HIV COUNSELLING & TESTING SERVICES (HCTS) - Integrated Counselling and Testing Centres (ICTC)

The Basic Services Division of Kerala State AIDS Control Society provides HIV Counseling and testing services (HCTS) for HIV infection, the critical first step in detecting and linking people with HIV to access treatment cascade and care. It also provides an important opportunity to reinforce HIV prevention. The national programme is offering these services since 1997 with the goal to identify as many people living with HIV, as early as possible (after acquiring the HIV infection), and linking them appropriately and in a timely manner to prevention, care and treatment services. The introduction of ART services for people living with HIV/AIDS in 2004, gave a major boost to Counseling and testing services in India.

The Basic Services Division through Integrated Counseling and Testing Centres (ICTCs) provide HIV counseling & testing services, Prevention of Parent to Child Transmission of HIV (PPTCT) services and HIV-TB cross referrals. These services have linkages with TI NGOs/CBOs and outward linkages with ART centres, outreach services, peer support services, OI management and home based care. NACP-IV envisages integration and scale-up of service delivery to sub-district and community levels through existing infrastructure in the public and private sectors.

In the financial year 2019-20, a total of 759 HCTS facilities were functional in the state, providing HIV counselling & testing services. In accordance with the global vision to end AIDS as public health threat by 2030, India has moved ahead towards achieving the global 90:90:90 target by 2020, wherein 90% of people living with HIV would know their HIV status, 90% of people who know their HIV status will receive treatment and 90% of people on treatment would have suppressed viral load to minimize HIV transmission.Scaling up of HIV Counselling & Testing Services (HCTS) is a crucial step towards achieving the first 90, wherein, it is desired that 90% of the estimated PLHIV are aware of their HIV status. Achieving this is vital for the success of the subsequent 90:90 related to anti-retroviral treatment and viral suppression.

Year Wise Scale up of HCTS Facilities:

 

Service package at different HCTS facilities

Sl No	Types of HCTS facility	Institutions where HCTS facility is established	Package of services
1	HCTS Confirmatory Facility (Stand Alone ICTCs)	Government Health Care centres - Medical college, General Hospital, District Hospital, Sub district hospital & Community Health Centre. Mobile Stand Alone ICTC	Pre test counselling & informed consent HIV testing and sharing of test result Post test counselling & disclosure Prevention of Parent to Child Transmission (PPTCT) services Early Infant Diagnosis (EID) HIV-TB Collaborative activities Testing of sexual partner/spouse Screening for STI/RTI, TB and other co infections Linkages to care and treatment and other health services Outreach activity Follow up testing and counselling Follow up of discordant couple
2	HCTS screening facility (FICTCs ,PPPs & CBHS)	Government Health Facility (PHC, CHC,SDH) Public-Private Partnership facility Urban Primary Health Centres (UPHCs) Family Health Centres (FHCs) Private Medical Colleges Private maternity homes Designated Microscopy Centres (DMCs)	Pre test couselling and informed consent HIV screening Screening for STI/RTI, TB and other co infections Post test counselling Linkages to Stand Alone ICTC for confirmation of diagnosis and care and treatment Linkage to other health services

All HCTS facilities should ensure adherence to 5 Cs – Consent, Confidentiality, Counselling, Correct test results and connection.

PROGRAMMES UNDER ICTC:

Testing of General Clients: Counselling and testing services are offered to clients who are referred by medical providers (Provider initiated counselling and testing) or to clients who come to an ICTC on their own volition (Client initiated counselling and testing).

Provider initiated counselling and testing may be offered to the following clients:

• All pregnant women
• Babies born to HIV positive women
• Untested children of women living with HIV (WLHIV)
• Children presenting with suboptimal growth or severe acute malnutrition , delay in developmental milestones, oral thrush, severe pneumonia and sepsis
• patients who present at a health facility with symptoms suggestive of HIV infection like patients with pneumonia, TB or persistent diarrhea,
• patients suffering from STI/RTI and pregnant women.
• persons who have undergone sexual assault,
• vulnerable adolescents in the age group of 10 to 19 yrs are tested to ensure early diagnosis of HIV infection.

Client initiated counselling and testing is provided mainly for:

• High Risk Groups.
• Sexual partners/spouses of PLHIV,
• prison inmates,

Year wise data on testing of general clients against the testing target is given below:

Prevention of Parent to Child Transmission of HIV: Women who access antenatal services at health facilities should receive a routine offer to test for the HIV infection. The PPTCT programme involves counselling and testing of pregnant women in the first trimester, detection of positive pregnant women and early initiation of ART to HIV positive pregnant women and Antiretroviral (ARV) prophylaxis to their infants, to prevent mother to child transmission of HIV. In the absence of any intervention, a substantial portion of children born to women living with HIV, acquire HIV infection from their mothers either during pregnancy, labour/delivery or during breast feeding. Without any intervention, the risk of transmission of HIV from infected pregnant women to her children is estimated to be around 20-45%.Initiation of ART for the mother in the first trimester itself and minimum 6 weeks Nevirapine syrup for the baby has shown to be quite effective in reducing this transmission as low as 3 percent.

In Kerala we have implemented the Multi Drug Anti-Retroviral Regimen from April 2014 onwards, whereby pregnant and breastfeeding women with HIV will be put on life-long ART irrespective of CD4 count. Positive pregnant women are encouraged to involve their partners in the treatment process. They require follow up for various issues related to safe pregnancy and delivery. Line list of positive pregnant women are kept in ICTCs and these clients are followed up by the counsellor for providing services, till the baby is 18 months old.

Physical Achievement Testing of Pregnant women: 2015-20