Insights from the journey of HIV Care & Support Programme (Vihaan)

Tara Rana and Rose Huidrom 1 December, 2020

Alliance India is the principal recipient of the Global Fund grant for HIV Care and Support Programme in India which is implemented nationwide in a diverse partnership with the government, civil society, and the networks of people living with HIV. Since 2013, Vihaan Care & Support programme has evolved over the years to deepen the reach, amplify the services and galvanise the positive impact of the programme. Currently, in its third phase of the implementation, we bring you a short interview with Huidrom Rosenara, Associate Director of the Vihaan Care & Support programme who along with her ninja team provides strategic direction to the national programme.

What keeps you motivated at a time when HIV and COVID-19, these two epidemics, are colliding and disrupting the hard-earned progress in HIV response?

The resilience and leadership that the PLHIV community in India demonstrated during the COVID-19 outbreak have been the most inspiring and re-assuring in midst of these turbulent times. I felt proudest that Alliance India always believed in the strength of the community and took the risk in 2013 to provide the state and district level network of people living with HIV with the excellent opportunity to play a significant role in implementing HIV Care and Support programme as strategic partners at a time when they had little faith in themselves and their capabilities were in question. Through Vihaan Care & Support programme, we not only built their capabilities and empowered them to lead but also laid a nationwide robust co-ordination mechanism and information sharing system in place. Their preparedness in HIV response is what we tapped into during COVID-19 outbreak. Throughout the lockdown, we witnessed the mass exodus of people due to loss of livelihood, our CSCs carried inter-state tracking of clients and ensured they accessed their medicines wherever they were. It was the dedication and prompt response of the community that truly helped us minimise the harms COVID-19 could have caused and helped us avert drastic loss of health and life of people living with HIV. The community we work with are our beacon of hope. I am certain that together we will continue to bravely tackle the challenges of COVID-19 while keeping the momentum of HIV response.

How is the PLHIV community defending the gains made in HIV response against the COVID-19 threats?

Hearing the stories of our frontline workers, to what length and breadth they were going to ensure the continuity of services to people living with HIV, even in far-flung and hard to reach areas, putting their own lives on the line, was overwhelming. Once the travel restrictions were relaxed, I visited some of the CSCs and interacted with the outreach workers. Their commitment and passion to assist their community are unmatchable. Thanks to their rock-solid support, from April to July 2020 total 1.05 million people in the duelist accessed antiretroviral medicines without any delay. The efficiency and leadership of the community were recognized and appreciated by the National AIDS Control Organisation (NACO) as well as its state and district level units. This led to increased trust in the capability of the community to take greater responsibilities. Today, most of our CSCs have become the distribution centre for not only ART medicines but also the public distribution of COVID-19 relief materials and hygiene kits. Our outreach workers continue to play a key role in advocating for resuming the general health checkup services for the PLHIV in hospitals where they are registered. Depending on the client needs, our outreach workers continue to provide home delivery of medicines and HIV screening services. Another area where the community has shown leadership is in taking initiative in quickly mobilising local resources like dry ration, masks, gloves, and sanitizers to distribute among the neediest PLHIV families. We are thankful to the Global Fund for additional support to procure hygiene kits to keep our frontline workers well equipped and safe. The hygiene kits (gloves, masks, soaps and sanitiser) will be distributed to more than 50,000 frontline workers including ART Centre staff, Targeted Intervention staff, 310 CSCs and other volunteers. We are also thankful to NACO and all SACS officials for their proactive leadership and guidance and all the necessary administrative support to the team from time to time enabling them to respond to the COVID 19 outbreak with much efficiency. The robust coordination between Alliance India team, NACO, Vihaan partners and all SACS and ART centres team across the country was the backbone in ensuring all PLHIV have uninterrupted accessed to their life-saving medicines amidst the COVID 19 outbreak. The momentum is still being carried on.

How has the Vihaan Care & Support programme contributed to the national HIV programme?

Besides partner testing and linkages to social welfare schemes, one of the most prominent achievements of Vihaan Care & Support programme has been to firming up the huge national database of lost-to-follow-up cases from the national HIV care as well as the actual number of PLHIV yet to be started with ART medicines. Our CSCs led by our partner NGOs, CBOs and networks of PLHIV worked closely with the ART centres with support from SACS and NACO, in contact tracing and removing duplicities and errors under ‘Mission Sampark’, an unprecedented national drive. Under this initiative, we not only brought back the lost-to-follow-up cases but also linked the ‘yet to start the treatment’ cases with the ART as per the new test and treat policy. The firming up of the database directly contributed in informing the national programme on clear numbers, the need to enhance efficiency in the investment of resources and accuracy in mapping encashment areas for effective establishment of new ART Centres to achieve optimal outcomes. As a result, we have tracked an upward trend in adherence from 61% treatment adherence in December 2017 to 81% in August 2020 (check this data with Pavan). In the third phase, since we had demonstrated result in tracking lost-to-follow-up cases and on the basis of our programmatic learnings, we are now focussing on prevention of new lost-to-follow-up cases thus contributing to the national goal of improving retention in HIV treatment and care. Another most important contribution of the programme has been to provide differentiated care services based on the needs of each client or specific group populations, which addresses the individual vulnerabilities of the clients. The client-centric approach helps us identify and address various socio-economic or psychosocial barriers so they overcome those and access treatment and other welfare schemes. Since we have been able to demonstrate the success of the peer-led or community-led model, the national programme has recognized Vihaan CSCs as an integral part of the Care, Support and Treatment component of the national HIV programme. Furthermore, from the next phase of the programme, the government will be supporting 100 CSCs through domestic funding, the provision in the budget has been already made. This recognition from the national programme is an excellent achievement for the programme and I am supremely proud of our partners and our national team for their unwavering commitment and relentless work.

On World AIDS Day, what is your message to our readers?

Not only on World AIDS Day but in also in the days, months, and years to come, we must maintain and sustain the global solidarity and a sense of shared responsibility towards achieving the unfinished agendas of HIV and supporting people living with HIV to sustain the community-led responses. The way world came together during COVID-19 outbreak, we must unite in our resolve to uplift and improve the quality of life for people living with HIV, reduce new cases of HIV and avert deaths due to HIV and AIDS-related complications. The initial panic of COVID-19 has slowed down but the pandemic is not over yet. It is very much a threat to public health, our economy and most importantly to HIV community who remain most vulnerable to COVID-19. The development frontline workers remain vulnerable and at-risk even as they keep the wheels of service delivery moving. The least we can do is be sensitive to the needs of our frontline workers and stand in solidarity with them.

~ Interviewed by: Tara Rana, Communication Officer, Alliance India