Basic Services Division (BSD), Mizoram State AIDS Control Society
The Basic Services Division of Mizoram State AIDS Control Society under National AIDS Control Organization (NACO) provides HIV Counseling and Testing Services for HIV infection, the critical first step in detecting and linking people with HIV to access treatment cascade and care. It also provides an important opportunity to reinforce HIV prevention. The national programme is offering these services since 1997 with the goal to identify as many people living with HIV, as early as possible (after acquiring HIV infection) and linking them appropriately and in a timely manner to prevention, care and treatment services. Basic Services Division includes the following components:
- I. HIV Counseling and Testing services (HCTS)
- II. Prevention of Parent-to-Child Transmission of HIV (PPTCT)
- III. HIV/Tuberculosis Collaborative Activities
- IV. District AIDS Prevention and Control Units (DAPCUs)
- V. Sexually Transmitted Infections/ Reproductive Tract Infections (STI/RTI) Services.
I. HIV Counseling and Testing Services (HCTS)
HCTS continues to envisage the provision of comprehensive services in an integrated manner, and not limited to HIV testing. HCTS comprises of
- Counseling (pre-test counseling, informed consent and post-test counseling)
- Testing and prompt delivery of test results with embedded quality assurance
- Ensuring audio-visual privacy and confidentiality
- Linkages to appropriate HIV prevention, care, support and treatment services.
Types of Facilities for HIV Counseling and Testing Services
All HCTS facilities have been divided into two groups:
- Screening Facility (F-ICTC, PPP-ICTC, TI-ICTC, OPD, IPD, Emergency wards etc.), and
- Confirmatory Facility (SA-ICTC)
There are different types of HIV counseling and testing services in Mizoram which include Stand Alone ICTC (SA-ICTC), Mobile ICTC, Facility Integrated Counseling and Testing Centers (F-ICTCs) and Public Private Partnership ICTCs (PPP ICTCs). In order to offer HIV testing to every pregnant woman in the State, so as to detect all HIV positive pregnant women and eliminate transmission of HIV and syphilis from mother to child, every pregnant woman is tested for HIV and Syphilis in these ICTCs.
HIV Counseling and testing services were started in Mizoram in the year 1998. Currently, there are 44 Stand Alone ICTCs (SA-ICTCs) including 5 Confirmatory PPP-ICTC, 1 NGO and 1 TI facilities, 88 F-ICTCs in Mizoram including Community Based Sites (CBS). In order to achieve the target of reaching the first 90 goal, Mizoram SACS had implemented HIV screening facilities in Community Based (TI & LWS) Sites.
HIV counseling and testing service is a key entry point to prevention of HIV infection and to treatment and care of people who are infected with HIV. When availing counseling and testing services, people can access accurate information about HIV prevention and care and undergo HIV test in a supportive and confidential environment. People who are found HIV negative are supported with information and counseling to reduce risks and remain HIV negative. People who are found HIV positive are provided psycho-social support and linked to treatment and care.
Stand-Alone Integrated Counselling and Testing Centre (SA-ICTC)
The facilities where 44 Stand Alone ICTCs are located are as follows:-
- Civil Hospital, Aizawl
- Synod Hospital, Aizawl
- State Referral Hospital, Falkawn
- District TB Centre, Falkawn
- Kulikawn Hospital, Aizawl
- Thingsulthliah PHC
- Darlawn PHC
- Saitual CHC
- Sakawrdai CHC
- Mobile ICTC East
- Mobile ICTC West
- Greenwood Hospital, Aizawl
- Ebenezer Hospital, Aizawl
- Adventist Hospital, Aizawl
- Aizawl Hospital, Aizawl
- LRM Hospital, Aizawl
- Shalom NGO, Aizawl
- Samaritan Society, Aizawl
- District Hospital, Champhai
- Ngopa CHC
- Khawbung PHC
- Khawzawl PHC
- Champhai Mobile ICTC
- District Hospital, Kolasib
- Vairengte CHC
- Kolasib Mobile ICTC
- District Hospital, Lawngtlai
- Chawngte CHC
- Lawngtlai Mobile ICTC
- District Hospital, Lunglei
- Christian Hospital, Serkawn
- Tlabung SDH
- Hnahthial CHC
- Serkawn Mobile ICTC
- District Hospital, Mamit
- Kawrthah CHC
- Mamit Mobile ICTC
- West Phaileng PHC
- District Hospital, Saiha
- Saiha Mobile ICTC
- District Hospital, Serchhip
- Thenzawl CHC
- North Vanlaiphai PHC
- Serchhip Mobile ICTC.
There are two types: – (a) Facility based services and (b) Community based services (CBS).
Facility based services or HIV Screening are offered to individuals accessing health-care facilities functioning as per the OPD timings of the institution where the HIV Counseling and Testing Services (HCTS) facility is located. However, SACS should ensure that at least HIV screening test services are available after normal work hours. Package of HIV testing services at FICTC are;
- Pre test counseling and informed consent
- HIV screening
- Screening for STI/RTI,TB and other co-infections
- Post test counseling
- Linkages to SA-ICTC for confirmation of diagnosis and care and treatment
- Linkages to other health services.
Community based screening (CBS) is another important approach for improving early diagnosis, reaching first time testers and people who seldom use clinical services, including men and adolescents in high-prevalence settings and HRG population. CBS has been implemented in all the TI (Targeted Intervention) sites in Mizoram in 2017.
The following are list of F-ICTC and CBS in Mizoram.
- Aibawk PHC, Aizawl District
- Alpha Hospital, Kulikawn, Aizawl
- AMRO DIC, Aizawl
- Bethesda Hospital, Bawngkawn, Aizawl
- BN Hospital, Kulikawn, Aizawl
- BSF, Durtlang
- Central Jail
- Chawlhhmun, UPHC
- FIWDC, Aizawl
- Grace Nursing Home, Zarkawt, Aizawl
- Hlimen UPHC
- ITI veng UPHC
- Jeracom DIC
- Kanghmun PHC
- Khawruhlian PHC
- Lawipu PHC
- Lengpui CHC, Aizawl District
- Living Hope Ministry DIC
- Mission For Social Reforms
- Nazaret Hospital, Aizawl
- Peniel Society
- Phuaibuang PHC
- Phullen PHC
- Reiek PHC
- Sairang PHC
- Samaritan Society, Aizawl
- Samaritan Society, IDU
- Sialsuk PHC
- Sihphir PHC
- Social Guidance Agency
- Society For Community Care – IDU
- Society For Community care – FIDU
- Suangpuilawn PHC
- Vaivenga Hospital & Research Center, Aizawl
- ZDRB Drop-in Center
- ZDRB – MSM
- Zemabawk UPHC
- Biate PHC
- Bungzung PHC
- Champhai AIDS Do Pawl
- CODNERC , Khawzawl
- Farkawn PHC
- Hnahlan PHC
- Kawlkulh PHC
- Khawhai PHC
- Mimbung PHC
- MSD & RB, Champhai
- NE Khawdungsei PHC
- Rabung PHC
- Sialhawk PHC
- AMRO, Kolasib
- Bairabi PHC
- Bilkhawthlir PHC
- Bukpui PHC
- Kawnpui PHC
- Lungdai PHC
- MHIP- Lawngtlai – Core
- MHIP- Lawngtlai – MIG
- BSF, Unit Hospital, Lunglei
- Buarpui PHC
- Bunghmun PHC
- Cherhlun PHC
- Chhipphir PHC
- Grace Society
- Haulawng PHC
- Lungsen PHC
- MHIP – Lunglei – IDU
- MHIP – Lunglei – MIG
- Tawipui PHC
- WADA, Lunglei
- BETHANY, Mamit
- NEXUS, West Phaileng
- Phuldungsei PHC
- Samaritan Society, Mamit
- Zawlnuam PHC
- WADA, Siaha
- Chhingchhip PHC
- CODNERC, Thenzawl
- Khawlailung PHC
- ZEP, Serchhip
- Cancer Institute, Zemabawk
- Rawpuichhip PHC
- DM Hospital, Champhai
- Med-Aim Hospital, Champhai
- Nazareth Nursing Home, Kolasib.
II. Prevention of Parent to Child Transmission of HIV (PPTCT):
The Prevention of Parent to Child Transmission of HIV (PPTCT) programme was started in Mizoram in the year 2004. The aim of PPTCT programme is to offer HIV testing to every pregnant woman (universal coverage) in the country, so as to cover all estimated HIV positive pregnant women and eliminate transmission of HIV from mother to child.
The goals of the PPTCT Programme are:
- Primary prevention of HIV, especially among women of child bearing age.
- Preventing unintended pregnancies among women living with HIV.
- Prevent HIV transmission from pregnant women infected with HIV to their child.
- Provide care, support and treatment to women living with HIV, her children and family in women in child bearing age.
The updated National Guidelines for PPTCT (2013) is to incorporate global recommendations and also provide Operational Guidelines for nationwide implementation of Multi Drug Regimen (MDR) for PPTCT with immediate effect.
It is crucial that for efficient PPTCT, all the States/UTs strengthen the convergence between NACP and national Reproductive & Child Health (RCH) including STI/RTI, to improve access of HIV awareness, counseling and screening/testing services to detect HIV infection amongst pregnant women on their very first contact with health system. This will promote birth of HIV free children and improve longevity with quality life of people living with HIV infection with supportive environment. It is important that synergies with National Health Mission (NHM) and the General Health Care System are sustained for efficient delivery & management of PPTCT services with well functioning referrals and linkages.
The new Guidelines of World Health Organizations (June 2013) recommends that the following options be practiced. This new Guideline has been implemented in Mizoram in October 2014.
- Providing lifelong ART to all the pregnant and breastfeeding women living with HIV regardless of CD4 count or clinical stage. OR
- Providing ART (ARV drugs) for pregnant and breastfeeding women with HIV during the mother to child transmission risk period and then continuing lifelong ART for those women eligible for treatment for their own health.
Elimination of Mother-to-Child Transmission (EMTCT) of HIV and Syphilis by 2020
India has made substantive progress to advance towards the goal of Elimination of Mother-to-Child Transmission (EMTCT) of HIV and congenital syphilis by 2020 in India. Along this process and towards achieving Elimination of Mother-to-Child transmission of HIV and congenital syphilis in India, the plan for conducting in-country data verification and data validation exercises in a phased manner in select states was approved by the Technical Resource Group on PPTCT in December 2016.
In line with this plan, the data verification in Mizoram, Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu and Telangana as Phase I states has been conducted in 2017. This exercise is a collaborative process undertaken under the leadership of NACO Basic Service Division and collaboration with UNAIDS, UNICEF, WHO, PEPFAR (CDC/USAID) and other partners who are members of the National Core Group on EMTCT and Technical Working Group on Data Verification. In country assessment of Elimination of mother to child Transmission of HIV and Syphilis Phase II in 19 States & UTs of India including Mizoram which included Program assessment, Laboratory assessment, Program services, Human rights and community engagement assessment was conducted in January 2019.
State Initiatives to reach first 90 by 2020
- CBS implemented in all TIs for key populations
- Health Care Providers from non-FICTC and sub-centers in all districts trained for HIV testing in collaboration with TISS, Mumbai
- Training of Trainers for district level training- Medical Officers, Staff Nurses/ANMs, and Counselors & Lab. Technician to achieve first 90 strategies in coordination with NHM, Mizoram.
- Implementation of Confirmatory facilities in 5 Private Hospitals and 1 TI NGO in Aizawl using Model B.
- CBS extended (with Project Sunrise) to LWS to cover unreached remote areas
- Mobile ICTC routes to be expanded with the available funds from other divisions and other agencies
- Training of remaining health care providers from non FICTC and sub centers in collaboration with TISS, Mumbai
- Advocacy meeting with Private Practitioners.
Best Practices & New Initiatives:
I. Prioritizing PPTCT programme resulting in Mizoram among the 6 best performing states for Elimination of Mother to Child Transmission of HIV & Syphilis by 2020.
- Good coordination with NHM in Training of Medical Professionals & Health Care Providers to achieve the first 90
- Good coordination with World Vision Care Project in giving awareness & advocacy of PPTCT program to Health Care Providers, Anganwadi workers & mothers under ICDS Project
- Collaboration with women church leaders about HIV/ AIDS, PPTCT & CST
- Advocacy with FOGSI on PPTCT and MDR program
- Training of all Health Care Providers from Non-FICTC sub centres & PHC in the State to improve the first 90 strategy in collaboration with Project Ahana
- Training of all Asha workers on Basic of HIV/AIDS, PPTCT, STI and importance of condom use.
II. Testing of all pregnant women for Syphilis in all ICTC’s with proper reporting system.
III. HIV/Tuberculosis Collaborative Activities:
1. State TB HIV Coordination committee (STCC), State Technical Working Group (SWG) meeting and training status
|No. of STCC meetings conducted||1||1||0|
|No. of STWG meetings conducted||4||4||2|
|No. of Districts conducting at least 1 DCC meetings in the year (Dr: Total number of districts)||8/8 (100%)||3/8 (37.5%)||8/8 (100)|
2. ICTC-DMC collocation status
|ICTC-DMC/CBNAAT collocation status|
|Total number of DMCs collocated with ICTC/F-ICTC*||33/35 (94%)|
|Total number of PPP-ICTC collocated with TB Pvt. Health facility registered in Nikshay||3/3 (100%) (Synod Hospital, Aizawl Hospital & Serkawn Hospital)|
|Number of ICTC collocated with CBNAAT sites||8/8 (100%)|
3. Status of implementation of PITC in state
|Name of the state||Total number of districts||Number of districts implementing PITC among presumptive TB cases (partially/wholly)|
|Mizoram||8 8 (Eight)||8/8 (100% )|
4. PITC among TB cases – State
|Registered (n)||Number (%) of TB patients with known HIV status||Number (%) of HIV positive TB patients with known HIV status (old+new)|
|Notified TB patients (Public + Private)||2605||2299 (88%)||283 (12%)|
|Presumptive TB cases examined||13589||1893 (14%)||227 (12%)|
5. ART & CPT coverage among TB HIV co-infected patients
|TB HIV co-infected patient Registered(n)||Number receiving therapy n (%)|
|ART coverage among TB HIV co-infected patients||283||240 (85%)|
|CPT coverage among TB HIV co-infected patients||283||282 (99.6%)|
IV. District AIDS Prevention and Control Units (DAPCUs)
There are three DAPCUs in 3 districts namely Aizawl, Champhai and Kolasib DAPCU in Mizoram. The DAPCUs are led by a District AIDS Control Officer from the Government Health Services and supported by the District Programme Manager (DPM), District ICTC Supervisor (DIS) and District Assistants for Monitoring & Evaluation, Accounts and Programme implementation.
The main objective of DAPCU is overall monitoring, coordination and troubleshooting for NACP facilities at district level, to develop evidence based district specific programme plan and build robust network with District Administration and line departments.
The DAPCU National Resource Team (DNRT) under NACO has been mandated to mentor the DAPCUs and provide support to SACS in review of DAPCU functioning and drawing up appropriate bottom up action up for improvement of Programme, in terms of scale and quality.
Innovations and performance by DAPCU Kolasib
- Establishment of 43 Condom Outlet by DAPCU in Kolasib Town monitored by DAPCU Staff.
- Conducting HIV and Drug abuse Awareness Program in 11 Middle School, Kolasib Town during 19th April to 26th April 2017.
- Jail Intervention Program – visit District Jail in coordination with Mobile ICTC, LWS NGO, TI-NGOs and ART Centre to link HIV Positive inmates due for ART registration, initiation and routine CD4 Count.
- On 24th April 2017, DAPCU Conduct Sensitization on HIV/AIDS among Sub-Headquarters YMA (SHYMA) in YMA Committee, Diakkawn, Kolasib.
- On 18th May 2017, and 23rd January 2018 DAPCU organize HIV & Drug Abuse Awareness Program at Observation Home, Sethawn, Thingdawl where there are 15 Juvenile In conflict with law. HIV Blood test is also conducted by Mobile ICTC among 21 persons including Office Staff of Observation Home.
- 15th June 2017, DAPCU Conduct HIV Awareness Campaign at Thingdawl Chhimveng among KTP, Youth Christian Fellowship.
- On 13th August 2017 DAPCU Conduct HIV Awareness at Khuangpuilam Presbyterian Church among Christian Youth Fellowship.
- Since September 2017 DAPCU collect monthly STI/VDRL Test and result report of all Private Laboratory with the purpose of having a specific scenario of STI cases within Kolasib Town. Follow up of Reactive cases was done in coordination with visiting Doctors and STI Clinic Counselor, District Hospital, Kolasib.
- On 17th September 2017 DAPCU Conduct HIV and Drug Abuse Awareness program at Bairabi among Sunday School Children.
- In pursuance of DAPCC Meeting conducted on 5th October 2017, DAPCU conducted hands-on training for District jail Nurse and Medical Officer on ART and ATT for purpose of follow up on Jail Inmates HIV Positive.
- 12th November 2017, DAPCU Conducted HIV and Drug Abuse Awareness among Sunday School Children, Tumpui Presbyterian Church.
- 10th November 2017, DAPCU Conducted HIV and Drug Abuse Awareness among Youth Group of Diakkawn YMA Area.
- 19th December 2017, DAPCU Conducted HIV and Drug Abuse Awareness among Youth Group of Saidan YMA Area.
- In Pursuance of DAPCC Meeting Resolution, among 15 Boys Hostellers of Regional Sports training Centre, Saidan, HIV & Drug Abuse Awareness programme was conducted by DAPCU on 22nd January 2018.
- As a result of HIV-TB Monthly Coordination meeting Resolution as initiated by DAPCU, Register for TB Client including TB Negative client referred to ICTC for HIV test is maintained by RNTCP for cross checking of referral activities.
- As per initiation of DAPCU, Line list of TB Patient whose HIV status are not known is prepared by DTC and in coordination with DAPCU through Mobile ICTC which prepare plan prioritizing TB Patient HIV testing outside Kolasib Town. Link Workers are coordinated for this purpose.
- On 27th February 2018, 450 IEC Materials and 500 pieces of condom were distributed during Legal Awareness Campaign organized by Mizoram State Legal Service Authority at Diakkawn Hall, Kolasib.
- ART Medical Officer has been changed with the initiation and suggestion of DAPCU through MSACS for effective functioning.
- On 6th march DAPCU Conduct HIV Awareness Campaign among Auto Rickshaw Driver Association during Sports program and distribute 3600 pieces of condoms along with 180 IEC Material.
- On 8th March 2018, DAPCU procured 3000 pieces of Condoms from RCH Program, CMO Office to prevent stock-out problem of AMRO TI NGO.
- On 21st March DAPCU Conduct Training of Service provider, Health Worker from 18 sub centers where no FICTC was established.10 Condom Flowchart each, 300 pieces each of IEC Materials and 480 pieces each of condom was distributed among the participants.
Innovations and performance by Aizawl DAPCU
- Completely identifying and started placing condoms in public pay and use urinals in the city.
- Placing condoms at hotels.
- Initiating to penetrate Bethel Camping Centre for TI functionaries to be able to give their services to their clients who are in the center.
- Meeting with district health authorities for linkages of PLHIV to ARTC. Discussion on same day initiation of ART to check the gaps in linkages and to achieve 90 90 90
- Advocacy with local community leaders for TI enabling environment in the near future.
- ARTC Kulikawn which was very congested and small, with the help of the DC Aizawl, Extension of room could be possible from MLA Fund.
- With the support of the DC Aizawl, Free Safe Delivery Kits costing around Rs. 1600/- to Rs.2300/- for Positive pregnant women could be made available from RKS fund.
- SBS under social welfare department Govt. of Mizoram were also availed by our PLHIV. RBSY teams also visit our VIHAAN for enrollment.
- The initiation of upgrading of PPP FICTC into Stand Alone ICTC through DAPCC was also underway. Consultation with the Hospital Directors in encouraging them with the steps and process of SA ICTC.
- Organize and trained all the ASHA in Aizawl district on PPTCT and on empirical STI treatment by ASHA to reach the unreached.
- Legal Awareness among NACP facility staffs where organized and a renowned Legal expert and Presiding Officer, MACT, Mr. KL Liana graced the meeting as a Resource person.
- “Fit for future” programme for the PLHIV was also conducted in collaboration with PWNM, YWCA, MSACS, World Vision
- Quarterly incentivizing of field workers (Best performing staff from each TI) for better linkages to ARTC.
- Camp Approach HIV Testing and Free Mobile Clinic has been carried out in the village of Sairang, Sialsuk, Samlukhai, Hmuifang, Tachhip, Sateek, Aibawk in collaboration with MMU and Link Workers. 5 villages more are still to be covered.
- Advocacy with Local Leaders of 10 highest localities with HIV has been underway.
Innovations and performance by Champhai DAPCU
- Training given among health workers within the District.
- Awareness among Jail Inmates.
- Awareness among Church leaders and YMA.
- Training on HIV/AIDS, ART and its related among Link Workers cluster.
- Awareness among higher Secondary School at Champhai and Khawzawl.
- Training on PHC Doctors on HIV and their report formats.
- Leaflet on HIV was distributed throughout Champhai District among Middle, High School and Higher Secondary School in aid of DEO.
- Awareness among Christian youth fellowship.
- Organizing Stall at State Legal Authority awareness.
- DAPCU attending at DISHA Meeting.
V. Sexually Transmitted Infections/ Reproductive Tract Infections (STI/RTI) Services:
Provision of quality RTI/ STI case management services through a network of public health care delivery institutions, private sector providers, franchisee clinics and in targeted intervention settings will result in achieving following objectives:
- Enhance access to services to all; especially for women and adolescents who are constrained to seek services and face several access related barriers.
- Standardized treatment protocols will improve prescription practices by reducing poly pharmacy, irrational drug combinations.
- Focus on prevention, with special reference to partner management, condom use, follow-ups and management of side effects.
- Emphasis on treatment compliance and better treatment outcomes.
- Behavior change communication leading to improved knowledge on causation, transmission and prevention of RTIs/STIs.
- Ensure that providers offer counseling and testing services for HIV/ AIDS and establish linkages with ART systems with respect to person’s detected positives.
- Screen asymptomatic women especially contraceptive ushers and antenatal clients for STIs.
- Ensure service provisions for groups practicing high risk behaviors such as sex workers, MSMs and IDUs.
STI/ RTI Services under Mizoram SACS was launched in 24/09/2008. STI/ RTI services are implemented through Designated STI/ RTI Centers (DSRCs) or Suraksha Clinic. Currently, DSRCs are located in:-
- Civil Hospital, Aizawl.
- Civil Hospital, Lunglei.
- Civil Hospital, Saiha.
- Civil Hospital, Champhai.
- District Hospital, Kolasib.
- District Hospital, Serchhip.
- District Hospital, Mamit.
- District Hospital, Lawngtlai.
- Referral Hospital, Falkawn.
- Kulikawn Hospital, Aizawl.