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Stand alone ICTC- separate counseller and Lab Technician available , Available at Medical college, district Dospital, Subdistrict Hospital F- ICTC- at 24x7 phc, Ppp- at private Hospitals, Trust Hospitals or by NGO.
Opt out option Tenofavir, Lamivudine, Efaverenz 300 mg, 300 mg, 600 mg . Once daily fixed dose combination. ALTERNATE regimen – AZT+3TC+EFV OR AZT+3TC+NVP Associated conditions like STI/ RTI, TB, OTHER opportunistic infections. If CD4 COUNT is < 250 cells/mm3, CPT Initiated with one tab of double strength daily to prevent opportunistic infections and continued through pregnancy, delivery and breastfeeding. Child-- CPT should be initiated and continued upto 18 months or until confirmatory test of baby is done.
Navirapin 1 to 1.5 ml Tab navirapin 10 to 15 mg. DBS , WBS
Integrated Counselling &
Testing Centre (ICTC)
HIV counselling and testing services were started in
India in 1997. The main functions of an ICTC are:
Conducting HIV diagnostic tests.
Link people with other HIV prevention, care and
Overview: National AIDS Control
1992: National AIDS Control Program Initiated
1997: VCTC services started in the country (voluntary counseling & testing centers)
1999: NACP II Initiated (99-06)
2000/2001: 11 centers of excellence conduct PPTCT ( Prevention of parent to child transmission)
2001: Operational guidelines for PPTCT and VCT (revised in ’04 & ’07)
2002: PPTCT services started throughout the country
2003: GFATM : support to PPTCT
2004: GFATM : support to HIV-TB coordination
2006: NACP-III framework designed, Integration of VCTC and PPTCT as ICTC
2007: Provider Initiated testing for ANC mothers, TB patients, STI patients, HRG population.
2014 : NACP-IV launched for 5 years(2012-2017).
Among the States/UTs, in 2015, Manipur has shown the
highest estimated adult HIV prevalence of 1.15%, followed by
Mizoram (0.80%), Nagaland (0.78%), Andhra Pradesh &
Telangana (0.66%), Karnataka (0.45%), Gujarat (0.42%) and
Goa (0.40%). Besides these States, Maharashtra,
Chandigarh, Tripura and Tamil Nadu have shown estimated
adult HIV prevalence greater than the national prevalence
(0.26%), while Odisha, Bihar, Sikkim, Delhi, Rajasthan and
West Bengal have shown an estimated adult HIV prevalence
in the range of 0.21– 0.25%.
Component 1: Intensifying and Consolidating Prevention services
with a focus on HRG and vulnerable populations
TI (Targeted interventions) for HRG & intervention among low-risk
ICTC (VCTC + PPTCT)
What is an Integrated Counselling and Testing Centre?
Under NACP-III, Voluntary Counselling and Testing Centres
(VCTC) and facilities providing Prevention of Parent to Child
Transmission of HIV/AIDS (PPTCT) services are remodelled
as a hub or ‘Integrated Counselling and Testing Centre’ (ICTC)
to provide services to all clients under one roof..
Who needs to be tested in an ICTC?
Subpopulations who are more vulnerable or practice high-risk behaviour like
1. Female sex workers (FSW)
2. Injectible drug users (IDUs) high risk group (HRG)
3. Men who have sex with men (MSM)
4. Clients of FSW
5. Truckers Bridge population
6. Migrant workers
7. Spouses and children of men who are prone to risky behaviour (vulnerable population)
ROLE OF AN ICTC
•Early detection of HIV.
•Promoting behavioral change and reducing vulnerability.
G = Greet the client
A = Ask about the problem
Assess degree of risk behavior
Show respect and tolerance
Enable patient or client to express freely
Determine access to support and help in family and community
T = Tell the client about specific information that he or she desires
H = Help them to make decisions
E = Explain any myths or misconceptions(also known as INFORMED
R = Return for follow up or Referral
Where can an ICTC be located?
An ICTC is located in
In public sector organizations/other government departments such
as the Railways, Employees' State Insurance Department (ESID)
in sectors where nongovernmental organizations (NGOs) have a
In the health facility, the ICTC should be well coordinated with the
Department of Medicine, Microbiology, Obstetrics and Gynecology,
Paediatrics, Psychiatry, Dermatology, Preventive and Social
Different types of ICTCs
Level of HIV counseling and Testing services
Eg. Subdistrict Hospitals, CHC, RH
State and district level
Eg. Medical College, District Hospital
Physical Infrastructure required for an
The counselling room
Blood collection and testing
r coded waste disposal bins
CD4 count room
Human resources for an ICTC
The ICTC requires a team of skilled persons consisting of the manager (medical
officer), counsellor and LT.
1. ICTC manager (medical officer)-- The administrative head of the facility
where the ICTC is located must identify and nominate a medical officer as
manager in-charge of the ICTC.
2. Counsellors--The counsellor should be a graduate in Psychology/Social
Work/Sociology/Anthropology/ Human Development or hold a diploma in
Nursing with a minimum of 3–5 years of experience in the field of HIV/AIDS.
4. Laboratory technician-- The LT should hold a Diploma in Medical Laboratory
Technology (DMLT) from an institution which is approved by the state government
5. Outreach workers– Mobilize & Follow up Patients. Follow up the mother–baby pair
till 18 months after delivery.
KITS USED FOR TESTING
1) SD BIOLINE HIV test
is an immunochromatographic (rapid) test for qualitative detection of
antibodies specific to HIV-1 and HIV-2 in plasma/serum/whole blood.
Manufactured by SD BIO STANDARD DIAGNOSTICS PVT. LTD.
2) HIV TRISPOT TEST KIT:
It is a rapid Trispot test to detect antibodies to HIV-1 & HIV-2
in human serum/plasma.
Manufactured by BHAT BIO-TECH INDIA(P) LTD.
3) COMBAIDS –HIV immunodot test kit:
It is for the detection of antibody to HIV 1 and/or HIV 2 in whole blood
Manufactured by Span Diagnostics Ltd.
For individual diagnosis of patients ,ICTC uses STRATEGY 3 which is as follows:
All samples are tested with one rapid test.(SD BIOLINE HIV-1/2 3.0 test).
If test result is NON-REACTIVE : final report NEGATIVE.
If test result is REACTIVE then sample is tested again by different systems(TRIDOT &BI-DOT
Results can be REACTIVE or NON-REACTIVE.
If result is REACTIVE with 2nd & 3rd antigen test then report is POSITIVE.
If result is NON-REACTIVE with either 2nd or 3rd antigen test ,then report is INTERMEDIATE.
If result is NON-REACTIVE with 2nd & 3rd antigen test then report is NEGATIVE.
When is ART (Anti-retroviral therapy) initiated?
Criteria for ART
If CD4 is between 200-250, this should be repeated in four weeks and treatment to
be considered in asymptomatic patients
•Adherence to ART regimen is vital in treatment. Any irregularity in following the
prescribed regimen can lead to resistance to HIV drugs, and therefore can weaken
or negate its effect.
• ART centres are located in medical colleges, district hospitals and non-profit
charitable institutions providing care, support and treatment services to PLHIV.
PREVENTION OF PARENT TO CHILD TRANSMISSION (
The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT)
programme was launched in the country in the year 2002 following a feasibility
study in 11 major hospitals in the five high HIV prevalence states.
The PPTCT programme aims to prevent the perinatal transmission of HIV
from an HIV infected pregnant mother to her newborn baby. The programme
entails counselling and testing of pregnant women in the ICTCs.
Currently, there are more than 15000 Integrated Counselling and Testing
Centres (ICTCs) in the country, most of these in government hospitals, which
offer PPTCT services. Of these ICTCs, nearly 550 are located in Obstetrics
and Gynaecology Departments and in Maternity Homes where the client load
is predominantly comprised of pregnant women.
Services to Pregnant Women
Offer HIV counselling and testing.
Moving from ANC centric to Family Centric
ART to all HIV pregnant women regardless of CD4 count and who
staging. Preferred regimen is TDF(TENOFOVIR)+
Promoting institutional delivery
Provision of care for associated conditions.
Counselling for exclusive breastfeeding up to 6 months
Services to HIV exposed infants(HEI)
Exclusive breastfeeding up to 6 months
ARV prophylaxis up to 6 weeks with Nevirapine syrup which can extend
to 12 weeks if duration of ART of mother is less than 24 weeks
CPT (clotrimoxazole prophylactic therapy) initiated after 6 weeks .
Confirmatory test done at 6 months, 9 months, and 12 months after
cessation of breast feeding.
Lifelong ART at the earliest if confirmed HIV positive .
Comprehensive management given to minimize the risk of infection following
potential exposure to blood-borne pathogens e.g. HIV.
1. First aid
3. Risk assessment
4. Relevant laboratory investigations based on informed
consent of the exposed person.
5. Depending on the risk assessment, the provision of short
term (4 weeks) of ART.
6. Follow up and support
HIV/AIDS counselling/education is a confidential dialogue between a client and a
counsellor aimed at providing information on HIV/AIDS and bringing about
behaviour change in the client. It is also aimed at enabling the client to take a
decision regarding HIV testing and to understand the implications of the test
Steps:- 1. HIV pre-test counselling/information
2. HIV post-test counselling
3. Follow-up counselling
1. Facilitating decision to undergo HIV test
2. Providing psychological, social and emotional support for
• People who have contracted the virus and
• Others affected by the virus.
3. Preventing transmission of HIV by
• Providing information about risk behaviours (such as unsafe sex or needle-
• Motivating people to take good care of their health,
• Assisting them to develop personal skills necessary for behaviour change,
• Adopting and negotiating safe sexual practices.
4. Ensuring effective use of treatment programmes by
• Establishing treatment goals and
PRE- TEST COUNSELLING
Information should be simple and up to date.
Pre test counseling helps a person to understand the
possible results of an HIV test. It may be positive, negative
or equivocal. The counselor must explain the meaning of
each such test result. This should be utilized as an
opportunity to assess the likely reaction of the client to a
positive or negative test result.
WHAT IF NEGATIVE RESULT
Prevention of further exposure
WHAT IF POSITIVE RESULT
Time to get over shock
Possible treatment and efficacy
WHAT IF EQUIVOCAL RESULT
• Window period
• Related HIV virus
• Cross reaction with Non viral protein
Cause of Equivocal result
FOLLOW-UP counselling 36
In follow-up counselling there is a re-emphasis on adoption of safe
behaviors to prevent transmission of HIV infection to others.
Follow-up counselling also includes establishing linkages and referrals
to services for care and support including ART, nutrition, home-based
care and legal support.
Issues to be addressed by HIV/AIDS counselling
HIV/AIDS counselling is intended to address the physical, social,
spiritual needs of the client. Besides, the following issues should also be
• Problems related to infection and illness
• Death, bereavement
• Social discrimination
• Prevention of transmission
In order to adopt an appropriate strategy
for prevention and control,
we need to detect the spread of the
disease in the country
That is we need an area specific targeted intervention and best practice
So we have various surveillances;
HIV sentinel surveillance
HIV sero surveillance
AIDs case surveillance
Integration with surveillance of other diseases like TB
HIV Sentinel surveillance
Determine the level of HIV infection among general
population and high risk groups.
To understand the trends of HIV epidemic again in
general population and high risk groups
To understand geographical spread of HIV infection
and to identify emerging pockets
To estimate HIV prevalence and HIV burden in the
Annual cross sectional survey of the risk groups
In the same place for over a few years by unlinked anonymous serological