1. Link ART Centres
Concept, Objectives, Structure,
Roles and responsibility
Link ART Centres Concept

2. Session Objectives
By the end of the session the participant will
understand:
• The Concept and Rationale of Link ART Centres
• Objectives of Link ART Centres
• Role of Link ART Centres in National Health System
Strengthening for HIV treatment and Care
• Infrastructure, Human Resources and Roles and
Responsibilities
• LAC Plus scheme
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3. Access to ART: Current situation
• The ART roll out is mostly confined to:
1) Medical Colleges
2) Tertiary Hospitals
3) Some big District Hospitals
• As a result, many a times, patients have to travel
long distances to get the treatment
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4. Link ART Centre: Rationale
• As the treatment is lifelong and drugs are provided
once a month, this leads inconvenience and long
travel
• May lead to missing of visits, particularly when
patient is otherwise feeling healthy
• Monthly visits may also entail the patient’s stay in
the city leading to escalation of costs in addition to
travel cost
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5. Link ART Centre: Rationale
• At times, natural phenomenon like heavy rain,
floods, landslides, extreme weather conditions make
drug collections on scheduled visit dates almost
impossible
• All these factors have been perceived as potential
barriers to an optimal adherence for ART
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6. Link ART Centre: Rationale
• To minimise the travelling needs for the patients
stable on ART and improve drug adherence , it was
envisaged to set up LINK ART CENTRES
• The Scheme of Link ART Centres was initiated in
2007
• It is a low cost facility and expenditure is only on
facility development, training and operational costs
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7. Link ART Centre: Objectives
• To integrate ART services with the Primary /
Secondary Health Care system
• To build capacity of the health care staff at the
Primary Health Care Level in ART treatment
• To act as bridge between testing & treatment
services
• Reduce the travel cost and travel time of PLHIV to
increase access to HIV care services
• Improve quality of ART services by decongesting ART
Centres
• To improve the adherence of PLHIV to HIV care & ART
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8. HIV Care in Integrated General Health System
Model of HIV Public Health
HIV-Related
treatment Infrastructure
Services
service & HIV-Relevant Staff
Centres of Excellence
- alternate First line &
Second line ART
Medical College
ART Centres
+
Referral
tertiary level care
District District with low Sero-positivity
ART Centre/ Link ART Hospital may have LAC only.
Centre
Community Health
Link ART Centres
Centre
ICTC, Primary Health Centre (PHC)
Designated & 24/7 PHC
Microscopy Centre
Community-Based
HIV Screening Sub-Centres & Anganwadi Centres
CCC / NGOs
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9. Functions of LAC
Back Referral
Provide ARV to ART Centre
Drugs to Stable
PLHIV on ART Screening of
HIV-TB
Co infection
Adherence LAC
Counselling and
Monitoring PLHIV
for side effects
Psycho-Social
Support
To PLHIV
Treatment of
Minor OIs
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10. Main Responsibility of LAC
• Adherence counseling and monitoring
• Provide ART drugs to stable patients on ART linked
out by Nodal ART Centre
• Identification of the critical side effects of ART /
medication for Opportunistic Infections (OIs)
• Identification of symptoms suggestive of OIs, side
effects of drugs
• Referral to the main ART centre at the earliest
Link ART center shall not initiate ART in any patient
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11. Link ART Centre: Site Selection
• Baseline analysis of the geographic distribution of
the patients is required.
• Mapping of the PLHIV seeking ART at all the centres
in the state to be done and then, we should identify
the number of patients coming from the districts and
identify the districts with at least:
– 50 patients on ART in plain and
– 25 patients on ART in hilly areas can be reduced
to as low as 10 patients.
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12. Link ART Centres: Ideal Sites
• The Link ART Centre should ideally be opened at
Integrated Counselling and Testing Centres (ICTC) in
Government Hospitals including Rural / Taluk
Hospitals (Block level) and CHCs
• Each LAC will be linked to the CLOSEST NODAL
ART Centre
• Each LAC will have one Nodal ART Centre. However,
one Nodal ART Centre may have more than one LAC
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13. Link ART Centres: Infrastructure
• Two rooms about 10 X10 feet are minimally required
– One room for the drug storage, and
– Second room for the drug dispensing, record keeping and
counseling.
• Rest of the infrastructure is adequately provided
under the ICTC
• The Link ART centre will utilize the computers
facility already available with the site (ICTC / CCC).
The LAC shall get a broad band internet connection
from the funds provided as per the LAC approved
financial support
PLHIV will be attended in General OPD of the centre daily
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14. Personnel at LAC
(No additional Manpower is provided)
Doctor:
• The institute (ICTC in hospital setting) should identify
2-3 Doctors (at least 2) in such a way that the patient
can be attended and examined on all working days.
• If this is not feasible (eg due to shortage of manpower)
this should be done on at least on two to three days a
week, but even if patient comes on days other than the
scheduled days, care should not be denied.
• The senior most doctor amongst them (preferably a
specialist physician) shall be the LAC In- charge and
responsible for day to day activities and reporting to the
Nodal ART centre.
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15. Personnel at LAC
• Counsellor:
The ICTC counsellor shall bear the responsibility of ART
counselling of PLHAs on ART.
• Nurse:
Institute should depute a nurse to assist the Doctor and
the Counsellor. Computer literate nurses should be given
preference for deputation in the LAC.
• Pharmacist:
The institutional pharmacist shall be the in charge of
drug storage, dispensing and drug record keeping.
Note: Nurse and counsellor will assist in record keeping
and reporting.
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16. Setting up of LAC
• Training of Staff of identified for LAC (Institutional &
ICTC)
• Transfer of PLHIV on ART from the nodal ART
Centres to LAC
• Transfer of ARV drugs
• Monthly reporting system to Nodal ART Centre
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17. Assessment of LAC
• By December 2010, 545 LACs were functioning
• Over 25,000 PLHIV are accessing ART services at
LACs
• An assessment study was undertaken in four states:
Gujarat, Maharashtra, Rajasthan & UP
• The study revealed that patient satisfaction had
increased significantly and cost and time on travel
to access ART had decreased
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18. Findings of LAC Assessment
• Time taken for travel reduced considerably
(Median time taken: 60 minutes)
• The distance traversed also reduced
(Median distance: 25 Km)
• 97 % of the patients were attending LAC regularly
every month
• 95 % PLHIV reported that waiting time <30 minutes
for availing counselling & collection of drugs
• Median expenditure on travel Rs. 40
• >90 % PLHIV were satisfied with services
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19. Roll out of LAC Plus Scheme
• The roll out of the revised scheme shall be initiated
at existing LAC with a patient load of more than 75
PLHIV on ART and will be expanded in a phased
manner after getting prior approval from NACO
• Manpower:
• The LAC will utilise the existing human resources
of the facility
• Considering the additional functions of LAC,
presently a staff nurse will be provided
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20. Roll out of LAC Plus Scheme
Enrollment of Back Referral
PLHIVA in HIV Care
and basic
investigations
Psycho–social
Support to PLHIV
LAC
Pre-ART
Management
Screening of HIV
-TB Coinfection
Treatment of OIs Monitoring of
PLHIV on ART
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21. Functions of LAC & LAC Plus
LAC LAC Plus
ARV Drug distribution Enrolment of PLHIV into HIV care and ART Care
Pre-ART management including basic investigations
Monitoring of PLHIV on ART
and sample collection for CD4 count
Follow up of pre-ART patients not eligible for ART
Counselling on adherence,
nutritional & positive prevention Referral of eligible patients to Nodal ART Centre for
ART initiation
Identification of side-effects Screening of HIV-TB co infection
Treatment of Minor OIs Monitoring of PLHIV on ART Drug distribution
Treatment of Minor OIs
Monitoring of side-effects of ARV drugs
Counselling on adherence, nutritional & positive
prevention
Tracing of LFU and Missed Cases (Pre-ART & ART)
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22. Key Points
• The Concept, Objectives and Rationale of Link ART
Centres were discussed
• The Role of LAC in the National Health System in
providing HIV care services were discussed
• Method of site selection of LAC and the details of
infrastructure and Human resources were provided
• Roles and responsibilities of LAC staff were discussed
• The extended LAC Plus scheme was described
• Standard operating Procedures of LAC will be
considered in detail in a separate session
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