Anti Retroviral Theraphy

Care Support Services for HIV positive people
• Antiretroviral Therapy (ART) Plus Centre
• Facility Integrated Anti Retroviral Therapy (FI ART)
• One Link ART Centres Plus (LAC+)
• Two Link ART Centres (LAC )
• Care Support Centre (CSC)
• Management of Opportunistic Infections (OIs)
• Post Exposure Prophylaxis (PEP)

• Anti Retroviral Therapy (ART) Centre
Free Anti retroviral drugs are being provided at the ART Centre, Goa Medical College since April 2005. To start with, the beneficiaries comprised of symptomatic patients with CD4 count of less than 200 which was recently increased to CD4 count of < 500. Government of India recently launched a new Strategy i.e. “Test and Treat. According to this strategy as soon as any person is diagnosis with HIV he/she is put on ART. All patients attending ART centre are screened for Opportunistic Infections like TB, Herpes Zoster, PCP etc and all HIV/TB co-infected patients are started on ART irrespective of their CD4 count. Existing ART center has been upgraded to ART Centre Plus with availability of alternate 1st line and 2nd line treatment. State AIDS Clinical Expert Panel (SACEP) meets every week to screen resistance cases.All HIV positive pregnant/breastfeeding women is been initiated on lifelong ART as per guidelines and all HIV exposed babies are screened and tested as per guidelines. Till date 5,903 patients have been registered; out of which, 3378 patients ever started on ART and till date 2039 patients are alive on ART.

• Link ART Centres Plus (LAC+)
The existing Link ART Centres at North Goa District Hospital (Asilo), Mapusa as been upgraded to Link ART Centre Plus wherein facility for collection of CD4 samples and ART drugs are made available for PLHIVs. In addition to above, Upgrading of Link ART centre to Link ART Plus Centre at Cottage Hospital, Chicalim is proposed in the current financial year 2017-18

• Link ART Centres (LACs)
Two Link ART Centres have been established at Cottage Hospital, Chicalim and Sub District Hospital, Ponda for the convenience of PLHIVs wherein ART drugs are made available. In addition to above, two more link ART Centre has been proposed in the Current financial year 2017-18 at PHC Bicholim and CHC, Canacona

• Facility Integrated Anti Retroviral Therapy (FI ART)
Link ART Plus centre at Hospicio Hospital, Margao has been upgrade to Facility Integrated Anti Retroviral Therapy (FI ART) Centre. FIART will provide ART services for delivery in the District that have lower HIV Prevalence, including those areas that are difficult to reach and where it is intricate to Start full-fledge ART centre. Till date 556, patients have been registered; out of which, 499 patients ever started on ART and till date 482 patients are alive on ART.

• Care Support Centre (CSC)
A Care Support Centre (CSC) “Vihaan” has been set up at North Goa District in Tiswadi taluka for establishing the linkages of PLHIVs with various service providers and to assist the ART Centre in tracking the missing /lost to follow-up patients.

• Management of Opportunistic Infections (OIs)
The facilities for the management of the Opportunistic Infections are provided at Goa Medical College Hospital at tertiary level and two District Hospitals at secondary level. The Goa SACS supports all the activities undertaken by Goa Medical College Hospital and the hospitals under Directorate of Health Services for OI management. There is absolute co-ordination between the National TB Control Programme, TB and Chest Diseases Hospital and Goa SACS when it comes to management of TB-HIV co-infections. Monthly meetings of Goa SACS and Goa State TB Control Society are conducted for proper co-ordination and management of data.

• Post Exposure Prophylaxis (PEP)
Goa SACS conducts training sessions and Continuing Medical Education (CME) programmes for Government as well as private sector medical professionals and others in Universal Work Precaution and Post Exposure Prophylaxis (PEP). Manual of PEP guidelines are provided to the participants during the training programme. Health Care Providers working in GMC having exposure receive PEP from ART Centre, Goa Medical College Hospital. However, for those under Directorate of Health Services, provision is made for PEP under emergency drugs budget, from State Government funds.

• HIV Viral Load Testing in Goa
• NACO has contracted M/s Metropolis Healthcare Limited, Mumbai under a public-private partnership (PPP) to provide viral load testing for patients across all ART centres in the country.
• Viral Load Testing for all PLHIV on ART is started on 23rd February 2018 in the state of Goa.

Eligibility of patients for viral load testing: All HIV-1 and HIV-1&2 co-infected patients who are registered under the programme and have been on ART for at least 6 months are eligible for viral load testing. However, NACO plans to introduce routine viral load testing in a phased manner. Hence, the following patient groups will be given priority for testing in 2018:

⇒ Priority Group 1: Patients with suspected treatment failure (immunological or clinical). Please refer to annexure 1 for definition of immunological failure
Priority Group 2: All PLHIV on second and third line ART
Priority Group 3: All pregnant and breast feeding HIV positive women
Priority Group 4: All PLHIV identified as Key population

Note: PLHIV with confirmed HIV-2 infection should not be referred for viral load testing.

Timing for Viral Load test:

For patients on first line of treatment, viral load test should be conducted at 6 months and 12 months from the date of ART initiation in first year, and once every 12 months thereafter.

⇒ For second/third line patients, viral load test should be conducted once every 6 months after initiation on ART.

Operational steps in routine viral load testing under PPP model:

Sample collection schedule at ARTC: Every Wednesday at the ART Centre in GMC

• The reports of the samples collected are obtained within 1 to 2 days.

View ⇒  Routine regarding viral load testing scale-up plan

CD4 Count Facility
For management of HIV/ AIDS patients, CD4 count facility has been established at Goa Medical College since July 2001. With the setting up of ART centre at Goa Medical College on an average 25 to 30 patients are screened per day for CD4 blood count to verify and assess the immune status of a HIV patient.