OPD-based screening

[Audio] Good morning/ afternoon everyone, Today we are going to discuss an important topic - the global and Indian HIV/AIDS epidemics. We will focus on the prevalence of HIV/AIDS among different population groups, government programs, and strategies for support. We will analyze data and examine the situation on the ground from various perspectives..

[Audio] In India, the adult HIV prevalence is 0.21%, making it a low-prevalence country. As of December 2021, the number of people living with HIV in India is second only to South Africa. Of those, 44% are women and 3.5% are children. Additionally, the HIV prevalence in specific population groups in India in 2021 is shown in the chart, ranging from 0.22% in HIV ANC to 9.08% in IDUs. This provides an overview of the current status of HIV & AIDS in India..

[Audio] As we can see on the chart, adult HIV prevalence in India varies greatly according to the state. For example, Mizoram has one of the highest adult HIV prevalence rates at 1.31%, while Chandigarh has one of the lowest rates at 0.24%. These figures point to a need for targeted intervention in certain states for HIV prevention and treatment. This project will be an important step toward achieving that goal." As we can see from the chart, HIV prevalence in India is not consistent across the states. From Mizoram to Chandigarh, we see a range of adult HIV prevalence rates, with Mizoram having the highest rate of 1.31%, and Chandigarh the lowest rate of 0.24%. These figures emphasize the need for a targeted approach to HIV prevention and treatment. Through Project Sunshine, we are taking an important step forward in addressing this issue..

[Audio] We will be discussing the progress of 95:95:95 in CDC PEPFAR geographies throughout India as of the 2021-2022 fiscal year. As demonstrated in the first table, Andhra Pradesh achieved 82% on the First 95, 78% on the Second 95, and 86% on the Third 95. Furthermore, Manipur achieved 56% on the First 95, 90% on the Second 95, and above 95% on the Third 95. Likewise, Mizoram achieved 64% on the First 95, 85% on the Second 95, and 91% on the Third 95. Additionally, Nagaland achieved 67% on the First 95, 76% on the Second 95, and 86% on the Third 95. The second table illustrates the progress made in the district of Mumbai, achieving 71% on the First 95, 85% on the Second 95, and 97% on the Third 95. Overall, these figures suggest that the 95:95:95 project is progressing positively in India, and we anticipate further success in the years to come..

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[Audio] I am here to discuss the Sunshine project which aims to identify and prevent new HIV cases and reduce existing ones using comprehensive approaches. We intend to employ index testing, implement a social network strategy, introduce motorbikes and virtual friendly ICTCs, and promote self-testing. Additionally, we have prevention initiatives and harm reduction innovations like PrEP, and will collaborate with One Stop Centers and other organizations. Moreover, virtual models will be utilized to reach out to unreached populations, mainly adolescents and young adults. We believe that with these measures, we will make a meaningful contribution to the fight against HIV..

[Audio] Today, we are discussing the priority population for OPD-based testing as part of Project Sunshine. This testing includes clients from NACP facilities, key populations, and sexually active populations, which is currently limited to ICTC attendees and DSRC clients. Additionally, we need to consider referrals from other infectious diseases programs, such as IPD, ANC, SNM, CBS, TI, and ICTC OST and ART. This is essential for the successful implementation of Project Sunshine..

[Audio] It is important to integrate HIV testing as part of a routine healthcare program. According to the CDC's Lets Stop HIV Together guide, they recommend testing individuals aged 13-64 at least once as part of health care, and those at higher risk should be tested more frequently. The World Health Organisation guidelines specify that HIV testing should be offered to a range of populations and services as an effective way to identify those with HIV. In India, the National HCTC guidelines recommend establishing FICTC facilities in both in-patient and out-patient departments, to ensure people can be screened for HIV..

[Audio] HIV screening at our Outpatient Department (OPD) is an important process that helps to diagnose and treat HIV-positive individuals early. The CDC's Integrating Routine HIV Screening Into Your Practice guide recommends that individuals aged between 13 and 64 years old should get tested at least once as part of their routine health care, with those at increased risk getting tested more frequently. There are multiple benefits to OPD-based screening. Early detection and treatment is possible when conducted in WHO stage 1 and 2, and it also increases our testing net and reduces stigma surrounding HIV testing due to its opt-out approach..

[Audio] Today we're talking about the benefits associated with OPD-based screening. Early detection and treatment of HIV-related conditions help people lead longer, healthier lives. It also expands testing nets, giving people the opportunity to get tested, no matter their age or where they live. Finally, it can reduce the stigma associated with HIV testing, making it easier for people to get medical help when they need it..

[Audio] We are examining the process of OPD-based screening. To guarantee success, an appropriate place must be chosen at the OPD, and medical and para medical staff must be made aware of the screening process. To make sure the screening is reliable and precise, a pilot danger appraisal instrument must be created and counselors must be knowledgeable on OPD screening. Additionally, an OPD with a great many individuals must be chosen for the screening process. Finally, those needing further assessment ought to be referred for confirmation and connection..

[Audio] Today, we are discussing ways to initiate OPD-based screening campaigns in order to detect HIV. As part of the screening, we will go through a planning phase, a training phase, and the implementation of the verbal screening by the medical officers. During the verbal screening, medical officers will ask questions like whether the person has heard about HIV, whether they or their partner have been tested for HIV, and if they would be interested in knowing their HIV status. We will also do a simple risk assessment, which includes asking questions like whether the person has had transactional sex, whether they use a condom during sexual activity, and so on. This will be followed by a simple test and the results will be explained by the counselor..

[Audio] Today's slide is about the client flow process for Project Sunshine, on July 30, 2023. The patient visits an Outpatient Department (OPD) and consults a doctor. The doctor administers a risk assessment tool to determine if the patient is at risk. If the patient is at risk, the doctor provides HIV testing. Patients who have screened positive and negative are then subjected to confirmatory testing. If the patient tests positive, they are referred to Sampoorna Suraksha Kendra (SSK) if available. Before the test, the patient will also have the chance to receive pre-test counseling..

[Audio] Project Sunshine, implemented in Nagaland, has been a great success. Screening individuals to determine those who require further medical assistance, it was conducted at the District Hospital in Dimapur, in a room with a desk and chair. This efficient and cost-effective approach has saved the healthcare system in Nagaland both time and money, and enabled more accurate results..

[Audio] Today we are going to take a closer look at the Project Sunshine OPD-based screening. Nagaland's OPD site offers a variety of services such as general medicine, dermatology, gynecology, ENT and antenatal care. They have an on-site sample collection site and patients may be referred to the OPD from ANC, dermatology and ICTC. The lab technician on site will first conduct a risk assessment of the patient, and then a pre-test counseling. If the test turns out to be non-reactive, the patient is not referred and the process ends there. If the test is reactive, the technician checks the patient's OPD card and proceeds for consultation. Referenced patients are then referred to a blood test. After the patient consents for a blood test, a total of 329 patients have been tested and out of them, 326 patients have tested positive and 10 were non-reactive..

[Audio] Between March 2023 and May 2023, the project collected data from 158 outpatients (OPDs) in Nagaland. All 158 OPDs agreed to HIV screening, which resulted in 326 screenings. Of these, 4 OPDs tested positive and were referred to ICTC, with all 3 being confirmed positive and subsequently linked to antiretroviral therapy (ART). In addition, all 158 OPDs were tested for STIs with 0 of those patients being referred to Suraksha Clinic. For 4S screening, the project offered 158 OPDs, while no referral was made to DMC. Lastly, 4 OPDs were offered index testing, all of whom accepted it..

[Audio] In Nagaland, Project Sunshine OPD-based screening was successful due to the selection of an OPD with high footfall, as well as the careful selection and thorough training of counsellors cum lab technicians in counselling, testing, and index testing. A challenge faced is difficulty in following up with a person tested reactive and the mitigation plan to this challenge is that the lab technician follows up with the ICTC counsellor. In Mumbai, challenges include the medical officer being unable to conduct risk assessment due to high-load at OPD/long queue, low acceptability of the concept by the hospital team, linkage loss between the point of OPD referral and reaching the OPD screening desk, quality pre-test counselling with high OPD and referrals, ICTC team’s apprehension about their target and achievements, and the client not waiting for 20-30 minutes to get to know the result due to personal commitments and visiting to other health consultants/investigations..

[Audio] Project Sunshine is an OPD-based screening program that is being championed by three individuals: Asha Hegde, G. S. Shreenivas and Santosh Suryavanshi. They have each provided research and support for the project, dedicating their time and resources to ensure its successful implementation. The outcome of their efforts is remarkable, and it is evident that their dedication has made a great impact..