with his or her own HIV diagnosis?
How did the family coping with the HIV diagnosis of the parent/s?
How did the parent/s cope with the childs HIV diagnosis?
How did the family cope with the childs HIV diagnosis?

What is the parents perception of the childs illness?

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 392 Section Four: Annexure-29
Annexure 30 : Ways to Promote ART Adherence in Children

Promoting adherence is multi-faceted and must be a continuous process. This is a task that requires
excellent skills, addressing both the childs needs and issues and those of the caregiver:
The child MUST be involved
Assessment of child & family prior to child commencing ARVs
Assist families in developing routine for ARVs; ARVs should NOT dictate every aspect of daily life
Open, supportive approach
Age-appropriate explanations to child regarding need for medication
Children cope far better when they are able to understand what is happening to them and
have a sense of control
Use child-sensitive, age-appropriate explanations such as you need the medicine to keep
you strong and prevent infections
Continuing support and re-assessment of each child and familys situation
Peer support: Support from other parents and children
A variety of strategies may be used to help encourage the child to take ARVs and to assist and
support the caregiver. Some methods are mentioned below. They could be used one at a time or
in combination:
Trial runs: Finding out the best way that the child would take the medicine
Play therapy:
Having a doll /puppet and showing the child how the doll or the puppet felt better after taking
some medicine
Then asking the child whether they would like to try the same
Sticker charts:
Having a chart with dates mentioned and timing.
Every time the child takes the medicine with no trouble, giving the child a golden star, little
trouble a silver star and lots of trouble, a colour that the child does not like
At the end of the month, telling the child the child would be given some reward if there were
more golden stars on the chart. Rewards cold be simple like taking the child to the park,
giving the child a big hug, or doing something that child likes to do with the parent/caretaker
Art therapy:
Making the child draw out what he or she feels about taking medicines. This could be a
way for the child to express self
Taking medication with parent:
Giving the child the medicine along with the parent
Asking the child to put the medicine in the parent/s mouth and checking whether he/she has
taken it
Then the parent could do the same for the child
Support groups:
Arranging meetings of children taking ART so that they could express their challenges,
how they deal with it etc.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-30 Page 393
Annexure 31 : WHO Growth Monitoring Charts

Using growth charts Infants and children who are well and healthy should gain weight and length/height.
Infants and children who are growing normally follow a growth curve parallel to one of the standard growth
curves. Weight loss or failure to gain weight can be identified by observing the childs weight over time.
When the growth curve flattens and is no longer parallel to the chart line, this indicates the need for clinical
assessment, management and nutritional intervention and possibly ART.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 394 Section Four: Annexure-31
Growth curves are used to follow changes in growth over time for a child thus, looking at trend of weight
is more useful than a single observation. The nurse will take the weight and enter it on the growth chart,
in the ICTC HIV-Exposed Infant/Child Card Using gender appropriate charts (different for girls and boys),
plot the weight measurement (in kg.) on the vertical axis against the age (in months/year) on the horizontal
axis
Connect the dots for each visit to obtain a growth curve for the child
Compare the plotted line of the childs growth with the standard curves in the chart
MO to interpret the growth chart and determine course of action:
 Child with growth curves lying between the 3rd and 15th percentile need careful history taking to
detect feeding problems. A physical assessment must be done and appropriate nutritional advice
must be given.
 Child with growth curves less than the 3rd percentile (growth below the bottom most line) need further
investigation and immediate testing for HIV.

Figure 3: Example of use of growth charts to detect potential problems in growth

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-31 Page 395
Annexure 32 : Dosing schedule for HIV infected infants
and children , 18 months

Dosing is twice daily Drug Child Children 6 weeks of age and above,
(paediatric fixed dose Strength till 24.9 kg
combination, FDC) (mg) Number of tablets or ml by weight band,
morning and evening
3-5.9 kg 6-9.9 kg 10-13.9 kg
AM PM AM PM AM PM

Zidovudine Lamivudine
2-drug FDC AZT/3TC 60/30 1 1 1.5 1.5 2 2

Zidovudine Lamivudine
Nevirapine
3-drug FDC AZT/3TC/NVP 60/30/50 1 1 1.5 1.5 2 2

Stavudine Lamivudine
2 drug FDC d4T/3TC 6/30 1 1 1.5 1.5 2 2

Stavudine Lamivudine
Nevirapine
3-drug FDC d4T/3TC/NVP 6/30/50 1 1 1.5 1.5 2 2

Lopvinavir/ritonavir
syrup 80/20
2-drug FDC LPV/r syrup per ml 1 ml 1 ml 1.5 ml 1.5 ml 2 ml 2 ml

Lopvinavir/ritonavir
tablet
2-drug FDC LPV/r tablet 100/25 2 1

Note:
When starting NVP regimen start with lead-in- period for 2 weeks
i.e. For first 2 weeks of ART initiation
Morning dose: AZT + 3TC ........ two-drug FDC
Evening dose: AZT + 3TC + NVP ........ three-drug FDC

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 396 Section Four: Annexure-32
Annexure 33: Antiretroviral Therapy For TB Patients

HIV-TB co-infection is one of the most challenging issues in the effort to scale up ART since more than
60% of PLHA develop TB. Patients with TB merit special consideration because the co-management of HIV
and TB is complicated by drug interactions between Rifampicin and NNRTIs and PIs; IRIS; pill burden;
adherence; and drug toxicity. Active TB is the commonest OI among HIV-infected individuals and is also
the leading cause of death in PLHIV.
The management of patients with HIV and TB poses many challenges, including patient acceptance of both
diagnoses. HIV-infected persons with TB often require ART and WHO recommends that ART be given to:

All patients with extra pulmonary TB (stage 4), and all those with pulmonary TB (stage 3) unless CD4
count is >350 cells/mm3
ART reduces the incidence and recurrence of TB, as well as the fatality rates.

Co-trimozaxole prophylaxis should be given to HIVTB patients as per the guidelines.

When to start first-line ART in patients with active TB


If a patient with active TB is diagnosed with HIV and requires ART, the first priority is to start TB treatment in
accordance with the RNTCP guidelines. ART may need to be started later, keeping in mind the pill burden,
time needed for acceptance of the diagnosis, counselling needs, drug interactions, toxicity and IRIS

Initiation of first-line ART in relation to anti-TB Therapy (Based on 2006 WHO Guidelines)

CD4 cell count Timing of ART in relation to ART recommendation


(cells/mm3) initiation of TB treatment

CD4 < 200 Start ATT first Recommend ART


Start ART as soon as TB treatment is (ii)
tolerated EFV-containing regimens
(between 2 weeks and 2 months) (iii)

CD4 between Start ATT first Recommend ART


200350 Start ART 8 weeks (vi)
after starting ATT
(i.e. after completion of TB-intensive phase)

CD4 > 350 Start ATT first Defer ART


Re-evaluate patient for ART at 8 (v)
weeks and at
end of TB treatment

CD4 not Start ART 28 weeks after ATT Recommend ART


available initiation (iv)

Notes:
i) Timing of ART initiation is based on clinical judgement, in accordance with other signs of immunodeficiency
and WHO clinical stages. In the case of extrapulmonary TB, ART should be started as soon as TB treatment
is tolerated, irrespective of the CD4 count.
ii) ART should be started as soon as TB treatment is tolerated, particularly in patients with severe
immunosuppression.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-33 Page 397
iii) EFV-containing regimens include d4T/3TC/EFV and AZT/3TC/EFV.
iv) ART should be started if other non-TB stage 3 or 4 events are present.
v) For some types of TB that generally respond well to anti-TB therapy (i.e. lymph node TB, uncomplicated
pleural effusion), or some cases where uncomplicated pulmonary TB disease is responding well to TB
treatment, consider deferring ART initiation.
vi) Rationale for ART recommendation during TB Treatment:
a) HIV-infected patients with a CD4 count of 200350 cells/mm3 are at an increased risk of developing
active tuberculosis, even in regions with high-baseline TB prevalence.
b) HIV-infected patients with a CD4 count of 200350 cells/mm3 and active tuberculosis are at a greater
risk of AIDS and death than those without TB and with CD4 counts in the same range.
c) In the absence of ART, TB therapy alone does not significantly increase the CD4 cell count. Nor does
it significantly decrease the HIV viral load. Thus, CD4 counts measured during active TB are likely to
reflect the actual level of immunosuppression.
d) The use of HAART in patients with TB can lead to a sustained reduction in the HIV viral load. It can
also facilitate immunological reconstitution, and decrease AIDS-defining illness and mortality. This
benefit is seen across different ranges of CD4 counts.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 398 Section Four: Annexure-33
Annexure 34 : Assuming the quantity/amount of PTH

(Take to annexure) Nurses can use of the Faces Pain Rating scale given below for children who might find
it difficult to describe the intensity of pain in terms of numbers.

When conducting an assessment of pain, remember to follow the guidelines given in the box below

A Always ask! Ask about pain regularly; Assess pain systematically. Ask family members,
friends or caregivers, if necessary.Be aware of those persons who cannot communicate.
If potential for pain exists, assume it is present until proven otherwise!
B Believe the patient and the family
C Choose treatment options appropriate to the patient and family
D Deliver medications round the clock with adequate break through medication
E Evaluate results frequently; empower patient and family members to control

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-34 Page 399
Annexure 35 : Music Therapy

Music acts like a magic key, to which the most tightly closed heart opens.
Maria Von Trapp

Music therapy is defined as


the systematic application of music by the music therapist
to bring about helpful changes
in the emotional or physical health of the client.

And the ability to experience an altered state of physical arousal and subsequent mood by processing
a progression of musical notes of
varying tone,
rhythm, and
instrumentation
for a pleasing effect.

HOW MUSIC PROMOTES THE RELAXATION EFFECT?

Biochemical theory
states that music is a sensory stimulus that is
processed though the sense of hearing.

Sound vibrations are chemically changed into nervous impulses that


activate either the sympathetic or
parasympathetic nervous system

HOW MUSIC PROMOTES THE RELAXATION EFFECT ?

Entrainment theory suggests that oscillations produced by music are


received by the human energy field and
various physiological systems entrain with or
match the hertz (oscillation) of the music

Metaphysical theory suggests


that music is divine in nature.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 400 Section Four: Annexure-35
MUSIC THERAPY
For music therapy to be fully effective as a relaxation technique
it is best that the music be
instrumental
without lyrics
Type of music selected
listening environment
posture, and
attitude
also affect the quality of the relaxation response

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-35 Page 401
Annexure 36 : National AIDS Control Organization Phase III

HIV/AIDS prevention activities were undertaken immediately after the first case of HIV infection was
detected in Chennai (formally Madras)

A comprehensive National AIDS Control Program (NACP) was initiated in 1992 with the establishment
of the National AIDS Control Organization (NACO) within the Ministry of Health and Family Welfare,
Government Of India.

The first phase of the program, NACP I, was implemented by NACO and Dedicated State AIDS Cells
in all the states between 1992-2004.

The second pahse of the program,NACP II saw an expanded response against the HIV/AIDS epidemic
with the establishment of State AIDS Control Societies.This program was implemented between 1999
to 2006

Under NACP III, (2006-2012), the goal is to halt and reverse the epidemic in India over the next five
years.

The goal of NACP II is being achieved through a four pronged strategy :

Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs)
and scaled up interventions in the general population.

Provide greater care, support and treatment to larger number of PLHIV.

Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment
programmes at district, state and national levels.

Strengthen the nationwide Strategic Information Management System.

Office of NACO

National AIDS Control Organization


Chandralok Building,
36, Janpath,
New Delhi 110001
www.nacoonline.org

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 402 Section Four: Annexure-36
Annexure 37 : List of State AIDS Control Societies (SACs)

Sr. States Addresss of Name STD Office Fax Email id


No. the SACS Code No. No.
1. Andaman AIDS Control Society, Shri S.N. Jha PD 03192 237941 231176 andmansacs@gmail.com
and Nicobar G.B. Pant Hospital Complex, APD
Port Blair 744104 JD
AD
2. Andhra State AIDS Control Society, Shri. R.V.Chandravadan PD 040 24657221 24650776 vadanrv@gmail.com
Pradesh Directorate of Medical and Dr. A. Rajaprasana Kumar APD 24650776 24652267 sacsandhra@gmail.com
Health Services, Sultan Bazar, Kailash Ditya JD
Hyderabad - 500059 Durga Prakash AD
3. Arunachal State AIDS Control Society, Dr. Emi Rumi PD 0360 2351268 243388 arunachalsacs@gmail.com
Pradesh Naharlagun, No APD APD 2245942 244178
New Itanagar - 791110 Dr. Rikenrina (Basic Service) JD
Dr. Marto AD (TI)
4. Assam State AIDS Control Society, M.H. Barman, IAS PD 0361 2620524 2620524 assamsacs@gmail.com
Khanapara, Guwahati - 781022 APD 2261605
Ms.Dhiriti Bani JD
AD
5. Ahmedabad Ahmedabad Municipal Corpn. Dr. Umesh.N. Oza PD 079 26409857 26409857 ahmedabadmacs@gmail.com
AIDS Control Society, Ms. Lata Brahmbhatt DD -TI 26468653
Old Municipal Dispensary, Dr. Kartik Shah (Blood Saf) DD
behind Lal Bungalow, AD
C.G. Road, Ahmedabad.
6. Bihar State AIDS Control Society, Mr. Devottam Varma PD 0612 2290278 8986184695 biharsacs@gmail.com
Health Department, Mr. C. V. Alex APD
New Secretariat, Patna - 800015 Mr. Pankaj Priya Chaubey JD TI
Mr. Hare Ram Singh AD TI
7. Chennai Chennai Municipal Corpn. B. Jothi Nirmala PD 044 24980081 25369444 chennaimacs@gmail.com
AIDS Control Society, Dr. Guganantam APD 24986514
82 Thiru Vi-Ka-Salai, Mylapore, Mr. N. Balaiah IEC
Chennai - 600003 No JD/AD
8. Chandigarh State AIDS Control International Dr. Vanita Gupta PD 0172 2544589 2700171 chandigarhsacs@gmail.com
Youth Hostel, Madhya Marg, NA APD 2783300
Near PGI Sector 15-A, Sh. Sandeep Mittal (TI) DD
Chandigarh-160018 NA AD
9. Chhattisgarh Chhattisgarh AIDS Control Sh. Ajay Kumar Pandey PD 0771 2235860 2235860 ajay.spandan@gmail.com
Society, Directorate of Health Dr. Abdul Gafar Sheikh APD 2221624 chattishgarhsacs@gmail.com
Services, State Health Training Sh. Vikrant Verma (TI) DD -TI 2221275
Centre, Near Kalibari Chowk, AD
Raipur.
10. Dadra & Dadra & Nagar Haveli Dr. L. N. Patra PD 0260 2642061 2642061 dnhsacs@gmail.com
Nagar Haveli AIDS Control Society, APD
1st Floor, Shri Vinobha Bhave JD
Civil Hospital, Silvassa - 396230 Ms. Sapana Prasad (TI) AD
11. Daman Daman & Diu AIDS Control Dr. S. S. Vaishya PD 0260 2230570 223070 pdsant@yahoo.co.in
& Diu Society, Primary Health Centre, APD
Moti Daman, Daman - 396220 JD
Sh. Prasad D. Sant (TI) AD
12. Delhi Delhi AIDS Niyantran Samiti, Sh. B. S.Banerjee PD 011 27055660 delhisacs@gmail.com
Dr. Baba Saheb Ambedkar APD 27055725
Hospital, Dharamshala Block, Shri. J. K. Mishra (TI) JD
Sector - 6, Rohini, AD
Delhi - 110 085
13 Goa Goa State AIDS Control Society, Sh. Pradeep Padwal PD 0832 2427286 2422158 goaaids@gmil.com
First Floor, Dayanand Smriti APD 2422519
Building, Swamy Vivekanand Sh. Ramesh Rathore (TI) JD 2427286
Road, Panaji - 403001 AD

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-37 Page 403
Sr. States Addresss of Name STD Office Fax Email id
No. the SACS Code No. No.

14. Gujarat Gujarat State AIDS Control Smt. Vijaya Laxmi Joshi PD 079 2680211-13 2680214 cohealth@gujarat.gov.in
Society, 0/1 Block, New Mental Dr. Pradeep Kumar APD 2685210 drpkumar_55@yahoo.com
Hospital, Complex, Menghani Narendra Gohil (TI) JD gujaratsacs@gmail.com
Nagar, Ahmedabad - 380016 AD
15. Haryana Haryana State AIDS Control Dr. Narbir Singh PD 0172 2585413 2585413 haryanasacs@gmail.com
Society, SCO - 10, Sector - 10, APD 2584549(PD)
Panchkula, Haryana JD
AD
16. Himachal Himachal Pradesh State AIDS Ms. Sulakshna Puri PD 0177 2621608 221314, hpsacs@gmail.com
Pradesh Control Society, Block No. 38, APD 2625857 225857
Ground Floor, SDA Complex, Ms. Meena (TI) JD
Kasumppti, Shimla - 171009 AD
17. J&K J & K State AIDS Prevention Dr. M. A. Wani PD 0194 2476642 2471579 jksacs@gmail.com
and Control Society, APD
1st Floor, Khyber Hotel, Khayam JD
Chowk, Srinagar AD
18. Karnataka Karnataka State AIDS Prevention Sh. R. R. Janu PD 080 22201438 22201435 ksapsho@gmail.com
Society, No.4/13-1, Crescent APD
Road, High Grounds, Ms. Chandrakanta (TI) JD
Bangalore - 560001 AD
19. Jharkhand Jharkhand State AIDS Control Mrs. Aradhana Patnaik PD 0651 2309556 2562621 jharkhandsacs@gmail.com
Society, Sadar Hospital Campus, Dr. Raj Mohan APD 2490649
Purulia Road, Ranchi Ms. Kavita (TI) DD -TI
AD
20. Kerala Kerala State AIDS Control Dr. Usha Titus PD 0471 2304882, 2305183 keralasacs@gmail.com
Society, IPP Building, Red Cross APD 2305183 09447030470
Road, Thiruvananthapuram, Sh. Dennis (TI) JD-TI
Kerala - 695037 AD
21. Lakshadweep Lakshadweep AIDS Control Sh. K.P. Hamzakoya PD 04896 262316, 262817 lakshyadweepsacs@gmail.com
Society, Directorate of Medical APD 262317,
and Health Services, JD 262114,
UT of Lakshadweep, AD 263582
Kavaratti - 682555
22. Madhya Madhya Pradesh State AIDS Arun Tiwari PD 0755 2559629 2556619 mpsacs@gmail.com
Pradesh Control Society, 1, Arera Hills, APD
Second Floor, Oilfed Building, JD
Bhopal - 462011 Sh. Rajneesh Bhatnagar AD-TI
23. Maharashtra Maharashtra State AIDS Control Sh. Ramesh Devakar (IAS) PD 022 24113097, 24113123, ramesh.devakar1@gmail.com
Society, Ackworth Leprosy APD 24115791 24115825 maharashtrasacs@gmail.com
Hospital Campus, Behind SIWS Ms. Shivaranjani JD-TI
Collete, R.A. Kidwai Marg, AD
Wadala (West), Mumbai - 400031
24. Manipur Manipur State AIDS Control Sh. P.K. Jha PD 0385 2414796, 2310796, manipursacs@gmail.com
Society, Room no. 202, APD 2411857, 2222629,
Annexee Building, Western Block Abhiram Mongjam JD-TI 2229014 2224360
Medical New Secretariat, AD
Imphal - 759001
25. Meghalaya Meghalaya State AIDS Control Dr. Mrs. S.M. Garod PD 0364 2223140, meghalayasacs@gmail.com
Society, Ideal Lodge, Oakland, APD 2315452,
Shillong - 793001 JD 2315453
AD
26. Mizoram Mizoram State AIDS Control Dr. Eric Zomawia PD 0389 2321566 2320922 mizoramsacs@gmail.com
Society, MV-124, Mission Veng APD
South, Aizwal - 796005 Betty JD-TI
AD

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 404 Section Four: Annexure-37
Sr. States Addresss of Name STD Office Fax Email id
No. the SACS Code No. No.

27. Mumbai Mumbai District AIDS Control Dr. S.S. Kudalkar PD 022 24100245-49, 24100245, mumbaimacs@gmail.com
District Society, Acworth Complex, APD 24100250 24100250
Behind SIWS College, Ms. Uma Mehta JD-TI
R.A. Kidwai Marg, Wadala (West), AD
Mumbai - 31
28. Nagaland Nagaland State AIDS Control Dr. Niphe Kire PD 0370 2244218, 2242224 nagalandsacs@gmail.com
Society, Medical Directorate, APD 2241046,
Kohima - 797001 Dr. Barnice JD-TI 2222626,
AD 2233027
29. Orissa Orissa State AIDS Control Dr. Alekh Chandra Padhiary PD 0674 2405134, 2407560, orissasacs@gmail.com
Society, 2nd Floor, Oil Orissa APD 2405104-06 2405105
Building, Nayapalli, Ms. Smita Jagdev JD-TI 2393415 2394560
Bhubaneshwar-12 Santanu AD-TI
30. Pondicherry Pondicherry State AIDS Control Dr.D. Gurumurthy, M.B.B.S. DD PD 0413 2343596, 2343596 pondicherrysacs@gmail.com
Society, No. 93, Perumal Kail APD 2337000
Street, Pondicherry JD
AD
31. Punjab Punjab State AIDS Control Sh. Satish Chandra IAS PD 0172 2743442 pbsatishias@gmail.com
Society, 4th Floor Prayaas APD punjabsacs@gmail.com
Building Sec-38B, Chandigarh JD
Ms. Meenu, Deputy Director DD-TI
32. Rajasthan Rajasthan State AIDS Control Dr. R.N.D. Purohit PD 0141 2381792, 2381792 rajasthansacs@gmail.com
Society, Medical and Health Dr Katara APD 2381707,
Directorate, Swasthya Bhawan, Ms. Rolly Sinha JD-TI 2383452,
Tilak Marg, C Scheme, Dr Raja Chawla DD-STI 2383282,
Jaipur - 302005. 2382765
33. Sikkim Sikkim State AIDS Control Dr. Namgyal T. Sherpa PD 03592 225343, 220896 sikkimsacs@gmail.com
Society, STNM Hospital, APD 220898,
Gangtok, 737101 JD 32965
Sh. Karan Sharma AD-TI
34. Tamil Nadu Tamil Nadu State AIDS Control Tmt.P. Amudha, IAS PD 044 28194917, 28190261 tnsacs@gmail.com
Society, 417, Pantheon Road, APD 28190467
Egmore, Chennai - 600008 Vender Vendan JD-TI
AD
35. Tripura Tripura State AIDS Control Dr. Keshab Chakraborty PD 381 2321614 dr.keshab@rediffmail.com
Society, Health Directorate APD tripurasacs@gmail.com
Building, Gurkhabasti, Sh. Rabendra Sen
P.O. Kunjaban, Agartala, AD
West Tripura - 799006
36. Uttar Uttar Pradesh State AIDS Sh. S.P.Goyal (IAS) PD 0522 2721871, upsacs@gmail.com
Pradesh Control Society, A Block, Ms. Kumudlata APD 2720360,
PICUP Bhawan, Vibhuti Khand, Ms. Preeti JD-TI 2720361,
Gomati Nagar, Lucknow - 10 Mr. Sheetal Prasad AD-TI 2283168
37. Uttaranchal Uttaranchal State AIDS Control Dr. D.C. Dhyani PD 135 2728144, 2728144 uttaranchalsacs@gmail.com
Society, Chandar Nagar, Sh. Sanjay Bisht DD-TI 2720377,
Dehradun. JD 2728155
AD
38. West Bengal West Bengal State AIDS Control Dr. R. K. Vats PD 033 23574400, 23570122 wbsacs@gmail.com
Society, Swasthya Bhavan, Dr. S. P. Banerjee APD 23570122,
GN-29, Sector-V, Salt Lake, Ms. Kiran Mishra JD-TI 23576000
Kolkatta -700091 Ms. Anindita Maity AD-TI

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-37 Page 405
Annexure 38 : List of ART Centres

Month - March 2010

S.No. State Name District Name ART Centre


1 Tamil Nadu Chennai Govt. Hospital for Thoracic Medicine
2 Chennai Madras Medical College
3 Madurai Government Medical College
4 Namakkal Government Hospital
5 Chennai Kilpouk Medical College
6 Salem Medical College
7 Tirunelveli Medical College
8 Coimbatore Coimbatore Medical College
9 Theni Theni Medical College
10 Thanjavur Thanzavur Medical College
11 Vellore Vellore Medical College
12 Kanniyakumari Medical College
13 Tiruchirappalli Trichy Medical College
14 Chennai Institute of Obstetrics & Gynecology MMC
15 Dharmapuri District Hospital
16 Virdhunagar District Hospital
17 Viluppuram District Hospital
18 KARUR District Hospital
19 Dindigul Govt. District Headquaters Hospital, Dindugal
20 Perambalur ART Centre, Govt Hospital, Perambalur
21 Chennai ICH
22 Ariyalur Govt. District Headquaters Hospital, Krishnagiri
23 Toothukudi Tuticorin Medical College Hospital, Tuticorin
24 Tiruvanamalai Govt. District Headquaters Hospital, Thiruvannamal
25 Thiruvallur Govt. District Headquaters Hospital, Thiruvallur
26 CUDDALORE Govt. District Headquaters Hospital, Cudallore
27 Vellore CMC Vellor
28 Chennai Stanley Medical College
29 Nagapatinim Nagapattinam District Headquarters Hospital,
30 Erode Erode District Headquarters Hospital
31 Sivaganga Sivagangai Medical College & Hospital
32 The Nilgiris Nilgiris District Headquarters Hospital
33 Ramanathapuram Ramanathapuram District Headquarters Hospital
34 Kancheepuram Govt. Medical College and Hospital, Chengalpattu
35 Thiruvarur Govt. Medical College and Hospital
36 Pudukkottai Govt. District Hospital
37 Maharashtra Mumbai Sir J. J. Hospital

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 406 Section Four: Annexure-38
S.No. State Name District Name ART Centre

38 Mumbai KEM Hospital


39 Mumbai BLY Nair Hospital
40 Mumbai LTMG Sion Hospital
41 Sangli Government Medical College, Sangli
42 Akola Medical college, Akola
43 Pune B.J. Medical college
44 Yavatmal Medical College, Yawatmal
45 Nagpur Govt. Med. College, Nagpur
46 BEED Medical College, Ambejogai
47 Pune NARI, Pune
48 Kolhapur RCSM Government Medical College
49 Aurangabad Medical College, Aurangabad
50 Solapur Govt. Medical College, Solapur
51 Dhule Medical College, Dhule
52 Nanded Govt. Medical College
53 Latur Civil Hospital and Govt. Medical College
54 Chandrapur BILT, Chandrapur
55 Chandrapur District Hospital ART Centre, Chandrapur
56 Mumbai Godrej Mumbai
57 Thane Vithal Sayanna General Hospital, Thane
58 Nashik Civil Hospital, Nashik
59 Ahmadnagar District Civil Hospital, Ahmednagar
60 Satara District Civil Hospital, Satara
61 Ratnagiri District Civil Hospital, Ratnagiri
62 Wardha ART Centre Civil Hospital, Wardha
63 Parbhani Civil Hospital, Parbhani
64 Jalgaon Civil Hospital, Jalgoan
65 Osmanabad Osmanabad DH
66 Sangli Bharati Vidyapeeth Sangli
67 Raigarh Reliance DAH Patalganga
68 Pune AFMC Pune
69 Nagpur IGMC Nagpur
70 Mumbai NMMC Vashi
71 Jalna Jalna DH
72 Bhandara Bhandara DH
73 Pune Bajaj Auto ITD YCMH Pimpri
74 Nandurbar Nandurbar ART Center
75 Gadchiroli GADCHIROLI ART Center
76 Mumbai L&T Health Centre
77 Mumbai LTMG Sion Hospital,Regional Pediatric ART Centre
78 Hingoli ART Center, Civil Hospital, Risala Bazar, Darga Ro

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-38 Page 407
S.No. State Name District Name ART Centre

79 Buldana ART Centre, District General Hospital


80 Amravati ART Centre, District Civil Hospital
81 Satara ART CENTER KARAD
82 Thane Central Hospital Ulhasnagar 3
83 Kolhapur Sub District Hospital,Gadhinglaj
84 Washim WASHIM DH
85 Solapur ART Center Sub District Hospital, Pandharpur
86 Gondiya ART Centre, Gondia
87 Andhra Pradesh Hyderabad Osmania Medical College, Hyderabad
88 Guntur Govt. Medical College, Guntur
89 Visakhapatnam Govt. MC (King George Hospital), Vizag
90 Anantapur GGH, Anantapur
91 Krishna GGH, Vijayawada
92 Cuddapah RIMS, Kadapa
93 Chittoor SVRR GGH, Triupati Chittoor
94 Prakasam Government District Hospital, Ongole
95 East Godavari GGH, Kakinada , East Godavari
96 Rangareddi Gandhi Med College, Secundarabad
97 Warangal Medical College, Warangal
98 Karimnagar Govt. District Hospital, Karimnagar
99 Hyderabad Govt. Gen. Chest hospital, Hyd
100 Nizamabad District Head Quarters Hospital, Nizamabad
101 West Godavari District Head Quarters Hospital, Eluru
102 Srikakulam District Head Quarters Hospital, Srikakulam
103 Khammam District Head Quarters Hospital, Khammam
104 Mahbubnagar District HQ Hospital, Mehboobnagar
105 Kurnool Government General Hospital, Kurnool
106 Nellore District Head Quarters Hospital, Nellore
107 Nalgonda District HQ Hospital, Nalgonda
108 Vizianagaram Government Medical College
109 Medak District Headquarter Hospital,Medak
110 Adilabad District HQ Hospital, Adilabad
111 Hyderabad Nillofer Hospital
112 East Godavari Rajahmundry ART Centre
113 Guntur Area Hospital, Tenali
114 Visakhapatnam ART Center Anakapalli
115 Chittoor District Hospital Chittoor
116 Hyderabad DH, King Koti, Hyderabad
117 Krishna DH, Machilipatnam,Krishna
118 West Godavari Tadepalligudem ART center
119 Khammam Bhadrachalam ART center

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 408 Section Four: Annexure-38
S.No. State Name District Name ART Centre

120 Prakasam Markapur ART center


121 Cuddapah Produtur ART center
122 Krishna Tandur ART center
123 Guntur Guntur ART center
124 Guntur Narasaraopet ART center
125 Karnataka BANGALORE Bowring & Lady Curzon Hosp., Bangalore
126 Mysore Mysore Medical College
127 Bellary VIMS, Bellary
128 Dharwad KIMS ART Centre, Hubli
129 Raichur District hospital, Raichur
130 Davanagere District hospital, Davangeri
131 Chikmagalur District hospital, Manglore
132 Bijapur District hospital, Bijapur
133 Gulbarga District hospital, Gulburga
134 Belgaum District hospital, Belgaon
135 Kolar District hospital, Kolar
136 Bagalkot District hospital, Bagalkot
137 BANGALORE IG Inst. of Child Health, Bangalore, (IGICH)
138 Koppal District Hospital, Koppal
139 Chamarajanagar District Hospital, Chamrajnagar
140 Mysore District Hospital, Hassan
141 Gulbarga Voluntary Counseling and ART Center, Wadi
142 Dakshina Kannada District Hospital, Chikmagalur
143 Uttara Kannada District Hospital, Karwar
144 Udupi District Hospital, Udupi
145 Bidar District Hospital, Bidar
146 Tumkur District Hospital, Tumkur
147 Haveri District Hospital, Haveri
148 Shimoga District Hospital, Shimoga
149 BANGALORE St. John Hospital
150 BANGALORE Victoria hospital
151 BANGALORE KIMS Bangolare
152 Mandya District Hospital ART Center ,Mandya
153 Gadag District Hospital ART Center, Gadag
154 Chitradurga District Hospital, Chitradurga
155 Kodagu District Hospital, Kodagu
156 Ramanagaram District Hospital, Ramanagara
157 Chikballapur District Hospital, Chikballapur
158 Manipur Thoubal ART CENTRE, DISTRICT HOSPITAL Thoubal
159 Imphal West ART CENTRE, RIMS HOSPITAL, Imphal West
160 Imphal East J.N. HOSPITAL, ART CENTRE, IMPHAL EAST

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-38 Page 409
S.No. State Name District Name ART Centre

161 Ukhrul ART CENTRE, DISTRICT HOSPITAL Chandel


162 Ukhrul ART CENTRE, DISTRICT HOSPITAL UKHRUL
163 Churachandpur ART Centre, District Hospital Churachandpur
164 Imphal East J.N. Regional Pediatric ART Centre,Imphal East
165 Nagaland Dimapur Ditrict Hospital, Dimapur,
166 MOKOKCHUNG ART Centern, Imkongliba Memorial Hospital
167 Kohima Naga Hospital Authority, Kohima
168 Tuensang Civil Hospital, Tuensang
169 Delhi NEW DELHI RML Hospital, New Delhi
170 Central LNJP Hospital, New Delhi
171 NEW DELHI AIIMS, New Delhi
172 WEST DDU Hospital, New Delhi
173 NORTH EAST GTB Hospital, Delhi
174 South LRS institute of TB, New Delhi
175 South SAFDARJUNG HOSPITAL
176 NEW DELHI Kalawati Saran Children Hospital
177 NORTH Dr. Baba Saheb Ambedkar Hospital
178 Chandigarh Chandigarh PGIMER
179 Rajasthan Jaipur SMS Hospital, Jaipur
180 Bikaner Bikaner, SP Medical College
181 Jodhpur SNMC, Jodhpur
182 Udaipur RNT Medical College, Udaipur
183 Kota Medical College
184 Gujarat Ahmedabad B.J. Medical College, Ahmedabad
185 Surat Govt. Medical College, Majura Gate, Surat
186 Rajkot Pandit Din dayal Upadhyay Hospital Rajkot
187 Bhavnagar Medical Collage, Bhavnagar
188 Mehsana Medical Collage, Mashana
189 Surat Mora Choriyasi, Reliance HIV & TB Control Center
190 Vadodara SSG Hospital ART Center
191 Surendranagar Mahatma Gandhi Smruti Hospital Surendranagar
192 Jamnagar G G HOSPITAL JAMNAGAR
193 Junagadh General Hospital Junagadh
194 Kachchh ART Center Bhuj
195 Surat SMIMER HOSPITAL SURAT
196 Ahmedabad ART Center V. S. G. Hospital
197 Banaskantha ART Centre, General Hospital, Palanpur
198 Amreli General Hospital, Amreli
199 West Bengal Medinipur Medinapur Medical College, Medinapur
200 Kolkata School of Tropical Medicine

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 410 Section Four: Annexure-38
S.No. State Name District Name ART Centre

201 Darjiling North Bengal Medical College, Siliguri


202 BARDDHAMAN Medinapur Medical College, Burdwan
203 Kolkata R.G.Kar Medical College
204 Maldah Malda District Hospital
205 Kolkata Medical College,Regional Pediatric ART Centre
206 Kolkata M.R. Bangur District Hospital
207 Uttar Dinajpur Islampore SD Hospital, (Room No. 10 & 11)
208 Uttar Pradesh Varanasi Banaras Hindu University, Varanasi
209 Lucknow KGMC, Lucknow
210 Allahabad MLN Medical College, Allahabad
211 Meerut LLRM Medical College
212 Aligarh J N Medical College, Aligarh
213 Gorakhpur BRD Medical College, Gorakhpur
214 Agra SN Medical College Hospital
215 Etawah ART Centre UP RIMS & R, Saifai,
216 Kanpur Nagar I.D. Hospital, GSVM Medical College, Kanpur
217 Jhansi MLB Medical College
218 Goa NORTH GOA Government Medical College, Bambolim
219 Kerala Thiruvananthapuram Hospital Trivandrum
220 Kottayam Medical College Kottayam
221 Palakkad USHUS District Hospital
222 Kozhikode ART Centre, Kozhikode
223 THRISSUR ART Centre, Thrissur
224 Alappuzha Medical College Allepy
225 Ernakulam ART Centre,General Hospital Ernakulam
226 Himachal Pradesh Shimla IGMC, Shimla
227 Hamirpur ART Center R.H Hamirpur
228 Pondicherry Pondicherry Govt General Hospital
229 Bihar Muzaffarpur SKMCH, Muzaffarpur
230 Patna PMCH, Patna
231 Darbhanga Dharbhanga Med Col, Laheriasarai,Darbhanga
232 Bhagalpur J L N Medical Collge,Bhagalpur
233 Patna ARTC, RMRI
234 Gaya ARTC, ANMMCH
235 Madhya Pradesh Indore M Y Hospital, Indore
236 Jabalpur Medical College, Jabalpur
237 Bhopal Gandhi Medical College, Bhopal
238 Ujjain R D G Medical College Ujjain (M.P)
239 Rewa ART Centre Rewa

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-38 Page 411
S.No. State Name District Name ART Centre

240 East Nimar ART Center District Hospital KhanDwa


241 Gwalior Department of Medicine, J.A. Hospital Gwalior
242 Assam Kamrup Guwahati Medical College Hospital
243 Dibrugarh AMC, Dibrugarh
244 Cachar Silchar Medical College & Hospital
245 Arunachal Pradesh Papum Pare ART Centre, General Hospital, Naharlagun
246 Mizoram Aizawl Civil Hospital, Aizawal
247 Punjab Jalandhar Civil Hospital, Jalandhar
248 Patiala Medical Collage, Patiala
249 Amritsar GMC, Amritsar
250 Ludhiana ART Centre, Lord Mahavir, Civil Hospital
251 Gurdaspur ART Centre, Civil Hospital, Pathankot
252 Sikkim East STNM HOSPITAL
253 Jharkhand Ranchi RIMS, Ranchi
254 Purbi Singhbhum MGM Medical College, Jamshedpur
255 Haryana Rohtak PGIMS
256 Uttaranchal Dehradun Doon Hospital
257 Nainital Dr. Susheela Tiwari Memorial Forest Hospital,
Haldwani
258 Tripura West Tripura Agartala
259 Jammu & Kashmir Jammu Govt. Medical College
260 Srinagar Sher-i-Kashmir Institute of Medical Sciences (SKI)
261 Orissa Cuttack S C B Medical Collage Cuttak
262 Ganjam MKCG Medical College and Hospital, Berhampur
263 Sambalpur V.S.S. Medical College. ART Centre
264 Koraput BILT ART Centre DHH
265 Chhattisgarh Raipur Govt Medical Collage, Art Center, Raipur
266 Durg ART Centre, District Hospital
267 Bastar ART Center Jagdalpur
268 Bilaspur ART Centre CIMS Bilaspur
269 Meghalaya East Khasi Hills Shillong

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 412 Section Four: Annexure-38
Annexure 39 : List of Community Care Centres (CCCs)

The CCC plays a critical role in enabling PLHIV to access ART as as providing monitoring, follow up
and counselling support to those who are initiated on ART, positive prevention, drug adherence,
nutrition counselling etc. The monitoring of PLHIV, who do not require ART as yet (Pre ART) will also
be a critical function that needs to be carried out by CCC.
A Community Care Centre (CCC) is a place with facilities for Out Patient and In-Patient treatment where
a PLHIV receives the following services:
 All PLHIV started on ART (at the ART Centre) will be sent to the CCC for a minimum of 5 days
of In patient care and be prepared for ART
 Treatment of OIs
 Appropriate referrals to ICTC,PPTCT and ART Centres
 Out Patient Services
 Home Based Care
 Some CCCs will serve as Link ART Centres
 Condom Distribution
Staff at CCC comprises of;
 Doctor 1 Full time or 2 Part time
 Project Coordinator 1 Full Time
 Counsellor 1 Full Time
 Out Reach Workers 4
 Laboratory Technician 1 Part Time
 Nurses 3
 Cook 1
 Helper 1
 Janitor 2
Under NACP III, it is proposed to set up 350 CCC over a period of 2007-2012 through PLHIV networks,
NGOs and other Civil Society Organizations
The CCCs are being established on priority,in districts which have high levels of HIV prevalence and
high level PLHIV plod and will be linked to the nearest ART centre.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 413
List of 235 Community Care Centers (19 March 2009)

S. State Name of District District Address Contact Phone No.


No. the CCC Category Person
1 Andhra Pradesh ASSISI Krishna A ASSISI Nagar, SR. PR. Prashanti Mary 08672-08248335 /
Dermatological Konkepudi, 9490635110 /
Centre Via Pedana 9441193550
Krishna-621366
2 Andhra Pradesh Bethesda West Godavari A Rustumbada, Dr. V. Rajeev Prasad, 08814-274618 /
Leprosy Narsapur, Medical Officer Incharge, 9440984979
Hospital West Godavari-534275 V. Paul Raju
3 Andhra Pradesh Canossa Srikakulam A Veeraghattam, Sr. Mercy Vullayil 8941-239878 /
Hospital Nadukooru, Srikakulam 239915 /
9490447068
4 Andhra Pradesh Damian Leprosy West Godavari A Vegavaram, Sr. Mary 08812-226132 /
Centre Gopannapale, 9490744875
West Godavari-534450
5 Andhra Pradesh Hand of Hope Mahaboobnagar A Doulathabad Mandal, Prerana Maddela 8505-287947 /
Methodist Chandrakal, 287994 /
Hospital Mahaboobnagar-509336 9849642457
6 Andhra Pradesh Holy Family TB Guntur A Sathenapalli, Sr. Anthony 9849114127
Sanatorium Guntur-522004
7 Andhra Pradesh Mother Vanninni West Godavari A Kadakatla, K.N.Road, Sr. Teresita Naralaly 8818-244121 /
Hospital Tadepalligudam, Administrator/ 9395347991 /
West Godavari-534101 Sr.Catherine 9490789682
8 Andhra Pradesh Raja Foundation Kadapa A Mylavaram, Kadapa Raja, Sleeva Reddy 9440650619 /
9290461051 /
08560-273881
9 Andhra Pradesh Sivananda Hyderabad A Kukatpally, Dr. Rishikesh 040-23057679 /
Rehabilaitation Hyderabad-500095 9866337152
Home Meera: 9246160251
10 Andhra Pradesh Soloman Prakasam A Soloman Gram Dr. A.Davidson, 08594-237199 /
Hospital Panchayat, Soloman S.Solomon Dr. David
Complex Center, Chirala, Cell: 9848129546
Prakasam-523155
11 Andhra Pradesh St. Anns Society, Krishna A Nunna, Vijiyawada, Sr. Teresa, 0866-2852231
Central Province Krishna-520004 Administrator
12 Andhra Pradesh St. Catald Krishna A Vattigudipadu Sr. Dr. Vincenza Mary, 8656-232611 /
Rehabilitation P.O., Teresanagar, Project Holder 9590607452
Centre Nuzivid, Krishna-521224
13 Andhra Pradesh St. Marys Nalgonda A Srirangapuram, Sr. Mercilla, Sr.Lilly 95863-255204 /
Hospital Kodad, Nalgonda 9848371137
14 Andhra Pradesh St. Vincents Prakasam A Medharametla Vimal Rose, Sr. Saley 8593-252652 /
Hospital P.O, Prakasam-523212 9985263137 /
9985263137
15 Andhra Pradesh St. Xaviers Guntur A Nirmala Nagar, Sr. Dr. Alphensa, 8646-272084 /
Hospital Vinukonda, Guntur Sr. Felicita 9849788014
16 Andhra Pradesh Suma Hospital Adilabad A Bheemaram P.O, Sr.Emi, Sr.Sancta Rose 48737-244029/
Jaipur Mandal, 9440594517
Adilabad-504204
17 Andhra Pradesh Women Ananthpur A Bathallapalli, Sirappa 08559-242746
Development Ananthapur Cell: 98490 15677
Trust

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 414 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

18 Andhra Pradesh Women Ananthpur A Kanekal Mandal, Sirappa 08559-242746


Development Ananthapur Cell: 98490 15677
Trust
19 Andhra Pradesh Rotary Abhaya Vijayanagaram A Rotary Abhaya Mr. Kumaran / 9393100585 /
Modavalasa Village S.Hanumantharao 9440190979
Denkada Mandal
20 Andhra Pradesh Srinivasa Vijayanagaram A Srinivasa Voluntary Dr. B.S.N. Murthy / 9440183216 /
Voluntary Organisation, B. Padmavathi 08964-252270
Organisation D.No. 59-112, Konki
Street, Salur
21 Andhra Pradesh Emmanuel Visakhapatnam A Emmanuel Ministries K. Jeevan Roy 08932-222531,
Ministries Association, 222231, 222236,
Association Kondalaagraharam, 9440147329
Makavarapalem Mandal
22 Andhra Pradesh NATURE Visakhapatnam A NATURE, # 38-37-38/2, S. Balaraju 08936-249228,
Bhaskar Gardens, 249408, 9441825181
Marripalem - 530018
23 Andhra Pradesh St. Anns Social Krishna A St. Anns Social Service Sr. Cyril 0878-2284404,
Service Society Society, Prashanth Sr. Joyce 9989558912
Bahvan (Care & Support Sr. Sudha 9963459078
Center), Deshrajpally X (Sr. Joycy)
Roads, Velichala,
Ramadugu Mandal
24 Andhra Pradesh Medak Catholic Medak A Medak Catholic Mission, Fr. Bali Reddy SVD, 9440226823
Mission (Asha Jyothi), Pregnapur Director 9866998727
(po), Gajwel Mr. Anandhan 9885782599
08454-211289
25 Andhra Pradesh David & Lois Chittoor A David & Lois Rees P.T. Mohanadoss, 9989799947
Rees Hospital Hospital, Deputy Director
Yerpedu - 517619 Emrys I. Rees
26 Andhra Pradesh Arogyavaram Chittoor A Arogyavaram Medical Dr. B Wesley, 08571-222228
Medical Centers, Centers, Union Mission Director 9440893669
Union Mission Tuberculosis Sanatorium,
Tuberculosis Arogyavaram,
Sanatorium Madanapally,
Chittoor District.
27 Andhra Pradesh AIDS Patients Nellore A AIDS Patients Care & K. Simhadri Rao 08626-657493
Care & Support Support Center, Bhavani V. Bhavani 9440277524
Center, Bhavani Educational Society, 08626-212434
Educational Mungamur Cross Road,
Society Near Kavali
28 Andhra Pradesh St. Josephs Khammam A St. Josephs Care Sr. Therese Marie, 08742-255763
Care Center Center, Asha Niketan Project Holder 9440869648
Hospital, Near Swarna Sr. Annie
Bharathi Eng. College,
Collectorate P.O.,
Khammam
29 Andhra Pradesh St.Josephs East Godavari A St. Josephs Hospital, Sr. Karuna 08868-246659,
Hospital, Prathipadu-533432 Sr. Vincentina 9849520542
Prathipadu- Via Samalkot 9963269271
533432
Via Samalkot

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 415
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

30 Andhra Pradesh Rural India Slef East Godavari A Rural India Slef N. Slesser Babu, 0883-2425367,
Development Development Trust, Coordinator 2420094,
Trust PB No-56, # 90-1-5/1, Mr. R. Praveen Das 9848185494,
Swaraj Nagar, 9440456772
A.C. Gradens,
Rajamandry -533101
31 Andhra Pradesh Mariyanilayam Kurnool A Mariyanilayam Social Sr. Samestha DSS, 9849517026
Social Service Service Society, Incharge 9441336003
Society Gargeyapuram, Kurnool. Sr. Deepthi 08518-200245
32 Andhra Pradesh Perali Narasaiah Nizamabad A Perali Narasaiah Dr. P.B. Krishna Murthy 08462-231060
Memorial & Memorial & Charitable R. Venkat Gopi 9849290234
Charitable Trust Trust, C/O Sree Rama 9490065888
Eye Hospital,
Khaleelwadi, Nizambad
33 Andhra Pradesh Freedom Secundrabad A Freedom Foundation, Jayasingh Thomas 9908582655
Foundation 21, Cariappa Road, Kishore Kumar 9848602446
Alwal, Bolarum, 040-27861023
Secundrabad.
34 Andhra Pradesh Rakshana Ranga Reddy A Rakshana Deepam, Sr. K. Clarit, 9441958720
Deepam 44-15/2, Survey No.113, Project Holder 9959543227
Himayat Nagar (Village), Sr. Swarnalatha 08413-235130
Via CBIT
35 Andhra Pradesh Viswakaruna Warrangal A Viswakaruna Fr. Jyothish 9849571049
Dermotoligical Dermotoligical Center, Sr. Pennamma 9440945756
Center Fathima Nagar, NIT Post 08711-223457
36 Andhra Pradesh Rajiv Gandhi Guntur A Rajiv Gandhi Asian Dr. Venkatappa Reddy, 9885623718
Asian Studies of Studies of Immunology Director 9848213718
Immunology (RASI) (CCC), Smt. M. Malleswari 0863-2223023
(RASI) D.No.13-8-147, 8th Line,
G.V. Thota, Opp. R.T.C.
37 Andhra Pradesh Ganne East Godavari A Ganne Subbalakshmi Dr. Ganesh 9959999805
Subbalakshmi Medical College (GSL) B.V. Soma Sastry 9959999802
Medical Dr. Jammy Rajesh 9989924783
040-30421517/18/19
38 Andhra Pradesh Kamineni Institute Nalgonda A Kamineni Institute of
of Medical Medical Sciences (KIMS),
Sciences (KIMS) Nalgonda
39 Andhra Pradesh APAIDSCON Medak A Dr. Ganesh 9959999805
B.V. Soma Sastry 9959999802
Dr. Jammy Rajesh 9989924783
040-30421517/18/19
40 Chandigarh Chandigarh Chandigarh B Khuda Ali Sher, Mr. Sachin Sharma 09872888177
Community Opposite Shivalik 09463456747, (Personal),
Care Center Nursery 0172-2786040 2786040 (Office)
41 Delhi Ashraya Holistic South B ASHRAYA - Holistic Ms. Nafisa Ali 9811548345
Care Centre Care Center, Multi (9818449999), (Henry, PC)
Purpose Community Mr. Henry : 9810398059
Center, Village Rajokari, henryasimte@yahoo.com
Delhi-Gurgaon Highway,
(Near Shiv Murti),
New Delhi-110038.

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 416 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

42 Delhi Akankshya / North East B Community Care Centre, Project coord. Mr. Harish Tel: 22130451,
Chelsea C-120, Gali No. 2, Varma (9810571911), 22130452
Near Police Station, Mrs. Doe Nair
Bhajanpura, 9810705450,
Delhi 110053 wagchelsea@vsnl.net,
Tel: 325 66703. wagchelsea@yahoo.com
wagchelsea@yahoo.com Mr Sumit Verma
wagchelsea@wagch coordinator: 9810255143
elsea.org Dr Umesh Bhatnagar:
9811213747
Mrs Doe Nair:
9810705450
43 Delhi Bhartiya New Delhi B BPS-Care Home Project Coord. Ms. Pooja
Parivartan C-42, Conductors (22356852, 9818233876),
Sansthan Colony, Burari, Mr. Dinesh Kumar
New Delhi-110084 (980064598)
Tel: 22351052,
22351053,
bps_org@rediffmail.com
44 Delhi Deepati West B H.No 8, Indira Service Mr. Joy Jacob 9910360825
Foundation Station, Main Dhansa
Road, Najafgarh 43
45 Delhi Aradhya North West C H.No. 15, Bhalaswa Mr. Umesh 9213429305
Colony, Harijan Basti,
Near Basti, Near G.T.
Road, Karnal Bypass
46 Delhi Sahara Center Central B 1765, Pataudi House, Ms. Riti 9818474619,
for Residential Kucha Dakhni Rai, 41639167
Care & Daryaganj,
Rehabilitation New Delhi 110002
47 Delhi Snehsadan/Child North West B SNEH SADAN - Care Projct coord. Tel:27874740,
Survival India Home, House No. 618, Ms. Sheela Mann 27874182
Prahladpur Road, (9810986101),
Village Khera Khurd, Ms. Deepa Bajaj
Delhi 110082, (9810647807)
csi_org@hotmail.com
48 Haryana Red Cross Rohtak C Arpan Institute, Near Mr. Nahar Singh Deswal 01262- 310107
Society, Rohtak Govt. Sr. Sec. School,
Gandhi Nagar,
Rohtak 124001
49 Karnataka Accept, Bangalore A AIDS Care Counseling Mr. Raju K Mathew 9448619619,
Bangalore Education and acceptindia@
Prevention Training gmail.com
(ACCEPT) 245m KRC
Road, (Next to Visthar),
Dodda Gubbi Post,
Bangalore - 562149.
50 Karnataka Moolika Shimoga A Moolika Samvrudhi Dr. Chandrashekar 0818326618
(Hariappa Arogyabhivrudhi
Hospital), Prathishthana, Hariyappa
Sanvruddhi Hospital, R.P. Road,
Sagar Taluk,
Shimoga - 577401.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 417
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

51 Karnataka Samraksha Kushtagi A Asha Jyothi - Ms. Sulekha 9448458301,


Samraksha # 10, si@samraksha.org
Gundi Road, NH 13,
Kushtagi - 584 121.

52 Karnataka SVYM, Mysore Mysore A Swamy Vivekananda Dr. Bindu 9448872708


Youth Movenent,
Handhipura Road,
Sangur, H.D. Kote Taluk,
Mysore - 571121.

53 Karnataka Freedom Bangalore A Freedom Foundation Ms. Madhuri 9945216412


Foudation, # 180, Hennur Cross,
Bangalore Bangalore - 560 035.

54 Karnataka Freedom Bellary A Freedom Foundation Ms. Rathi Kapadia 9880055140


Foudation, #30B, Infantry Road,
Bellary Opp. T.B. Hospital,
Bellary Contonment,
Bellary- 583 102.

55 Karnataka Snehadan Bangalore A Snehadaan, Fr. Sunny Joseph 9448242730


St. Camillus Home of
Charity, Sarjapura Road,
Ambedkar Nagar,
Carmelaram Post,
Banglore - 560 035.

56 Karnataka Snehasadan Mangalore A Snehasadan, Fr. Joy George 9448118119


St. Camillus Rotary
Rehavilitation Centre,
Kinnikambla Post,
Kaikamba,
Mangalore - 574151.

57 Karnataka Sri Shakti Belgaum A Sri Shakathi Association, Mr. Shashikumar 9945221004
Sri Shakthi Multi
Speciality Hospital,
Belgaum.

58 Karnataka Assissi Hospital Raichur A Vidyanagar, Sr. Felicia Mary 08532-240991 /


Raichur - 584103 240944

59 Karnataka Holy Cross Chikmagalur A Holy Cross Hospital, Dr. Bhagyalakshmi 9448130268 /
Hospital Jyothi Nagar, 08262-220077 /
Chikamagalur - 577102 220017

60 Karnataka Holy Cross Chamarajnagar A Kamagere, Kollegal, Sr. Regi John 9740664598 /
Hospital Chamarajnagar - 560068 08224-263681

61 Karnataka Dayabhavan Tumkur A Bhaktharahalli, Kunigal Fr. Jinesh Varkey 9448371298 /


Taluk, Tumkur - 572120 08132-320909 /
9242620548

62 Karnataka St. Marys Bellary A OPD Road, Cantonment, Sr. Mary Varghese 9449536191 /
Hospital Bellary 583 104 08392-242641

63 Karnataka Lourdes Dharwad A # 14337, Shanti Sadan, Sr. Nirmala Dsilva 9449483074 /
Hospital Ward 13, Block No. K A 0836 -2448224
19/2429, Nirmal Nagar
12th Cross Road,
Dharwad - 580003

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 418 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

64 Karnataka C G Hospital Belgaum A Cardinal Gracias Hospital Sr. Tessy 9448194244 /


Nirmal Nagar, Modage, 0831-2418244
Belgaum 591103

65 Karnataka St. Luke Hospital Gulbarga A Aurad - B, Dr. K A Abraham 9448042663 /


Gulbarga - 585316 08472 -211831

66 Karnataka Support Bangalore A Magadi Road, Fr. George K 9845811515 /


Sumanahalli, 9945333122 /
Vishavaeedam Post, 23485317
Bangalore 560091

67 Karnataka Karwar Diocesan Karwar A Bishops House, Fr. Lawrence Fernandes 9448129063 /
Development Baithkol Road, Karwar, 08382-220563
Council UK - 581302

68 Karnataka Haemophilia Davangere A No 352/1, 9th Cross, Dr. Suresh Hanagavadi 9341004109
Society P J Extn, Behind Mothi
Veerappa JR College,
Davanagere - 577002

69 Karnataka St Annes Bijapur A #54, Centre for Non Fr. Vincent Crasta 9448308585 /
Hospital Formal Education (CNFE), 08352-256453
Station Road,
Mukund Nagar,
Bijapur - 586104

70 Karnataka Freedom Udipi A Freedom Foundation Mr. Manohara 9449167897 /


Foundation #3/3A, Survey No. 14/1, 2530312
C-2, Moolur Village,
NH 17, Post Uchila,
Udupi District - 574117

71 Karnataka HEERA, (Health, Chitradurga A Community Care Center, Dr. Nagendra Gowda. 08194-230658,
Education, City Multispeciality M.R. 9880096765,
Empowerment, Hospital Premises, 9243205726
Rehabilitation Turuvanur Road,
Association) Chitradurga

72 Karnataka (ORBIT) Bidar A Asha Deepa, ORBIT Fr Santhosh Dias 08483 271032
Organisation for Community Care Centre,
Bidar Integral Kristhashrama,
Transformation Kaudiyal (s) ,
Basavakalyan Raluka,
Bidar District

73 Karnataka Our Lady of Kolar A Nava Jeevan Health Sr. Josena 8152223418
Mercy SAB Centre, Opp K.P.T.C.L,
Trust M.B. Road, Mulbagal,
Kolar

74 Karnataka Sri Sai Chikballapur A ARAIKE, Anakur, Ms. Rashmi R. 9945080817


International off Siddlagatta Main
Charitable Trust Road, Chikkaballapur

75 Karnataka Dakshina Dakshina A Navajeevana Care and Fr. Thomas K.C. 9008606605 /
Kannada Rural Kannada Support Centre, Kakkinje, 9448656926
Development Charmady P.O.,
Society Belthangady, D.K.,
Karnataka

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 419
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

76 Karnataka Asha Kiran Mysore A Asha Kiran Hospital, Mr. Gururaja 9980055905 /
Hospital CA-1, Ring Road, 984511058
Hebbal Industrial Housing
Area, Next to JK Tyres
Plant, Hebbal,
Mysore - 570016
77 Maharashtra Bel-Air Hospital, Satara A Bel Air Hospital, Fr. Tomy 09422606672,
Panchgani, Panchagani, 02168241109
Satara Satara - 412805
78 Maharashtra Acharya Vinobha Wardha A DMDPGMER, Sawangi Dr S Z Quazi, Dr Abhay 09370043029,
Bhave Rural (Meghe), Wardha Gaidhane 9325191810,
Hospital, Wardha 07152- 320750
79 Maharashtra Krupa Prasad Nasik A Krupa Prasad Kendra, Dr Dimple Chauhan, 0253- 2595586
Kendra, Nasik Old Mumbai, Agra Road, kkrupaprasad@ 9422759960
Behind Vasan Showroom, yahoo.co.in,
Mumbai Naka, digimol_2006@
Nasik 422001 yahoo.co.in
80 Maharashtra G.M. Priya Latur A G M P Hospital, Dr D William 02383- 226069
Hospital, Latur Dapegaon, Taluk Ausa,
Dist Latur - 413572
81 Maharashtra Jan Kalyan Sholapur A C/O Chaitanya Hospital, Mr. J Shilgekar 0217-2741870,
Samiti, Sholapur 538 Vithal Arcade, 2741874, 2741872
North Kasba,
Sholapur - 413001
82 Maharashtra Nirmaya Niketan, Mumbai A V N Purav Marg, Mr. John Lobo, Mr. A.S. 022-25513314,
Mumbai Dhobighat, Trombay, Gaikwad, Chairman- Fax:91-022-25581450
Mumbai - 400088, Mr. Santan DSouza, Tel: 91-022-2551
<chairman@nirama Eduljee Framjee Allbless 3314 (OPD)
yniketan.org> Niramay Niketan, Mob. No. Chairman -
V.N. Purav Marg, 9869682397,
Dhobi Ghat, Trombay, Treasurer -
Mumbai-400088 9867618832,
Co-ordinator (CCC) -
9869289347
83 Maharashtra Sarvodaya Mumbai A Lal Bahadur Shastri Mr. Krishnan 022-25152237
Hospital, Marg, Ghatkopar (W),
Mumbai Mumbai
84 Maharashtra Snehalaya, Ahmednagar A Block No 239, Near Mr. Ambadas Chavan, 0241-2778353,
Ahmaednagar Super Ammonia Plant, Mr. Anil Gawde 2327593,
Shree Tile Chowk, 9881946116
MIDC, Nimblak, 9890306407
Ahmednagar-414001
85 Maharashtra Priyadarshani Akola A Sant Tukaram Hospital, Dr. Jagannath Dhone, 0724-2433092
Rural and Tribal Gorakshan Rd, Anand Janotkar 9923584209
Upliftment Tukaram Chowk,
Foundation, Akola - 444001
Akola
86 Maharashtra Godavari Jalgaon A Godavari Foundations Dr. Ulhas Patil 0257-2200830
Foundation, CCC, Mahesh Housing Mr Yogesh Mahajan 9371616716
Jalgaon Society, Near Hotel Step
Inn, Jalgaon - 425001

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 420 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

87 Maharashtra Lotus Medical Kolhapur A Sona Towers, Survey Dr. Kimaya Shah 0231-2692411
Foundation, No 644, Plot No. 143/B1, 9422051305
Kolhapur YP Pawar Nagar Chowk,
Jawaharnagar Rd,
Kolhapur-416008

88 Maharashtra Balvikas Mahila Latur A Swadhar Mahila Mr. Vilas Deshpande 02382-228773
Mandal, Latur Vastigruh, Sudarshan 02382-240418
Colony, Indra Nagar,
Latur - 413512

89 Maharashtra Mure Memorial Nagpur A Maharajbagh Road, Mr. Vilas Shende 0712-2522370
Hospital, Nagpur Sitabuldi,
Nagpur-440001

90 Maharashtra Bhartiya Adim Nagpur A C Mr. R.K. Malviya 0712-2290421


Jati Sevak Amruta Joshi 9372543322
Sangh, Nagpur 9422804228

91 Maharashtra Dhanvantri Nanded A Infront of Water Tank, Dr. B.K. Kardile 02462-234330
Vaidyakiya Mahavir Society, 9422186245
Pratishthan, Nanded - 431602
Nanded

92 Maharashtra Sai Sneha Pune A Sai Sneha Hospital, Dr. Sunil Jagtap 020- 26959208,
Hospital, Pune A/P Khed Shivapur 9822036736
(Bagh) Near Police
Station, Tal. Haveli,
Dist. Pune-412213

93 Maharashtra Loknete Islampur A Loknete Rajarambapu Dr. Pramod Patil 02342-225792


Rajarambapu Patil Hospital and
Patil Hospital Research Centre,
and Research Islampur Sangli Rd,
Centre, Sangli Islampur-415409

94 Maharashtra Sangli Mission Sangli A Dilasa House, Darga Fr. Sabu 0233-2211292,
Society, Sangli Mohalla, Aman Nagar, 9420678520
Malgao Rd, Miraj,
Dist Sangli-416410

95 Maharashtra Loknete Rajaram Sangli


Bapu Hospital &
Research Centre

96 Maharashtra Param Prasad Pune A Dr. Jal Mehta Foundation Fr. Shaju 0-9970963246
Charitable Campus, Survey No. 1,
Society Yevlewadi, Pune

97 Maharashtra Sai Prem Yavatmal A Dhanashre Rugnalay, Reeta Bhawnae 0723-2322929


Gramina Vikas Behind Basaveshwar
Sanstha Mangal Karyalaya,
Darwha Rd., Yavatmal

98 Maharashtra Kamlini Nilmani Mumbai A Goel Hospital, J B Nagar, Ravi Patil 022 28323659 /
Charitable Trust Andheri (East), 28349714
Mumbai - 400 059 982013653

99 Maharashtra Jyotish Raigad A Jyothis Care Centre, Sr. Infanta 022-27423399


Charitable Trust Sector 11, Plot No 4,
Kalamboli, Navi Mumbai

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 421
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

100 Maharashtra Jeevan Vikas Amravati A Navjeevan Care Centre, Fr.Jolly 07223 221352 /
Sanstha C/O Leprosy Relief & 221576 / 07223 /
Rehabilitation Centre, 223740 /
Nimbhora Khurd, 09422156032
Badnera P.O.,
Amravati Dist. - 444701

101 Maharashtra Dhanvantaris Parbhani A DOST CCC, Sadguru Dr.Jawade (02452) 241122
Organization for Nagar, Old Pedgaon Rd, 9970764224
Socio Health Parbhani-431401
Transformation

102 Maharashtra Shanti Mandal - Aurangabad A Vimala Sadan Social Sr.Sheeba


Vimala Sadan Service Centre, New
Shantiniketan Colony,
Jalna Road,
Aurangabad - 431005

103 Maharashtra Diocese of Chandrapur A Christ Hospital, Dr. Gregory Ellyadom 07172-264387,
Chanda Society Jyoti Nagar, Tukum, 264389,
Chandrapur- 442401 09423115594

104 Maharashtra Shri Gajanan Jalna A Shrikrishna Clinic, Ganesh Sonunae 07261-232226,
Maharaj Krishi Mantha Road, Jalna 232393,
Va Shishanak 9422880291,
Santha 9881719227

105 Maharashtra Sangli Mission Ratnagiri A Navajeevan Arogya Fr. Siju 094211-22204
Society Kendra, St. Thomas
Church Campus, MIDC
PO, Karwanchi Wadi
Road, PB-12,
Ravindranagar,
Ratnagiri - 415639

106 Maharashtra DOST- Hingoli Hingoli DOST-CCC Hingoli, 9970764224


Hingoli-CCC Near Civil Hospital,
Hingoli, Dist. Hingoli

107 Maharashtra Hope Centre Mumbai Andheri The Catholic Nurses 9892950509
Guild of India., C.N.G.I.
National Secretariate &
Hope Centre,
Mhatarpada Road,
Amboli, Andheri West,
Mumbai - 400058

108 Maharashtra Sparsh Hospital Osmanabad Sastur SPARSH Rural Hospital, 094220 95053
At Sastur, Taluka Lohara,
Dist. Osmanabad-413606

109 Maharashtra Ashakiran Pune Pune Ashakiran Jubilee Hope 020-27482626,


Hospital Centre, Survey No. 138, 020-65320462
Chinchwad (East),
Near St. Andrews School,
Pune - 411018

110 Maharashtra Vanchit Vikas Pune Pune Mogal Market, 2nd Floor, 020 24454658/
CCC CTS No: 1003, Budgwar 24483050
Peth, Pune - 411002

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 422 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

111 Maharashtra Late Shriram Dhule Dhule CCC - Late Shriram 9422788421
Ahirrao Memorial Ahirrao Memorial Trust,
Trust- Dhule-CCC Betawad, Tal. Sindkheda,
Dist.: Dhule
Pin: 425403

112 Maharashtra Late Shriram Nandurbar Nandurbar Jai Prakash Narayan 9422788421
Ahirrao Memorial Hospital Compound,
Trust- Near Meera Agency,
Nandurbar-CCC Main Road,
Nandurbar

113 Maharashtra Sant Gulab Baba Bhandara Bhandara Doctors Colony, 9823593554
CCC Takia Ward,
Behind MSEB Office,
National Highway-6,
Bhandara - 441904

114 Maharashtra Yuva CCC Beed Parli Late Suwalalji Wakekar (02446) 222891
Community Care Center,
Parli (V), Near Over
Bridge, beside
Khandinala Complex,
Hindnagar, Parli (V),
Dist. Beed - 431515

115 Manipur Centre for Canchipur A Centre for Organising Th. Promila 98562-15673,
Organising Labours Development 2406411
Labours (COLD), Canchipur,
Development Imphal West
(COLD)

116 Manipur LEWS Imphal A Leprosy Patients Welfare A. Tolen Singh 2421363(O),
Society, Lei-Ingkhol, 94360-20161,
Imphal 94360-27065
Email: lews2003man
@yahoo.co.in

117 Manipur RUSA, Moreh Moreh A Rural Service Agency Y. Surchandra Singh 98622-78785,
(RUSA), Moreh, Ward 2231145
No.9, Near Trade Center Email: rusapalace
compound@
yahoo.com

118 Manipur SHALOM Churchanpur A Society for HIV/AIDS and Ms. Lalruatpuii Pachuau 953874-33891,
Lifeline Operation in 953874-22531,
Manipur (SHALOM), 953874-33541
Churachandpur Bazar Email: shalomccp@
yahoo.co.in

119 Manipur Kha Manipur Thoubal A Kha Manipur Yoga and Dr. M. Rajkumar Singh 98620-88092,
Yoga and Nature Cure, Kakching 953848-261320
Nature Cure Thoubal District Email: ayncrh@
yahoo.co.in

120 Manipur PRDA Bishnupur A Peoples Resources L.Suranjoy Singh 98561-92762


Development Association Email: prda@
(PRDA), Ningthoukhong rediffmail.com
of Bishnupur District

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 423
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

121 Tamil Nadu YRG Centre for Chennai B YRG Centre for AIDS Thiru. SK. Satish Kumar 9381006380
AIDS Research Research and Education suniti@yrgcare.org,
and Education (YRG CARE), Voluntary satish@yrgcare.org
(YRG CARE) Health Services (VHS)
Campus, Taramani,
Chennai - 113
122 Tamil Nadu Sneha Sadan Dharmapuri A Sneha Sadan, Sr. Shobhana, 9486091091,
Selliampatty Village & snehasadan2007@
Post, Palacode Taluk, gmail.com
Dharmapuri
District - 636809
123 Tamil Nadu The Association Dindigul C The Association of Dr. Margret Kalaiselvi, 9944210076
of Arulagam Arulagam Hospice, margaret_larbeer@
Hospice Bangarapuram, yahoo.com,
Reddiarchatram Post, arulhos@yahoo.co.in,
Dindigul District - 624622 arulagampc@yahoo.co.in
124 Tamil Nadu Family Planning Dindigul C Family Planning Thiru. A.K. Serumalai 9952118640
Association of Association of India fpaidindigul@yahoo.com
India (FPAI) (FPAI), Plot No. 69-70, 9952118640
AJMG Nagar, 4th Lane,
Opp. to Beschi College,
Karur Road,
Dindigul District - 624001
125 Tamil Nadu Centre for Action Erode A Centre for Action and Thiru. Charles Prabhu, 9443736367
and Rural Rural Education (CARE), 9443736367,
Education (CARE) No. 6, Kambar Street, carecharles@dataone.in
Teachers Colony, Erode
126 Tamil Nadu Family Planning Madurai A Family Planning Dr. Louis S. Paulraj, 9442035900
Association of Association of India 9442035900,
India (FPAI), (FPAI), Madurai Branch, fpaim@satyam.net.in
FPAI Bhavan, FPAI Road,
TNHB Colony,
Ellis Nagar, Madurai,
Madurai District - 625010
127 Tamil Nadu Meenakshi Madurai A Meenakshi Mission Thiru. S. Palaniappan, 9842161185
Mission Hospital Hospital and Research 9842161185,
and Research Centre, Lake Area, charityrd@gmail.com,
Centre Melur Road, palaniappan_law@
Madurai District - 625107 yahoo.co.in
128 Tamil Nadu HIV Positive Namakkal A HIV Positive People Ms. S. Kausalya, 9840693679
People Welfare Welfare Society (HPPWS) 9840693679,
Society (HPPWS) No.119-28B, Madha Koil hppwscare@gmail.com
Street, Trichy Road, <hppwscare@gmail.com>
Namakkal - 637001
129 Tamil Nadu Human Uplift Perambalur A Human Uplift Trust (HUT) Dr. Raja Venkat 9842414711
Trust (HUT) Meikandar Complex, 9842414711
Kalpalayam Road, rajavenkat@hutindia.org
Mannachanallur,
Trichy - 621005
130 Tamil Nadu Sri Ponnalagi Pudhukottai A Sri Ponnalagi Amman Dr. A. Alegesan, 9344545449
Amman Trust Trust, Thottiampatty, 9344545449,
Ponnamaravathy, dralagesan@yahoo.co.in,
Pudukottai District spatrust@gmail.com
<spatrust@gmail.com>

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 424 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

131 Tamil Nadu Immaculate Sivagangai A Immaculate Conception Sr. Motchalangaram, 9486013389
Conception Women Development 9486013389,
Women Social Service Society st_jsph@rediffmail.com
Development of Sivagangai Province <st_jsph@rediffmail.com>
Social Service Sirpi & St. Joseph
Society of Hospital, Pulial,
Sivagangai Pulial (Post),
Province Sirpi & Devakottai (via),
St. Joseph Sivagangai - 630 312
Hospital

132 Tamil Nadu Mass Action Thiruvallur A Mass Action Network G. Babu, 9444275762
Network India India Trust (MAN), No.14, 9444275762,
Trust (MAN) 1st Floor, West Sivan, massaction@
Kovil Street, Vadapalani, rediffmail.com
Chennai - 600029

133 Tamil Nadu St. Joseph Tuticorin A St. Joseph Leprosy Sr. Rose Francis, 9442948815
Leprosy Hospital Hospital and HIV/AIDS 9442948815,
and HIV/AIDS Care Centre, joseind@gmail.com ,
Care Centre Arokyapuram, Sr. Dr. Rita
Thoothukudi

134 Tamil Nadu Holy Family Trichy A Holy Family 9443401125, 9443401125
Hansenorium Hansenorium, ritasr@sify.com
Fathima Nagar (Post),
Trichy - 620 012

135 Tamil Nadu Sri Meenakshi Ramnad A Sri Meenakshi Dr. S. Sundarraj, 9443155181
Educational and Educational and 9443155181,
Development Development srimedu@rediffmail.com
Organization Organization (SMEDO),
(SMEDO) No. 3/622 A3,
Bagawath Singh Road,
Paramakudi - 623707,
Ramanathapuram District

136 Tamil Nadu Tamilnadu Villupuram B Tamilnadu Network of Thiru. Rama Pandian, 944040469
Network of Positive People (TNP+), 944040469,
Positive People No. 10, Kalaignar, tnpluz@yahoo.com
(TNP+) Karunanidhi Street,
Chennai Main Road,
Villupuram - 605 602

137 Tamil Nadu N.A.A.DT. People Vellore A N.A.A.DT. People Thir. M.S. Rajendran, 9790571391
Welfare Service Welfare Service Society, 9790571391,
Society Dharma Nagar, Vellore msrajendran@yahoo.co.in
Govt. Medical College
Hospital back side,
Adukkambarai,
Vellore District

138 Tamil Nadu Community of Vellore A Community of People Mr.Pandian, 9894807208, 9894807208
People Living Living with HIV/AIDS in knirmala@yahoo.co.in
with HIV/AIDS in Tamilnadu (CPT+), <knirmala@yahoo.co.in>
Tamilnadu No. 5/74C, Katpadi Main
(CPT+) Road, Senrayanapalle,
Katpadi Taluk,
Vellore District

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 425
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

139 Tamil Nadu Sri Narayani Vellore A Sri Narayani Hospital & Dr. J. Sundra Babu, 9952416822
Hospital & Research Centre, 9952416822
Research Centre, Thirumalaikodi, snhrc_76@yahoo.com,
Vellore District - 632055 suresh1980edp@
gmail.com
140 Tamil Nadu Society of the Theni A Society of the Sisters Sr. Anestesia, 9443862311
Sisters of the of the Presentation of 9443862311
Presentation of the Blessed Virgin Mary
the Blessed Community Health
Virgin Mary Department, No. 5/73,
Community Theni District,
Health Theni - 625 531
Department
141 Tamil Nadu Ramana Thiruvannamalai A Ramana Maharishi Thiru. F. Jayaraj, 9442274235
Maharishi Rangammal Hospital, 9442274235,
Rangammal Shiva Nagar, Athiyandal sm_wright21@hotmail.com
Hospital Village, Thiuvannamalai
District - 606603
142 Tamil Nadu Society for Nagapattinam C Society for Education Tmt. A.G. Manimekalai, 9443847312
Education and and Economic 9443847312,
Economic Development (SEED) seedngo@rediffmail.com
Development No.3/273, Main Road,
(SEED) Thirumarugal,
Nagapaatinam
143 Tamil Nadu Indo Srilankan The Nilgiris A Indo Srilankan Mr. Alphone Raj M.L., 9443371224
Development Development (Island) 9443371224,
(Island) Trust Trust, No. 14/56, islandtrust@bsnl.in
Club Road,
Kothagiri - 643217
144 Tamil Nadu TCNR Virudhunagar A TCNR Padmavathi Dr. Kamalasekarn, 9443122784
Padmavathi Ammal Free Medical 94431 22784,
Ammal Free Charties (TCNRP), tcnrp86@yahoo.co.in
Medical Charties Bo. 121B, Hospital Road,
(TCNRP), Rajapalayam - 262117
145 Tamil Nadu Selvi Memorial Kancheepuram A Selvi Memorial Illam Ms. Mary Thomas, 9840541108
Illam Society, Society, No. 9, 2nd Main 9840541108,
Road, Jaya Nagar, smis99@gmail.com,
Tambaram Sanitorium, selvi_mary@sify.com
Chennai - 600 047
146 Tamil Nadu We Care Social Kancheepuram A We Care Social Service Mr. Antony, 9340001000, 9340001000
Service Society Society, No. 4/98, wecareindia@gmail.com
Nethaji Road,
Singaperumal Koil Post,
Kancheepuram
District - 603 204
147 Tamil Nadu Arogya Agam Theni A Arogya Agam, Mr. John Dalton 9842115449/
Palakombai Road, 9842115449/9842142306, 9842142306
Aundipatty, info@arogyaagam.org,
Theni - 625 512 arogyaagam@gmail.com
148 Tamil Nadu Indian Red Krishnagiri A Indian Red Cross Society Mr. P. Shanmugam, 9443331118
Cross Society (IRCS), No.8, Krishnappa 944331118
(IRCS), Layout,
Krishnagiri Krishanagiri - 635001

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 426 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

149 Tamil Nadu Vailankanni Thiruvarur C Vailankanni Society for Er. S. Xavier, 9842452597
Society for Rural Rural Construction and 9842452597,
Construction and Technical Education virtueorg@yahoo.co.in
Technical (VIRTUE), No.18/94-V,
Education Hospital Street,
(VIRTUE) Tiruthuraipoondi - 614713

150 Tamil Nadu Anbalayam Thanjavur B Anbalayam, No. 6/142, Thiru. K. Senthil Kumar, 9443167607
Natarajapuram South, 9443167607,
10th Cross Street, anbalayam2001@
Thanjavur - 613 007 yahoo.co.in

151 Tamil Nadu Freedom Chennai A Freedom Foundation, Mr. Varadhan, 9444041619
Foundation No. 15, Redhills Road, 9444041619
United Colony, Kolathur,
Chennai - 600 099

152 Tamil Nadu Preshistha Coimbatore A Preshistha Service Fr. Seby Vellanikaran, 9443006094
Service Society Society, Unjavelampatty, 9443006094,
Pollachi Taluk, pss_poy@yahoo.com,
Pollachi - 03, sebyvellani@yahoo.co.in
Coimbatore District

153 Tamil Nadu Isha Yoga Coimbatore A Isha Yoga Foundation, Dr. Bhavani Balakrishnan 9840804496
Foundation, Grama Puthunarvu 9840804496,
Iyyakkam, No. 13/24, isha.healthservices@
North End Road, gmail.com,
Krishnasamy Nagar, bhavani.balakrishnan@
Coimbatore - 45 gmail.com

154 Tamil Nadu Sharanalayam Coimbatore A Sharanalayam, No. 34, N. Chandran, 94443054204
Thiruvengada Nagar, 94443054204,
Pollachi - 642 001, aid@sharanalyam.org,
Coimbatore District sharanalayam@
rediffmail.com

155 Tamil Nadu PEACE TRUST Tirnelveli B PEACE TRUST, No. 15, Dr. R. Anburajan, 9442612138
Kurichi Road, 9442612138,
Kulavanigar Puram, anburajandoctor@
Palayamkotta - 627 002 gmail.com

156 Tamil Nadu Modern Karur A 15/2 11th Cross Street, R. Thirumal@ 93676 20313
Educational 1st Floor, Rajanmessscuddalore@ 94424 40747
Social Service Sengunthapuram, yahoo.co.in
Society (MESSS) Karur - 2

157 Tamil Nadu Saraswathi Dindigul C Saraswathi Women S. Kalaiarasi


Women Educational Service 9442641104
Educational Training Improvement swestic1990@yahoo.co.in
Service Center (SWESTIC),
Training Opp. to Lokayarkottai,
Improvement Solaipudur (Post),
Center Oddanchatram - 624619,
(SWESTIC) Dindigul District

158 Tamil Nadu James Memorial Kanniakumari A James Memorial G. Frederick Raja Sekhar
Charitable Trust Charitable Trust, 9443326327
Colachel Post, gmrsekhar@gmail.com
Kannyakumari
District - 629 251.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 427
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

159 Tamil Nadu Centre for Kanniakumari A Centre for Human chardep_98@yahoo.com G. Manikandan
Human Resource Resource and Rural 9942979160
and Rural Developmental
Developmental Programmes (CHARDEP),
Programmes No. 21B, Sargunaveedi,
(CHARDEP) Cross Street,
Ramavarmapuram,
Nagercoil - 1,
Kanyakumari District
160 Tamil Nadu The Modern Cuddalore A The Modern Educational R. Thirumal @ Rajan 93676 20313
Educational & & Social Service Society messscuddalore@ 94424 40747
Social Service (MESSS), No. 10, yahoo.co.in
Society (MESSS) Srinivasa Pillai Street,
Pudupalayam,
Cuddalore - 1
161 Tamil Nadu Doctor Typhagne Salem A Doctor Typhagne dtmctrust@gamil.com A. John Paul,
Memorial Memorial Charitable dtmctrust@yahoo.co.uk 9894137826
Charitable (DTMC) Trust, SMMI Sr. Francina,
(DTMC) Trust Convent Staff Quarters 9443221482
Arisipalayam,
Salem - 636 009
162 Mizoram Joy Adventist Aizwal A Seventh Day Tlang, Dr. Eileen (94361-43503), (0389) 234-0326,
Aizawl Cathy Lalnunpuii 94361-97768
aadhos@gmail.com (98630-42694)
163 Mizoram Presbytarian Duruthalang A Presbytarian Hospital, Dr. Sanghluna (0389) 236-1222,
Hospital Dururthlang 0-94361-41739
164 Jharkhand Snehdeep, Hazaribag C Snehdeep Holy Dr. Sandeep Mukerjee
Hazaribagh Cross CCC, Sitagarh,
Hazaribagh
165 Jharkhand Ashadeep, Ranchi C Ashadeep CCC,
Ranchi Hefag Hatia, Ranchi
166 Himanchal Swami Sri Chamba C Swami Shri Hari Giri
Pradesh Harigiri Hospital Hospital Cum Research
and CCC, Centre, Kakira,
Chamba Distt. Chamba
167 Punjab Community Care Amritsar C Inside Guru Nanak Ph. 0183-2572401
Center for people Dev Hospital, Near
living with De-Addiction Centre,
HIV/AIDS, Majitha Road,
Amritsar Amritsar - 143001
168 Punjab Community Care Patiala C Information not received
Center Patiala
169 Punjab Community Care Kapurthala C Information not received
Center Jalandhar,
Kapurthala
170 Kerela St Johns Health Trivandrum C St Johns Health Services Fr Jose Kizhakkedath 0472 2872047
Services Pirappancode, Trivandrum,
0472-2872047
171 Kerela Amrita Kripa Trivandrum C Amrita Kripa Sagar Care Br Amarnath 9447090075
Sagar Care Centre, Nedumangad,
Centre Trivandrum,
Phone: 0472 2891237

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 428 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

172 Kerela Snehatheeran Ernakulam B Snehatheeran Care Fr Naveen Mathew 9495676232


Care Centre Centre, West
Kadungallor, Aluva
10 Ernakulam Dist

173 Kerela Asha Kiran, Kottayam C Pampady, Ms Isha Jacob 0482 2500431
Pampady, Near Near KG College,
KG College Kottayam - 686502
Kottayam 686502
0481 2500431

174 Kerala Nazarath Care Palakkad C Narareth Sabs Centenary srtessinmynatty@ 0491-2910035
and support Charitable Trust, gmail.com
Center Kinasery PO,
Muthukad - 678707

175 Kerala Institute of Calicut B Medical College PO, dr.suresh.kumar@ 9349113532


Palliative Kozikode - 673008 gmail.com
Medicines

176 Assam Borukha Public Guwahati B guwahati@bpwt.org Mr. Ratul Kalita, 98642-16627,
Trust, Guwahati Dr. J.N. Bhattacharya 0361-223-1104,
0361-223-4104

177 Assam Anubhuti Silchar C Deshasandhu Club, Mousami Roy communitycarecenter


Community Sahid Bazar, Sibburi dbc@gmail.com
Care Center Road, Silchar, Cachar

178 Assam Astha CCC Dibrugarh C Chiring Chapori, Ranjita Tayeng Dr. H Das
Opposite Bhattacharjee 03732316917,
Press, Behnid Assam 03732310060,
Tribune, 9435112933
Dibrugarh-786001

179 Goa CARITAS Goa A Near Church Cavelossim, Sr. Vinita Joseph 0832-2871745
Salcete, Goa - 403802

180 Goa Freedom Goa A 105/A-2, Opp. Hotel Ms. Zinya DSouza 0832-2264262
Foundation Green Park, Sorvem,
Guirim, Bardez,
Goa 403507 (North Goa)

181 Nagaland ECS Hospice Tuensang A Eleutheros Christian Dr. Panker, 0361-220127 /
Society (ECS) Tuensang, M - 09436658220 09436658220
Nagaland PO Box -51
Tel: 0361-220127

182 Nagaland HIV/AIDS Care Kohima A Naga Mothers Dr. Kekhrievilhou Nakhro 0370-2800356 /
Hospice Association (NMA) Mobile No. 09856150359 09856150359
HIV/AIDS Care Hospice
Cradle Ridge, Seithogei,
PO Box No. 160,
Kohima- 797001,
Nagaland
Tel: 0370-2800356

183 Nagaland Impur Christian Mokokchung A Impur Christian Hospital, Mr. Talitemsu, Manager 0369-2262441
Hospital, Mokokchung. M-9436408316
Mokokchung

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 429
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

184 Nagaland Western Sumi Dimapur A Western Sumi Community Khekiho Katy (03862)245033 (R)
Community Development Project, (Development Officer)
Development Akuvuto, P.O. Box-34, 9856544303 (M)
Project Thakhekhu
(WSCDP) Village-797112, Dimapur
Dimapur E-mail: wsbak_
development@yahoo.com

185 Uttar Pradesh Umang CCC Lucknow C Near Petrol Pump, Mr. Arif 9935859534 /
Foundation Andhe ki Chowki, 9935451159
for Social Care Hardoi Road

186 Uttar Pradesh Umang CCC Merrut C B-104, Takshila Colony, Mr. Arun Kumar (0121) 3208543
Adarsh Sewa Garh Road, Meerut
Samaiti

187 Uttar Pradesh Umang CCC Varanasi C Umang Community Care Ms. Kanchana Singh 09415223387,
Centre for Social Centre, Plot No.17, 09336747468
Research Sukhi Sansar Colony,
Giri Extention,
Mahmoorganj,
Varanasi

188 Uttar Pradesh Umang CCC Gorakhpur C C-362, Raptinagar, Mr. Arvind Kumar 0551-2506064
Gramin Seva Phase-4, P.O.
Sansthan Charaganva,
Gorakhpur

189 Uttar Pradesh Umang CCC Allahabad A 21 Shivpur, Mr. Manoj Kumar 0532-232845
Society for P.O. Dhoomanganj,
Welfare & Allahabad 211010
Advancement of
Rural
Generations
(SWARG)

190 Uttar Pradesh Umang CCC Kanpur C

191 Uttar Pradesh Umang CCC Agra C

192 Rajasthan SAMBAL CCC Ajmer B Swasti B-88, Sarswati Mr. Bhanwer Govind 0145-2600415,
Bal Sansar Marg, Bajaj Nagar, Singh 09461478052
Jaipur

193 Rajasthan Jeevan Prakash Bikaner D Basadi-Boroda, Ms. Nisha Seezo 0151-2110285
CCC Gramin Post Udawala,
Vikas Evam via Sainthal,
Paryavaran District Dausa,
Sanstha Rajasthan

194 Rajasthan Seva Mandir Udaipur B Old Fatehpura, Ms. Ratan Paliwal 0294-2451041,
CCC Seva Udaipur- 313004, 2450960
Mandir Rajasthan

195 Rajasthan Jeevan Asha Jaipur B

196 Rajasthan Jeevan Anand Jodhpur C 776/17 E, Housing Board Mr. Kuldeep Chaudhary 0291 2707498
CCC St. William Chopashni, Jodhpur
Educational and
Social Welfare
Society

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 430 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

197 Gujarat Karuna Shakti Ahmerdabad B Karuna Shakti CCC, Sr. Elizabeth 079-22861216/49 &
CCC Kaira Matikhan Talawadi, 079-65442593
Social Service Ramol Gatrad Road,
Society Nr. Toll-tax Bridge,
Ring Road, Ahmedabad
ksss@gmail.com,
Karunasccc@gmail.com

198 Gujarat Navjeevan Trust Rajkot B Jamnagar Road, Fr. C.C. Jose CMI 0281-2490916
CCC Opp. Morbi House,
Post Box No. 36,
Rajkot, Gujarat

199 Gujarat Navjeevan CCC Bhavnagar B Our Lady Pillar Sr. Dr. Scholastica (0278) 2573559
Navjeevan Disceinsary, Plot No. Macwan
Welfare Society 428/F, Prabhudas Talav,
Ruvapari Road,
Bhavnagar

200 Gujarat Sphoorti Mehsana B Sabarmati Sammrudhi Ms. Hemlata (079) 23227856
Sabarmati Seva Sangh,
Samruddhi C/o Catholic Ashram,
Seva Sangh Post Box No.3,
Ramosana Road,
Mehshana - 384002

201 Gujarat Jeevan Jyoti Vadodara B Jeevan Jyot CCC, Ms. Susan (0265) 5596970
Kripa Foundation C/O Kripa Rehabilitation
Centre,At & Post Amodar,
Taluka-Vaghodiya,
Vadoara - 390019

202 Gujarat Santwana CCC Jamnagar B

203 Gujarat Sarvjanik CCC Surat A Pastagia Street, M. M. Amla 0261-2492678


Sarvjanik Medical Nr. Rampura Petrol
Trust Pump, Rampura,
Surat - 395003 (Gujarat)

204 Chattisgarh Lifeline CCC Bastar C C/o MPM Hospital, Fr. K.T. Thomas 07782 229030,
Model Bastar Aghanpur, Jagdalpur, 229032
Integrated Rural Bastar DT.,
Development Chhattisgarh - 494005
Society (BIRDS)

205 Chattisgarh Holy Cross Sarguja C Holy Cross CCC, Sr. Juliet Jacob (+91-79363660)
Pavitra Cruz Holy Cross Hospital, (+91-9425255922)
Sisters Society Ambikapur,
DistrictSarguja,
Chattisgarh - 497001

206 Chattisgarh Karuna CCC Durg A Karuna CCC, Karuna Sr. Sushila 0788 - 2296486;
Hospital, Nandini Road, 9752898960
Khurispar, Bhillai,
Durg - 490002

207 Chattisgarh Maria Sahay Bilaspur C Maria Sahaya CCC, Sr. Kusum 0775 -22733673;
CCC Sipat Road, Sarkanda, 98983396495
Bilaspur - 495006

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 431
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

208 Chattisgarh Jeevodaya CCC Raipur C Jeevodaya CCC, Social Fr. Abraham 0771 2120131
Jeevodaya Social & Leprosy Rehabilitation Thylammanal SAC
& Leprosy Center, P.O. Abhanpur,
Rehabilitation Dt. Raipur,
Center Chattisgarh - 493661

209 Madhya Pradesh Saathi CCC Ujjain C MIG A 5/16 Mahakal 0734-2533246
Kripa Social Vanijyik Kendra,
Welfare Society Ujjain - 456010

210 Madhya Pradesh Asha Kiran Jabalpur C M-54, 7th Lane, Avinash Pillai 9425873616
Jabalpur Behind Gupta Hotel,
Diocesan for Sharda Colony,
Social Service Shakti Nagar, Jabalpur
Society

211 Madhya Pradesh Maitri Asha Bhopal B Gandhi Bhavan, Mr. Shaji Chacko 0755-4273848
Niketan Shyamla Hills

212 Madhya Pradesh Vishwas CCC Indore B R-847, Near Poineer Sr. Geeta 0731-2556372
Pavitra Atma Convent, Mahalaxmi
Sevika Sangh Nagar, Indore

213 West Bengal Arunima CNI Kolkatta A 81, Diamond Harbour Mr. Suvobrata Das (033) 6450 8840
Calcutta Road, Barisha,
Diocesan Kolkata - 700 008
Central Fund

214 West Bengal Snehalaya Midnapur B Vill - Dihibaliharpur, Mr. Badal Maharana 03225-254217
Gandhi Mission Post - Daspur,
Trust Dist - Paschim Medinipur,
West Bengal - 721211,
India

215 West Bengal Sparsha Howrah C Vill. - Majerati, Banitabla, Mr. Surja Kanta Ghosh 33 2661 1815
SPARSHA P.O. Jadurberi,
P.S. Uluberia, Howrah

216 West Bengal Jeshu Ashram Siliguri Vill Matigara, Mr. Ratan Lama 3536453470
Jesu Ashram P.O. Matigara,
Dist Darjeeling,
West Bengal

217 West Bengal Chetna CCC Bardwan A Jhinguti, P.O.- Phagupur, Mr. Rahul Sonkar 9832713315
Asansol Burdwan Burdwan
Seva Kendra

218 West Bengal Sewa Kendra Kolkatta A Seva Kendra, Community Mukul Haldar (033) 30239384
Sewa Kendra Care Centre, Seva
Kolkotta Kendra, Calcutta
Extension, Dum Sum,
93, P.K. Guha Road,
Kumarpara,
Dum Dum Cantonment,
Kolkata 700 028

219 West Bengal ASHAAR ALO Malda C P.O. - Phulbari, Mr. Selestion Minz 03512-340900
CCC Social Manaskamana Road,
Welfare Institute Dist. Malda - 732101,
West Bengal

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 432 Section Four: Annexure-39
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

220 West Bengal Bhalobasha, Jalpaiguri B Bhoruka Bhalobasha, Tamali Dutta 9733263805
Bhoruka C/o Mr. Sushil Chandra,
Farm More, Mohit Nagar,
Post - Jalpaiguri-735101

221 West Bengal Anugalaya CCC Darjeeling Hills B 4, Mall Villa., Mr. Albert Rai 9749091420
Anugyalaya C.R. Das Road,
DDSSS Darjeeling - 734101

222 Bihar Nai Asha Mokama C Nazareth Hospital, Sr. Nirmala Mulackal 06132232367 /
Nazareth CCC, Mokama P.O., 233014
Mokama Patna Dist., Bihar
Nazareth
Hospital Society

223 Bihar Holy Family, Bhagalpur C The Poreyahat Holy Sr. Grace
Bhagalpur Holy Family Society,
Family, Bhagalpur Holy Family Convent,
Tilakmanjhi, Bhagalpur,
Bihar - 812001

224 Bihar Sanjeevani Darbhanga C Sanjeevini Community Er. Kaushendra Sanjay (+91-9308004404)
Sanjeevani Care Centre, Kumar
Darbhanga Hospital Road, Beta,
P.O. Leheriasaria,
Dist. - Darbanga, Bihar

225 Bihar Jeevan Sagar Muzaffarpur C Fakirana Sisters Society, Sr. Mary Elise 0621-2280196
Fakirana Sisters Sacred Heart Convent,
Society Bettiah, District West
Champaran, Bihar

226 Bihar Navjeevan Kurji Patna C Kurji Holy Family Sr. Francina 0612-2262156
Holy Family Hospital, Bihar - 800010
Hospital

227 Orissa Ashray LEPRA Koraput B Behind Collectorate, Mr. Rajendra Chowdhury 06658-252352
Society Hati Line, Koraput,
Orissa

228 Orissa SATHI TSRDS Ganjam A At/Po- Bahadurpeta, Dr. P.C. Mahapatra 0657-2425999
(On the way to
Gopalpur-on-Sea)
Via- Bhanjabihar, Ganjam

229 Orissa Astha CCC Khurda B Near Kalinga Vihar Dr. Dilip Kumar Pradhan 06764-234075;
The Medics Phandi, Kalinga Vihar 09437018075
Phase II, Plot No.
HIG-358, Patrapada,
Bhubaneswar-19

230 Orissa Kiran CCC Utkal Cuttack C Plot No. 191, Mahanadi Mr. Amiya Bhusan Biswal 0671-2444984
Sevak Samaj Vihar, Nayabazar,
Cuttack, Orissa-753004
0671-2444984
ussngo@sify.com

231 Orissa Jyothi CCC Balasore NA Jyoti CCC, Pretheep Jose/ Fr. Paul 06782 - 256173
Post - Kuruda,
Balasore - 756054

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-39 Page 433
S. State Name of District District Address Contact Phone No.
No. the CCC Category Person

232 Tripura Hepititis Agartala, A Anandlok, Indra Nagar, Shri Snehangshu 3812321166
Foundation of West Tripura Agartala, Tripura West Sekhar Dutta,
Tripura, Agartala 9436463337
233 Tripura Udaipur Bignan South Tripura B Aaswas, Shri Jaglul Ahsan, 0381-223117,
O Sanskriti Nehru Supermarket, 9436521882 09856140969
Mancha, Udaipur House No. 47/48,
Udaipur, South Tripura
234 Pondicherry Shanti Bhavan Pondicherry B

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 434 Section Four: Annexure-39
Annexure 40: Ice Breakers & Energizers

Remember these are more fun when the trainers join in!

1. SHAKE ALL HANDS:


Everyone in the room shakes everyone elses hand within a strict time limit of one minute. This gets energy
up, and obliges each participant to acknowledge everyone else.

2. SPACE ON MY RIGHT:
Participants are seated in a circle. The facilitator arranges for the space on their right to remain empty. They
then ask a member of the group to come and sit in the empty space; for example, I would like Lili to come
and sit on my right. Lili moves and there is now a space on the right of another participant. The participant
who is sitting next to the empty space calls the name of someone different to sit on his or her right. Continue
until the entire group has moved once.

3. WHAT WE HAVE COMMON:


The facilitator calls out a characteristic of people in the group, such as having children. All those who have
children should move to one corner of the room. As the facilitator calls out more characteristics, such as
likes football, people with the characteristic move to the indicated space.

4. THE SUN SHNES ON:


Participants sit or stand in a tight circle with one person in the middle. The person in the middle shouts
out the sun shines on... and names a colour or articles of clothing that some in the group possess. For
example, the sun shines on all those wearing blue or the sun shines on all those wearing socks or the
sun shines on all those with brown eyes. All the participants who have that attribute must change places
with one another. The person in the middle tries to take one of their places as they move, so that there
is another person left in the middle without a place. The new person in the middle shouts out the sun
shines on... and names a different colour or type of clothing.

5. BODY WRITIING:
15 Body writing Ask participants to write their name in the air with a part of their body. They may choose
to use an elbow, for example, or a leg. Continue in this way, until everyone has written his or her name
with several body parts.

6. TIDES IN / TIDES OUT:


Draw a line representing the seashore and ask participants to stand behind the line. When the facilitator
shouts Tides out!, everyone jumps forwards over the line. When the leader shouts Tides in!, everyone
jumps backwards over the line. If the facilitator shouts Tides out! twice in a row, participants who move
have to drop out of the game.

7. SIMON SAYS :
The facilitator tells the group that they should follow instructions when the facilitator starts the instruction
by saying Simon says... If the facilitator does not begin the instructions with the words Simon says, then
the group should not follow the instructions! The facilitator begins by saying something like Simon says
clap your hands while clapping their hands. The participants follow. The facilitator speeds up the actions,
always saying Simon says first. After a short while, the Simon says is omitted.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-40 Page 435
8. WHAT SOUND IS THIS?
Someone makes a sound and everyone else tries to identify it the person who guesses right makes
another sound. Sounds could include animal and bird noises, machines, vehicles or food preparation.

9. WHERE WERE YOU?


Ask each participant to pull a coin out of their purse and look at the year on the coin. Give them one minute
to think about where they were and what significant event took place during that year. Ask few or all
participants (depending on time) to share their memories in one or two sentences.

10. REFLECTING ON THE DAY:


To help people to reflect on the activities of the day, make a ball out of paper and ask the group to throw
the ball to each other in turn. When they have the ball, participants can say one thing they thought about
the day.

11. WRITING ON BACKS:


At the end of a workshop, ask participants to stick a piece of paper on their backs. Each participant then
writes something they like, admire or appreciate about that person on the paper on their backs. When they
have all finished, participants can take their papers home with them as a reminder

12. TREASURE HUNT


Material Needed: Any object eg Book/ Hand bag/Vase etc. (Treasure)
A thin dupatta to blind fold

Steps:
Ask for a participant to volunteer, without telling the purpose of the game ( Volunteer should trust the
Trainer).
Take her out of the room and blindfold her.
In the meantime, come back and ask the other participants to rearrange the furniture in the room to
create enough space and to make the game more interesting.
Bring the volunteer back in the room, make her feel the treasure and put it at some accessible location
in the room.
Instruct her to hunt for it in the room.
Do not give any explicit instructions to the volunteer or the group on whether she can seek the help
from the group or whether the group can guide her.
Make sure that the volunteer does not hurt herself while hunting for the treasure; If you observe that
the volunteer is finding it difficult to locate the treasure ,keep it at a more convenient location.
Observe the group behavior ie whether they remain silent or assist the volunteer in locating the treasure
(by providing her appropriate directions) - both while you are present in the room or when you move
out; do they wait for instructions from you to guide the volunteer or do they themselves take the
initiative.
Ultimately, when the volunteer is able to successfully hunt for treasure, congratulate her on her efforts
and remove the blindfold.

13. PAPER DANCE (Achieving Maximum with Minimum resources)


Resources Needed: Double page or half page same size old news papers, (depending upon the number
of participants examples for 30 participants take 15 papers).

Process:
Make the group count 1,2,1,2
Divide all the 1s and 2s in two groups and pair them

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 436 Section Four: Annexure-40
Distribute one paper to each pair and make them stand comfortably and dance on the paper. Instruct
them to make sure that their feet remain inside the paper only.
After few minutes, ask them to fold the paper in half and dance, with their feet remaining inside the
paper.
Ask the participants to repeat the process, as many times as they can, by folding the paper half every
time (some would be able to do it by folding the paper 5 or 6 times, where as some would stop at 3
or 4 times only)
In the end, ask the participants:
Q 1 qualities needed to do this exercise
Q 2 their feelings during the excercise, and write them on the flip chart
Q 3 What made some of the pairs carried on with the exercise for long?
Write their responses on a flip chart.

SAMPLE ENERGIZERS:
The following can be carried out to music, with brief stops in the music to signal that the movement/role
should change.
Divide the participants into pairs, one person in the front and the other person behind. Get the person
at the back to rub the shoulders of the person in front. The pair turns around and exchange roles.
Get participants of the same size and preferably same gender, to stand back to back. Each person
drops her/his head on the other persons shoulder and relaxes.
Participants can form a semi-circle with the person at the far end bending forwards from the waist,
hands forward and inhaling, and exhaling while coming up, everyone follows suit.
Everyone does spot jogging while facing her/his partner.
Get a small group to stand on either side of a person. The person in the middle gets gently pushed
from one group to another. The person in the middle should not resist or move voluntarily, but just relax
and let others take care of her/him.

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-40 Page 437
Annexure 41 : Role of Nurse at ART and CCCs

Roles and Responsibilities of Nurses at ART Centres


One or two nurses (depending upon the volume of patients) should be deputed to the ART center by the
hospital (or institution). There should beone contractual nurse, in addition, supported by NACO (qualification
being same as far appointment of nurses in the hospital).
Nurses play a very important role at the ART center and their responsibilities include the following:
Dispensing of ARV drugs (till a pharmacist isadded to the team)
Counselling of patients at the ART Centre and the attached hospital
Assisting in record keeping and maintenance of patient documents of HIV+ patients at the ART Centre and
the attached hospital.
Streamlining and guiding patients at theART center and helping the center to run efficiently and in an
orderly fashion
Coordinating and tracking the referrals made within the hospital by establishing linkage with various
departments and in-patient wards
Nursing care and follow-up of patients admitted in the hospital
Supervise the Infection Control practices at the ART Centre and the attached hospital
Ensure provision of PEP to all the nurses /Health Care staff at the ART Centre and the attached hospital
and the management of relevant records
Management of the ART Centre,
Roles and Responsibilities of Nurses at CCCs
The candidate should be a Diploma in nursing from a recognized nursing school/college with experience of
providing nursing care for preferable two years in a public or private health institution.
Nursing Care
Nursing care required for inpatients
Take the vital signs and follow-up readings of the patients as perrequirement
Maintaining follow-up charts
Provide medicine intake to the patients as per doctors prescription
Watch out for any changes in condition and report to the doctor
Assist the doctor in OP clinic as well as during ward rounds
Counsel patients on different aspects such as treatment adherence,drug intake as per regimen prescribed,
nutrition and safe sexual behaviour, positive prevention and positive living, reproductivehealth choices
Provide Anti-natal and Post-natal care
Provide nutritional supplements as required
Maintenance of patient records and case sheets
Administrative Responsibilities
Coordinate and track the referrals from and to other medical facilities
Report on the referred cases from other facilities
Report on stocks of medicines and other consumables
Provide data on the formats required for monitoring
Maintain the drug dispensed register and the stock of drugs received
Function as case manager for overview of the referrals and linkagesincluding integrated care of the PLHIV
case.
In-charge of coordinating the outreach workers to follow the treatment and follow up plan as has been decided
for the PLHIV by the clinical team
Other Responsibilities
Practice Universal precaution principles
Participate in the staff meetings and provide feed back

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 438 Section Four: Annexure-41
Annexure 42 : Patient Treatment Card ART White Card

Pre ART No. or ART Registration No. __ __ __ __ __ __ __ __ __ __ ART Registration Number : __ __/__ __/__ __/__ __ __ __
ID No. as per child health card __ __ __ __ __ __ __ __ __ __ Date of start of ART : __ __/__ __/__ __/__ __ __ __

PATIENT TREATMENT RECORD


(To be stored in a locked cabinet at the ART centre and arranged serially by registration number to be filled for all patients)

1. Identification Data (Write complete information)

Date of Registration: ____________________ Treatment status at registration: On ART  Not on ART 


Name of ART Centre / City: _____________________ ART Centre Code _____________________
State _____________________
Name of patient: _____________________
Age: ____________ (date of birth: __ __ / __ __ / __ __ __ __ ) Sex:  Male  Female  TG/TS*
Patients phone number: _____________________
Address: _____________________________________________________________________________
City/village: __________________ District: __________________ State/province: ___________________
Caregivers name: ______________________________________________________________________
Caregivers address and phone number: ____________________________________________________
______________________________________________________________________________________
Date confirmed HIV+ test: __ __ / __ __ / __ __ __ __ Place of HIV Test: _____________________
Entry point (services referring the patient for HIV care):  1-VCTC  2-TB/RNTCP  3-Outpatient  4-Inpatient
 5-Paediatric  6-PPTCT  7-STI clinic  8-Private practitioner  9-Other NGO  10-Self referred
 11-IDU outreach  12- Sex worker outreach  13-PLHA network  14 MSM  15-other__________________
Patient transferred in on ART from:  ARTC  Private
Name of previous clinic: _________________________ Date transferred in : _________________________

2. Personal History (tick all applicable)

Risk  1 Heterosexual
Factor  2 MSM
HIV  3 Injecting drug use (IDU)
 4 Blood transfusion
 5 Mother to child
 6 Probable unsafe injection
 7 Unknown
For IDUs Substitution therapy  Y  N
If yes, type:
Education:  Non-literate
 Primary school _________________________
 Secondary school
 College & above
Employed:  Yes  No Occupation: ___________
Instruction: Sections 1-3 to be filled by Counsellor. Sections 4-13 by Physician/Doctor.
* TG/TS Transgender/Transexual ** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing A Ambulatory = Able to perform activities of daily living but not able to work B Bedridden = Not able to perform activities of daily living.
National AIDS Control Organization (NACO), Ministry of Health and Family Welfare, Government of India, February 2007

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-42 Page 439
3. Family History

Marital status:  Single Estimated monthly


 Married  Divorce/separate household income:
 Widowed  Live-in
Family members: Age / HIV ART Regist. No
partner/children sex +/- Y/N if in care
/unknown

4. Antiretroviral treatment history

Were ARVs received ? Initial CD4 count No. _____ % ____ Place of ART:  Private  Govt  NGO
 Yes  No
Drugs and duration:
If yes,  PMTCT  ART
 PEP

5. Clinical and Laboratory Investigations (Summary)

Date WHO Weight Height Functional CD4 count


(dd/mm/yy) clinical (kg) (cm) Status WAB**
stage No. %

At 1st visit in clinic


At ART medical eligibility
At start of ART
At 6 months ART
At 12 months ART
At 24 months ART
At 36 months ART
At 48 months ART

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 440 Section Four: Annexure-42
6. Antiretroviral Treatment (Summary)

Treatment Started SUBSTITUTION within 1st line, SWITCH to 2nd line, STOP, RESTART
 STV + LMV + NVP Date Substitution, Reason Date New
 STV + LMV + EFV switch or stop (code) restart regimen
 ZDV + LMV + NVP
 ZDV + LMV + EFV
Others : __________
_________________

Reasons SUBSTITUTE: 1. Toxicity / side effects, 2. Pregnancy, 3. Newly diagnosed TB,


4. New drug available, 5. other reason (specify) ________________________________
Reasons for SWITCH only: 1. Clinical treatment failure, 2. Immunological failure, 3. Virologic failure
Reasons STOP: 1. Toxicity / side effects, 2. Pregnancy, 3. Treatment failure, 4. Poor adherence,
5. Illness hospitalisation, 6. Patient lack of finance, 7. Patient decision, 8 others: ______________________

7. Tuberculosis treatment (RNTCP) during HIV care

Diseases class (tick) TB Regimen (tick) TB registration (tick)

 Pulmonary TB  Category I District: ______________________

 Smear-positive  Category II TB Unit: ______________________

 Smear-negative  Category III (if applicable) Health Centre: ______________________

 Extrapulmonary  Other specify: TB number: ______________________

 Past history of TB  NonDOTS

______________  Rx for MDR Treatment outcome:  Cure  Rx completed


site: ______________ Date start TB Rx:  Rx failure  Died  Default  Transfer out
___/___/______ Date: ____/____/_____

8. Reasons for Stopping ART

 Death Date of death: ____/____/______

 Transferred out Date last visit: ____/____/______ New ART centre name: _________

 On medical advice Date: ____/____/______ ___________________________

 Lost to follow-up (>3 months) Date last visit: ____/____/______

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-42 Page 441
9. Medical History

Habit of Alcohol use: Habit of Smoking:

 Habitual  Social  Never  Current smoker  Past smoker  Never

 HBV carrier  Yes  No  Unknown

 HCV carrier:  Yes  No  Unknown

 STI  Diabetes  Hypertension  Cardiovascular disease

Coexisting conditions :

Current Medication : Drug allergy:

Contraception :
1. Condoms 2. Oral contraceptives 3. IUD 4. Tubal ligation 5. Vasectomy 6. None

GYNECOLOGICAL HISTORY

G ______ P ______ A ______ Last Menstrual Period: ____ day ____ month ______ year

PAP smear: Pregnant now:  Yes  No

Gynecological exam: Refer to PPTCP:  Yes  No

Other Remarks :

10. Linkages to NGOs/Care Institutes

Date Name of Institute / Organization Purposes **


and type*

*1. NGO; 2. Community Care and Support; 3. PLHA network; 4. Others**


1. Adherence; 2. Retention; 3. Psychosocial support; 4. Others

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 442 Section Four: Annexure-42
11. Pediatric Patients (under 15 years of age)

Staying with: 1. Own family 2. In a center but contact with family

3. In a center but no family contact 4. Others _______________________

Guardian / Caregiver: 1. Self 2. Parents 3. Relatives 4. Friends 5. Others __________

Sex :  Male  Female Age: ________years Date of birth: ___ day ____month ____ year

Guardian/Caregivers highest education:

 Non-Literate  Primary School  Secondary School  College and above

Birth History : 1. Normal 2. Caesarean 3. Vacuum 4. Forceps

Birth Weight : _____________________________ Neonatal complications : _______________________

Infant feeding : 1. Breast (stop_______ months of age) 2. Replacement 3. Mixed

DNA PCR results : 1st ______________________________ 2nd _____________________________

Others _____________________________________________________________

Neurodevelopment Normal :  Yes  No __________________________________________

Immunization Record
Age Vaccine Due on Given on Age Vaccine Due on Given on
BCG 15-18 MMR
Birth OPV 1 months DPT 1 booster
HBV 1 OPV 6

DPT 1 5 years DPT 2 booster


6 weeks OPV 2 OPV 7
HBV 2 10 years TT 3

10 weeks DPT 2 15-16 yrs TT 4


OPV 3 Others vaccines

14 weeks DPT 3
OPV 4

6-9 mths. OPV 5


HBV 3

9 months Measles
& Vit. A

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-42 Page 443
Facilitator Guide HIV/AIDS and ART Training for Nurses
Page 444 Section Four: Annexure-42
12. Investigations

Test \ date // // // // // // // // // // // //

Hb

TLC

DLC

ESR

PLT
Essential Laboratory: blood, serology, urine

MCV

S. Creatinine

S. Bilirubin

Blood Urea

SGOT

SGPT + Alk. PO4

Amylase

Blood Sugar

Cholesterol

Triglycerides

VDRL

HBsAg

Anti-HCV

CD4 count/CD4 %

Viral Load
Additional
labs.

Pap smear

Mantoux Test

CXR (PA view) Date & Finding: Date & Finding: Date & Finding: Date & Finding:
Others (Imaging,
culture, etc.)

Date & Finding: Date & Finding: Date & Finding: Date & Finding:

Date & Finding: Date & Finding: Date & Finding: Date & Finding:

Date & Finding: Date & Finding: Date & Finding: Date & Finding:

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-42 Page 445
13. Patient Follow-up

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Sl. Date Date Weight Height Func- WHO Oppot- Drugs prescribed for Anti- Adher to Any TB ART Con- Preg- Condoms Remarks/ Staff
No. of of (kg) (cm) tional Clinical tunistic Opportunistic Infections retroviral ART## other treatment Side current nancy given Referrals Signature
visit* next of Status Stage Infections Prophylaxis (Dosage) Rx drugs (No. of medicine Y / N effects condition (y / n) Y/N
visit child WAB** (code)* CTX Other and dose doses code$ e.g. STI of FP
prescribed missed) method***

10

11

12

13

Instructions and codes:


* Date: Write the date of actual visit starting from the 1st visit for HIV care ALL DATES: DD/MM/YY
** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing: A Ambulatory = Able to perform activities of daily living but not able to work/go to school/play B Bedridden = Not
able to perform activities of daily living
*** FP: family planning; 1 condoms, 2 oral contraceptive pills, 3 injectable/implantable hormones, 4 diaphragm/cervical cap, 5 intrauterine
device, 6 vasectomy/tubal ligation/hysterectomy
# Opportunistic infections: Enter one or more codes Tuberculosis (TB); Candidiasis (C); Diarrhea (D); Cryptocococal meningitis (M);
Pneumocystis Carinii Pneumonia (PCP); Cytomegalovirus disease (CMV); Penicilliosis (P); Herpes zoster (Z); Genital herpes (H);
Toxoplasmosis (T); Failure to thrive (FTT), Recurrent respiratory infectious (ARI), Mycobacterium avium-intracellulare complex (MAC),
Cardiomyopathy (CMP), AIDS-Nephropathy (AN), Molluscum contagiosum (MDL), Parotitis (PAR), Lymphoid interstitial pneumonitis
(LIP), Lymphadenopathy (LAD) Hepatosplenomegaly (HSM), Delay in or missing developmental milestones (DEV), Other-specify
## Adherence: Check adherence by asking the patient if he/she has missed any doses. Also check the bottle/blister packet. Write the
estimated level of adherence (e.g. >95% = < 3 doses missed in a period of 30 days; 80-95% = 3 to 12 doses missed in a period of 30
days; < 80% = >12 doses missed in a period of 30 days)
$ Side effects: Enter one or more codes S=Skin rash; Nau-nausea; V=Vomiting; D=Diarrhoea; N=Neuropathy;J=Jaundice; A=Anemia;
F=Fatigue; H=Headache; Fev=Fever; Hyp=Hypersensitivity; Dep=Depression; P=Pancreatitis; L=Lipodystrophy; Drows=Drowsiness;
O=Other Specify

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 446 Section Four: Annexure-42
13. Patient Follow-up

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Sl. Date Date Weight Height Func- WHO Oppot- Drugs prescribed for Anti- Adher to Any TB ART Con- Preg- Condoms Remarks/ Staff
No. of of (kg) (cm) tional Clinical tunistic Opportunistic Infections retroviral ART## other treatment Side current nancy given Referrals Signature
visit* next of Status Stage Infections Prophylaxis (Dosage) Rx drugs (No. of medicine Y / N effects condition (y / n) Y/N
visit child WAB** (code)* CTX Other and dose doses code$ e.g. STI of FP
prescribed missed) method***

14

15

16

17

18

19

20

21

22

23

24

25

26

Instructions and codes:


* Date: Write the date of actual visit starting from the 1st visit for HIV care ALL DATES: DD/MM/YY
** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing: A Ambulatory = Able to perform activities of daily living but not able to work/go to school/play B Bedridden = Not
able to perform activities of daily living
*** FP: family planning; 1 condoms, 2 oral contraceptive pills, 3 injectable/implantable hormones, 4 diaphragm/cervical cap, 5 intrauterine
device, 6 vasectomy/tubal ligation/hysterectomy
# Opportunistic infections: Enter one or more codes Tuberculosis (TB); Candidiasis (C); Diarrhea (D); Cryptocococal meningitis (M);
Pneumocystis Carinii Pneumonia (PCP); Cytomegalovirus disease (CMV); Penicilliosis (P); Herpes zoster (Z); Genital herpes (H);
Toxoplasmosis (T); Failure to thrive (FTT), Recurrent respiratory infectious (ARI), Mycobacterium avium-intracellulare complex (MAC),
Cardiomyopathy (CMP), AIDS-Nephropathy (AN), Molluscum contagiosum (MDL), Parotitis (PAR), Lymphoid interstitial pneumonitis
(LIP), Lymphadenopathy (LAD) Hepatosplenomegaly (HSM), Delay in or missing developmental milestones (DEV), Other-specify
## Adherence: Check adherence by asking the patient if he/she has missed any doses. Also check the bottle/blister packet. Write the
estimated level of adherence (e.g. >95% = < 3 doses missed in a period of 30 days; 80-95% = 3 to 12 doses missed in a period of 30
days; < 80% = >12 doses missed in a period of 30 days)
$ Side effects: Enter one or more codes S=Skin rash; Nau-nausea; V=Vomiting; D=Diarrhoea; N=Neuropathy;J=Jaundice; A=Anemia;
F=Fatigue; H=Headache; Fev=Fever; Hyp=Hypersensitivity; Dep=Depression; P=Pancreatitis; L=Lipodystrophy; Drows=Drowsiness;
O=Other Specify

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-42 Page 447
Annexure 43 : Counselling Checklists : Checklist for the
Nurses, for various Counseling sessions

Checklist No.1 : Self Assessment of Effective Counselling

Note: You can check your own progress in counselling clients at the clinic

Always At times Rarely

You create rapport by:


Greeting your client in a culturally acceptable way
Arranging for client privacy
Sitting facing or close to your client

You maintain two-way interaction by:


Asking open-ended questions and
using encouraging remarks
Listening attentively and observing
without interrupting or writing
Encouraging the client to talk and ask questions

You find out what the client knows about:


The problem, the issue, or concern
under discussion
Its effects on his or her health and /or family/child

You explain facts about the problem


or issue, especially:
Symptoms and effects of the problem
Possible technical/factual solutions
Rumours, misconceptions and relevant facts
Need for treatment, continuity, behavior
change, or referral, if necessary
Causes of the problem or potential problem

You clarify or check the clients understanding


of the facts (causes, effects, solutions and
possible next step) by:
Asking the client to repeat (or re state) the basic
factual information in his/her own words

Clarifying misunderstood information


Asking the client if he/she has any questions
Answering the clients questions politely
and completely

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 448 Section Four: Annexure-43
Always At times Rarely

You help the client determine what to do about


the problem , or issue, or concern by:
Encouraging the client to consider the
need to act on the problem; explain
the consequences if it is ignored
Encouraging the client to make a
decision that is safest and most
practical in the circumstances
Provides required service or referral
when appropriate

You genuinely invite the client to return to


the clinic whenever they need to, e.g. if they
have more questions. You also tell the client
about the suitable hours of service.

Checklist No 2. Assessment of Risk of the Client

RISK EVALUATION FORM


Client code:_____________
Client has a regular partner: Yes/No
Regular partners status: HIV-positive/unknown/HIV-negative
Date of last test: ___________
Client/partner* indicates history of STI infection: Yes/ No
Treatment referral required: Yes/ No
Client/partner* reports
Symptoms of TB: Yes/ No
Treatment referral required: Yes/ No
Occupational Exposure: Yes/NO Date Window Period : Yes/ No
Tattoo, scarification: Yes/ No Date: Window Period: Yes/No
Blood products: Yes/ No Date: Window period: Yes/No
Vaginal intercourse: Yes/ No Date: Window period: Yes/No
Oral sex: Yes/ No Date: Window period: Yes/No
Anal intercourse: Yes/ No Date: Window period: Yes/No
Sharing injecting equipment: Yes/ No Date: Window period: Yes/No
Client risk was with a known HIV-positive person: Yes/ No
Client is pregnant: Yes/ No
If Yes, Stage of pregnancy: 1st trimester/2nd trimester/3rd trimester
Client/partner* is using contraception regularly: Yes/ No

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 449
Checklist No 3. Pre-test Counselling Form

PRE-TEST COUNSELLING FORM

Note to counsellor: Confidentiality of the client information should be strictly maintained at all times.
1. Date: ___ /___ /___ 2. Time: (start of session): _________
3. PID number: ________ 4. ICTC code___________________
5. Age: ___ years 6. Sex: M / F / Transgender
7. Education: standard: illiterate/1.5/6.8/8.10/11.12/Graduate/Post-graduate
8. Occupation: ________ (Migrant/ Non-migrant)
9. Monthly income in Rs: 0.2,500/2,501.5,000/5001.7,000/7,001.10,000/ more than 10,000
10. Marital status: unmarried/ married/widowed/divorced/separated/living together
11. Referred by: Self/Doctor/NGO/CBO/Spouse/Family/Friends/Others ______
12. Medical history: (Does your client currently have any medical problems or symptoms?]
Nil/Recurrent fever/weight loss/cough/diarrhoea/STIs/TB/OIs/Others ______
13. Currently on treatment: ______
14. Tested before for HIV: How many times? ___ Last test (month/year): ___ /___
Where (Place): ___________________________ Result: _________________

The form is to be filled in AFTER the counselling session with whatever information was discussed.

Counsellor instruction: Please explore the following issues with your client:
15. Risk assessment of the past six months: (perception of risk to self)
Q: Why has the client presented for counselling and testing?
__________________________________________________________________________________
__________________________________________________________________________________
Q: Why does your client think he/she is at risk of HIV?
__________________________________________________________________________________
__________________________________________________________________________________
(a) No risk (b) Perinatal (from mother to child)
(c) Contaminated blood through:
Blood transfusion .IDU
Organ transplant .Tattoo
Needle stick injury
(d) Unprotected sex:___ Vaginal___ Anal
(e) Partner or family member infected
__________________________________________________________________________________
16. Development of a risk reduction plan
(a) Increase condom use (b) Reduce number of sexual partners
(c) Reduce needle sharing (d) Reduce alcohol or drug use
(e) Discussion with spouse/partner (f) Others
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 450 Section Four: Annexure-43
17. Client.s vulnerabilities:
(a) Unprotected sex with Males Females Hijras CSW
(b) Use of drugs/alcohol during or before sex
(c) Gender related (violence, rape, etc.)
18. Client.s current psycho-social stressors
Q. What are currently your client.s major worries in life?
(a) Finances/debt (b) Addictions (alcohol/drugs)
(c) Family (d) Violence
(e) Loss of work or occupation (f) Sex related
(g) Serious illness/death (h) Social
(i) Others
List issues and psycho-social stressors discussed:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

19. Client.s anticipated psycho-social stressors


Q. What are anticipated concerns of your client in case of a positive HIV Test result?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(a) Prior history of self harm/suicide attempt
(b) Harm to others in case of positive test result
(c) Signs of suicidal thoughts
(Feeling of hopelessness/helplessness/overburdened/no options/social withdrawal)
20. Clients coping mechanisms
Q. How has your client coped with a crisis in the past, e.g. loss of job, death of Spouse or partner, or relationship
issues? Who helped your client?
List coping strategies discussed (including alcohol, violence, attempted suicide):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

What plans does your client have for managing the crisis associated with HIV/AIDS?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 451
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

21. Client.s social support systems


Q. In case your client has a crisis in his/her life, who provides support to him/ her?
(a) Immediate family (Spouse) (b ) Extended family (c) Friends (d) Others
Q. Who will accompany the client to pick up the HIV test result?
(a) Immediate family (Spouse) (b) Extended family (c) Friends (d) No one (e) Others
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
22. Client.s readiness to undergo HIV test
Q. Would your client like another appointment before deciding on the HIV test?
__________________________________________________________________________________
__________________________________________________________________________________
23. Clients readiness to involve partner
Q. Will your client bring his/her spouse or partner for counselling? If not, explain why?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
24. Date for follow-up visit given: ___ /___ /___
25. List of referrals given: (counsellor should have a referral list prepared)
__________________________________________________________________________________
__________________________________________________________________________________
26. Counsellor.s checklist:
___________ Client.s understanding of STI/HIV/AIDS addressed
___________ Information about STI/HIV/AIDS provided including
a. modes of transmission
b. nature of HIV/AIDS
___________ Misconceptions corrected
___________ Information about HIV test provided
a. Nature of test and testing process
b. Benefits and consequences
What plans does your client have for managing the crisis associated with HIV/AIDS?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 452 Section Four: Annexure-43
c. What does a positive result mean
d. What does a negative result mean
e. Window period
___________ Client.s emotional preparedness for HIV test result assessed
___________ Checked for suicidal ideation
___________ Importance of post-test counselling explained
___________ Information on .living with HIV.provided (nutrition, ARVs) provided
___________ Risk reduction counselling done
a. Safer sex practices
b. Condom use
c. Safe needle use (for IDUs)
___________ Prevention counselling provided
___________ Condom demonstration done and condoms provided
Willingness to involve partner in follow-up assessed
___________ Informed consent obtained
___________ Identification of TB symptoms undertaken
___________ Referrals discussed and given
___________ Follow-up arrangements discussed (date provided)
27. Counsellor.s remarks:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
28. Time (end of session): ______________
29. Length of session (minutes):__________
30. Counsellor.s signature and date:____________________________________

Checklist No 4. Post-test Counseling Form

POST-TEST COUNSELLING FORM (NACO)

Note to counsellor: Confidentiality of the client information should be strictly maintained at all times.

1. Date: ___ /___ /___ 2. Time: (start of session): _________

2. PID number: ________ 4. VCTC code number: _________

5. Type of visit: Post-test counselling/follow-up visit

6. Test result: positive/negative/indeterminate

7. Age: ___ years 8. Sex: M/F/Transgender

The form is to be filled in AFTER the counselling session with whatever information was discussed

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 453
For NEGATIVE Result
9. Initial reaction
Surprise/resentment/guilt/happy/relaxed/others
Observe and discuss with client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
10. Assessment of any concerns (Window period)
Summary of discussions with the client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
11. Development of a risk reduction plan
(a) Increase condom use (b) Reduce number of sexual partners (c) Reduce needle sharing
(d) Reduce alcohol or drug use (e) Discussion with spouse/partner (f) Others
List risk reduction plan developed:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
12. Willingness to change behaviour to decrease vulnerability ___Yes/___No
13. Need for HIV test after window period discussed ___Yes/___No

For POSITIVE Result


14. Initial reaction
Acceptance/shock/fear/denial/suppressed emotion/anger/violence/grief/sadness/depression/anxiety/crying
spells/suicidal ideation/withdrawal/resentment/others
Observe reaction and discuss with client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
15. Assessment of immediate concerns
Stigma/fear of rejection (discrimination)/loneliness/loss of prestige/loss of job/
loss of income/loss of self esteem/family disclosure/fear of death/loss of health
Summary of discussions with the client
__________________________________________________________________________________
__________________________________________________________________________________

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 454 Section Four: Annexure-43
__________________________________________________________________________________
__________________________________________________________________________________
16. Assessment of other concerns
(a) Marriage counselling (b) Partner notification and testing
(c) Disclosure to spouse or family (d) Concerns about support systems
(e) STI medical follow-up (f) TB follow-up
(g) Nutrition counselling (h) Sex with spouse/partner
(i) Social/psychological support follow-up (j) Social support and referrals
(k) Rights and responsibilities (l) Others
Summary of discussions with the client
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
17. Risk-reduction strategies discussed
(a) Increase condom use (b) Reduce number of sexual partners
(c) Reduce needle sharing (d) Reduce alcohol or drug use
(e) Others
Summary of discussions with the client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
18. Willingness to increase safer behaviour _____Yes /_____No
19. Referrals* and follow-up given (*counsellor should have a referral list prepared)
(a) Individual counselling (b) Family counselling
(c) Within the hospital (d) To medical doctor (nonhospital)
(e) Psychiatric intervention (f) Support groups/PLHA
(g) Intervention and workplace (h) Community intervention
(i) TB/MC center (j) ANC
(k) IDU interventions (l) Needle stick
(m) Marriage counselling (n) Legal
List referrals made (types and places):
__________________________________________________________________________________
__________________________________________________________________________________
20. Agreed to disclose HIV status to spouse/partner _______
Client.s issues associated with disclosure to spouse/partner
__________________________________________________________________________________
__________________________________________________________________________________
21. Willingness to bring spouse/partner for counselling _______
Summary of discussions:
__________________________________________________________________________________
__________________________________________________________________________________
HIV/AIDS and ART Training for Nurses Facilitator Guide
Section Four: Annexure-43 Page 455
For POSITIVE and NEGATIVE result
22. Date for follow-up visit given: ___ /___ /___
23. List of referrals given: (counsellor should have a referral list prepared)
__________________________________________________________________________________
__________________________________________________________________________________
24. Counsellor checklist
For negative result:
___________ Result given
___________ Immediate concerns/questions assessed
___________ Window period explained
___________ Risk reduction strategy developed
___________ Willingness to change behaviour assessed
___________ Need for an HIV test after window period discussed
___________ Follow-up appointment given
For positive result:
___________ Result given
___________ Discussion of the meaning of the result for the client
___________ Dealt with immediate emotional concerns
___________ Client able to understand and absorb the result
___________ Discussion of personal, family and social implications
___________ Checking of availability of immediate support
___________ Discussion of follow-up care and support
___________ Partner evaluation
___________ Risk reduction strategy developed
___________ Willingness to change behaviour assessed
___________ Immediate plans, intentions and actions reviewed
___________ Discussion of symptoms of TB and importance of early referral
___________ Further support and referrals given (ANC, TB, STI)
___________ Rights and responsibilities discussed
___________ Legal support discussed
___________ Follow-up appointment given
___________ Disclosure discussed
___________ Bring spouse for counselling discussed
25. Counsellor.s remarks
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
26. Time (end of session): ____________________________________
27. Length of session (minutes): ___________________________________
28. Counsellor.s signature and date:____________________________________

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 456 Section Four: Annexure-43
Checklist No 5. Adherence Counselling form

ADHERENCE COUNSELLING CHECKLIST 1


Name of the client
Date of counselling session
Assess the patient
Medical history
Knowledge of HIV/AIDS
Prior use of ART
Determine the social support
Disclosure.have they disclosed to anyone?
Alcohol/drug use
Mental state
Review the health status
OIs
CD4/viral load
Review living conditions and employment
Housing
Employment/income
Describe the treatment programme and importance of adherence
Drug regimen.name/frequency/storage/dietary instructions/not to share pills
What ART does.suppresses virus/improves immunity/lessens OIs/not a cure
Cost
Side-effects and what to do
Follow-up
Importance of adherence and consequences of non-adherence
Discuss adherence promotion strategies
Buddy reminder.discuss role of support person
Pill diary
Other reminder cues
Identify barriers to adherence Yes No
Poor communication
Low literacy
Inadequate understanding about HIV/AIDS
Lack of social support
Failure to disclose the HIV-positive status
Alcohol and drug use
Mental state
Schedule the next counselling session and complete the appointment card

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 457
ADHERENCE COUNSELLING CHECKLIST 2
Name of the client
Date of counselling session
Review client.s understanding of HIV/AIDS
What is HIV and AIDS?
What are opportunistic infections?
What do they understand by CD4 counts/viral load?
What are the effects of treatment?
Review the treatment programme and importance of adherence
Drug regimen
Dummy pill demonstration
What ART does.improves immunity/lessens OIs/ART is not a cure?
Need for continued prevention.use of condoms
Side-effects and what to do
Follow-up
Importance of adherence and consequences of non-adherence
Review proposed adherence promotion strategies
Buddy reminder.discuss the role of a support person
Review the pill diary
Other reminder cues.discuss HAART
Review barriers to adherence and the progress made so far
Poor communication skills
Low levels of literacy
Inadequate understanding about HIV/AIDS
Lack of social support
Failure to disclose the HIV-positive status
Alcohol and drug use
Mental state
Take the client.s address and establish contact system

ADHERENCE COUNSELLING CHECKLIST 3


Name of the client
Date of counselling session
Assess the client.s understanding of the disease and readiness to start
What is HIV disease?
What are opportunistic infections?

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 458 Section Four: Annexure-43
What is meant by CD4 count/viral load
What are the effects of treatment
What is their level of commitment to adherence
Review the treatment programme and importance of adherence
Drug regimen
Dummy pill demonstration
What ART does.improves immunity/lessens OIs/ART is not a cure
Need for continued prevention.condom use
Side-effects and what to do
Follow-up
Link between adherence and successful outcome
Review proposed adherence promotion strategies
Buddy reminder.discuss the role of a support person
Review the pill diary
Other reminder cues.discuss HAART
Fill the ART register, schedule the next appointment and complete the appointment card
Refer to the Pharmacy/Chemist

ADHERENCE COUNSELLING CHECKLIST 4


Name of the client
Date of counselling session
Review the patient.s experience with treatment and adherence over the past month
Drug regimen and adherence.pill counts, self-report
Discuss the side-effects and the actions taken
Discuss the need for continued prevention.use of condoms
Review the experience with a follow-up plan
Discuss the follow-up plan for the next month
Review the patient.s goals and success at achieving them
Review barriers to adherence
Buddy reminder.discuss the role of a support person
Review the pill diary
Review barriers to adherence
Poor communication skills
Low levels of literacy
Inadequate understanding of HIV/AIDS
Lack of social support

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 459
Failure to disclose the HIV-positive status
Alcohol and drug use
Mental state
Fill the ART register, schedule the next appointment and complete the appointment card
Refer to a pharmacy/chemist

Checklist No 6. Home Care counseling form

HOME VISIT DATA SHEET


Name of the patient Registration No
Sex: M/F
Purpose of home visit
Observed emotional and physical status of the patient
Chief caregiver
Observed dynamics at home
Observed dynamics with the caregiver
Locality and neighbourhood
Socioeconomic situation as observed
Expressed concerns/issues/opinions
Home visit conducted by
Visit requested by
Visit commissioned by
Date of request Date of visit

Checklist No 7. Suicidal risk assessment form

SUICIDE RISK ASSESSMENT GUIDELINE EXERCISE

Use assessment format given below for assessing the clients risk for suicide.
Note: The suicide risk assessment provides a guideline for professionals on how to interview persons at risk
for suicide. As guidelines rather than a ready-to-use questionnaire, many questions would need more
exploration and probing in order to evaluate the subjective reality of each individual at risk.

1. Do you sometimes feel so bad/hopeless/helpless you think about suicide? YES /NO
Follow this up with the following explorations:
2. How often?
a. Are you currently thinking of suicide? YES / NO
b. Have you thought of how would you do it? YES / NO
3. Do you have a plan? YES / NO
a. How lethal is the planned method?
(EXPLORE the perception of the person at risk!)

Facilitator Guide HIV/AIDS and ART Training for Nurses


Page 460 Section Four: Annexure-43
4. Do you have the means? EXPLORE
5. Have you decided when you would do it? EXPLORE
6. Have you ever tried suicide before? EXPLORE
If yes check whether previous attempt was:
a. Impulsive?
b. Planned?
c. Did you use any booster to make you do it, such as alcohol/drugs?
7. If you have tried suicide before, what difference, if any, did it make

Write down the clients answer. Generally, any positive change perceived by the Client makes the risk
higher.

Check for symptoms of clinical depression.


a. Neuro-vegetative symptoms:
Sleep disturbances
Loss of appetite
Tiredness/lack of energy
Agitation/slowing down
Loss of interest in sex
b. Mood and motivation
Prolonged unhappiness
Loss of interest or pleasure
Hopelessness/helplessness
Difficulties performing at work
Difficulties carrying out routine activities
Withdrawal from friends and social activities
Check for somatization (pains, aches, physical discomfort without any organic cause)

HIV/AIDS and ART Training for Nurses Facilitator Guide


Section Four: Annexure-43 Page 461