Nambikkai Maiyyam (Integrated Counselling & Testing Centre) is an initiative of TANSACS. It aims at building awareness on HIV/AIDS, offering counselling, testing facilities and treatment.  These centres are spread across the state and help to remove the fear and misconceptions prevalent. Those who visit these centres walk out with confidence after receiving appropriate counselling.

Dhillu Durai alias Dhillu Dura, is a character in the campaign that creates awareness about Nambikkai Maiyyam (ICTC). The character Dhillu Durai affectionately called Dhillu Dura has endeared himself to viewers. He has been successful in getting a serious message across to the TG effectively.

Integrated Counseling & Testing Centers – ICTC                                                         


Introduction

HIV counselling and testing services were started in India in 1997. There are now more than 4000 Counselling and Testing Centres, mainly located in government hospitals. 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. An ICTC is a place where a person is counselled and tested for HIV, of his own free will or as advised by a medical provider. The main functions of an ICTC are:

    * Conducting HIV diagnostic tests.
    * Providing basic information on the modes of HIV transmission, and promoting behavioural change to reduce vulnerability.
    * Link people with other HIV prevention, care and treatment services.

Ideally, a health facility should have one integrated counselling and testing centre for all groups of people. However, an ICTC is located in facilities that serve specific categories such as pregnant women. Accordingly, an ICTC is located in the Obstetrics and Gynaecology Department of a medical college or a district hospital or in a maternity home where the majority of clients who access counselling and testing services are pregnant women. The justification for such a centre is the need for providing medical care to prevent HIV transmission from infected pregnant women to their infants.  Similarly an ICTC is located in a TB microscopy centre or in a TB sanatorium, where the majority of clients are TB patients. As TB is the most common co-infection in people with HIV, availability of HIV counselling and testing can help patients to diagnose their status for accessing early treatment.

As of today, only 13 percent of HIV positive people in the country are aware of their HIV status. The challenge before NACO is to make all HIV infected people in the country aware of their status so that they adopt a healthy lifestyle; access life-saving care and treatment and help prevent further transmission of HIV. Thus, counselling and testing services are important components of prevention and control of HIV/AIDS in the country.

However, it is not the mandate of an ICTC to counsel and test everyone in the general population. The sub-populations that are more vulnerable or practice high risk behaviour or have higher HIV prevalence levels are the target group for counselling and testing services in the country. In 2006, more than 2.1 million clients accessed counselling and testing services in the ICTC throughout the country. Under NACP-III, the target is to counsel and test 22 million clients annually by the year 2012.

HIV counselling and testing services are a key entry point to prevention of HIV infection and to treatment and care of people who are infected with HIV. When availing counselling and testing services, people can access accurate information about HIV prevention and care and undergo HIV test in a supportive and confidential environment. People who are found HIV negative are supported with information and counselling to reduce risks and remain HIV negative. People who are found HIV positive are provided psycho-social support and linked to treatment and care.

1. Role of ICTC in prevention of HIV/AIDS

As the HIV problem intensifies, the issues of care and support for affected individuals, and prevention of HIV transmission to those who are not affected, become even more critical. Integrated Counselling and Testing (ICT) is now seen as a key entry point for a range of interventions in HIV prevention and care. It provides people with an opportunity to learn and accept their HIV sero status in a confidential and enabling environment and to cope with the stress arising out of HIV infection. ICT should become an integral part of HIV prevention programmes, as it is a relatively cost–effective intervention in preventing HIV transmission.

The potential benefits of ICTC are:

    * Earlier access to care and treatment
    * Providing factual information about HIV /AIDS and clearing misconceptions
    * Reduction of fear and stigma through counselling
    * Creating enabling environment for PLHA
    * Emotional support
    * Better ability to cope with HIV related anxiety
    * Improved health status through good nutritional advice
    * Motivation to initiate or maintain safer sexual practices and behaviour change
    * Prevention of HIV related illness
    * Motivation for drug related behaviour
    * Safer blood donation
    * Motivating HIV infected person to involve spouse/partner for future spread and care.

2. Setup At ICTC

ICTC is not a place just for testing a sample for HIV, but much more than that. One of the basic elements involved is a confidential discussion between the client and the trained counsellor and the focus is on emotional and social issues related to possible or actual HIV infection. The aim of the ICTC is to reduce psycho–social stress and provide the client with information & support necessary to make decisions, therefore it needs a private and peaceful setting.

    * Separate enclosures for male & female clients have been set up to provide confidential environment for encouraging disclosure and providing IPC.

    * For the effective functioning of the ICTCs, two trained counsellors and one laboratory technician have been provided in each ICTC.

    * In order to ensure that the result of the HIV test is given on same day to the individual after post–test counselling, Rapid HIV Test Kits have been supplied to these centres or the client is asked to meet the same counsellor for post test counselling on appointed date.

    * Waiting space, trained Microbiologist/Pathologist, training to staff functionaries of ICTC, two trained counsellors and one laboratory technician have been provided in each ICTC.

    * In order to ensure that ICTCs provide quality counselling services, stress has been laid on pre–placement in–service training of counsellors & technicians by master trainers & resource persons. Orientation training is also conducted for these functionaries.

3. Service Offered byICTC

    * ICTCs are located in easily accessible areas mostly in OPDs.
    * Informed consent in local language is taken before HIV testing. Clients are informed about the nature and consequences of HIV test before their consent is taken. It is emphasised that testing should not be forced but left at the will of the client.
    * Here it is emphasised that counsellors should not be rotated from centre to centre and from one day to another since the rapport between the counsellor and client is very essential.
    * Adequate supply of condoms is made available in these counselling centres. Individuals attending the ICTC are also made aware about the outlets from which they can get condoms under various schemes.
    * Counselling is integrated into other services, including STI, antenatal and RCH clinics.
    * Referral system has been developed in consultation with NGOs, community based organisations, hospitals and PLWA networks.
    * Counsellors are provided adequate training and ongoing support and supervision to ensure that they give good quality counselling and avoid burnout.
    * Linkages with NGOs for social support, follow–up counselling and care for those tested sero positive are emphasised.
    * Innovative ways of scaling up ICT services and making them more accessible and available is the endeavour.

There is an emphasis to make it more client–friendly and service based by augmenting the following services:

    * Anti retroviral drugs in PPTCT
    * Anti–tubercular treatment in HIV–TB co–infection
    * Free treatment of STI & opportunistic infections
    * Follow up services & networking among patients living with AIDS.

The concept of ICTC is owned by all the Health Care Providers and it is aimed at the following activities:        

   1. To integrate all the counseling & testing services of Voluntary Confidential Counseling Centre (VCCTC),  Blood Safety (BS), Ante-Natal Care (ANC), Prevention of Parent to Child Transmission of HIV/AIDS  (PPTCT),  Anti - Retroviral Therapy (ART), Sexually Transmitted Infection (STI) and HIV – TB,  under one roof
   2. To link ICTC with field level activities of NGOs, PLHAs networks, Care centers, Private Hospitals, etc.,
   3. To establish guidance and information center to involve community in the Health care services.
   4. To integrate and to mainstream services of ICTC with hospital services, changing from project mode to system mode.