Targeted Intervention:

Objective of the component

Targeted Intervention (TI) is one of the major sub-components under ‘Prevention’ component of the National AIDS Control Programme (NACP) –IV. As the overall goals of the NACP –IV to reduce new infections by 50 %( 2007 base line of NACP-III) and comprehensive care, support and treatment to all persons living with HIV/AIDS; therefore, highest priority has been given to cover the sub-populations that have the highest risk of exposure to HIV through intervention programmes. This High-Risk Group (HRG) includes Female Sex Workers (FSWs), Injecting Drug Users (IDUs) and Man Having Sex with Man (MSMs). Also high priority in intervention programme is accorded to Migrant Labourers (ML) and long-distance Truckers.

As on 31^st March, 2016, total 14 TI projects are running across the State out of which 11 are among HRGs (8 FSWs, 1 Core Composite MSM & FSW, 2 IDUs) and 3 among Destination Migrants.

The Tripura State AIDS Control Society has given priority for ensuring coverage of all available hot-spots of HRGs through TI projects. As the State is considered to be the gateway to all the north-eastern States, therefore its contribution in route of HIV epidemic in case of FSWs and IDUs holds an important strategic collaboration. Recent upsurge in economic activities in north-eastern States has drawn a lot of consideration in terms of movement of truckers and migrants through the State.

Based on the epidemiological importance, National AIDS Control Organisation (NACO) in consultation with the Tripura SACS has carried out accurate participatory size estimation/site assessment for saturation of all active High Risk Groups and hot spots. Development of micro plans has been conducted by all TI projects. All project staff, inclusive of peer educators has been trained.

Selection and Role of  TI NGOS-

The aim of NGO collaboration is to educate the vulnerable groups engaging in high risk behaviour and to promote safe sex practice. Tripura State AIDS Control Society (TSACS) encourages area and population-specific intervention programmes through the NGOs followed by the selection criteria laid down by National AIDS Control Organisation (NACO), Govt. of India, and New Delhi. Tripura SACS supports and links up with many NGOs to create awareness, provide proper counselling, and promote safe sex, care and treatment - seeking for HIV / AIDS cases. Broadly there are two types of organisations which are supported by Tripura SACS. The first group comprises NGOs / CBOs who undertake intervention projects. The second group includes organisations of People Living with HIV/AIDS, with a focus on activities related to care support and treatment.

As part of its policy of transparency, Tripura SACS places advertisements in newspapers inviting application from NGOs. The selection of NGOs involves three stages:

1. Scrutiny of the proposal by the Technical Advisory Committee (TAC).
2. A pre-sanction Field inspection by the Joint Appraisal Team (JAT).
3.  Approval by the Executive Committee.

All proposals from NGOs are appraised by the Technical Advisory Committee (TAC). Proposals recommended by the TAC are inspected by Joint Appraisal Team (JAT) who makes field visits to verify the working of the NGO, their capability and the community's perception of the NGO. After field inspection, the proposals along with the field inspection reports are presented to the Technical Advisory Committee of Tripura SACS. Based on the inspection reports & recommendation of the TAC, Executive Committee (EC), Tripura SACS make necessary approval.

Tripura SACS periodically inspects the NGOs to monitor the progress made. Intervention programmes are aimed at promoting safe behaviour by providing vulnerable and marginalised groups with access to condoms, counselling and STD treatment services. The groups identified for intervention programmes are truck drivers, Female Sex Workers (FSW), Migrant Labour (ML), Man having Sex with Man (MSM), Injecting Drug Users (IDU), industrial workers, hotel and lodge workers, domestic helper, students, street children etc. Tripura SACS has developed working relationships with NGOs to ensure that the HIV/AIDS situation is properly and adequately addressed in the appropriate manner.

Through NGOs, Tripura SACS provides support for the following activities:

• Behaviour change communication(BCC)
• Counselling
• Services to prevent STD/STI (Sexually Transmitted Diseases/ Sexually Transmitted Infection) and treatment as well.
• ICTC Services (Integrated Counselling & Testing Centre) to know HIV infection status and provide necessary care, support and treatment thereof.
• Commodities services (Condom, Lubes &Needle / Syringe) for safe practice.
• Home care for people living with AIDS

The continuous efforts in improving awareness levels and regular advocacy have created an environment for Community Members & PLHA ( People Living with HIV/AIDS) as well as to come out in the open to disclose their status and united to form an organisation to empowered themselves and address social stigma discrimination etc with the help of Tripura SACS.

Name of NGO	Typology	District covered	HRG Population Size for 2014-15	HRG Population Size for 2015-16
Sanghadip	FSW	North & Unakoti (Dharmanagar &  Kumarghat Sub div.)	600	600
Prabaha Dhalai	FSW	Dhalai Dist	559	559
Village Development Team	FSW	West & Sipahijala District including  Agartala AMC	641	641
Village Development Team	MSM	West, Sipahijala & Khowai District including  Agartala AMC	427	Nil
Hambai Club	FSW	Khowai & West	508	508
Udaipur Bignan O Sanskriti Mancha	FSW	Gomati District (Udaipur & Amarpur Sub-Division)	800	800
Udaipur Bignan O Sanskriti Mancha	FSW	South District (Shantirbazar Sub-Division)	Nil	617
Dishari	FSW	South (Belonia NP, Hrishaymukh & Rajnagar Block)	685	685
Voluntary Social Development Organisation	FSW	South (Sabroom Sub div.)	485	485
St Vincent Welfare Society	IDU	Dhalai & Unakoti Dist	201	201
Socio Economic welfare Society	IDU	North District	228	228
Teresa Social welfare Organisation	FSW & MSM	Dharmanagar &  Kanchanpur Sub-Division	250 & 150	250 & 150
Prabaha Dhalai	Destination Migrant	Dhalai Dist	5000	5000
Narikalyan Samity	Destination Migrant	Gomati Dist	5000	5000
Organisation For Rural Survival	Destination Migrant	South Dist	5000	5000
	Employer Lead Migrants	North & Unakoti	3000	3000

Link Workers Scheme

Goal:- To reverse the HIV/ AIDS epidemic in rural parts of the country by –preventing new infections in high risk groups & vulnerable populations and linking persons living with HIV/AIDS to receive care and treatment,

 Young people i.e. FSW, MSM, IDU & partners / spouses of migrants, mobile population, young girls/women, persons infected and affected by HIV, particularly in the context of stigma and discrimination and their linkage to care, support and treatment  are vulnerable. These sub- populations of 200 remote villages (100 villages of each district) are addressing by 2 Link Worker Scheme (LWS) in the State i.e. undivided North Tripura District from 2009 & West Tripura district from 2010 (based on District mapping of rural areas).

Opiod Substitution Therapy (OST):-

Three(3) OST centres are functioning in the State i.e. 1 centre for North Dist & 2 centers for Unakoti Dist in the State through public Health facilities i.e. Kumarghat Rural Hospital, Unakoti Dist, RGM Hospital, Kailashahar, Unakoti & Jampui PHC, North Dist. to provide Oral Substitute Therapy for Injecting Drug Users

Injecting drug use (IDU) is recognised as an important mode of transmission of HIV in India and elsewhere. Sharing of needles/syringes and other injecting paraphernalia among IDUs is as resulting high positivity rate in the country. In addition, HIV spreads from the IDUs to their female sexual partners, leading to spread of HIV to the general population. To address this issue, National AIDS Control Organisation (NACO) has adopted harm reduction as a strategy to prevent HIV among IDUs.

OST involves substitution of illicit, unsafe opioid drugs which may be taken through injecting route with a legal medicine which has similar properties as that of the injection opioid but taken with a safer route. The medicine is prescribed by a doctor and administered under the supervision of a trained health-care staff in such doses that the opioid dependent IDUs would not have craving or withdrawals. As the medicine takes care of the drug hunger, IDUs stop or reduce injecting drugs, leading to decreased risk of transmission of HIV and other blood borne viruses.

Blood Safety Division

Introduction:

Blood transfusion services play a vital role in the Health care delivery system. The Blood Safety program of National AIDS Control Program is targeting Low Risk population by providing adequate and safe Blood for those who seek Blood Transfusion Services in Hospitals / First Referral Units (FRUs) functioning in the State. Tripura State AIDS Control Society aims to ensure easily accessible and adequate supply of safe and quality Blood & Blood components from a voluntary non-remunerated regular Blood donor in well-equipped premises, which is free from Transfusion Transmitted Infections (TTI), and is stored and transported under optimum conditions.

Tripura State AIDS Control Society aims to reduce transmission of HIV infection through Blood and Blood products by reducing the Sero-reactive rates among the Blood donors. All the Blood Units collected in the Blood Banks are mandatorily tested for 5 TTI markers namely HIV (I & II), HBV, HCV, Malaria, and Syphilis as per the rules laid down in the Drugs and Cosmetics Act 1940.

Tripura State Blood Transfusion Council was formed on 04-07-1996 as per direction of honorable Supreme Court, with the vision to setup a well organized blood transfusion service in our state as per the National Blood Policy.

Role and Functions of State Blood Transfusion Councils (SBTCs) :

The State Blood Transfusion Council is a society registered under the Societies registration Act. The SBTC should be a representative body having in it representation from the Directorate of Health Services in the state, State Drug Controller, Department of Finance of the State/UT,   Indian Red Cross Society, private blood banks, NGO active in the field of securing voluntary blood donations. The Secretary to the Government in-charge of Department of Health would be the president of the SBTC. The SBTC will be responsible for overall implementation, within individual state/UT, all policy decisions for the BTS taken by the NBTC, within the parameters of the NBP and as detailed in the Action Plan for blood safety. This encompass:

1. Organising the BTS in their state /UT into a network of RBTC, BB and BSCs with participation from government, private, IRCS and other NGO run blood centres with SBTC monitoring their functioning.

2. Developing a structured donor recruitment and retention programme for the state including IEC campaigns for youth, to generate voluntary non-remunerated blood donors and phase out replacement donors.

3. Implementing a mechanism to recognise the services of regular voluntary donors and donor organisers.

4. Developing a comprehensive quality management system for the BTS in the state including EQAS/ accreditation.

5. Providing adequate facilities for transporting blood and blood products including
cold chain maintenance and ensuring appropriate management of blood supply.

6. Organise in-service training programme for all category of personnel working in the BTS including drug inspectors and other officers from regulatory agencies. Create a separate cadre for the blood transfusion services in the state to retain suitably trained medical and paramedical personnel in the field and improve their career prospects and opportunities for promotion.

7. Make a corpus of funds available to facilitate research in transfusion medicine and technology related to blood banking.

8. Ensuring adherence to bio safety guidelines and disposal of bio hazardous waste as per the provisions of the existing guidelines/rules.

Role of National AIDS Control Organization:

1. Operate Blood Safety programme as an integral component of NACP through technical, financial and administrative support.

2. Establish National Blood Transfusion Council.

3. Support funding of NBTC and facilitate its functioning as the apex policy making and implementation body.

4. Provide funds for NBTC and SBTC.

5. Provide support to TRG for best practices in the BTS.

6. Provide funds for training program in the area of blood transfusion to different functionaries.

Role of AIDS Control Society:

1. Operate Blood Safety programme as an integral component of NACP through technical, financial and administrative support.

2. To establish SBTC.

3. Support funding of SBTC and facilitate its functioning as per the role assigned to it by NBTC for implementation of the action plan in the state.

4. Ensure that the policies laid down by NBTC are followed.

5. Supply of consumable item Blood Bank, Reagents kits etc to NACO supported Blood Bank.

Information, Education and Communication (IEC)

Information, Education & Communication: The focus of IEC activities has been on promoting safe behaviours, reduction of HIV stigma and discrimination, demand generation for HIV/AIDS services, and condom promotion. Mass media campaigns were synergised with other outreach activities and mid-media activities. Adolescence Education Programme is being implemented in States covering 400 schools. Red Ribbon Clubs are functional in 24 colleges throughout the State. The Red Ribbon Express project, the biggest of its kind in the world, has become a model for such campaigns in the FY 2013-14. In its third phase, the project covered 3 AIR stations in the State reaching out to about 20 Lakhs people and training over 4771 stakeholders. Over 1 Lakh persons were counselled and tested for HIV. Mobilization of political leaders and enormous support of State Governments and district administrations have been key to the success of this project.

Mainstreaming: Mainstreaming facilitates the expansion of key HIV/AIDS services through integration with health systems of various stakeholders and designs policies, programmes and schemes to support social protection needs of PLHIV and HRG. Initiatives are being taken for strengthening convergence of NACP.

Major Achievements in awareness generation and Information, Education & Communication (IEC) related activities:

• Tripura Legislative Forum on AIDS (TLFA) was formed on 30^th August, 2012, involving all the Hon’ble MLAs of the State.
• 6000+ newly elected PRI functionaries have been sensitized in HIV/AIDS.
• 26 nos. of Red Ribbon Clubs (RRC) have been formed in the University/College/Institutions throughout the State.
• 400 Teachers have already been trained on Adolescence Education Programme (AEP) throughout the State.
• Topic of HIV/AIDS has been included in the syllabus of Class VIII Science (SCERT).
• 16 nos. of Master Trainers from Tripura Police trained for regular basis training of police personnel in HIV/AIDS.
• Promotion of positive message on HIV/AIDS via Talk Shows in All India Radio (Agartala, Kailashahar, Belonia).
• Positive message on HIV/AIDS was promoted via Talk Shows & Jingles through 21 nos. of electronic channels in the FY 2014-15 and in the FY 2015-16 the number of channels would be 24.
• Mid Media (Street Drama & Puppet Show) activities are being conducted in all Blocks & Sub-divisions.
• A Joint Working Group committee has been formed for mainstreaming activities with other departments under the Chairmanship of Secretary, Health.

  Integrated Counselling & Testing:

• An Integrated Counselling and Testing Centre is a place where a person is counselled and tested for HIV, on his own free will or advised by a medical provider. The main functions of an ICTC are - Early detection of HIV, basic information on modes of transmission and prevention of HIV/AIDS, Link people with other HIV prevention, care and treatment services.
• In our State there are 22 nos. Stand Alone ICT Centres and 60 nos. FICTC (Facility Integrated ICTC), and 2 PPP ICTCs and 1 Mobile ICTC are functioning throughout the State.
• These 85 nos. ICT Centres are functioning in 8 district of our State.

          District wise Breakup of Stand Alone ICT Centres is as follows:

Name of the District	No. of Stand Alone ICT Centre
West	3
Sipahijala	3
Khowai	2
Gomoti	2
South	3
Unokoti	1
North	4
Dhalai	4
Total	22

Sexually Transmitted Diseases (STD):

STD Clinics are meant for syndromic detection of Sexually Transmitted Infection (STI)/Reproductive Tract Infection (RTI) for syndromic treatment and control and management, as persons suffering from STI/RTI are more vulnerable to acquire and transmit of HIV among the population. So, STD Clinics are established for prevention and treatment of STI/RTI to control the spread of HIV.

For the above stated purpose, at present total 18nos STD Clinics are established in 8(eight )  districts of Tripura which are as follows:

In all the STI clinics, STI/RTI diseases like Gonorrhoea, Clamydia, Syphillis, Chancroid, Lympho Granoluma Venereum, Herpis Symplex, Vaginal Discharge, Cervical Discharge, Pelvic Inflamatory Diseases (PID), Inguinal Bubo (IB), Scrotal Swelling  etc. are syndromically diagnosed and syndromically treated with STI/RTI Drugs freely supplied by Department of AIDS Control, Govt of India.

Care, Support and Treatment:

The Care, Support and Treatment (CST) needs of HIV positive people vary with the stage of the infection. The HIV infected person remains asymptomatic for the initial few years; it manifests by six to eight years. As immunity falls over time the person becomes susceptible to various opportunistic infections (OIs). At this stage, medical treatment and psycho-social support is needed. Access to prompt diagnosis and treatment of Opportunistic infection ensures that PLHAs live longer and have a better quality of life. 

Under NACP–II & III, focus was given on low-cost care, support and treatment of common opportunistic infection. Apart from further improving the availability, accessibility and affordability of ART treatment to the poor and also plans to strengthen family and community care through psycho-social support to the individuals, more particularly to the marginalised women and children affected by the epidemic, improve compliance of the prescribed ART regimen, and address stigma and discrimination associated with the epidemic.

To achieve this objective, Tripura State AIDS Control Society along with 1(one) nos. of Anti Retroviral Treatment (ART) Plus Centre which is present at AGMC & GBP Hospital, Agartala, 2 nos. of Facility Integrated (FI) -ART center viz. District Hospital North (Dharmanagar) & Dhalai District Hospital and 3 nos. of Link ART (LA) Centre among them one is at District Hospital Gomoti, 2nd one is at District Hospital Unokoti (RGM) Hospital and rest one is at Sabroom S.D Hospital, South District and also 1 nos. of Community Support Centre (CSC) namely Anandalok CSC, works together to provide counseling for drug adherence, nutritional needs, treatment support, referral and outreach for follow up, social support and legal services.

Tripura State AIDS Control Society aims to Reduce sexual transmission of HIV, Reduce transmission of HIV among people who inject drugs, Estimate new HIV infection among children and substantially reduce AIDS related maternal death, Reach positive people living with lifesaving antiretroviral treatment, Reduce tuberculosis death in people living with HIV, Eliminate gender inequalities and gender base abuse and violence and increase the capacity of women and girls to protect themselves from HIV, Eliminate stigma and discrimination against people living with HIV/AIDS etc.

Proposed new treatment target in NACP-IV is 90:90:90 which are 90 % of the general people will be tested, among them 90 % of positive clients will bring on treatment and among them 90 % will be virally suppressed. Expected Outcome At least 73% of all people living with HIV worldwide will be virally suppressed – a two- to three-fold increase over current rough estimates of viral suppression. Modeling suggests that achieving these targets by 2020 will enable the world to end the AIDS epidemic by 2030, which in turn will generate profound health and economic benefits and Tripura State AIDS Control Society will also work accordingly.

STRATEGIC INFORMATION MANAGEMENT UNIT:

 The Strategic Information Management Unit (SIMU) comprises four divisions: Monitoring & Evaluation Division, Research Division, Surveillance & Epidemiology Division and Data Analysis & Dissemination Unit. In our State, only M&E Division is responsible for SIMU. The division generates and manages crucial information on the entire spectrum of the HIV epidemic and its control including HIV vulnerabilities and risk behaviours, levels, trends and patterns of spread of HIV and factors contributing to it, disease progression, treatment requirements and regimens, planning and implementing interventions, monitoring service delivery and tracking beneficiaries, effectiveness and impact of interventions. Another key function of SIMU is to promote data use for policymaking, programme planning, implementation and review at national, State, district and reporting unit levels.

Key activities undertaken by Monitoring and Evaluation (M&E) division include:

• Managing Strategic Information Management System (SIMS) for monthly reporting from programme units, training programme personnel in its use, troubleshooting and mentoring.
• Monitoring programme performance across the state through SIMS/CMIS and providing feedback to concerned programme divisions and SACS.
• Monitoring & ensuring data quality, timeliness and completeness of reporting from programme units data management, analysis and publications.
•  Processing data requests and data sharing.
• Capacity building in strategic information areas.
• Preparation of Programme Status Notes and Reports (Annual Report, Monthly report for NACO and State Government, etc.)
• Providing Data for National/State level  documents

Strategic Information Management System:

Strategic Information Management System (SIMS) is a web-based integrated monitoring and evaluation system that allows capture of the data directly from various levels such as reporting units, districts, and States, and enables it to be viewed anywhere on a real time basis. It undertakes automatic aggregation of key indicators that can be reviewed through standard and customised reports at any level. It enhances the efficiency of the computerised M&E system by ensuring adequate data quality through centrally validated data. It can be integrated with all other data bases such as Surveillance, PLHIV database, other survey data etc. It enables capture of individual level information from Counselling and testing centres and ART centres, with all security measures to ensure data confidentiality of personal information. It is modular, expandable & scalable with slice & dice capabilities. SIMS also provides tools for better decision-making through data triangulation from different sources and thereby facilitates ease of evaluation, monitoring and taking policy decisions at strategic or tactical levels.

Total 22 Integrated Counselling & Testing Centres, 60 Facility Integrated Counselling & Testing Centres, 18 Designated STI/RTI Clinics, 6 Blood Banks, & 14 Targeted Intervention NGOs are registered in SIMS throughout Tripura. Online reporting system has been rolled out in our state likewise the whole country.  We have trained almost 100 participants for online reporting in SIMS. Amongst them, around 50 nos of HMIS Assistants of NHM have been trained from different PHC/CHCs where the FICTCs are functional for online SIMS reporting. As a result, the SIMS reporting of ICTC & FICTC have been increased to 100% and 61% respectively in the FY 2015-16.

Last year, the Annual Report 2014-15 of Tripura SACS has been published. The honorable Secretary, Health has opened the First Annual Report of Tripura SACS for the FY 2013-14.

 

 Physical Achievement of Tripura State AIDS Control Society for the FY 2015-16:

Targeted Intervention:

Indicators	FSW	MSM	IDU	Migrant
Coverage	5200	156	480	17567
Clinic Access	18485	567	1923	8791
Syphilis Screening	7304	222	744	3934
Syphilis Reactive	11	2	0	9
STI  Treated	327	2	0	344
ICTC Tested	8977	309	893	5765
No of  positive	8	6	11	7
Linked to ART	7	6	7	5
Condom  Distribution/	729811	18151	44417	65815
N/S Distribution (Demand Vs Distribution)			56842
N/S Return			42661

Blood Safety:

Sub-component	Target in 2014-15	Achievement Of 2014-15	Target of    2015-16	Achievement of  2015-16
Blood Donation Camps	330	727	330	742
Blood Collection	32,000 units	28509Units	32000	28084
% of voluntary Blood Collection	100 %	27742 Units (97.3%)	100%	27101Units (96.5%)

Information Education & Communication:

Type of Program	Total Episodes to be aired in Year (2014-15)	Total Episodes aired per month	Theme covered
Long format TV Prog	52	205	General issue, Stigma & Discrimination, Service Centre information
Long format Radio Prog	110	78	General issue, Stigma & Discrimination, Service Centre information
TV	1955	1810	General issue, Stigma & Discrimination, Service Centre information
Newspaper	162	153	Information on Service Centers / General etc

Activity	AAP 2015-16 Target	Achievements
Mass Media Activities (TV, Radio, Newspaper Advt.)	1764	3219
Mid Media Activities (Hiring of Folk Troupe, Exhibition and Event)	350	560
IEC Material Production, replication	75500	75500
Outdoor (Hoarding & Wall Writing)	12 (Annual fee)	12 (Annual fee)
Events	5	3
Piggy Back Activity	48	98
M&E and documentation	4	3
Youth intervention (AEP, RRC, Out of school youth)	94	91
Mainstreaming & GIPA Activities	1745 participants	1615+400 Newly elected TTAADC member + 300 members of Urban bodies

Integrated Counselling and Testing Centre:

S.No.	Sub-Component	2014-15		2015-16
		Target	Achieved	Target	Achieved
1	Testing for General clients	65100	52275	68335	70184
2	Positive found	0	239		276
3	Testing of PWs during ANC	32200	30341	50000	31305
4	Positive found	0	25		17
5	Mother Baby Pair received Nevirepine		16	17	10
6	HIV-TB Cross referral	8888	2610	6838	2140
7	HIV/TB co-infection to be detected	20	11		12

Sexually Transmitted Disease (STD):

Sub Component	Target in 2014-15	Achievement	Target in 2015-16	Achievement
Establishment of New Facilities	2	2	2	0
STI/ RTI episodes to be managed by Designated STI Clinics	14559	14571(100%) (RPR test done 25453 nos.) (RPR reactive 158 nos.)	18347	16690 (91%) (RPR test done 34902 nos.) (RPR reactive 180 nos.)
2STI/ RTI episodes to be managed by TI – NGOs	6196	1101 (18%) (RPR test done 5787nos.) (RPR reactive 16 nos.)	5360	673 (RPR test done 12204 nos.) (RPR reactive 22 nos.)

Care Support & Treatment (CST):

Indicator	Target  for 2014-15 (Cumulative)	Achievement (Cumulative)	Target  for   2015-16 (Cumulative)	Achievement of 2015-16 (Cumulative)
ART Centers (Cumulative)	1	1	0	0
LAC(Cumulative)	3	2	1	1
PLHA Registered  at ART Centre	1500	1331	1500	1611
PLHA  alive  & on ART	650	612	650	843
Number of OI episodes treated	1100	435	1100	288
CD4 Test done	1302	1285	1302	1247