India

Project Goal:

The HIV/AIDS program was started 5 years ago and is now providing HIV/AIDS awareness, prevention, counseling, testing, and treatment services to hundreds of community members per month. We have the most integrated public private partnership (PPP) HIV/AIDS services set-up in the state of Madhya Pradesh with a PPP Integrated Testing and Counseling Center, PPP Link Antiretroviral Treatment Center, and a ‘DOTS’ treatment center for tuberculosis (often occurring in HIV+ patients). Our care and support program assists 247 HIV positive individuals with medical, psychosocial, and livelihood generation services. We specifically tailor our prevention and care programs to the needs of the tribal communities that we work with, addressing the needs of vulnerable populations such as children, migrants, truckers, and female sex workers.

As of March 31st, 2011, RMF has decided to shift the base of operations and the partner of its HIV/AIDS program away from Jeevan Jyoti and to the Jhabua District Hospital. This move comes after over a year of internal debates over where RMF’s program, funds, and time can be put to best use over the long-term. When RMF started the HIV/AIDS program in late 2006, the only option for quality care in Jhabua district was the private facilities at Jeevan Jyoti Hospital. At the time the Jhabua District Hospital was a decrepit, corrupt, and honestly terrifying establishment where RMF employees would never consider referring a patient or loved one. The district administration was unwilling to talk about HIV/AIDS care and local doctors were afraid to even be in the same room as HIV patients.

Over the past 4 years, however, RMF has seen a drastic change in the Jhabua District Hospital and in the attitude of the district administration and doctors. After four years of advocacy at the district level and as HIV/AIDS awareness has spread country-wide, doctors are more than willing to treat HIV+ patients and are educated about Universal Precautions. The new head of the Health Department, the CM&HO, is an honest and dynamic woman who is dedicated to turning around the negative health scenario in Jhabua.

The hospital has recently gone through major physical upgrades and has been awarded an International ISO Certification.

Today the Jhabua District Hospital is the best hospital in the region, with young, dedicated doctors serving their mandatory time in rural India and the best facilities we could expect in a rural hospital. Even more important, there is a hospital administration keen on improvement and willing to discuss ideas and plans to improve services offered. RMF’s staff all agrees that if one of us or one of our loved ones were sick, this would be the first place we would bring them.
In recognition of this high quality, free of cost care available through the government system and also with long-term sustainability in mind, RMF has decided to shift the focus of our HIV/AIDS program to building up the services of the District Hospital.

RMF was also excited to learn that MPSACs is in the final stages of opening an ART centre in Barwani District Hospital, about two hours travel time by road from Jhabua. This new ART centre will provide all of the diagnostics, counseling, treatment services, and registration that is currently being conducted in Indore, but in a much more accessible location that easily serves our target populations. Barwani District is also the headquarters of RMF’s “Eradicate Malnutrition” Program, which will give more of our staff a chance to assist patients in Barwani.

Project Objectives during this reporting period:

• Provide counseling and diagnoses of HIV/AIDS and STIs
• Facilitate treatment at ART Center (Indore) for HIV-positive patients in the community
• Support ART medication distribution for eligible patients through a Public Private Partnership Link-ART Centre at JJH, Meghnagar
• Treat HIV positive patients with complications and Opportunistic Infections at Jeevan Jyoti Hospital
• HIV prevention, education, counseling, and testing initiatives in villages, surrounding communities, and with High Risk Groups (HRGs)
• Capacity building for members of the community, NGOs, government workers, and individuals from all backgrounds
• Provide support to Jhabua Positive People’s Network (DLN)
• Treat HIV related Tuberculosis Cases at DOTS center
• Work with Madhya Pradesh State AIDS Control Society and the National AIDS Control Organization to transition Link-ART centre to Jhabua District Hospital
• Locate partners for Public Private Partnership ART Centre at Jhabua District Hospital

Summary of RMF-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):

• Referred and transported patients to ART center in Indore to receive Anti-Retroviral Treatments and check-ups with doctors
• Provided ART medication to stable patients from link-ART center
• Provided outreach support and counseling for suspected new cases and high-risk individuals in the field
• Provided in-patient support, counseling and testing for drop-in cases and potential new cases at Integrated Counseling and Testing Center
• Provided in-patient support for unstable HIV patients suffering from complications, TB, or other opportunistic infections (OI)
 

Number served/number of direct project beneficiaries:

The HIV/AIDS Care and Support Program currently has 316 PLHAs enrolled with 109 receiving lifesaving ART Medication.
 

Lokendra:

Lokendra is a HIV+, 16 year old boy from a village near Jhabua enrolled in RMF India’s Care and Support Program. With the assistance of our program, Lokendra began receiving ART treatment from a government centre in Indore in October 2008. However, despite strict adherence to his medication, Lokendra’s condition gradually declined until his CD4 count was 41 in August 2010 and he suffered from several serious illnesses. Despite repeated trips to the ART centre in Indore, the staff there failed to recognize his need for 2nd line treatment. However, RMF India staff quickly mobilized its resources and assisted Lokendra by gaining him admission to a specialty hospital in Mumbai. After quickly raising his case with doctors at NACO based in Delhi, and consultations with the State AIDS Clinical Expert Panel (SACEP), Lokendra was placed on 2nd Line ART treatment. RMF India also engaged its network of supporters in Mumbai to visit the family and provide them with a place to stay, helping them cope with their difficult situation. 

As of July 2011, Lokendra is still receiving his 2nd line ART under close supervision with our partners. His condition remains at least stable, if not gradually improving. As always, his spirit and determination continue to be an inspiration to all who meet him, and one of the key components of his continued survival. 

Integrating program goals and single patient care is part of RMF India’s ‘whole health’ approach. By carefully tracking barriers to treatment in individual cases such as Lokendra’s, and assisting patients and their families, RMF India is able to gain valuable insights into gaps in government services while at the same time improving the lives of marginalized individuals.