India has more than 2 million people living with HIV/AIDS. HIV prevalence of the adult (15-49) age group at the national level has continued its steady decline from an estimated level of 0.41% in 2001 to 0.27% in 2011. But still, India is home to the third highest number of people living with HIV/AIDS in the world.
I-TECH provides technical assistance to the National AIDS Control Organization (NACO), which is the division of the Ministry of Health and Family Welfare (Government of India) that has provided leadership to HIV/AIDS control programs in India since 2003. The NACO/CDC/I-TECH collaboration has produced HIV experts through training and fellowship programs, increased teaching skills in training units and, in collaboration with the World Health Organization, created the first ART training manuals for India. In 2008, I-TECH provided technical assistance to establish 10 Centers of Excellence (CoE). These preeminent medical/tertiary institutions are well equipped to model high-quality comprehensive patient care for persons living with HIV; train and mentor staff from ART centers, care and support centers, and linked ART centers; and undertake operational and clinical research. Today I-TECH provides a complete array of capacity-building activities to 17 CoE (now encompassing seven pediatric CoE, or pCoE) comprising distance learning seminars, continuing medical education, access to a clinical consultation warm line, medical library resources including e-journals, and site visits focused on technical assistance.
- National Distance Learning Seminar (NDLS) is I-TECH India’s flagship activity that trains health care workers (HCW) at ART centers, linked ART centers, and care & support centers on the latest and relevant HIV/AIDS related topics as presented by national and international experts. These bi-monthly one-hour sessions are streamed live, using Adobe Connect Pro software. The interface is interactive and intuitive, with real-time responses by the presenter. On average, about 400 HCWs from over 100 ART centers across the country attend NDLS sessions.
- Regional Distance Learning Seminar (RDLS)is the regional version of NDLS. Seminars train health care workers on locally relevant topics, unique case studies and treatment guidelines, often in local or regional languages. RDLS is organized and conducted by CoE at the regional level, using regional medical officers and experts to specifically address the issues pertaining to the respective state and/or region. All 17 CoE have initiated RDLS and are streaming sessions regularly.
- Building CoE Libraries is an activity initiated by I-TECH in conjunction with the CoE. Each CoE has designated a physical library space and assigned a person to maintain the book collection. I-TECH installed and trained CoE staff on an open-source electronic cataloguing database to track the use of the physical library; and I-TECH provides all CoE with free subscriptions and access to key e-journals. In addition, I-TECH medical advisors select and circulate recent, pertinent e-articles every week. CoE then lead the dissemination of these articles to designated ART centers and other facilities in their respective catchment areas.
- CoE Assessments are conducted to gain insight on how the CoE function within the context of national operational guidelines and protocols. The 10 CoE were established in 2008 under predetermined goals of the National AIDS Control Programme Phase III to serve as model treatment centers and to impart quality training to health care providers who care for persons living with HIV. With technical assistance from I-TECH and funding from CDC, NACO is assessing the CoE to appraise the extent to which the CoE scheme is meeting its predetermined objectives.
- Expert Physician Access Number (EPAN) is a telephone-based clinical consultation line that provides physicians with easy and timely access to updated HIV clinical information, and individualized India-specific expert case consultation. Previously, when medical officers at ART centers called CoE for clinical consultation on difficult cases, documentation of these calls was a challenge. I-TECH developed and supports a smartphone application using Open Data Kit (ODK) for easy and real time data entry.
- Continuing Medical Education (CME) Program and ART Review Meetings are offered in tandem by CoE with assistance from I-TECH. I-TECH facilitates two-day CME programs designed to provide participants with relevant and reliable information on the current clinical management of persons living with HIV. The CME programs are usually facilitated by resource personnel from NACO, pCoE, I-TECH and State AIDS Control Societies (SACS). Following a CME program, the facilitating CoE convenes a review meeting of ART centers in the CoE catchment area. These periodic reviews are based on a set of key performance and delivery indicators developed by NACO with support from I-TECH.
- Research and Publication Support is a recent form of technical assistance I-TECH provides to CoE. Per the new mandate, I-TECH assists CoE, pCoE and selected high-burden ART centers with training on research and cohort analysis, and data extraction. This is followed by onsite support and mentoring for developing studies, data analysis and report writing.
- Technical Assistance to NACO, SACS, and CoE provided by I-TECH covers a wide range of support areas. In addition to examples described throughout these program highlights, I-TECH assists NACO with curriculum revision, national guidelines and technical guides. I-TECH provides technical assistance to the National AIDS Clinical Expert Panel in resolving complicated clinical cases, as well as providing mentoring technical assistance to the State AIDS Clinical Expert Panel. I-TECH also participates in the national Technical Resource Group on ART.
- University of Washington Distance Learning Courses are offered through I-TECH in conjunction with University of Washington (UW) Department of Global Health E-learning Program to key staff from NACO, CoE, and pCoE, and ART medical officers. To ensure that content of the online courses is relevant to the local India audience and context, each site has a local Site Coordinator who provides examples and discussion best suited to the participants’ needs. The UW courses offered are: Principles of STD/HIV Research, Leadership and Management in Health, Clinical Management of HIV, and Introduction to Epidemiology for Global Health.