Facilitator Guide Section 4 Annexures

SECTION FOUR

Annexures

Annexures
Annexure
Annexure
Annexure
Annexure
Annexure
Annexure
Annexure
Annexure
Annexure
Annexure

1
2
3
4
5
6
7
8
9
10
Baseline Assessment
Quick Reference Steps In using a Maleand a Female Condom
Referral Linkage Organogram
Disinfection of Needles and Syringes with Bleach
Hand Hygiene Checklist
Guidelines for Disposal of Used Disposable Needles and Syringes
Guidelines for Disinfection and Sterilization
Situational Guide - Cleaning up a Blood Spill on the Floor
Situational Guide - Care of the Body after Death of a PLHIV
NACO PEP Policy: Procedure to be followed after an Accidental Exposure to HIV
Infectious Fluid
Annexure 11
STI Syndrome Flowchart Management Urethral Discharge & Burning micturation
Annexure 12
STI Syndrome Flowchart Management of Scrotal swelling
Annexure 13
STI Syndrome Flowchart Management of Inguinal Bubo
Annexure 14
STI Syndrome Flowchart Management of Genital Ulcers
Annexure 15
STI Syndrome Flowchart Management of Vaginal Discharge
Annexure 16
STI Syndrome Flowchart Management of Lower Abdominal pain in females
Annexure 17
STI Syndrome Flowchart Management of Oral & Anal STIs
Annexure 18
STI Syndrome Flowchart Management of Molluscum and Ectoparastic infestation
Annexure 19
STI Syndrome Flowchart-Management of Ophthalmic Neonatorum
Annexure 20
Guide to Common Symptoms and Possible Aetiologies
Annexure 21
What a Nurse needs to know about Dementia and Delirium
Annexure 22
Comprehensive laboratory evaluation in HIV/AIDS
Annexure 23(a) Diagnosis of HIV infection among infants and children below 18 months
Annexure 23(b) Specimen Collection (by heel prick) and handling procedure
for HIV DNA PCR testing by Dried Blood Spot (DBS) sample collection
Annexure 24
Monitoring and follow up patients on ART: Recommendations in the National
Programme
Annexure 25
4 Prong NACO PPTCT Strategy
Annexure 26
PPTCT True or False Statements and Answers
Annexure 27
PPTCT: Three Safe Infant Feeding Options Some Important Points
You Could Keep In Mind When Counselling Mothers On Feeding Options
Annexure 28
Replacement Feeding Checklist
Annexure 29
Questions and Issues that must be assessed by the Nurse to Aid In
Preparing the Child And Family For ARV
Annexure 30
Ways to Promote ART Adherence in Children
Annexure 31
WHO Growth Monitoring Charts
Annexure 32
Dosing Schedule For Infants and children below 18 months
Annexure 33
Antiretroviral Therapy For TB patients
Annexure 34
Assuming the quality /amount of PTH
Annexure 35
Music Therapy
Annexure 36
National AIDS Control Organization (Phase III)
Annexure 37
List Of State AIDS Control Societies (SACs)
Annexure 38
List Of ART Centres
Annexure 39
List Of Community Care Centres (CCCs)
Annexure 40
Ice Breakers & Energizers
Annexure 41
Role Of Nurse at ART & CCCs
Annexure 42
Patient Treatment CardART White Card
Annexure 43
Counselling Checklists
HIV/AIDS and ART Training for Nurses

Section Four: Annexures
334
337
339
340
341
342
343
344
346
347
359
360
361
362
363
364
365
367
370
370
372
374
375
377
382
384
388
389
391
392
393
394
396
397
399
400
402
403
406
413
435
438
439
448
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ANNEXURE 1: BASELINE ASSESSMENT

BASELINE ASSESSMENT:
Focus on information that is significant to HIV care. Approach the assessment in a systematic, organized
manner using the information below as a guide.
Baseline assessment: Presented below is a checklist , one could use when assessing a patient
Focus on information that is significant to HIV care. Approach the assessment in a systematic, organized
manner using the information below as a guide.
I.
FACTOR
DETAILS
Name (Optional)
Age
Gender
Address (Optional)
Contact Details
Care Givers Contact Details
Entry Point (Services referring the patient for HIV care) :
(ICTC/ RNTCP/ Outpatient/ Inpatient/ Pediatric/ PPTCT
Centre/ STI Clinic/ ART Centre/ IDU outreach/
Sex Worker Outreach/ PLHIV Network/ MSM/
Private Practitioner/Self Referred
Employed (Y/N)
Occupation
For Pediatric Patients (under 15 yrs.):
Staying with (Own Family/ In a centre No family contact/In a centre - family
contact
Guardian /Caregivers Education
Date of admission or clinic visit
II. HIV status
Risk Factor for HIV: Heterosexual/MSM/ IDU/Mother to
child/Blood Transfusion/ Unsafe injection/Unknown
For IDUs: Substitution Therapy (Y/N)
When was the patient diagnosed with HIV?
Any complications (e.g. OIs)
What does patient know about HIV/AIDS?
Is patient being tested for HIV
If yes, is report available
HIV Status
If positive, any complication
If No, Check for window period
Repeat test if required
Has patient received counselling or medical care?
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Section Four: Annexure-1
I.
FACTOR
DETAILS
III. Chief complaint

What is the main reason for which the patient
was hospitalised or came to clinic?
Significant presenting symptoms, complaints
IV. Significant recent medical history
Malaria, TB, STIs? HBV/ HCV/ Diabetes/
Hypertension/ Cardiovascular/ Other diseases?
Co existing Conditions
Is patient taking any medications?
ART Treatment History (Received-Y/N; Initial
CD4 Count/Drugs & duration
Prophylactic medications? Traditional remedies?
Any allergies
History of mental illness? Depression?
Previous hospitalisations? Surgery?
History of Alcohol use
History of smoking/ Substance use
For women:
LMP (Last Menstrual Period), pregnancy,
RTIs,Surgeries, Contraception and
Gynaecologic history?
For Pediatric Patients (under 15 yrs. of age):
Birth History Normal/ Caesarean/ Vacuum/Forceps)
Birth Weight
Neonatal Complications
Infant Feeding (Breast Feeding; till when/
Replacement Feed/Mixed)
DNA PCR Results
Neurodevelopment
Immunization Record
V. Relevant social history
Primary language
Family structure? Married, no of children?
Family income? Financial status?
Employment? Living situation?
Educational status/ literate?
Is anyone else in the family ill?
What is the partner spouse status
Have HIV? Spouse status
Who is the decision- maker in the family?
What is the Childrens status
Does anyone else know of patients HIV status?
Their reaction to the clients HIV status
Can the patient identify family member
community, faith based organization group
where they may receive support?
Does the patient use alcohol/drugs/cigarettes?
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I.
FACTOR
DETAILS
VI. Relevant sexual history

Nature and status of current sexual relationship(s) currently sexually active with spouse or one
significant partner or with multiple partners?
Men, women or both?
Current sexual practices vaginal, anal, oral sex?
Exchanging sex for money, drugs or other?
Use of condoms?
Other safe practises Eg. Mutual masturbation
VIII.Patient Self Appraisal
How is s/he feeling?
Change in weight - current weight and previous
weight if available
Mood changes
Weakness or fatigue
Respiratory symptoms (cough, breathlessness, chest pain)
GI symptoms (nausea, vomiting, loss of
appetite, diarrhoea, thrush)
Neurological symptoms (memory loss, headaches,
visual changes, neurological deficit)
GU symptoms (genital itching, sores, dysuria, incontinence)
Dermatological (rash, itching)
Pain (assess using the visual analogue pain scale)
Other
VIII. Significant physical exam findings
Significant vital signs at presentation
Weight, height, including assessment of wasting
& severity of dehydration
Note general appearance
Head & neck, including mouth & oral cavity
(Candidiasis, Hairy cell Leukoplakia)
Lymph nodes
Examination of eyes for jaundice, anaemia, etc
Examination of genitals for sores, rash, discharge
Examination of skin and mucous membrane for
rashes, common skin infections (fungal
infections, dermatitis, KS, HZV)
Examination of mental status: appearance,
behaviour, orientation and memory
IX. Significant results of lab and other investigations
If needed, confirmatory HIV test
CD4 count
Hemogram (CBC)
Full chemistry panel
Sputum AFB
TST (Mantoux) chest x-ray
Others, if needed
Current diagnosis or multiple diagnoses if available
Some questions to answer:
What is the WHO clinical stage of this patient?
Is this patient eligible for ART?
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Annexure 2: Quick Reference Steps in Using a Male and

Female Condom
Steps in Using a Male Condom
Do
Dont
Check expiry date
Re-use condoms
Use condom correctly and consistently
Store condoms in the sun
Use each condom only once
Use the teeth or nails to tear the condom packet
Use water based lubricants
Use oil-based lubricant
Think of dual protection
Use condoms made with natural products

like lambskin as these are not protective
against HIV
Use the male and female condom together

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Steps in Using the Female Condom

Behaviour change communication: HIV transmission
1.
OPEN END (Outer ring): Covers the
area around the opening of the vagina.
INNER RING used for insertion. Helps
hold the pouch in place.
2.
HOW TO HOLD THE POUCH: Hold
inner ring between thumb and middle
finger. Put index finger on pouch
between other two fingers.
3.
HOW TO INSERT IT: Squeeze the
inner ring. Insert the pouch as far as
possible into the vagina. Make sure the
inner ring is past the public bone.
4.
MAKE SURE PLACEMENT IS
CORRECT: The pouch should not be
twisted. Outer ring should be outside
the vagina.
Fig. 2.7 How to use a female condom for vaginal sex

Proper use of the female condom (vaginal sex)
It is advisable to decide on the use of a condom with your partner beforehand as you may forget in
the heat of the moment.
Always check the expiry or manufacture date on the condom package to make sure it has not expired.
Make sure it is not more than 4 years old.
Using your fingers, carefully open the condom at the indicated place. Make sure your fingernails do not
damage the condom. DO NOT use sharp objects, such a scissors or a razor as they may cut the
condom.
Inspect the condom to make sure it is intact.
Rub the outside of the condom to evenly spread the lubricant inside the condom. Add the lubricant as
desired.
Find a comfortable position for inserting the condom.
Hold the condom at its closed end. Squeeze the inner ring (the ring at the closed end of the condom)
between the thumb and the middle finger with the forefinger between the two.
Spread the vaginal lips with the other hand, and insert the condom in the vagina.
Use your forefinger to push the inner ring all the way up in the vagina until you feel the pubic bone
with your finger.
Make sure the outer ring (at the open side of the condom) lies against the outer lips.
Guide and insert the penis inside the condom. Make sure the penis does not go underneath or beside
the condom.
If during intercourse the penis does not move freely, there is a sound, or the condom is moving in and
out with the penis, add lubricant (to the penis or inside the condom).
If the outer ring is pushed in the vagina or the penis goes beneath or to the side of the condom, stop
and put on a new condom.
Keep the condom on during intercourse. After ejaculation and after the penis is pulled out, squeeze and
twist the outer ring to avoid spilling semen and pulling the condom out of the vagina.
Wrap the condom in toilet paper and, as soon as possible, throw it away out of reach of others. Do
NOT flush the condom down the toilet.
NEVER reuse the condom.
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Annexure 3: Referral Linkage Organogram
Annexure 3: Referral Linkage Organogram

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Annexure 4: Disinfection of Needles and Syringes with Bleach

Injecting drug users often do not have access to a steady supply of disposable syringes, and re-use/share
needles with other IDUs. The procedure below can be taught to them to minimize the risk of HIV transmission
under such circumstances. Remember, where available disposable, unshared needles are always the first
choice.
Procedure:
It will probably take 5-10 minutes to follow the recommended procedures for
cleaning and disinfecting.
Fill the needle and syringe completely with clean water

Shake vigorously for 30 seconds, and shoot out the water into the sink or
onto the ground
Repeat the process
Then, completely fill the needle and syringe (to the top) with full-strength (not
diluted) liquid household bleach several times.
Keep the bleach for at least 30 seconds
Shoot out the bleach and repeat
Rinse the syringe and needle by completely filling several times with CLEAN
water.
Remember:
Cleaning and disinfecting should be done at two points of timeonce

immediately after use and again just before re-use of needles and syringes.
ALL used solutions should be disposed of (e.g. by placing in a waste container
or pouring down a sink or toilet or on the ground). DO NOT REUSE.
Every time the cleansing process is repeated, the more likely HIV and other
blood borne pathogens will be inactivated
Taking the syringe apart by removing the plunger may also improve the
cleaning/disinfection of parts that might be hard to reach (e.g., behind the
plunger).
Although it is important to follow all steps in the bleach disinfection procedures
to ensure maximum effectiveness, drug users who indicate they may be
unable to do so should be encouraged to perform as much of the process
as possible.
The more steps done, the more effective the disinfection process is likely to
be in reducing risk of HIV transmission.
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Annexure 5: Hand Hygiene Checklist

Procedure
Done
Ensure short finger nails

Ensure water supply/ alcohol hand - rub solution
Remove accessories from hands
Pour soap solution / alcohol rub into hand or apply soap uniformly on the hand
Scrub
Scrub
Scrub
Scrub
Scrub
Scrub
Scrub
both hands
palms and fingers
back of hands
fingers and knuckles
thumbs
finger tips and nails
wrists and up to elbows if needed
Wash hands ensuring removal of soap from all applied areas / if using
alcohol rub, rub all surfaces till dry (Do not wash with water)
Air dry or dry using clean towels
Keeping the above points in mind, think about what resources are required for regular efficient hand
hygiene and make a mental note to check if these are available at your centre.

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Annexure 6: Guidelines for Disposal of Used Disposable

Needles and Syringes
No.
Steps / Stages
Sever needles from disposable syringe immediately after administering injection using a needle
cutter/hub-cutter that removes the needle from disposable syringes or cuts plastic hub of
syringe from AD syringes
The cut needles get collected in the puncture proof container of the needle cutter/hub-cutter.
The container should contain an appropriate disinfectant and the cut needles should be completely
immersed in the disinfectant
Segregate and store syringes and unbroken (but discarded) vials in a red bag or container.
Send the collected materials to the common bio-medical waste treatment facilities. If such
facilities do not exist, then go to the next step.
Treat the collected material in an autoclave. If this is unavailable, treat the waste in 1%
hypochlorite solution or boil in water for at least 10 minutes. It shall be ensured that these
treatments ensure disinfection
Dispose the autoclaved waste as follows: (i) Dispose the needles and broken vials in a pit /
tank, (ii) Send the syringes and unbroken vials for recycling or landfill.
Wash the containers properly for reuse
Make a proper record of generation, treatment and disposal of waste
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Annexure 7: Guidelines for Disinfection and Sterilization

Device Classification
Devices Examples
Type of Process
Process Examples
High Risk
Enters sterile tissue
or vascular system,
includes dental
instruments
Implants, scalpels,
needles, other
surgical instruments
and Endoscopic
accessories
Sterilisation
(cycle time per
manufacturer)
Steam under pressure,

Dry heat, Ethylene oxide gas,
Chemical gas sterilizers
Intermediate Risk
Touches mucous
membranes or
broken skin
Flexible Endoscopes,
Laryngoscopes,
Endotracheal Tubes,
Respiratory Therapy
and Anaesthesia
equipment, Diaphragm
fitting rings, and other
similar devices.
High-level
disinfection
(exposure time
20 minutes)
Glutaraldehyde based
formulations (2%) Stabilized
Hydrogen Peroxide (6%)
Household bleach (Sodium
Hypochlorite 5.25%
1,000 ppm available
Chlorine = 1:50 dilution)
Thermometers
(oral or rectal)
Intermediate-level
disinfection
(exposure time
> 10 minutes)
Ethyl or Isopropyl Alcohol

(70% to 90%)
(do not mix oral and Rectal
Thermometers)
Smooth, hard
surfaces such as
Hydrotherapy tanks
Intermediate-level
disinfection
(exposure time
> 10 minutes)

(70 to 90%) Phenolic
detergent (dilute per label)
Iodophor detergent (dilute
per label) Household bleach
(Sodium Hypochlorite 5.25%
1,000 ppm available
chlorine = 1:50 dilution)
Stethoscopes,
Tabletops, floors,
Bedpans,
Furniture, etc.
Low level
disinfection
(exposure time
> 10 minutes)

(70 to 90%) Phenolic
detergent (dilute per label)
Iodophor detergent (dilute
per label) Household bleach
(Sodium Hypochlorite 5.25%
100ppm available
chlorine = 1:500 dilution)
Low Risk
Touches intact skin
Copyright 1996 The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) 1016
Sixteenth Street NW, Sixth Floor, Washington, DC 20036
202-296-2742 Fax 202-296-5645 E-mail [email protected]

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Annexure 8: Situational Guide - Cleaning up a Blood Spill on

the Floor
Instruct the hospital worker or cleaner to wear appropriate personal protective equipment: plastic
apron, shoes and disposable gloves.
Put a towel / gauze / cotton over the spill area to cover it completely.
Pour hypochlorite solution 10% over the covered cloth to soak it completely.
Leave the solution on the cloth for another 30 minutes without disturbance.
Carefully lift the cloth from the floor, mopping the whole spill onto the cloth and dispose into the
yellow bin.
Using a routine mop and soap water solution swipe the area and wash the mop and hang it out to
dry.
Remove gloves and dispose into red bin.
Wash hands under running water with soap and dry hands.
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Annexure 9: Situational Guide - Care of the Body after Death

of a PLHIV
HIV can survive in cadavers for a considerable amount of time (up to 16 days after death if stored at 2C.
Viable HIV has also been isolated from bone fragments, spleen, brain, bone marrow, and lymph nodes at
autopsy 6 days post-mortem.
Do
Dont
Protect self by using PPE and avoiding

injuries
Gloves, especially if the body has many
wounds.
Wear other PPE only if large quantities of
splashes of blood are anticipated.
Bodies that need to be handled especially
directly from emergency rooms or after
resuscitation procedures may contain
needles or other sharps. Care should
be taken to avoid needle stick and
sharps injuries.
Enclose the body in double plastic
sheet/bag to avoid contamination and
spread of infection
Remove PPE after the procedure
Discard PPE into linen bin for laundering or
dispose appropriately.
Wash hands after removing PPE.
A shower should be taken before leaving
the room.
Disinfect the environment and any other place
or item that is contaminated with body
secretions with 1% hypochlorite solution.
Educate relatives of deceased about
a. Body to be kept enclosed in the double
plastic sheet/bag with seal.
b. Need for burial or cremation as early
as possible,
c. Sealing the coffin is not required.
Disinfecting if needed and then washing
patients clothing, bed linen, and other
personal items.
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Give bath to the dead body.

Embalming bodies, especially when infected
with hepatitis B, hepatitis C, HIV or rabies as
it involves the extraction of infected material
from body as well as further exposure of
infected tissues and cant be guaranteed to
eliminate the risk of infection from the body.
(If absolutely essential, use all PPE)

Annexure 10 : NACO PEP Policy: Procedure to be followed

after an Accidental Exposure to HIV Infectious Fluid
Do
Do Not
Remove gloves, if appropriate
Do not panic
Wash the exposed site thoroughly with

running water
Do not put pricked finger in mouth
Irrigate with water or saline if exposure sites

are eyes or mouth
Do not squeeze wound to bleed it
Wash skin with soap and water
Do not use Bleach, Chlorine, Alcohol, Betadine,

Iodine or other antiseptics/detergents on
the wound
** Do - Consult the designated physician immediately as per institutional guidelines for

management of the occupational exposure **
Step 1: Management of Exposure Site First Aid

For skin if the skin is broken after a needle-stick or sharp instrument:
Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub.
Do not use antiseptics or skin washes (Bleach, Chlorine, Alcohol, Betadine)
After a splash of blood or body fluids:
To unbroken skin:
Wash the area immediately
Do not use antiseptics
For
the eye :
Irrigate exposed eye immediately with water or normal saline
Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye.
If wearing contact lens, leave them in place while irrigating, as they form a barrier over the eye and
will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal
manner. This will make them safe to wear again
Do not use soap or disinfectant on the eye.
For
mouth :
Spit fluid out immediately
Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times
Do not use soap or disinfectant in the mouth
Consult the designated physician of the institution for Management of the Exposure immediately.
Step 2: Risk assessment

The HIV sero-conversion rate of 0.3% after an AEB (for Percutaneous Exposure) is an average rate. The
real risk of transmission depends on the amount of HIV transmitted ( amount of contaminated fluid and the
viral load).
A designated person/trained doctor must assess the risk of HIV and HBV transmission following an AEB.
This evaluation must be made rapidly, so as to start any treatment as soon as possible after the accident

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(Ideally within 2 hours but certainly within 72 hours). This assessment must be made thoroughly (because
not every AEB requires prophylactic treatment).
PEP must be initiated as soon as possible, preferably within 2 hours
Two main factors determine the risk of infection: the nature of exposure and the status of the source patient.
Step 2 (a): Assessing the nature of Exposure and Risk of Transmission

Three categories of exposure can be described based on the amount of blood/fluid involved and the entry
port. These categories are intended to help in assessing the severity of the exposure but may not cover
all possibilities.
Categories of exposure
Category
Definition and example
Mild exposure:
Mucous membrane/non-intact skin with small volumes

E.g. : a superficial wound (erosion of the epidermis) with a plain or low
calibre needle, or contact with the eyes or mucous membranes,
subcutaneous injections following small-bore needles
Moderate exposure:
Mucous membrane/non intact skin with large volumes OR

Percutaneous superficial exposure with solid needle
E.g.: a cut or needle stick injury penetrating gloves.
Severe exposure:
Percutaneous with large volume e.g.:

An accident with a high calibre needle (>=18 G) visibly
contaminated with blood;
A deep wound (haemorrhagic wound and/or very painful);
Transmission of a significant volume of blood;
An accident with material that has previously been used
intravenously or intra-arterially.
The wearing of gloves during any of these accidents constitutes a protective factor.
Note: In case of an AEB with material such as discarded sharps/needles, contaminated for over 48 hours,
the risk of infection becomes negligible for HIV, but still remains significant for HBV. HBV survives longer
than HIV outside the body.
Step 2 (b): Assessment of the Exposed individual

The exposed individual should have confidential counselling and assessment by an experience physician.
The exposed individual should be assessed for pre-existing HIV infection as PEP is intended for people
who are HIV negative at the time of their potential exposure to HIV. Exposed individuals who are known
or discovered to be HIV positive should not receive PEP. They should be offered counselling and information
on prevention of transmission and referred to clinical and laboratory assessment to determine eligibility for
antiretroviral therapy (ART). Besides the medical assessment, counselling of the exposed HCP is essential
to allay fear and start PEP (if required) at the earliest.
Step 2(c): Assessing the HIV status of the source of exposure

PEP needs to be started as soon as possible after the exposure and within 72 hours. In animal studies,
initiating PEP within 12, 24 or 36 hours of exposure was more effective than initiating PEP 48 hours or 72
hours following exposure. PEP is not effective when given more than 72 hours after exposure.
A baseline Rapid HIV testing should be done before starting PEP.
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Initiation of PEP where indicated should not be delayed while waiting for the results of HIV testing of the
source of exposure. Informed consent should be obtained before testing of the source as per national HIV
testing guidelines.
Categories of situations depending on results of the source
Source HIV Status
Definition of risk in source
HIV negative
Source is not HIV infected but consider HBV and HCV
Low risk
HIV positive and clinically asymptomatic
High risk
HIV positive and clinically symptomatic (see WHO clinical staging)
Unknown
Status of the patient is unknown, and neither the patient nor his/her blood
is available for testing (e.g. injury during medical waste management the
source patient might be unknown). The risk assessment will be based only
upon the exposure (HIV prevalence in the locality can be considered).
HIV infection is not detected during the primary infection period by routine-use HIV tests. During the
window period , which lasts for approximately 6 weeks, the antibody level is still too low for detection
but infected persons can still have a high viral load. This implies that a positive HIV test result can help
in taking the decision to start PEP, but a negative test result does not exclude HIV infection. In countries
or population groups with a high HIV prevalence, a higher proportion of HIV-infected individuals are found
in the window period. In these situations, a negative result has even less value for decision-making on PEP.
Step 3: Informed consent from exposed person

Exposed persons (clients) should receive appropriate information about what PEP is about and the risk and
benefits of PEP in order to provided informed consent. It should be clear that PEP is not mandatory.
Key information to provide informed consent to the client after occupational exposure
Key information to Exposed Person (Client)
Specific Details include
The risk of acquiring HIV infection from

the specific exposure
What is known about PEP efficacy

Ask client for understanding of HIV

transmission risk after exposure
The risk of getting HIV infection from a
person known to be HIV positive is estimated
to be
Sharps injury: 3 in 1000 exposures (0.3%)
Mucous membrane splash: 1 in 1000
exposures (0.1%)
the risk is increased with large exposure e.g.
needle-stick from hollow bore needles with
visible blood, from artery or vein and from
source patients with high viral load
(usually very sick persons with OIs)
Ask Clients understanding of PEP
PEP is provided to prevent potential
transmission of HIV
PEP is not 100% effective and should be
given within 72 hours (ideally as soon as
possible, if eligible).
Balance risk and benefits of PEP: PEP may
prevent HIV transmission, versus possible
risk of side effects
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Key information to Exposed Person (Client)
Information about clients risk of HIV

infection based upon a risk assessment
(if s/he has not had a recent HIV test)
The importance of being tested and
receiving appropriate post-test counselling
(although HIV testing can be delayed
if needed)
PEP medicines will be discontinued
if their initial (baseline) HIV test is positive
Importance of adhering to medication

once started
Duration of the course of medicine
(4 weeks)
Common side effects that may be

experienced
They can stop at any time but will

not get the benefit of PEP if the source
is HIV positive
Prevention during the PEP period e.g.

sexual intercourse and unplanned pregnancy
If Client is pregnant she can still take

PEP during pregnancy
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Clients possibility of prior HIV infection

should be assessed
Counsel for HIV testing and follow-up
psychosocial support where possible rapid
testing should be used based on national
testing guidelines
Inform if the Baseline HIV test is positive,
then the PEP will be discontinued
Arrange referral to ART centres for
assessment if found HIV positive
Discuss dosing of the PEP medicine e.g.
Pill should be taken twice a day for 28 days,
once in the morning and once in the evening
Depending on the nature and risk of exposure,
2 drugs or 3 drugs may be used
Side effects may be important with use of 3 drugs
Expert opinion/consultation by phone or
referral may be needed with a HIV specialist
if 3rd drug is to be used
Arrange for special leave from work
(2 weeks initially)
Discuss possible side effects of the PEP
medicines e.g. Nausea, Fatigue, Headache
(depending on which drugs given)
Side effects often improve over time. It is
often minor and do not need specialised
supervision.
Symptomatic relief can also be given by
using other drugs
Animal studies suggest that taking less than
4 weeks of PEP does not work
If client decides to stop at any time, s/he
needs to contact the physician before
stopping the medications
Arrange for follow-up visit and decide further
course of action/follow-up
After any AEB, the exposed person should
not have unprotected sexual intercourse until
it is confirmed, 3 months after the exposure,
that s/he is not HIV infected.
It is also advised to avoid pregnancy.
Use of condoms is essential
The PEP drugs used are safe for pregnancy
If the client gets HIV during the pregnancy
due to the exposure, the baby will have
some risk of becoming HIV infected

Key information to exposed person (client)
Safety of PEP if the client is breastfeeding
The PEP drugs used are safe during

breast-feeding
May consider stopping breastfeeding if
PEP is indicated.
Educate client on the possible signs and

symptoms of early HIV sero-conversion
Signs and symptoms of early HIV seroconversation: Fever, Rash, Oral Ulcers,
Pharyngitis, Malaise, Fatigue, Joint Pains,
Weight loss, Myalgia, headache
(similar to Flu-like symptoms)
Risk of acquiring Hepatitis B and C from

a specific exposure and availability of
prophylaxis for this
Risk of Hepatitis B is 9-30% from a Needle

Stick Exposure the client can be given
vaccinations
Risk of Hepatitis is 1-10% after Needle Stick
Exposure there are no vaccinations for this.
* Provider should correct misconceptions at all times during the counselling sessions
Psychological support:
Many people will feel anxious after exposure. Every exposed person needs to be informed about the risks
and the measures that can be taken. This will help to relieve part of the anxiety, but some may require
further specialised psychological support.
Documentation on record is essential. Special leave from work should be considered for a period of time
e.g. 2 weeks (initially) then, as required based on assessment of the exposed persons mental state, side
effects and requirements.
Practical application in the clinical settings:
Once Prophylactic treatment has begun, the exposed person must sign form A1.
Informed consent also means that if the exposed person has been advised PEP, but refuses to start
it, s/he should sign Form A1. This document should be kept by the designated officer for PEP.
An information sheet covering the PEP and the biological follow-up after any AEB may be given to the
person under treatment. However, this sheet cannot replace verbal explanations.
Arrange for follow-up visit and leave from work.
Step 4: Deciding on PEP Medications/Regimen

Deciding on therapy
There are two types of regimens:
a) Basic regimen: 2-drug combination
b) Expanded regimen: 3-drug combination
The decision to initiate the type of regimen depends on the type of exposure and HIV serostatus of the
source person. See Table 6.
HIV Post-exposure Prophylaxis Evaluation

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Exposure
Status of source
HIV+ and
asymptomatic
HIV+ and Clinically

symptomatic
HIV status unknown
Mild
Consider 2-drug PEP
Start 2- drug PEP
Usually no PEP or consider 2-drug PEP
Moderate
Start 2-drug PEP
Start 3-drug PEP
Severe
Start 3-drug PEP
Start 3-drug PEP
HIV testing of the source patient should not delay the decision about whether or not to start PEP. Start
2-drugs first if required, then send for consultation or refer.
In the case of a high risk exposure from a source patient who has been exposed to or is taking
Antiretroviral medications, consult an expert to choose the PEP regimen, as the risk of drug resistance
is high. Refer/consult expert physician. Start 2 drug regimens first.
Expert opinion may be obtained for the following situations:

(Refer to list of PEP experts on www.nacoonline.org)
Delay in reporting exposure (> 72 hours)

Unknown source: Use of PEP to be decided on case to case basis after considering the severity of
exposure and the Epidemiologic likelihood of HIV transmission. Do not delay PEP initiation if indicated
Known or suspected pregnancy: Do not delay PEP, if indicated
Breastfeeding issues in the exposed person: Do not delay PEP if indicated. Consider stopping breast
feeding, if PEP is indicated.
Source patient is on ART or possibly has HIV Drug resistance : Refer/Consult as soon as possible
Major toxicity of PEP regimen: minor side effects may be managed symptomatically. Refer to expert
if non-tolerance or non-adherence
Refer/ consult if in doubt or complicated cases (e.g. major psychological problem)
Step 5: Starting PEP

Various animal studies done over the years have provided encouraging evidence of post exposure
chemoprophylactic efficacy. Studies have also shown that delaying initiation, shortening the duration or
decreasing the antiretroviral dose of PEP, individually or in combination, decreased its prophylactic efficacy.
In a retrospective case control study of HCP, it was demonstrated that use of Zidovudine as PEP was
associated with a reduction in the risk of HIV infection by approximately 81%. Also the experience in HIV
infected patients has shown that combination of different antiretroviral agents is superior to monotherapy
regimen, so a combination of two or three drugs in PEP regimen should be more beneficial than a single
drug. One needs to consider toxicity of a combination regimen vis--vis risk of transmission.
PEP must be initiated as soon as possible, preferably within 2 hours
Initiate HIV Chemoprophylaxis
Because Post-Exposure Prophylaxis (PEP) has its greatest effect, if begun within 2 hours of exposure, it
is essential to act immediately. There is little benefit if >72 hours later. The prophylaxis needs to be
continued for 4 weeks.
Report exposure immediately to appropriate authority.

Fill in the medical form
Never delay start of therapy due to debate over regimen. Begin with basic 2-drug regimen, and once
expert advice is obtained, change as required.
The 3rd drug can be added after consultation with an expert.
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Dosages of the Drugs for PEP

Medication
2-drug regimen
3-drug regimen
Zidovudine (AZT)
300 mg twice a day
300 mg twice a day
Lamivudine (3TC)
150 mg twice a day
150 mg twice a day

1st choice : Lopinavir/Ritonavir (LPV/r)
400/100 mg twice a day or 800/200 mg
once daily with meals
Protease Inhibitors
2nd choice : Nelfinavir (NLF)1250 mg

twice a day or 750 mg three times a
day with empty stomach
3rd choice : Indinavir (IND)800 mg
every 8 hours and drink 6-8 litres
of water daily
Note: If Protease Inhibitor is not available and the 3rd drug is indicated, one can consider using Efavirenz
(EFV 600 mg once daily). Monitoring should be instituted for side effects of this drug e.g. CNS toxicity
such as Nightmares, Insomnia etc.
* Fixed Dose Combination (FDC) are preferred, if available. Ritonavir requires refrigeration.
PEP regimens to be prescribed by health centres:
2-drug regimen
(basic PEP regimen)
Preferred
Alternative
1st choice:
Zidovudine (AZT) +
Lamivudine (3TC)
2nd choice:
Stavudine (d4T) +
Lamivudine (3TC)
3-drug regimen (expanded PEP regimen) consult expert opinion for starting 3rd drug e.g.
LPV/r, NLF or IND
Not recommended
ddI + d4T combination

NNRTI such as Nevirapine should not be used in PEP
More information on alternative schedules is available in the latest update USPHS guidelines issued 30
September 2005. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm) or www.who.int
Selection of the PEP regimen when the source patient is known to be on ART: The physician should
consider the comparative risk represented by the exposure and information about the exposure source,
including history of and response to antiretroviral therapy based on clinical response, CD4 cell counts, Viral
load measurements (if available), and current disease stage (WHO clinical staging and history). When the
source persons virus is known or suspected to be resistant to one or more of the drugs considered for the
PEP regimen, the selection of drugs to which the source persons virus is unlikely to be resistant is
recommended. Refer for expert opinion.
If this information is not immediately available, initiation of PEP, if indicated, should not be delayed.
Give the 2 drug (basic) regimen. Changes in the PEP regimen can be made after PEP has been started,
as appropriate. Re-evaluation of the exposed person should be considered within 72 hours Post-Exposure,
especially as additional information about the exposure or source person becomes available.
Antiretroviral Drugs during Pregnancy
If the Exposed person is pregnant, the evaluation of risk of infection and need for PEP should be approached
as with any other person who has had an HIV exposure. However, the decision to use any Antiretroviral
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drug during pregnancy should involve discussion between the woman and her Health-Care Provider(s)
regarding the potential benefits and risks to her and her fetus.
Data regarding the potential effects of Antiretroviral drugs on the developing fetus or neonate are limited.
There is a clear contraindication for Efavirenz during entire pregnancy) instead use of Nevrapine is adviced
similarly, Indinavir is contraindicated during Pre-hatal record.
In conclusion, for a female HCP considering PEP, a pregnancy test is recommended if there is any chance
that she may be pregnant. Pregnant HCP are recommended to begin the basic 2-drug regimen, and if a
third drug is needed, Nelfinavir is the drug of choice.
Side-effects and Adherence to PEP
Studies of HCP taking PEP have reported more side effects than PLHIV taking ART, most commonly
Nausea and Fatigue. Possible side-effects occur mainly at the beginning of the treatment and include
Nausea, Diarrhoea, Muscular pain and Headache. The person taking the treatment should be informed that
these may occur and should be dissuaded from stopping the treatment as most side-effects are mild
and transient, though possibly uncomfortable. Anaemia and/or leucopoenia and/or thrombocytopenia may
occur during the month of treatment. A complete blood count and liver function tests (transaminases) may
be performed at the beginning of treatment (as baseline) and after 4 weeks.
In practice and from HCP studies, many HCP did not complete the full course of PEP because of side
effects. Side effects can be reduced by prescribing regimens that do not Include a Protease Inhibitor (PI),
by giving medications to reduce Nausea and Gastritis and by educating clients about how to reduce side
effects e.g. taking PEP medications with food. It is important that side effects should be explained before
initiating PEP so that the symptoms are not confused with symptoms of Seroconversion to HIV.
Adherence information is essential with psychological support. More than 95% adherence is important in
order to maximise the efficacy of the medication in PEP.
Management of Minor ARV drug side effects
Signs or symptoms
Management at health facility
Nausea
Take with food. If on AZT, reassure that this is common, usually self-limited.
Treat symptomatically.
Headache
Give Paracetamol. Assess for Meningitis. If on AZT or EFV, reassure that

this is common and usually self-limited. If persists more than 2 weeks,
call for advice or refer.
Diarrhoea
Hydrate. Follow diarrhoea guidelines. Reassure patient that if due to ARV,

this will improve in a few weeks. Follow up in 2 weeks. If not improved,
call for advice or refer.
Fatigue
This commonly lasts 4 to 6 weeks especially when starting AZT. Give

sick leave from work. If severe or longer than this, call for advice or refer.
CNS side effects:

Anxiety, nightmares,
psychosis, depression
This may be due to EFV. Take EFV at night before sleeping; counsel
and support (usually lasts < 3 weeks). Initial difficult time can be managed
with amitriptyline at bedtime.Call for advice or refer if severe depression
or suicidal tendencies or psychosis. (Stop EFV).
Blue /black nails
Reassure. It is a non-threatening side effect, common with AZT
Rash
If on EFV, assess carefully. Is it a dry or wet lesion? Call for advice.

If generalised or peeling, stop drugs and refer for expert opinion.
Fever
Assess clinically for Hepatitis or if this could be Primary (acute) HIV

infection or other non-HIV related infections e.g. concurrent common cold.
Call for advice or refer.
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Signs or symptoms
Management at health facility
Jaundice or
abdominal or
flank pain
Stop drugs. Call for advice or refer.

(Abdominal pain may be pancreatitis from d4T.) If jaundice or liver
tenderness, send for ALT test and stop ART. Call for advice or refer.
Pallor
Measure Haemoglobin. Refer if sever pallor or symptoms of anaemia or

very low haemoglobin (<8 grams). This may be due to AZT.
Tingling, numbers
or painful feet/legs
If new or worse on treatment, call for advice or refer. Patient on d4T/3TC

should have the d4T discontinued substitute AZT if no anaemia
(check haemoglobin).
Amount of medication to dispense for PEP

All clients starting on PEP must take 4 weeks (28 days) of medication. In all cases, the first dose of PEP
should be offered as soon as possible, once the decision to give PEP is made. HIV testing or results of
the source HIV test can come later. As usage of PEP drugs is not frequent and the shelf life is 1 to 1.5
years, it is proposed that:
Starter packs for 7 days can be put in the Emergency Department with instructions to go to a
designated clinic/officer within 1-3 days for a complete risk assessment, HIV counselling and testing
and dispensing of the rest of the medications and management. At least 3 such kits are provided in
the casualty department.
It is important to monitor and regularly follow-up the person once PEP is started.
Post-Exposure Measures against Hepatitis B and C
20
HEPATITIS B
All health staff should be vaccinated against Hepatitis B. The vaccination for Hepatitis B consists of 3
doses: initial, 1 month, and 6 months. Sero-conversion after completing the full course is 99%.
HBV vaccination after an AEB:

HBV vaccination status of Exposed Person
Action after AEB
* Anti-HbS level > 10 IU/L
No action
* Anti-HbS level <10 IU/L
Hep B Vaccine Booster
Vaccinated, anti-HbS not known
Vaccinated more than 5 years ago
Never vaccinated
Give complete hepatitis B vaccine series
* Antibody test (anti-HbS level), if available, is not necessary.
HEPATITIS C
There is presently no prophylaxis available against hepatitis C. There is no evidence that Interferon,
pegalated or not, with or without Ribavirin is more effective when given at this time than when given
at the time of disease. Post-Exposure management for HCV is based on early identification of chronic
HCV disease and referral to a specialist for management.
Step 6: Follow up of an exposed person

Whether PEP prophylaxis has been started or not, follow up to monitor possible infections, and psychological
support are indicated.
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Laboratory follow-up
Laboratory tests after AEB
Timing
In persons taking PEP

(standard regimen)
In persons not taking PEP
Baseline
(within 8 days after AEB)
HIV-Ab, anti-HCV, HBsAg *

Complete blood count
Transaminases
HIV-Ab, anti-HCV, HBsAg *
Week 2 and 4
Transaminases **
Complete blood count ***
clinical monitoring for hepatitis
Week 6
HIV-Ab
HIV-Ab
Month 3
HIV-Ab, anti-HCV, HBsAg

Transaminases**
Month 6

Transaminases**
*HIV, HBV and HCV testing of exposed staff within 8 days of an AEB is required (baseline serostatus).
Offer an HIV test in case of an AEB, as a positive HIV status may indicate the need to discontinue
PEP. The decision on whether to test for HIV or not should be based on informed consent of the exposed
person.
** Transaminases should be checked at week 2 and 4 to detect hepatitis in case the exposed person
contracted HBV from the AEB.
*** For persons started on AZT-containing PEP regimens
Clinical follow-up
In addition, in the weeks following an AEB, the exposed person must be monitored for the eventual
appearance of signs indicating an HIV seroconversion: Acute Fever Generalised Lymphadenopathy,
Cutaneous Eruption, Pharyngitis, non-specific Flu symptoms and Ulcers of the mouth or Genital area.
These symptoms appear in 50%-70% of individuals with an HIV primary (acute) infection and almost always
within 3 to 6 weeks after exposure. When a primary (acute) infection is suspected, referral to an ART centre
or for expert opinion should be arranged rapidly.
An exposed person should be advised to use precautions (e.g., avoid Blood or tissue Tonations, Breastfeeding,
Unprotected sexual relations or Pregnancy) to prevent secondary transmission, especially during the first
6-12 weeks following exposure. Condom use is essential.
Adherence and side effect counseling should be provided and reinforced at every follow-up visit. Psychological
support and mental health counseling is often required.
Follow-up HIV testing:
Exposed persons should have post-PEP HIV tests. Testing at the completion of PEP may give an initial
indication of seroconversion outcome if the available antibody test is very sensitive. However, testing at 46 weeks may not be enough as use of PEP may prolong the time to seroconversion; and there is not
enough time to diagnose all persons who seroconvert. Therefore, testing at 3 months and again at 6
months is recommended. Very few cases of seroconversion after 6 months have been reported. Hence,
no further testing is recommended if the HIV test at 6 months is negative.
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Flow chart: Management of an AEB and PEP

Steps
Actions
timing
Accidental exposure to blood
0 h 0 min

Step 1
Immediate first aid

Step 2
Risk assessment by a medical doctor
As soon as possible

Step 3
Decision on therapy (medical doctor and exposed person)

Counselling and information
Offer of psychological support
Special leave from work/duty
Step 4Step 5
Prophylactic treatment against HIV Infection

and HBV vaccinations as required
Yes
Step 5
Start 2-drug
Start 3-drug
Ideally within
2 hours but
certainly
within 72 hr
No

Offer follow-up &
counselling as required
Step 6
Monitor and follow-up of HIV, HBV and HCV status
6 months
Access and Availability to PEP at a Health Care Facility

In order to ensure that an exposed person has access to prophylactic therapy in a timely manner, it is
recommended that PEP drugs be kept available round-the-clock in any one location where a doctor is on call
24-hours a day (e.g. casualty, ICU). All health staff should know through in-house trainings where to get PEP
as required.
For the full course of drugs, this can be purchased locally to complete 4 weeks of drugs or refer to nearest ART
centre. In case these drugs are not available on site at the healthcare facility, the hospital can purchase.
It locally and it shall be reimbursed by SACS.

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Drug stock at the Health care Facility

Level of health
care facility
Designated person/team
in charge of PEP
Minimum drug stock of PEP

exposure-response kits*
Tertiary hospitals
and medical
colleges
Team: Infection control officer,

Physician, Casualty officer
Where ART centers are within the
same institution, the ART nodal officer
should be the reference person for PEP
3 kits of 7 days supply

i.e. FDC (AZT/3TC) 2 tabs/day
x 7 days x 3 kits = 42 tabs
If ART centre available, to link for
supply and referrals
Secondary
district, taluk
Team: infection control officer,

casualty officer
The district/Taluk physician (internal
medicine) should be the reference
person for PEP

i.e. FDC (AZT/3TC) 2 tabs/day
x 5 days x 3 kits = 30 tabs
If ART centre available, to link for
supply and referrals
Primary CHC
The medical officer of the CHC is the

reference person for PEP

i.e. FDC (AZT/3TC) 2 tabs/day x 3
days x 2 kits = 12 tabs
Primary Health
centers (PHC)
The PHC medical officer is in-charge

of referring for PEP to CHC or
district level
Link to CHC or district level

for PEP
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Annexure 11: STI Flowchart For management Urethral

Discharge & Burning micturation
Causative Organisms
Syndrome Urethral discharge in Males
Neisseria Gonorrhoea
Chlamydia trachomatis
Trichomonas vaginalis
RTs STIs Gonohorrhea, Chlamydial Infection, Trichomoniasis
History of
Urethral discharge
Pain or burning while
passing urine, increased
frequency ofurination
Sexual exposure of
either partner including
high risk practices
likeoro-genital sex
Examination Look for

Redness and swelling of the
urethral meatus
Urethral discharge. If discharge
is not seen, then gently massage
the urethra from the ventral part of
the penis towards the meatusand
look for a thick, creamygreenishyellow or mucoid discharge
Laboratory investigations (if

available)
Gram stain examination of the urethral
smear will show gram-negative intra
cellular diplococci in case of gonorrhea
In non-gonococcal urethritis, more
than 5 neutrophils per oil immersion
field (1000X) in the urethral smear
or more than 10 neutrophils per high
power field in the sediment of the
first void urine are observed
Treatment
As dual infection is common, the treatment for urethral discharge should adequately cover therapy for both gonorrhoea
and chlamydial infections.
Recommended regimen for uncomplicated gonorrhoea + chlamydia Uncomplicated infections indicate that the disease is
limited to the anogenital region (anterior urethritis and proctitis).
Tab. Cefixime 400 mg orally, single dose Plus
Tab Azithromycin 1 gram orally single dose under supervision
Ensure patient takes medication under your direct observation
Advise the client to return after 7 days of start of therapy
When symptoms persist after adequate treatment for gonorrhoea and chlamydia in the index client and partner(s), they
should be treated for Trichomonasvaginalis.If discharge or only dysuria persists after 7 days
Tab. Secnidazole 2 gm orally, single dose (to treat for T.vaginalis)
If the symptoms still persist
Refer to a higher centre as early as possible
Syndrome-specific guidelines for
partnermanagement
Treat all recent partners
Treat female partners (for gonorrhoea and
chlamydia) on the same lines after ruling out
pregnancy and history of allergies
Advise sexual abstinence, and if not acceptable,
advise consistent condom usageduring the course
of treatment
Provide condoms, educate about correct and
consistent use
Refer for voluntary counseling and testing for
HIV, Syphilis and Hepatitis B
Schedule return visit after 7
Management of pregnant partner

Pregnant partners of male clients with urethral discharge should be
examined by doing a per speculum as well as per vaginal
examination, and treated for gonococcal as well as chlamydial
infections.
Cephalosporins to cover gonococcal infection are safe and
effective inpregnancy
Tab. Cefixime 400 mg orally, single dose OR
Ceftriaxone 125 mg by intramuscular injection
+
Tab. Erythromycin 500 mg orally four times a day for
seven days OR
Cap Amoxicillin 500 mg orally, three times a day for seven
days to cover chlamydial infection
Quinolones (like ofloxacin, ciprofloxacin), doxycyclineare
contraindicated in pregnant women.
Follow up After seven days

To see reports of tests done for HIV, syphilis and Hepatitis B
If symptoms persist, to assess whether it is due to treatment failure or re-infection or prompt referral if required

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Annexure 12 : STI Flow Chart for Management of Scrotal swelling
Syndrome Scrotal swelling
Neisseria Gonorrhoea
RTIs/ STIs Gonorrhea, Chalamial

Infection
History of
Swelling and pain in scrotal

region
Pain or burning while

passing urine
Systemic ymptoms like

malaise, fever
Sexual exposure of either

partner to high risk practices
including oro-genital sex
Examination
Look for
Scrotal swelling
Redness and edema of the
overlying skin
Tenderness of the
epididymis and vas deferens
Associated urethral
discharge/genital ulcer/
inguinal lymph nodes and
if present refer to the
respective flowchart
A tranillumination test to
rule out hydrocoele should
be done.
Laboratory Investigations
(If available)
Gram stain examination of
the urethral smear will show
gram-negative intracellular
diplococci in case of
complicated gonocoocal
infection
In non-gonococcal urethritis
more than 5 neutrophils per
oil immersion field in the
urethral smear or more than
10 neutrophils per high
power field in the sediment
of the first void urine are
observed
Treatment:
Treat for both gonococcal & chlamydial infections Tab Cefixime 400mg orally BD for 7 days Plus
Cap Doxycycline 100mg BD for 14 days & refer to hihercentre as soon as possible since complicated
gonococcal infection needs parental & longer duration of treatment.
Sopportivetherapyto reduce pain (bed rest, scrotal elevation with T bandage and analgesics
Differential diagnosis( Non RTIs /STIs) Infections Causing Scrotal Swelling Tuberculosis,Filariasis,
Coliforms. Pseudomonas,Mumpsvirus infection.
NonInfectious causes:
Trauma, Hernia, Hydrocoel,Testicular torsion & Testicular tumors
Syndrome Specific Guidelines for

Partner management
Partner needs to be treated depending on
the clinical findings
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Management of protocolin case the

partner is pregnant
Depending on the clinical findingsin the pregnant
Partner (wether vaginal discharge or endocervical
discharge or PID is present) the drug
regimens should be used

Annexure 13 : STI Flow Chart management of Inguinal Bubo
Causative Organism
Bacteria Haemophilus ducreyi
Calymmatobacterium granulomatis
(Klebsiella granulomatis)
History
Swelling in inguinal region
which may be painful
Preceding history of genital
ulcer or discharge
Sexual exposure of either
partner including high risk
practices like oro-genital sex
etc
Systemic symptoms like
malaise, fever
Examination
Look for
Localized enlargement of
lymphnodes in groin which
may betender and fluctuant
Inflammation of skin over
the swelling
Presence of multiple sinuses
Edema of genitals and
lower limbs
Presence of genital ulcer or
urethral discharge, if present,
refer to respective flowchart
TREATMENT
Start Cap Doxycycline 100mg orally twice
dailyfor 21 days (To cover LGV) Plus
Tab Azithromycin 1gm orally single dose
OR
Tab Ciprofloxacin 500mg orally, twice daily
for 3 day to cover chancroid.
Refer to higher centre as early as possible.
Syndrome specific guidelines for partner

management
Treat all partners whoare in contact with
the client in last 3 months
Partners should be treated for
chancroid & LGV
Tab Azithromycin 1gm orally single
dose to cover chancroid
Cap Doxycycline 100mg, twice daily
for 21 days to cover LGV
Advise Abstinence during treatment
Provide condoms, educate for
correct & consistent use

Laboratory investigations
Diagnosis is on clinical grounds
Differential diagnosis
Mycobacterium tuberculosis,
filariasis
Any acute infection of skin of
pubic area, genitals, buttocks,
anus and lower limbs can also
cause inguinal swelling.
If malignancy or tuberculosis
is suspected refer to a higher
centre for biopsy.
Note:
A bubo should never be incised and drained at the
primary Designated STI Clinic, even if it is fluctuant,
as there is a high risk of fistula formation and
chronicity. If bubo becomes fluctuant always refer for
aspiration to a higher centre.
In severe cases with vulval edema in females,
surgical intervention in the form of vulvectomy
may be required for which they should be referred to
a higher centre.
Management of pregnant partner

Quinolones (like ofloxacin, ciprofloxacin), doxycycline,
sulfonamides are contraindicated in pregnant women.
Pregnant and lactating women should be treated with
the erythromycin regimen and consideration should
be given to the addition of a parenteral amino
glycoside (e.g., gentamicin)
(Erythromycin estolate is contraindicated in pregnancy
due to hepatotoxicity. Erythromycin base or
erythromycin ethyl succinate should be given)
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Annexure 14 : STI Flow chart for management of Genital ulcers
Granuloma Inguinale
Syphilis
Chancroid
Herpes Genitalis
Causative Organisms:
BacteriumTreponemapallidum.
(Syphilis)
Bacteria Haemophilus ducreyi (Chancroid)
Herpes Simplex Virus (Herpes Genitalis)
Calymmatobacterium granulomatis (Granuloma Inguinale)
Chlamydia trachomatis (Lympho Granuloma Venerium) LGV
History
Genital ulcer/
vesicles
Burning sensation in
the genital region
Sexual exposure of
either partner including
high risk practices
like oro-genital sex
Examination
Presence of vesicles
Presence of genital ulcer,

single or multiple
Associated inguinal lymph

node swelling and if present
refer to espective flowchart
Ulcer characteristics:
Painful vesicles/ulcers, single
Treatment:
If vesicles or multiple painful ulcers are present treat for
herpes with Tab. Acyclovir 400mg orally, thrice a day for 7
days.
If vesicles are not seen and only ulcer is seen, treat for
syphilis and chancroid and counsel on herpes genitalis.
To cover syphilis give Inj. Benzathine penicillin 24 million
IUIM after Test daose in two divided doses (with
emergency tray ready) In patients allergic to Penecillin,
Syndrome specific
guidelines for partner
management
Treat all partners who are
in contact with client
during last 3 months
Partners should be treated
for Syphilis &chancroid
Advise Abstinence during
treatment
Provide condoms, educate
for correct & consistent use
Ref to ICTC for HIV
testing
Follow up after 7
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LGV
or multiple-Herpes simplex
Painless ulcer with shotty lymph
nodes - Syphilis
Painless ulcer with inguinal lymph
nodes - Granuloma inguinale and
LGV
Painful ulcer usually single sores Chancroid associated with painful
bubo
Lab
Investigations:
RPR Test
for Syphilis
Refer to
higher centre
for
further tests
Doxycycline 100mg BD for 14 days

Tab Azithromycin 1gm orally single dose OR Tab
Ciprofloxacin 500mg BD for 3 days to cover Chancroid.
Treatment should be extended to 7 days if ulcers have not
epithelialized i.e. formed a new layer of skin over the sore.
Refer to higher centre
If not responding to treatment
Genital ulcers coexist with HIV
Recurrent lesions
Management of Pregnant Women

Quinolones (like ofloxacin, ciprofloxacin), doxycycline, sulfonamides are contra indicated in
pregnant women.
Pregnant women who test positive for RPR should be considered infected unless adequate
treatment is documented in the medical records and sequential serologic antibody titers have declined.
InjBenzathine penicillin 2.4 million IU IM after test dose (with emergency tray ready).
A second dose of benzathine penicillin 2.4 million units IM should be administered 1 week after
the initial dose for women who have primary, secondary, or early latent syphilis.
Pregnant women who are allergic to penicillin should be treated withErythomycin and the neonate
should be treated for syphilis after delivery.
Tab. Erythromycin 500mg orally 4 times daily for 15days
(Note: Erythromycin estolate is contraindicated in pregnancy because of drug related hepatotoxicity.
Only Erythromycin base or erythromycin ethyl succinate should be used in pregnancy).
All pregnant women should be asked history of genital herpes and examined carefully for herpetic
lesions.
Women without symptoms or signs of genital herpes or its prodrome can deliver vaginally.
Women with genital herpetic lesions at the onset of labour should be delivered by caesarean
section to prevent neonatal herpes.
Acyclovir may be administered orally to pregnant women with first episode of genital herpes or
severe recurrent herpes.

Annexure 15 : STI Flow Chart for management of Vaginal Discharge
Vaginitis
Trichomoniasis
Causative Organisms Vaginitis

Trichomonasvaginalis(TV)
Candida albicans
Gardnerellavaginalis, Mycoplasma causing
bacterial vaginosis (BV)
History
Menstrual history to rule out
pregnancy
Nature and type of
discharge (amount, smell,
color, consistency)
Genital itching
Burning while passing urine,
increased frequency
Presence of any ulcer,
swelling on the vulval or
inguinal region
Genital complaints in sexual
partners
Low backache
Cervical Herpes
Causative Organisms Cervicitis

Neisseria gonorrheae
Trichomonasvaginalis
Herpes simplex virus
Examination
Per speculum examination to differentiate between
vaginitis and cervicitis.
a) Vaginitis:
Trichomoniasis-greenish frothy discharge
Candidiasis - curdy whitedischarge
Bacterial vaginosis adherentdischarge
Mixed infections may present with Atypical discharge with
fishy odour
b) Cervicitis:
Cervical erosion /cervical ulcer/ mucopurulent cervical
discharge
Bimanual pelvic examination to rule out pelvic
inflammatory disease
If speculum examination is not Possible or client is
hesitant, treat both for vaginitis and cervicitis
Treatment
Vaginitis (TV+BV+Candida)
Tab. Secnidazole 2 gm orally, single doseORTab. Tinidazole
500 mg orally, twice daily for 5 days
Tab. Metoclopropramide taken 30 minutes before Tab.
Secnidazole, to prevent gastric intolerance
Treat for candidiasis with Tab Fluconazole 150 mg orally
single dose OR
localClotrimazole500 mg vaginal pessaries once
Management in pregnant women

Per speculum examination should be done to rule out
pregnancy complications such as abortion, premature
rupture of membranes
Treatment for vaginitis (TV+BV+Candida)
In first trimester of pregnancy
Local treatment with Clotrimazole vaginalpessary/ cream only
for candidiasis. Oral Flucanozole is contraindicated in
pregnancy.
Metronidazole pessaries or cream intravaginally if
trichomoniasis or BV is suspected.
In second and third trimester, oral Metronidazole can
be given
Tab. Secnidazole 2 gm orally, single dose or
Tab. Tinidazole 500 mg orally, twice daily for 5days
Tab. Metoclopropramide taken 30 minutes before
Tab. Metronidazole, to prevent gastric intolerance

Cervicitis
Laboratoryinvestigations
(ifavailable)
Wet mount microscopy of
the discharge for
Trichomonas
vaginalisand clue cells
10% KOH preparation for
Candida albicans
Gram stain of vaginal
smear for
clue cells seen in
bacterialvaginosis
Gram stain of
endocervical smear
to detect gonococci
Treatment for cervical infection (chlamydia and gonorrhea)

Tab Cefixim 400 mg orally, single dose
PLUS Azithromnycin 1 gram, 1 hour before lunch. If
vomiting within 1 hour, give anti-emetic and repeat
o If vaginitis and cervicitis are present, treat for both
o Instruct client to avoid douching
o Pregnancy, diabetes, HIV may also be influencing factors
and should be considered in recurrent infections
o Follow up after one week
Specific guidelines for partnermanagement

Treat current partner only if no improvement after
initial treatment
If partner is symptomatic, treat client and partner
using above protocols
Advise sexual abstinence during the course of
treatment
Provide condoms, educate about correct and
consistent use
Schedule return visit after 7 days
Treat the partner/s of women with cervical
discharge for gonorrhoea and chlamydia
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Annexure 16 : STI Flow Chart for Management of Lower

Abdominal pain in females
Causative Organisms
Neisseria gonorrheae
Mycoplasma Gardnerella Anaerobic
bacteria(BacteroisSp, Gram positive cocci)
History
Lower abdominal pain
Fever
Vaginal discharge
Menstural irregularities
like heavy, irregular
vaginal bleeding
Dysmenorrhoea
Dyspareunia
Dysuria,tenesmus
Low backache
Contraceptive use like
IUD
Per Speculum examination: vaginal/ cervical

discharge, congestion or ulcers
Per abdominal examination: lower abdominal
tenderness or guarding
Pelvic examination: uterine/ adnexal
tenderness, cervical movement tenderness.
Note: A urine pregnancy test should be done
in all women suspected of having PID to
rule out ectopic pregnancy.
Treatment(out client treatment)

In mild or moderate PID(In the absence of Tubo ovarian abscess), out client
treatment can be given. Therapy is required to cover Neisseria
gonorrheaeChlamydia trachomatis and anerobes.
Tab. Cefixim 400 mg orally BD for 7 days Tab. Metronidazole 400 mg orally,
twice daily for 14 days
Doxycycline, 100 mg orally, twice a day for 2 weeks (to treat chlamydial
infection)
Tab. Ibuprofen 400 mg orally, three times a day for 3-5 days
Tab Ranitidine 150 mg orally, twice daily to prevent gastritis
Remove intra uterine device, if present, under antibiotic cover of 24-48 hours
Advise abstinence during course of treatment and educate on correct and
consistent use of condoms
Observe for 3 days. If no improvement (ie. Absence of fever, reduction in
abdominal tenderness, reduction in cervical movement, uterine tenderness) or
if symptoms worsen, refer for inClient treatment.
Caution PID can be a serious infection. Refer the client to the hospital if
she does not respond to treatment within 3 days and even earlier if her
condition worsens.
Management of Pregnant Women

Though PID is rare in pregnancy,
Any pregnant woman suspected to have PID should
be referred to district hospital for hospitalization and
treated with a parenteral regimen which would be
safe in pregnancy.
Doxycycline is contraindicated in pregnancy
Note: Metronidazole is generally not recommended

during the first three months of pregnancy. However,
it should not be withheld for a severely acute PID,
which represents an emergency.
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Laboratory Investigations
if available
Wet smear examination
Examination
General examination: Temperature, Pulse,
Blood pressure
Gram stain for gonorrhea

Complete Blood count & ESR
Urine microscopy for pus cell
Differential Diagnosis
Ectopic Pregnancy
Twisted Ovarian cyst
Ovarian tumor
Appendicitis
Abdominal tuberculosis
Syndrome specific guidelines for

partner management
Treat all partners in past 2 months
Treat male partners for urethral
discharge (gonorrhea and chlamydia)
Advise sexual abstinence during the
course of treatment
Provide condoms, educate on correct
and consistent use
Refer to voluntary counseling and
testing for HIV, Syphilis and
Hepatitis B
Inform about the complications if left
untreated and sequelae
Schedule return visit after 3days, 7
days and 14 days to ensure
compliance
Hospitalization of clients with acute PID should be seriously

considered when
The diagnosis is uncertain
Surgical emergencies eg. Appendicitis or ectopic pregnancy

cannot be excluded
A pelvic abscess is suspected
Severe illness precludes management on an out Client basis
The woman is pregnant
The client is unable to follow or tolerate an out Client

regimen
The client has failed to respond to out Client therapy.

Annexure 17 : STI Flow Chart for management of Oral & Anal

STIS
Causative Organisms
Neisseria gonorrhoeae
Treponema pallidum (syphilis)
History of
Unprotected oral sex
with
pharyngitis.
Unprotected anal sex
with anal discharge or
tenesmus, diarrhea,
blood in stool,
abdominal cramping,
nausea, bloating
Haemophilus ducreyi (chancroid)

Klebsiella granulomatis (granuloma
inguinale)
Herpes simplex (genital herpes)
Examination
Look for
Oral ulceration, redness, pharyngeal
inflammation
Genital or anorectal ulcers single or
multiple
Presence of vesicles
Rectal pus
Any other STI syndrome
(Do proctoscopy for rectal
examination if available)
Laboratory
Investigations
RPR/VDRL for syphilis
Gram stain examination
of rectal swab will
show gram negative
intracellular diplococcic
in case of gonorrhea.
Management of Oral /Anal STIs

Pharyngitis with history of unprotected oral sex
Or
Anal discharge, tenesmus bloating with history of
unprotected anal sex
Or
Rectal pus or bloating with history of
unprotected oral
Follow
flowchart
urethral discharge
syndrome and treat
accordingly
Any other STI syndrome

Genital or anorectal ulcers seen

Or
Vesicles seen or history of
recurrent vesicular eruptions
Follow flowchart
genital
ulcer
syndrome
Diarrhoea, blood in stools,

abdominal cramping, nausea,
bloating with history of
unprotected anal sex.
Tab. Azithromycin 1 gm
Tab. Cefixime 400 mg
(Follow urethral discharge syndrome flowchart)
Anti-diarrheal medicines as needed
&
Refer to higher facility
Refer to relevant STI Syndromic
flow chart
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Annexure 17 : STI Flow Chart for management of Oral & Anal

STIS
Causative Organism
Virus: Human Papilloma Virus (HPV)
Clinical Features
Single or multiple soft, painless, pink in colour, cauliflower like growths which appear around the
anus, vulvo-vaginal area, penis, urethra and peri-neum.
Warts could appear in other forms such as papules which may be keratinized.
Diagnosis
Presumptive diagnosis by history of exposure followed by signs and symptoms.
Differential diagnosis
i. Condyloma lata of syphilis
ii. Moluscum contagiousm
Treatment
Recommended regimens:
Penile and Perianal warts
20% Podophyllin in compound tincture of benzoin applied to the warts, while carefully
protecting the surrounding area with Vaseline, to be washed after 3 hours. It should not be used
on extensive areas per session.
Treatment should be repeated weekly till the lesions resolve completely.
Note: Podophyllin is contraindicated in pregnancy. Treatment should be given under medical
supervision. Client
Should be warned against self medication
Cervical warts
Podophyllin is contra-indicated.
Biopsy of warts to rule out malignant change.
Cryo cauterization is the treatment of choice.
Cervical cytology should be done in the sexual partner(s) of men with genital warts.
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Annexure 18 : Management of Molluscum and Ectoparasitic

infestation
Causative Organism
Pox virus
Clinical features
Multiple, smooth, glistening, globular papules of carrying size from a
pinhead to a split pea can appear anywhere on the body. Sexually
transmitted lesions on or around genitals can be seen. The lesions are not
painful except when secondary infection sets in. When the lesions are
squeezed, a cheesy material comes out.
Diagnosis
Diagnosis is based on the above clinical features.
Treatment
Individual lesions usually regress without treatment in 9-12 months.
Each lesion should be thoroughly opened with a fine needle or scalpel. The contents should be exposed
and the inner wall touched with 25% phenol solution or 30% trichloracetic acid.
Pediculosis pubis
Causative Organism
Lice-Phthirus pubis
Clinical features
There may be small red papules with a tiny central clot caused by lice irritation.
General or local urticaria with skin thickening may or may not be present.
Treatment
Recommended regimen:
Permethrin 1% crme rinse applied to affected areas and wash off after 10 minutes
Special instructions
Retreatment is indicated after 7 days if lice are found or eggs observed at the hair-skin junction.
Clothing or bed linen that may have been contaminated by the client should be washed and well dried
or dry cleaned.
Sexual partner must also be treated along the same lines.

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infestation
Scabies
Causative Organism
Mite-Sarcoptes Scabiei
Clinical features
Severe pruritis (itching) is experienced by the client which becomes worse at night.
Other members of family also affected (apart from sexual transmission to the partner,
other members may get infected through contact with infected clothes, linen or
towels).
Complications
Eczematization with or without secondary infection
Urticaria
Glomerulonephritis
Contact dermatitis to antiscabetic drug
Diagnosis
The burrow is the diagnostic sign. It can be seen as a slightly elevated grayish dotted line in the skin, best seen in the
soft part of the skin.
Treatment
Recommended regimens:
Permethrin cream (5%) applied to all areas of the body from the neck down and washed off after 8 to 14 hours
Benzyl benzoate 25% lotion, to be applied all over the body, below the neck, after a bath, for two consecutive nights.
Client should
bathe in the morning, and have a change of clothing. Bed linen is to be disinfected.
Special instructions
Clothing or bed linen that have been used by the client should be thoroughly washed and well dried or dry cleaned.
Sexual partner must also be treated along the same lines at the same time.
Partner management
Timely partner management serves following purpose:
Prevention of re-infection
Prevention of transmission from infected partners and
Help in detection of asymptomatic individuals, who do not seek treatment.
Critical issues on partner management
Confidentiality Partners should be assured of confidentiality. Many times partners do not seek services, as they
perceive confidentiality as a serious problem. Respecting dignity of client and ensuring confidentiality will promote
partner management.
Voluntary reporting Providers must not impose any pre-conditions giving treatment to the index client. Providers may
need to counsel client several times to emphasize the importance of client initiated referral of the partners.
Client initiated partner management Providers should understand that because of prevailing gender inequalities,
women may not be in a position always to communicate to their partners regarding need for partner management. Such
client imitated partner management may not work in some relationships and may also put women at the risk of
violence. Hence alternative approaches should be considered in such situations.
Availability of services RTI/STI diagnostic and treatment services should be available to all partners. This may mean
finding ways to avoid long waiting times. This is important because many asymptomatic partners are reluctant to wait
or pay for services when they feel healthy.
Approaches for partner management
Date:
There are two approaches to partner management:
Please attend the following centers along
i. Referral by index client
with the card
In this approach, index client informs the partner/s of possible infection.
This appears to be a feasible approach, because it does not involve extra
Stamp of the Facility
personnel, is inexpensive and does not require any identification of partners.
Timings:
A partner notification card with relevant diagnostic code should be given
Diagnostic Code:
to each index client where partner management is indicated. This approach
may also include use of client initiated therapy for all contacts.
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infestation
ii. Referral by providers
In this approach, service provider contacts clients partners through issuing appropriate partner notification card. This
information provided by the client is used confidentially to trace and contact partners directly. This approach needs
extra staff and is expensive
Coupon for a free examination
General principles for partner management
In general, partners should be treated for the same STI as the index xlient,
whether or not they have symptoms or signs of infection.
Health care providers should be as sure as possible about the presence of an STI before informing and treating the
partner, and should remember that other explanations are possible for most RTI symptoms like vaginal discharge.
Special care is required in notifying partners of women with lower abdominal pain who are being treated for possible
pelvic inflammatory disease. Because of the serious potential complications of PID (infertility, ectopic pregnancy),
partners should be treated to prevent possible re-infection. It should be recognized, however, that the diagnosis of PID
on clinical grounds is inaccurate, and the couple should be adequately counseled about this uncertainty. It is usually
better to offer treatment as a precaution to preserve future fertility than to mislabel someone as having an STI when
they may not have one.
Follow up visits
Follow up visits should be advised
To see reports of tests done for HIV, Syphilis and Hepatitis B.
If symptoms persist, advise clients to come back for follow up after 7 days. In case of PED, follow up should be done
after 2 to 3
days. Management of treatment failure and re infection
When clients with RTI/STI do not respond to treatment, it is usually because of either treatment failure or re-infection.
Ask the following questions to ascertain the cause:
To probe treatment failure
Did you take all your medicines as directed
Did you share your medicines with anyone, or stop taking medicines after feeling some improvement
Was treatment based on the national treatment guidelines. Also consider the possibility of drug resistance if cases of
treatment failure are showing an increasing trend.
To probe for re infection
Did your partner(s) come for treatment
Did you use condoms or abstain from sex after starting treatment
For treatment failure
All cases of treatment failure should be referred to higher health facility.
For re infection
Consider re-treatment with same antibiotics.
Refer to higher health facility if symptoms persist.
Screening for Asymptomatic Clients
It is well known that most RTIs/STIs are asymptomatic, especially amongst the women. The case finding is a process
of opportunistic screening at the time when an individual presents to a health facility, regardless of presence of symptoms.
Case findings opportunities are most commonly seen while providing services for contraception. Providers should use
opportunities for potential contraceptive clients to screen for RTIs/STIs. The National Guidelines for IUD, Oral Pills,
National Sterilization Services provide detailed guidelines regarding screening of RTIs/STIs.
Similar opportunities exist in pregnancy care settings. Most common screening programmes worldwide are those for
detecting syphilis in pregnant women. Untreated syphilis in pregnant female is associated with number of adverse
outcomes such as pregnancy loss, stillbirths and congenital syphilis. Providers are recommended to follow Government
of Indias following guidelines while providing services to pregnant women:
1. Guidelines for Pregnancy Care and Management of Common Obstetric Complications by Medical Officers, 2005.
2. Guidelines for Ante-Natal Care and Skilled Attendance at Birth by ANMs and LHVs, 2006.

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Annexure 19 : STI Flowchart-Management of Ophthalmic

Neonatorum
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Annexure 20 : Guide to Common Symptoms and Possible

Aetiologies
Symptoms
Requiring
Attention
Possible Aetiologies
Dyspnoea
Pulmonary infection (e.g., Pneumonia-bacterial or fungal)

Invasive Pulmonary disease (e.g. Pulmonary)
Obstructive Airway Disease, Emphysema
Severe anaemia
New Fever or
Change in
Fever Pattern
Central nervous system (CNS) mass lesion-often accompanied by Headache

Meningitis
Sinusitis
Oesophagitis
Lymphoma
Fungal infections-often caused by characterized by Hepatomegaly;
If respiratory, characterized by Cough
Mycobacterium Avium Complex (MAC) - often accompanied by chronic
Diarrhoea and Abdominal pain
Bacterial parasites - Clostridium difficile, cytomegalovirus (CMV),
accompanied by Diarrhoea
Pneumonia - often accompanied by Dyspnoea , Tuberculosis - often
accompanied by Dyspnoea
Pneumocystis - often accompanied by cough
Drug reactions
Advanced HIV disease
New or Persistent
Headache
Medications
CNS lymphoma
Cryptococcus Meningitis, Toxoplasmosis
Altered Mental State
AIDS dementia
Complex CNS infection
Tumours
Seizures or Loss
of Consciousness
CNS lymphoma
Medications
AIDS dementia
Toxoplasmosis
Peripheral
Neuropathy
Medications
HIV infection
CMV
Herpes Zoster
Visual Changes
CMV retinitis (most common)

VZV, HSV, Toxoplasmosis
Syphilis
New or Persistent
Diarrhoea
Medications, Diet
Bacterial infections - Salmonella, Shigella, Campylobacter, C. difficile
Invasive diseases affecting the bowel - M. avium- intracellular, lymphoma,
CMV, Wasting syndrome

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Symptoms
Requiring
Attention
Possible Aetiologies
Gastrointestinal
Bleeding
Herpes simplex, CMV, Candidiasis

Kaposis sarcoma, Lymphoma
Cryptosporidium
Salmonella, C. difficile
Dysphagia and
Odynophagia
Candidiasis
Herpes simplex
CMV
Neurologic impairment
Oedema
Obstruction of venous or lymphatic vessels (e.g., from Kaposis sarcoma,

venous thrombosis, lymphoma)
Hypoalbuminemia
Renal failure, Congestive heart failure
Liver disease
Nauseous and
Vomiting
Medications
Infections, Massive disease of GI tract
CNS disease
Adrenal insufficiency
Inadequate
Oral Intake
Anorexia
Nauseous and vomiting
Dysphagia
Odynophagia
Inadequate access to food
Altered nutrition
Skin, Mucous
Membrane lesions
Drug reactions
Dry skin
Viral infections - Molluscum, herpes simplex or zoster
Bacterial infections - Bacillary angiomatosis, folliculitis, Impetigo, ecthyma,
abscesses
Fungal infections - Tinea, candida
Malignancy - Kaposis sarcoma
Pressure ulcers
Source: Adapted from Kirton, C. Talotto, D. & Zwolski, K. (2001) Handbook of HIV/AIDS Nursing
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Annexure 21 : What a Nurse needs to know about Dementia

and Delirium
Dementia
Definition:
An organic mental disorder characterised by loss of intellectual abilities of sufficient severity to interfere with
social or occupational functioning. HIV-associated dementia is known as AIDS Dementia Complex (ADC)
Patients may present with ambulation/gait problems, mania, panic, psychosis, withdrawal or anxiety. Dementia
is progressive with a variable course. Patients with HIV-related dementia are often acutely aware of their
deterioration, which may lead to an adjustment disorder with profound fear, anxiety or depression.
Aetiology
HIV associated dementia HIV directly invades the brain tissue shortly after infection-was the most frequently
seen single neurologic complication of AIDS before the HAART era in the U.S.
Drug withdrawal
Pain
Clinical Manifestations of Dementia
Early manifestations:
Memory loss, Impaired concentration

Depressed mood, Apathy
Motor weakness, Tremor, poor handwriting
Irritability, Agitation
Personality change
Late manifestations:
Global Cognitive Dysfunction

Amnesiac features
Organic Hallucinations
Parkinsonism
Vegetative state
Mutism, Aphasia, Spasticity, Ataxia
Assessment
Screening tool for Dementia

Thorough physical examination to determine potential reversible causes:
Toxoplasmosis, Cryptococcoma, MAI, Lymphoma, CMV ventriculitis or Encephalitis, or Meningitis
associated with Syphilis, TB, or Cryptococcus Neoformans.
Neurologic Exam
CT scan or MRI to check for Cortical Atrophy, Ventricular Enlargement, or Masses
Labs: Thyroid function, RPR, LFTs, Bio-chemistry, Haemogram
Nursing Interventions
Educate patient and family.

Teach behavioural management strategies so patient with early manifestations of dementia can live
with some degree of independence, yet be safe in the home environment. (E.g. establishing a daily
routine and sticking to it).
Memory aids such as Notes, Calendars, Alarm Clocks, etc

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Referral to Home care Agency, may need 24 hour supervision

Because disease is frightening and may be progressive, the patient and family need assistance to plan
for the future.
Pharmacologic: ART, SSRI for Depression, Anti-psychotics for agitation and Hallucinations
Delirium
Definition:
Characterized by disturbance of consciousness and a change in cognition that develops over a period of
time and is caused by the direct physiologic consequences of a medical condition. Delirium is the most
common neuron-psychiatric complication in hospitalised AIDS patients.
Risk factors for Delirium in AIDS patients:
Advanced stage of immuno-suppression

History of OIs, especially affecting CNS
Substance use
Head or brain injury
Episodes of delirium or dementia
Aetiology May be single or multiple

Infectious: Cryptococcal or Toxoplasmosis Encephalitis
Assessment
Sudden change in mental status

Level of alertness may vary from agitation to lethargy, stupor or coma. Patients are usually drowsy and
may require repeated explanations from caregivers and examiners. Early signs of delirium may be
inaccurately attributed to anxiety.
Abrupt disturbances in sleep patterns or changes in level of activity should raise suspicion.
Interview caregiver and observe patient to assess functional status
Clinical Manifestations
Impaired memory, orientation: difficulty with abstractions, difficulty with sequential thinking, impaired
temporal memory, impaired judgment
Disturbances in thought and language with decreased verbal frequency
Disturbances in perception: visual hallucinations, paranoid delusions
Disturbances in psychomotor function: hypoactive, hyperactive or mixed
Disturbances in sleep-wake cycle with daytime lethargy, night time agitation
Affective lability: rapidly changes from one emotional state to another
Neurologic abnormalities: Tremors, Myoclonus, Nystagmus, Ataxia, Cranial Nerve Palsies, and Cerebellar
signs
Nursing Interventions
Address underlying condition such as metabolic abnormalities, sepsis, anaemia, CNS infections and
Malignancies, Antiretroviral therapy, Opioids, and Illicit substance use
Provide safe and consistent environment and increase supervision of patient as indicated
Communicate in clear simple terms to avoid misconceptions
Educate patient and family regarding care and procedures, medications, expected outcomes, and need
to orient patient to person, time, place, and situation
Ensure patients activities of daily living are met
Pharmacologic: Low doses of Neuroleptics (Haldol or Risperdal) to treat confusion or agitation
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Annexure 22: Comprehensive Laboratory Evaluation in

HIV/AIDS
The purpose of the baseline laboratory evaluation is to 1) stage the HIV disease, 2) rule out concomitant
infections and 3) determine baseline safety parameters. The following tests are recommended
Essential
Optional
Confirm HIV infection: HIV status must be

documented. Refer to ICTC if in doubt.
Fasting lipid profile: May be recommended

in patients with established coronary disease
risk factors or if Stavudine, Efavirenz, Protease
Inhibitor (PI) use is contemplated.
Specific investigations to rule out OIs

depending on the clinical need
Pregnancy test: EFV is contraindicated in

pregnancy
CD4 counts: all patients should have a

baseline screening
Anti-HCV Screening: The prevalence of HCV is

low in HIV infected patients except, such as in
north-eastern states of India where injection drug
use is a risk factor. It is also recommended in
HIV infected haemophiliacs and thalassaemics.
CBC: Hb, TLC, DLC, ESR, GBP
Chest X-ray : To rule out TB or other pulmonary

infection
LFTs: Necessary to find evidence of hepatitis,

particularly when NVP use is contemplated.
Plasma viral load (PVL): A baseline PVL may

not be necessary. With optimum adherence and
a potent regimen, undetectable levels at 6 months
after ART initiation should be achieved.
Urine routine: To evaluate proteinuria and

sugar (necessitate estimation of blood glucose)
HBsAg: To rule out concomitant hepatitis B
infection as this can influence choice of ARV
regimen. Additionally, abrupt stopping of anti-HBV
drugs like Lamivudine and Tenofovir is not
recommended in patients with chronic Hepatitis B
co-infection since it may result in Hepatitis B
flare-up. This screening is mandatory for IDUs
and transfusion-associated HIV infection
HCV screening: mandatory for IDU and
transfusion- associated HIV infection
VDRL/TPHA (syphilis screening): especially
with persons of high risk behaviour group, history
of STIs and/or suggestive symptoms of syphilis
Pap smear : Helps in earlier diagnosis of
cervical intraepithelial neoplasia (CIN)

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Annexure 23 (a): Diagnosis of HIV Infection in Infants/

Children below 18 months
Diagnosis of HIV status in infants/children is very important in order to plan their care, support and treatment.
HIV DNA-PCR would provide testing for HIV-exposed infants and children < 18 months. Serology for HIV
antibodies, which is the gold standard for diagnosis in adults cannot be used for children below 18 months
due to false positive results because of presence of maternal HIV antibodies in the infants blood which
cross react.
In order to establish if the infant/child has acquired HIV infection, the DNA of the virus has to be detected
in the infants blood through the Polymerase Chain Reaction (PCR). The test specimen for DNA PCR can
be collected in two ways:
1. Dried Blood Spot (DBS): Infant/childs blood is collected on filter paper by heel/finger/ toe prick and
this specimen is sent to the laboratory, where the DNA PCR test is performed.
2. Whole Blood (WB): Infant/childs blood is collected in a microtainer/vacutainer and this specimen is
sent within a few hours to the laboratory where the actual DNA PCR test is performed.
Plan for HIV diagnosis among HIV exposed infants/children below 18 months
In infants between 6 weeks to 6 months of age:
Perform DNA PCR on DBS specimen collected at ICTC
If DNA PCR shows not detected follow up at ICTC

If DNA PCR shows detected refer to ART Centre for testing on WB specimen
Perform DNA PCR on WB specimen at ART Centre
If DNA detected on WB specimen at ART Centre, register and follow up at the ART Centre as per national
paediatric ART guidelines
If DNA not detected on the WB specimen at ART Centre, collect fresh WB specimen
Use the result of this specimen for further management
In infants/children between 6 months to 18 months of age:

Perform antibody test at ICTC
If antibody test is negative, follow up at ICTC.

If antibody test is positive proceed for DNA PCR
Perform DNA PCR on DBS specimen collected at ICTC if antibody test is positive
If DNA PCR not detected on DBS follow up at ICTC

If DNA PCR detected refer to ART Centre
Perform DNA PCR on WB specimen at ART Centre
If DNA detected on WB specimen at ART Centre, register and follow up at the ART Centre as per national
paediatric ART guidelines.
If DNA not detected on the WB specimen at ART Centre, collect fresh WB specimen.
Use the result of this specimen for further management

The HIV DNA-PCR results will be communicated from the reference lab to ICTC/ART collection centre
whichever applicable
Infants/children showing uninfected must continue to be followed up at the ICTC till 18 months as
per algorithm
Ensure definitive diagnosis of all infants/children by antibody tests at 18 months
All 3 antibody tests are to be used at 18 months for confirmatory HIV diagnosis, irrespective of the
first test results
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Section Four: Annexure-23(a)
Annexure 23(b) : Specimen Collection (by heel prick) and

handling procedure for HIV DNA PCR testing by
Dried Blood Spot (DBS) sample collection
Introduction
Pediatric HIV infection is an evolving entity and continues to be a challenge for the medical community. The
standard diagnostic tool for HIV infection in adults, testing for antibodies to HIV antigens, has limited utility
in infants less than 18 months of age because of the transplacental transfer of maternal antibodies. An
essential priority in caring for HIV-infected children is accurate and early diagnosis of HIV.
The diagnosis of HIV in infants under eighteen months of age must therefore be conducted by direct
detection of the virus-specific genetic material. The assay can be conducted successfully on DBS specimens.
Use of DBS facilitates access to DNA PCR testing given its high sample stability and low biohazard, which
facilitate sample handling and transport from the clinic to the laboratory. This sample type, which can be
taken from a heel prick, requires a reasonably small amount of blood and is therefore well suited for routine
testing in infants, where blood volumes are small and blood draws are challenging. The use of DBS with
this assay is a strong advantage and is the preferred method of sample collection.
This describes a procedure for collection, packaging and transport of a dried blood spot (DBS) sample from
an infant below 18 months of age. A correct performance of the DBS collection using the aseptic technique
is critical to ensure the safety of the procedure and to assure the quality of the test results obtained thereof.
An optimal sample collection also contributes significantly to the comfort and satisfaction of the donors thus
encouraging retesting as and when required
Dried blood spots (DBS) should be made only by nursing personnel who have been appropriately trained
in both the making of dried blood spots and in universal blood and fluid precautions
Material Required
Sterile disposable Lancet with tip less than 2.4mm

Sterile Alcohol preparation ( 70% isopropanolol)
Sterile Gauze pad
Soft cloth
Blood collection form
DBS card[ specially formulated commercially available absorbent filter paper( Schleicher & Schuell 903
or Whatman BFC 180); (do not use ordinary filter paper)]
Gloves( powderless)
Discard jar with 5% Sodium Hypochlorite

Section Four: Annexure-23(b)
Facilitator Guide
Page 377
Preparation
Observe Universal Precautions at all times by wearing gloves, lab coat and safety glasses.
Put down a clean paper towel.
Lay out all the supplies you will need
Method
1. Obtain proper written informed consent from the parent/ guardian with appropriate
pre test counselling
2. Complete ALL information on the collection/ test requisition form. Write patient identification
information on a new clean filter paper card
3. Select the
appropriate site for
puncture. Hatched
area indicates safe
areas for puncture
site.
4. Warm site with

soft cloth, moistened
with warm water
up to 41C, for
three to five
minutes.
5. Cleanse site with

alcohol preparation.
Wipe DRY with
sterile gauze pad.
6. Puncture heel. Wipe

away first blood drop
with sterile gauze pad.
Allow another LARGE
blood drop to form.
Discard the lancet
safely into the discard
jar for sharps containing
5% freshly prepared
sodium Hypochlorite solution
7. Lightly touch filter paper

8. Fill remaining circles in
to LARGE blood drop.
the same manner as
Allow blood to soak
step 7, with successive
through and completely
blood drops. If blood
fill circle with SINGLE
flow is diminished,
application to LARGE
repeat steps 5 through
blood drop.
7. Once the required
(To enhance blood
amount of sample has
flow, VERY GENTLE
been collected,
intermittent pressure
pressure must be
may be applied to area
applied gently at the
surrounding puncture site). Apply blood to one
puncture site with a sterile gauze ensure
side of filter paper only (the side with printing).
that there is no further bleeding from the
Do not contaminate filter paper circles by
site following which the skin puncture site
allowing the circles to come in contact with
should be dressed and protected with an
spillage or by touching before or after
occlusive bandage.
blood collection
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9. Dry blood spots on a dry, clean, flat non-absorbent

surface for a minimum of four hours. Avoid touching
the part of the card where blood has been applied
to see of the blood has dried. As the blood dries
on the filter paper it will change from a bright red
color to a darker red-brown color, also the paper
will buckle slightly. Once dry, send completed form
to testing laboratory within 24 hours of collection
10. This figure below shows how an acceptable good quality DBS should appear. ID information
should be placed on the card. Each printed circle should have been filled with blood
Acceptable Sample
11. A figure demonstrating an unacceptable sample is also shown below.

Unacceptable Sample
Documentation
Document and maintain all consent forms

All necessary documentation and pertinent information of every sample collected and dispatched to the
lab for testing must be made in the designated register / computer
All samples sent to the lab for testing must be accompanied by the test requisition forms and a compiled
delivery checklist that carries a list and pertinent information of all the samples being dispatched from
the collection site to the testing laboratory
Record of failed attempts at taking a heel prick sample must be recorded .
Packaging and transport of samples to the testing laboratory

Material Required
Plastic ziplock storage packs

Dessicant packs
Humidity indicators
Biohazard labels
Glassine paper
Paper envelopes
Padded envelopes
Stapler
Gloves( powderless)

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Preparation
Observe Universal Precautions at all times by wearing gloves and lab coat .
Lay out all the supplies you will need
Ensure that all the DBS samples are of acceptable quality and well dried
Method
Packaging and storing DBS
1. When packaging DBS into zip lock bags,
separate each card with a sheet of
weight/glassine paper.
2. You can store up to 15 cards in a single

zip-lock bag.
3. Place DBS cards inside the storage

bag gently
4. Add 5-10 Silica packets per zip-lock bag and

push the Silica packets to the bottom of the bag.
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5.
Add a humidity indicator card.

Push as much air out of the bag as possible.
Double check that the bag is sealed completely.
Apply a Biohazard sticker to the outside of this
zip lock bag
If refrigeration is available use this to store DBS or
send it to testing Lab.
When ever possible avoid exposing the DBS to sunlight
and high temperatures (try to avoid leaving DBS in
your vehicle in the hot sun). If storage is being done
store the entire package of samples in a refrigerator
(4C) or freezer (-20C).
Transportation
1. Place the zip-lock bag containing the DBS
inside an envelope.
2.
Place the previous envelope inside a padded labelled
envelope to avoid damage to the DBS during postage/
courier transportation.
Place the test requisition forms and the compiled
delivery checklist in a separate zip lock bag and
place it in this padded envelope
Staple the envelope shut.
Place another biohazard sticker on the side carrying
the address of the testing site
3. Use a reliable and tested courier/ mailing system for transportation of the sample packages

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Annexure 24 : Monitoring and follow up patients on ART Recommendations in the National Programme
Day 0
(baseline)
Before or at
start of ART
At
15 days
At 1
month
At 2
month
At
3 month
Every
6 month
Clinical and
adherence
counselling
Weight
Hb

(if on AZT) (if on AZT)
ALT*

(if on NVP) (if on NVP)
*
*
Urinalysis

(if on TDF)
Lipid profile

(if on EFV
and PI)

(if on d4T,
EFV or PI)
Random
Blood sugar

(if on PI)
CD4
Pregnancy
testing for
women with
pregnancy
potential

(if planning
for EFV)
Plasma Viral
Load**
As needed
(symptomDirected)
Notes:
* For HBV and/or HCV co-infected patients, 3-monthly screening of Liver Function is recommended.
** Plasma Viral Load (PVL): The national programme does recommend routine viral load monitoring as part
of the programme. Viral load measurement is not recommended for decision-making on initiation or regular
monitoring of ART in resource-limited settings (WHO 2006). It may be considered for making diagnosis of
early treatment failure or to assess discordant clinical and CD4 findings in patients suspected of failing ART.
Scheduled follow up during the initial months of ART is necessary to diagnose and efficiently manage acute
adverse events, work with the patient on adherence issues, and diagnose clinical conditions like IRS and
new episodes of OIs.
Estimation of CD4 count for patients receiving ART:
Is recommended at 6 months to document immunological improvement on ART. After initiation of a NVP
based regimen, ALT measurement is recommended in the first month to detect drug-induced Hepatitis. With
an AZT- based regimen, it is important to monitor CBC for earlier detection of Haematological Toxicity. The
Facilitator Guide
Page 382

prevalence of Lipid abnormalities is significant on ART, particularly if a patient is on d4T, EFV or Lipid PIs.
In these patients and in patients with significant risk factors for Coronary Artery Disease a fasting lipid
profile should be done at 6 months, otherwise yearly estimations suffice. Random Blood sugar (RBS) is
recommended in the baseline screening of all patients to be started on ART, as currently one of the major
causes of morbidity in India is diabetes and hence screening should be done for pre-morbid status.
Questions to be asked During History Taking
History taking
2
weeks
3rd
months
6th
months
9th
months
Every 3-6
months
thereafter
HIV related diseases

incl. TB
Cough > 2 weeks
Fever
Weight loss
Diarrhoea
Other symptoms
as GI,CNS,
neurology, skin rash
Other medicationstaken

1st
month
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Page 383
Annexure 25 : 4 Prong NACO PPTCT Strategies

Prong 1 of the PPTCT Strategy: Primary prevention of HIV infection
This prong focuses on the parents-to-be. HIV infection cannot be passed on to children if their parents are not
infected with HIV. This consists of promoting safer and responsible sexual behaviours which include, where
appropriate, delaying the onset of sexual activity, practising sexual abstinence, reducing the number of sexual
partners and using condoms. The strategies here include condom provision, early diagnosis and treatment of
STIs, HIV counselling and testing , and suitable counselling for the uninfected so that they remain HIV negative.
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Prong 2 of the PPTCT Strategy: Prevention of unintended pregnancies among HIV-infected women
This prong looks at the family planning needs of the HIV infected women. With appropriate support, women
who are aware of being sero-positive can plan their pregnancy and therefore reduce the possibility of passing
the virusto their future children. They can also take measures to protect their own health. The strategies here
include high-quality reproductive health counselling and providing effective family planning measures such as
effective contraception, and early and safe abortion in case the womandecides to end the pregnancy. At the
ICTC, post-test counselling should cover this information if the client is in a position to absorb it, namely inform
sero-positive clients that they are capable of transmitting the HIV to others including their spouses and in the
case of women, to the children theymight bear. They should be informed that a counselling personnel can
explain to them how to reduce the risk of transmission and invite them to come back for more information
whenever they feel the need.

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Prong 3 of the PPTCT Strategy: Prevention of HIV transmission from HIV-infected women to their
infants
Specific interventions to reduce transmission from a woman living with HIV to her child include HIV counselling
and testing, ARV prophylaxis and treatment, safe delivery practices, and safer infant feeding practices.
Specifically this involves:
Decreasing viral load Monitoring and treating infections

Supporting optimal nutrition
Avoiding premature rupture of membrane and invasive delivery techniques
Treating infections such as STIs
Promoting safer infant feeding
When an ARV drug is given to prevent transmission from the mother to the infant, it is referred to as ARV
prophylaxis. This is different from ARV treatment for the mother the mother which is used to treat her HIV
disease.
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Prong 4 of the PPTCT Strategy: Provision of care and support to HIV-infected women, their infants and
their families
Medical care and social support are necessary to help the woman living with HIV to address and manage her
worries about her own health and that of her family. If she is assured of receiving adequate care for herself and
her loved ones, she is more likely to undergo HIV testing, and also adhere to the treatment.
The service elements here include prevention and treatment of OIs, ARV treatment, palliative (pain-reducing)
and non-ARV care, nutritional support, reproductive health care and psychosocial support.
Thus, a comprehensive PPTCT programme provides a continuum of care for the mother and the child. The
continuum begins with educating adolescent women about primary prevention of infection and continues
through treatment, care and support to HIV-positive women and families. It ensures that women receive education
and services to reduce the risk of mother-to-child-transmission throughout pregnancy, labour and childbirth,
and infant feeding. It also provides support for both mother and child, especially during the crucial years of
childhood growth and development. This comprehensive approach ultimately provides linkages to existing
community services to address the complex needs and issues involved in HIV prevention, treatment and
management.
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Annexure 26 : PPTCT True or False Statements and Answers

1. Pregnancy makes HIV disease worse.
False - Pregnancy does not accelerate the progression of HIV disease.
2. HIV-infected sperm can directly infect the infant even if the mother does not have HIV infection.
False- Although there is HIV in male semen, there is no HIV in the sperm. Therefore, the mother could get
HIV infection from the male semen but the foetus could not get HIV infection from the males sperm. The
foetus can only acquire HIV infection from exposure to the mothers blood or vaginal/cervical secretions
during pregnancy, birth, or breast milk during breast feeding. Remember that about 70% of time, the foetus
will not get HIV infection at all.
3. If a woman is HIV+, there are medications she can take to reduce the likelihood of passing the
virus to her infant
True- If a woman is HIV+, she can be prescribed ART depending on clinical criteria either during her
pregnancy. She should be given ART during labour, and the baby must be given ART within 72 hours of
birth. Details of ART to prevent mother to child transmission will be dealt with in this unit. If she is on ART
and her viral load is suppressed, her risk of transmission is very low, about 1 or 2%
4. If both parents are HIV +, using condoms during pregnancy isnt necessary
False - One partner may transmit a resistant virus to the other through sexual intercourse so it is essential
that the couple practice safe sex with use of condoms.
5. If a woman is HIV positive, all her babies will be HIV-infected because they share the same
blood.
False - The mother and baby do not share the same blood. The mothers blood is filtered by the placenta
so the baby gets oxygen and nutrients without exchange of blood. The baby can only become infected if
she/he is exposed to the mothers blood. This may happen from an infection in the placenta, a maternal
abruption or abdominal trauma causing bleeding into the amniotic sac, or during birth. It is also important
to note that even with exposure to the mothers blood during pregnancy and birth, there is only about a
30% chance of the baby becoming infected.
6. Procedures during delivery that may cause exposure of the newborn to maternal body fluids
should be avoided whenever possible
True - This includes artificial rupture of membranes, forceps or vacuum delivery, episiotomy, or vigorous
suctioning of the infant.
7. If an HIV positive woman has a Caesarean section (C/S), her risk of having a baby with HIV
is 0%.
False - Although in some cases, when the womans virus is not suppressed or she has advanced HIV
disease, a C/S may reduce the risk of infection, it will never reduce it to 0%. The actual risk depends on
the severity of disease and the actual viral load. When a woman is on ART and her viral load is fully
suppressed, there does not appear to be an advantage to C/S. Also, there is a higher risk of maternal
infection and mortality with C/s and the higher cost to consider.
8. Giving Nevirapine to babies after they are born is like giving a nurse post-exposure prophylaxis
after a needlestick injury.
True. Giving Nevirapine is like giving PEP to a nurse after a needle stick injury.
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Annexure 27 : PPTCT: Three Safe Infant Feeding Options

Some Important Points You Could Keep In Mind When
Counselling Mothers On Feeding Options
Advantages
No Breastfeeding
at all Providing
Cows/Tinned milk
Breastfeed Exclusively
For 6 Months
Stopping Abruptly
Switching to
Weaning Foods
Breast milk increases

PTCT risk by up to 20%.
Not breastfeeding at
all eliminates this risk
completely
Breastfeeding provides infants with optimal nutrition,

reduces morbidity and mortality associated with
infections other than HIV, and delays the mothers
return to fertility.
Baby would have received all the anti-infective
available in breast milk
Bonding between the mother and baby is better
The babys gut is safe from any mucosal injury
reducing the chance of infection
It is economical and considerably more safe to breast
feed than to bottle or spoon feed the baby
At 6 months of age, breast milk alone may not be
enough to meet the nutritional needs of the baby,
hence complementary or weaning foods could be
introduced
Disadvantages Infant gets no colostrum

It is an expensive option
In India the chance of
baby dying due to
gastroenteritis (because
of poor hygienic
practices, ignorance of
mother about sterilizing
feeding bottles, etc.)
is higher than it dying
of HIV!
Risk of over dilution of
formula could result in
malnutrition of the baby
Microscopic mucosal
injury of the gut is very
high with formula feeds
Social stigma if mother
does not breastfeed

Baby is exposed to
virus in breast milk
Colostrum along with
its advantages is also
considered to be
highly infectious
Continue breastfeeding
if at 6 months
replacement feed is not
acceptable, affordable,
feasible, safe and
sustainable with
complementary foods
Baby is exposed to virus

in breast milk
Colostrum along with its
advantages is also
considered to be highly
infectious
The longer the duration
of the breast feeding
the higher the risk of
transmission
Facilitator Guide
Page 389
No Breastfeeding
at all Providing
Cows/Tinned milk
Breastfeed Exclusively
For 6 Months
Stopping Abruptly
Switching to
Weaning Foods
Continue breastfeeding
if at 6 months
replacement feed is not
acceptable, affordable,
feasible, safe and
sustainable with
complementary foods
What to
Assess to
Help Mother
Decide Option
Formula feeding will be

acceptable
affordable
feasible
safe
sustainable
Formula feed is
considered to be
expensive
unsustainable over
the long term
unsafe
cause for social
problems
risk for mixed feeds
unacceptable
All under second option

plus
If socio-economic
situation is such that
safe and sustainable
exclusive alternate feeds
cannot be provided
even after 6 months
Additional
Information
to Provide
to Mothers
Why never to give

mixed feeding.
With formula feeds
microscopic mucosal
injury to gut is high
If mixed feeds (i.e.
breast milk and other
milk such as cows
milk) are given the
chance of HIV to enter
the increases risk of
HIV transmission.
Infant feeding hygiene.
Preparation of formula
milk
References to NGOs/
support centres which
may provide free/
subsidized alternate
feeds
Teach mothers how to express breast milk and give

it safely if there is risk for cracked nipples, mastitis
that could increase the risk of HIV transmission
Reinforce feeding hygiene if expressed breast
milk is given
Good breast feeding practices: position of the mother
and the baby as well as breast hygiene
How to stop breast-feeding abruptly - it is important
if mother has been feeding directly to teach mother
how to express breast milk at least two weeks
before stopping abruptly.
Baby gets used to feeding with a cup/spoon/ palada
Amount of breast milk supply reduces
To practice safer sex while breastfeeding to
prevent reinfection and higher viral load
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Annexure 28 : Replacement Feeding Checklist

Yes
Can she afford to buy enough milk/milk powder?
Does she have access to clean water?
Can she prepare milk safely?

Boil the water
Make the correct concentration of milk if
using the tin milk
Can she clean and sterilize the feeding articles?
Will she have enough support from significant

others in the family?
Does she know how much of milk the baby can

be given
each time
for a day
how often
No
If answers are No, see what patient education/ linkages can be provided to support replacement feeding
OR advise safe breastfeeding.

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Annexure 29 : Questions and Issues that must be assessed

by the Nurse to Aid In Preparing the Child And Family
For ARV
What does the child understand about HIV?
Does the child know about his/her own HIV diagnosis?
If so, has the child felt any difference in treatment from family members, school authorities (stigma)?
Does the child (if old enough) understand the need to take ARVs?
How will ARVs fit into childs daily activities?
How will ARVs fit into the childs going to school?
Does the child know that ART is to be taken life long?
Is the child aware of how to store the medication?
Is the child aware of the side effects?
Is the child aware of toxicities?
Is the parent alive?
If yes (i.e. parent alive),
Is the parent sick/unable to administer ARVs?
Has the parent had any prior negative experience with ARVs?
Is the parent adherent himself or herself?
Does the parent know the implications of ART (life long, non adherence, administration
and toxicities, storage)?
If no (i.e. parent not alive), who is the support person for the child?
Does the support person know the importance of taking ARV?
Does the support person know the implications of ART
(life long, non adherence, administration and toxicities, storage)?
How
How
How
How
did
did
did
did
the
the
the
the
parent cope with his or her own HIV diagnosis?

family coping with the HIV diagnosis of the parent/s?
parent/s cope with the childs HIV diagnosis?
family cope with the childs HIV diagnosis?
What is the parents perception of the childs illness?
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Annexure 30 : Ways to Promote ART Adherence in Children

Promoting adherence is multi-faceted and must be a continuous process. This is a task that requires
excellent skills, addressing both the childs needs and issues and those of the caregiver:
The child MUST be involved

Assessment of child & family prior to child commencing ARVs
Assist families in developing routine for ARVs; ARVs should NOT dictate every aspect of daily life
Open, supportive approach
Age-appropriate explanations to child regarding need for medication
Children cope far better when they are able to understand what is happening to them and
have a sense of control
Use child-sensitive, age-appropriate explanations such as you need the medicine to keep
you strong and prevent infections
Continuing support and re-assessment of each child and familys situation
Peer support: Support from other parents and children
A variety of strategies may be used to help encourage the child to take ARVs and to assist and
support the caregiver. Some methods are mentioned below. They could be used one at a time or
in combination:
Trial runs: Finding out the best way that the child would take the medicine
Play therapy:
Having a doll /puppet and showing the child how the doll or the puppet felt better after taking
some medicine
Then asking the child whether they would like to try the same
Sticker charts:
Having a chart with dates mentioned and timing.
Every time the child takes the medicine with no trouble, giving the child a golden star, little
trouble a silver star and lots of trouble, a colour that the child does not like
At the end of the month, telling the child the child would be given some reward if there were
more golden stars on the chart. Rewards cold be simple like taking the child to the park,
giving the child a big hug, or doing something that child likes to do with the parent/caretaker
Art therapy:
Making the child draw out what he or she feels about taking medicines. This could be a
way for the child to express self
Taking medication with parent:
Giving the child the medicine along with the parent
Asking the child to put the medicine in the parent/s mouth and checking whether he/she has
taken it
Then the parent could do the same for the child
Support groups:
Arranging meetings of children taking ART so that they could express their challenges,
how they deal with it etc.

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Annexure 31 : WHO Growth Monitoring Charts

Using growth charts Infants and children who are well and healthy should gain weight and length/height.
Infants and children who are growing normally follow a growth curve parallel to one of the standard growth
curves. Weight loss or failure to gain weight can be identified by observing the childs weight over time.
When the growth curve flattens and is no longer parallel to the chart line, this indicates the need for clinical
assessment, management and nutritional intervention and possibly ART.
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Growth curves are used to follow changes in growth over time for a child thus, looking at trend of weight
is more useful than a single observation. The nurse will take the weight and enter it on the growth chart,
in the ICTC HIV-Exposed Infant/Child Card Using gender appropriate charts (different for girls and boys),
plot the weight measurement (in kg.) on the vertical axis against the age (in months/year) on the horizontal
axis
Connect the dots for each visit to obtain a growth curve for the child
Compare the plotted line of the childs growth with the standard curves in the chart
MO to interpret the growth chart and determine course of action:
Child with growth curves lying between the 3rd and 15th percentile need careful history taking to
detect feeding problems. A physical assessment must be done and appropriate nutritional advice
must be given.
Child with growth curves less than the 3rd percentile (growth below the bottom most line) need further
investigation and immediate testing for HIV.
Figure 3: Example of use of growth charts to detect potential problems in growth

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Annexure 32 : Dosing schedule for HIV infected infants

and children , 18 months
Dosing is twice daily
(paediatric fixed dose
combination, FDC)
Drug
Child
Strength
(mg)
Children 6 weeks of age and above,

till 24.9 kg
Number of tablets or ml by weight band,
morning and evening
3-5.9 kg
6-9.9 kg
10-13.9 kg
AM
PM
AM
PM
AM
PM
60/30
1.5
1.5
60/30/50
1.5
1.5
6/30
1.5
1.5
Stavudine Lamivudine
Nevirapine
3-drug FDC
d4T/3TC/NVP
6/30/50
1.5
1.5
Lopvinavir/ritonavir
syrup
2-drug FDC
LPV/r syrup
80/20
per ml
1 ml
1 ml
2 ml
2 ml
Lopvinavir/ritonavir
tablet
2-drug FDC
LPV/r tablet
100/25
Zidovudine Lamivudine
2-drug FDC
AZT/3TC
Zidovudine Lamivudine
Nevirapine
3-drug FDC
AZT/3TC/NVP
Stavudine Lamivudine
2 drug FDC
d4T/3TC
1.5 ml 1.5 ml
Note:
When starting NVP regimen start with lead-in- period for 2 weeks
i.e. For first 2 weeks of ART initiation
Morning dose: AZT + 3TC
........ two-drug FDC
Evening dose: AZT + 3TC + NVP
........ three-drug FDC
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Annexure 33: Antiretroviral Therapy For TB Patients

HIV-TB co-infection is one of the most challenging issues in the effort to scale up ART since more than
60% of PLHA develop TB. Patients with TB merit special consideration because the co-management of HIV
and TB is complicated by drug interactions between Rifampicin and NNRTIs and PIs; IRIS; pill burden;
adherence; and drug toxicity. Active TB is the commonest OI among HIV-infected individuals and is also
the leading cause of death in PLHIV.
The management of patients with HIV and TB poses many challenges, including patient acceptance of both
diagnoses. HIV-infected persons with TB often require ART and WHO recommends that ART be given to:
All patients with extra pulmonary TB (stage 4), and all those with pulmonary TB (stage 3) unless CD4
count is >350 cells/mm3
ART reduces the incidence and recurrence of TB, as well as the fatality rates.
Co-trimozaxole prophylaxis should be given to HIVTB patients as per the guidelines.
When to start first-line ART in patients with active TB
If a patient with active TB is diagnosed with HIV and requires ART, the first priority is to start TB treatment in
accordance with the RNTCP guidelines. ART may need to be started later, keeping in mind the pill burden,
time needed for acceptance of the diagnosis, counselling needs, drug interactions, toxicity and IRIS
Initiation of first-line ART in relation to anti-TB Therapy (Based on 2006 WHO Guidelines)
CD4 cell count
(cells/mm3)
Timing of ART in relation to

initiation of TB treatment
ART recommendation
CD4 < 200
Start ATT first

Start ART as soon as TB treatment is
tolerated
(between 2 weeks and 2 months)
Recommend ART
(ii)
EFV-containing regimens
(iii)
CD4 between
200350
Start ATT first

Start ART 8 weeks
after starting ATT
(i.e. after completion of TB-intensive phase)
Recommend ART
(vi)
CD4 > 350
Start ATT first

Re-evaluate patient for ART at 8
weeks and at
end of TB treatment
Defer ART
(v)
CD4 not
available
Start ART 28 weeks after ATT

initiation
Recommend ART
(iv)
Notes:
i)
Timing of ART initiation is based on clinical judgement, in accordance with other signs of immunodeficiency
and WHO clinical stages. In the case of extrapulmonary TB, ART should be started as soon as TB treatment
is tolerated, irrespective of the CD4 count.
ii)
ART should be started as soon as TB treatment is tolerated, particularly in patients with severe
immunosuppression.

Facilitator Guide
Page 397
iii) EFV-containing regimens include d4T/3TC/EFV and AZT/3TC/EFV.

iv) ART should be started if other non-TB stage 3 or 4 events are present.
v) For some types of TB that generally respond well to anti-TB therapy (i.e. lymph node TB, uncomplicated
pleural effusion), or some cases where uncomplicated pulmonary TB disease is responding well to TB
treatment, consider deferring ART initiation.
vi) Rationale for ART recommendation during TB Treatment:
a) HIV-infected patients with a CD4 count of 200350 cells/mm3 are at an increased risk of developing
active tuberculosis, even in regions with high-baseline TB prevalence.
b) HIV-infected patients with a CD4 count of 200350 cells/mm3 and active tuberculosis are at a greater
risk of AIDS and death than those without TB and with CD4 counts in the same range.
c) In the absence of ART, TB therapy alone does not significantly increase the CD4 cell count. Nor does
it significantly decrease the HIV viral load. Thus, CD4 counts measured during active TB are likely to
reflect the actual level of immunosuppression.
d) The use of HAART in patients with TB can lead to a sustained reduction in the HIV viral load. It can
also facilitate immunological reconstitution, and decrease AIDS-defining illness and mortality. This
benefit is seen across different ranges of CD4 counts.
Facilitator Guide
Page 398

Annexure 34 : Assuming the quantity/amount of PTH

(Take to annexure) Nurses can use of the Faces Pain Rating scale given below for children who might find
it difficult to describe the intensity of pain in terms of numbers.
When conducting an assessment of pain, remember to follow the guidelines given in the box below
A
Always ask! Ask about pain regularly; Assess pain systematically. Ask family members,
friends or caregivers, if necessary.Be aware of those persons who cannot communicate.
If potential for pain exists, assume it is present until proven otherwise!
Believe the patient and the family
Choose treatment options appropriate to the patient and family
Deliver medications round the clock with adequate break through medication
Evaluate results frequently; empower patient and family members to control

Facilitator Guide
Page 399
Annexure 35 : Music Therapy

Music acts like a magic key, to which the most tightly closed heart opens.
Maria Von Trapp
Music therapy is defined as
the systematic application of music by the music therapist
to bring about helpful changes
in the emotional or physical health of the client.
And the ability to experience an altered state of physical arousal and subsequent mood by processing
a progression of musical notes of
varying tone,
rhythm, and
instrumentation
for a pleasing effect.

HOW MUSIC PROMOTES THE RELAXATION EFFECT?
Biochemical theory
states that music is a sensory stimulus that is
processed though the sense of hearing.
Sound vibrations are chemically changed into nervous impulses that
activate either the sympathetic or
parasympathetic nervous system
HOW MUSIC PROMOTES THE RELAXATION EFFECT ?

Entrainment theory suggests that oscillations produced by music are
received by the human energy field and
various physiological systems entrain with or
match the hertz (oscillation) of the music
Metaphysical theory suggests
that music is divine in nature.
Facilitator Guide
Page 400

MUSIC THERAPY
For music therapy to be fully effective as a relaxation technique
it is best that the music be
instrumental
without lyrics
Type of music selected
listening environment
posture, and
attitude
also affect the quality of the relaxation response

Facilitator Guide
Page 401
Annexure 36 : National AIDS Control Organization Phase III
HIV/AIDS prevention activities were undertaken immediately after the first case of HIV infection was
detected in Chennai (formally Madras)
A comprehensive National AIDS Control Program (NACP) was initiated in 1992 with the establishment
of the National AIDS Control Organization (NACO) within the Ministry of Health and Family Welfare,
Government Of India.
The first phase of the program, NACP I, was implemented by NACO and Dedicated State AIDS Cells
in all the states between 1992-2004.
The second pahse of the program,NACP II saw an expanded response against the HIV/AIDS epidemic
with the establishment of State AIDS Control Societies.This program was implemented between 1999
to 2006
Under NACP III, (2006-2012), the goal is to halt and reverse the epidemic in India over the next five
years.
The goal of NACP II is being achieved through a four pronged strategy :
Prevent infections through saturation of coverage of high-risk groups with targeted interventions (TIs)
and scaled up interventions in the general population.
Provide greater care, support and treatment to larger number of PLHIV.
Strengthen the infrastructure, systems and human resources in prevention, care, support and treatment
programmes at district, state and national levels.
Strengthen the nationwide Strategic Information Management System.

Office of NACO
National AIDS Control Organization
Chandralok Building,
36, Janpath,
New Delhi 110001
www.nacoonline.org
Facilitator Guide
Page 402

Annexure 37 : List of State AIDS Control Societies (SACs)

Sr.
No.
States
Addresss of
the SACS
Name
STD
Code
Office
No.
Fax
No.
Email id
1.
Andaman
and Nicobar
AIDS Control Society,

G.B. Pant Hospital Complex,
Port Blair 744104
Shri S.N. Jha
PD
APD
JD
AD
03192
237941
231176
[email protected]
2.
Andhra
Pradesh
State AIDS Control Society,

Directorate of Medical and
Health Services, Sultan Bazar,
Hyderabad - 500059
Shri. R.V.Chandravadan
Dr. A. Rajaprasana Kumar
Kailash Ditya
Durga Prakash
PD
APD
JD
AD
040
24657221
24650776
24650776
24652267
[email protected]
[email protected]
3.
Arunachal
Pradesh

Naharlagun,
New Itanagar - 791110
Dr.
No
Dr.
Dr.
PD
APD
JD
AD (TI)
0360
2351268
2245942
243388
244178
[email protected]
4.
Assam

Khanapara, Guwahati - 781022
M.H. Barman, IAS
PD
APD
JD
AD
0361
2620524
2261605
2620524
[email protected]
Emi Rumi
APD
Rikenrina (Basic Service)
Marto
Ms.Dhiriti Bani
5.
Ahmedabad
Ahmedabad Municipal Corpn.

Old Municipal Dispensary,
behind Lal Bungalow,
C.G. Road, Ahmedabad.
Dr. Umesh.N. Oza

Ms. Lata Brahmbhatt
Dr. Kartik Shah (Blood Saf)
PD
DD -TI
DD
AD
079
26409857
26468653
26409857
[email protected]
6.
Bihar

Health Department,
New Secretariat, Patna - 800015
Mr.
Mr.
Mr.
Mr.
PD
APD
JD TI
AD TI
0612
2290278
8986184695
[email protected]
7.
Chennai
Chennai Municipal Corpn.

82 Thiru Vi-Ka-Salai, Mylapore,
Chennai - 600003
B. Jothi Nirmala
Dr. Guganantam
Mr. N. Balaiah
No JD/AD
PD
APD
IEC
044
24980081
24986514
25369444
[email protected]
8.
Chandigarh
State AIDS Control International

Youth Hostel, Madhya Marg,
Near PGI Sector 15-A,
Chandigarh-160018
Dr. Vanita Gupta
PD
NA
(TI) DD
AD
0172
APD
2544589
2783300
2700171
[email protected]
Devottam Varma
C. V. Alex
Pankaj Priya Chaubey
Hare Ram Singh
Sh. Sandeep Mittal

NA
9.
Chhattisgarh
Chhattisgarh AIDS Control

Society, Directorate of Health
Services, State Health Training
Centre, Near Kalibari Chowk,
Raipur.
Sh. Ajay Kumar Pandey

Dr. Abdul Gafar Sheikh
Sh. Vikrant Verma (TI)
PD
APD
DD -TI
AD
0771
2235860
2221624
2221275
2235860
[email protected]
[email protected]
10.
Dadra &
Nagar Haveli
Dadra & Nagar Haveli

1st Floor, Shri Vinobha Bhave
Civil Hospital, Silvassa - 396230
Dr. L. N. Patra
PD
APD
JD
AD
0260
2642061
2642061
[email protected]
11.
Daman
& Diu
Daman & Diu AIDS Control

Society, Primary Health Centre,
Moti Daman, Daman - 396220
Dr. S. S. Vaishya
PD
APD
JD
AD
0260
2230570
223070
[email protected]
12.
Delhi
Delhi AIDS Niyantran Samiti,

Dr. Baba Saheb Ambedkar
Hospital, Dharamshala Block,
Sector - 6, Rohini,
Delhi - 110 085
Sh. B. S.Banerjee
PD
APD
JD
AD
011
27055660
27055725
Goa State AIDS Control Society,

First Floor, Dayanand Smriti
Building, Swamy Vivekanand
Road, Panaji - 403001
Sh. Pradeep Padwal
PD
APD
JD
AD
0832
2427286
2422519
2427286
Ms. Sapana Prasad (TI)
Sh. Prasad D. Sant (TI)
13
Goa
Shri. J. K. Mishra (TI)
Sh. Ramesh Rathore (TI)

[email protected]
2422158
[email protected]
Facilitator Guide
Page 403
Sr.
No.
States
Addresss of
the SACS
Name
14.
Gujarat
Gujarat State AIDS Control
Smt. Vijaya Laxmi Joshi
PD
Society, 0/1 Block, New Mental
Dr. Pradeep Kumar
APD
Hospital, Complex, Menghani
Narendra Gohil (TI)
JD
Nagar, Ahmedabad - 380016

15.
Haryana
Haryana State AIDS Control
STD
Code
Office
No.
Fax
No.
Email id
079
2680211-13
2680214
[email protected]
2685210
[email protected]
[email protected]
AD
Dr. Narbir Singh
PD
Society, SCO - 10, Sector - 10,
APD
Panchkula, Haryana
JD
0172
2585413
2585413
[email protected]
2621608
221314,
[email protected]
2625857
225857
0194
2476642
2471579
[email protected]
080
22201438
22201435
[email protected]
0651
2309556
2562621
[email protected]
2304882,
2305183
[email protected]
2305183
09447030470
262316,
262817
[email protected]
2584549(PD)
AD
16.
Himachal
Himachal Pradesh State AIDS
Pradesh
Control Society, Block No. 38,

Ground Floor, SDA Complex,
Ms. Sulakshna Puri

Ms. Meena (TI)
JD
Dr. M. A. Wani
PD
Kasumppti, Shimla - 171009

17.
J&K
J & K State AIDS Prevention
Karnataka
and Control Society,
APD
1st Floor, Khyber Hotel, Khayam
JD
Karnataka State AIDS Prevention
AD
Sh. R. R. Janu
Society, No.4/13-1, Crescent

Road, High Grounds,
Jharkhand
PD
APD
Ms. Chandrakanta (TI)
JD
Jharkhand State AIDS Control
Mrs. Aradhana Patnaik
PD
Society, Sadar Hospital Campus,
Dr. Raj Mohan
APD
Purulia Road, Ranchi
Ms. Kavita (TI)
DD -TI
Kerala State AIDS Control
Dr. Usha Titus
PD
Bangalore - 560001
19.
0177
AD
Chowk, Srinagar
18.
PD
APD
AD
2490649
AD
20.
Kerala
Society, IPP Building, Red Cross

Road, Thiruvananthapuram,
Sh. Dennis (TI)
Kerala - 695037
21.
Lakshadweep Lakshadweep AIDS Control
0471
APD
JD-TI
AD
Sh. K.P. Hamzakoya
PD
04896
Society, Directorate of Medical
APD
262317,
and Health Services,
JD
262114,
UT of Lakshadweep,
AD
263582
Kavaratti - 682555
22.
Madhya
Madhya Pradesh State AIDS
Pradesh
Control Society, 1, Arera Hills,
Arun Tiwari
Maharashtra
0755
2559629
2556619
[email protected]
022
24113097,
24113123,
[email protected]
24115791
24115825
[email protected]
[email protected]
APD
Second Floor, Oilfed Building,

23.
PD
JD
Bhopal - 462011
Sh. Rajneesh Bhatnagar
AD-TI
Maharashtra State AIDS Control
Sh. Ramesh Devakar (IAS)
PD
Society, Ackworth Leprosy
APD
Hospital Campus, Behind SIWS
Ms. Shivaranjani
Collete, R.A. Kidwai Marg,
JD-TI
AD
Wadala (West), Mumbai - 400031

24.
Manipur
Manipur State AIDS Control
Sh. P.K. Jha
Society, Room no. 202,

Annexee Building, Western Block
Abhiram Mongjam
Medical New Secretariat,
PD
2414796,
2310796,
APD
0385
2411857,
2222629,
JD-TI
2229014
2224360
AD
Imphal - 759001
25.
Meghalaya
Meghalaya State AIDS Control
Dr. Mrs. S.M. Garod
PD
0364
2223140,
Society, Ideal Lodge, Oakland,
APD
2315452,
Shillong - 793001
JD
2315453
[email protected]
AD
26.
Mizoram
Mizoram State AIDS Control
Dr. Eric Zomawia
Society, MV-124, Mission Veng

South, Aizwal - 796005
PD
0389
2321566
2320922
[email protected]
APD
Betty
JD-TI
AD
Facilitator Guide
Page 404

Sr.
No.
States
Addresss of
the SACS
27.
Mumbai
District
Mumbai District AIDS Control

Dr. S.S. Kudalkar
Society, Acworth Complex,
Behind SIWS College,
Ms. Uma Mehta
R.A. Kidwai Marg, Wadala (West),
Mumbai - 31
28.
Nagaland
Nagaland State AIDS Control

Society, Medical Directorate,
Kohima - 797001
29.
Orissa
Name
Dr. Niphe Kire

Dr. Barnice
Orissa State AIDS Control

Society, 2nd Floor, Oil Orissa
Building, Nayapalli,
Bhubaneshwar-12
Dr. Alekh Chandra Padhiary

Ms. Smita Jagdev
Santanu
STD
Code
Office
No.
Fax
No.
Email id
PD
APD
JD-TI
AD
022
24100245-49, 24100245,
24100250
24100250
[email protected]
PD
APD
JD-TI
AD
0370
2244218,
2241046,
2222626,
2233027
2242224
[email protected]
PD
APD
JD-TI
AD-TI
0674
2405134,
2405104-06
2393415
2407560,
2405105
2394560
[email protected]
[email protected]
30.
Pondicherry
Pondicherry State AIDS Control

Society, No. 93, Perumal Kail
Street, Pondicherry
Dr.D. Gurumurthy, M.B.B.S. DD PD

APD
JD
AD
0413
2343596,
2337000
2343596
31.
Punjab
Punjab State AIDS Control

Society, 4th Floor Prayaas
Building Sec-38B, Chandigarh
Sh. Satish Chandra IAS
0172
2743442
[email protected]
[email protected]
Ms. Meenu, Deputy Director
PD
APD
JD
DD-TI
32.
Rajasthan
Rajasthan State AIDS Control

Society, Medical and Health
Directorate, Swasthya Bhawan,
Tilak Marg, C Scheme,
Jaipur - 302005.
Dr. R.N.D. Purohit

Dr Katara
Ms. Rolly Sinha
Dr Raja Chawla
PD
APD
JD-TI
DD-STI
0141
2381792,
2381707,
2383452,
2383282,
2382765
2381792
[email protected]
33.
Sikkim
Sikkim State AIDS Control

Society, STNM Hospital,
Gangtok, 737101
Dr. Namgyal T. Sherpa
PD
APD
JD
AD-TI
03592
225343,
220898,
32965
220896
[email protected]
34.
Tamil Nadu
Tamil Nadu State AIDS Control

Society, 417, Pantheon Road,
Egmore, Chennai - 600008
Tmt.P. Amudha, IAS
PD
APD
JD-TI
AD
044
28194917,
28190467
28190261
[email protected]
Tripura State AIDS Control

Society, Health Directorate
Building, Gurkhabasti,
P.O. Kunjaban, Agartala,
West Tripura - 799006
Dr. Keshab Chakraborty
PD
APD
381
2321614
[email protected]
[email protected]
Sh. Rabendra Sen
Sh. Karan Sharma
35.
Tripura
Vender Vendan
AD
36.
Uttar
Pradesh
Uttar Pradesh State AIDS

Control Society, A Block,
PICUP Bhawan, Vibhuti Khand,
Gomati Nagar, Lucknow - 10
Sh. S.P.Goyal (IAS)

Ms. Kumudlata
Ms. Preeti
Mr. Sheetal Prasad
PD
APD
JD-TI
AD-TI
0522
2721871,
2720360,
2720361,
2283168
37.
Uttaranchal
Uttaranchal State AIDS Control

Society, Chandar Nagar,
Dehradun.
Dr. D.C. Dhyani

Sh. Sanjay Bisht
PD
DD-TI
JD
AD
135
2728144,
2720377,
2728155
2728144
[email protected]
38.
West Bengal
West Bengal State AIDS Control

Society, Swasthya Bhavan,
GN-29, Sector-V, Salt Lake,
Kolkatta -700091
Dr. R. K. Vats
Dr. S. P. Banerjee
Ms. Kiran Mishra
Ms. Anindita Maity
PD
APD
JD-TI
AD-TI
033
23574400,
23570122,
23576000
23570122
[email protected]

[email protected]
Facilitator Guide
Page 405
Annexure 38 : List of ART Centres

Month - March 2010
S.No. State Name
District Name
ART Centre
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
Tamil Nadu
Chennai
Chennai
Madurai
Namakkal
Chennai
Salem
Tirunelveli
Coimbatore
Theni
Thanjavur
Vellore
Kanniyakumari
Tiruchirappalli
Chennai
Dharmapuri
Virdhunagar
Viluppuram
KARUR
Dindigul
Perambalur
Chennai
Ariyalur
Toothukudi
Tiruvanamalai
Thiruvallur
CUDDALORE
Vellore
Chennai
Nagapatinim
Erode
Sivaganga
The Nilgiris
Ramanathapuram
Kancheepuram
Thiruvarur
Pudukkottai
Govt. Hospital for Thoracic Medicine

Madras Medical College
Government Medical College
Government Hospital
Kilpouk Medical College
Medical College
Medical College
Coimbatore Medical College
Theni Medical College
Thanzavur Medical College
Vellore Medical College
Medical College
Trichy Medical College
Institute of Obstetrics & Gynecology MMC
District Hospital
District Hospital
District Hospital
District Hospital
Govt. District Headquaters Hospital, Dindugal
ART Centre, Govt Hospital, Perambalur
ICH
Govt. District Headquaters Hospital, Krishnagiri
Tuticorin Medical College Hospital, Tuticorin
Govt. District Headquaters Hospital, Thiruvannamal
Govt. District Headquaters Hospital, Thiruvallur
Govt. District Headquaters Hospital, Cudallore
CMC Vellor
Stanley Medical College
Nagapattinam District Headquarters Hospital,
Erode District Headquarters Hospital
Sivagangai Medical College & Hospital
Nilgiris District Headquarters Hospital
Ramanathapuram District Headquarters Hospital
Govt. Medical College and Hospital, Chengalpattu
Govt. Medical College and Hospital
Govt. District Hospital
37
Maharashtra
Mumbai
Sir J. J. Hospital
Facilitator Guide
Page 406

S.No. State Name
District Name
ART Centre
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
Mumbai
Mumbai
Mumbai
Sangli
Akola
Pune
Yavatmal
Nagpur
BEED
Pune
Kolhapur
Aurangabad
Solapur
Dhule
Nanded
Latur
Chandrapur
Chandrapur
Mumbai
Thane
Nashik
Ahmadnagar
Satara
Ratnagiri
Wardha
Parbhani
Jalgaon
Osmanabad
Sangli
Raigarh
Pune
Nagpur
Mumbai
Jalna
Bhandara
Pune
Nandurbar
Gadchiroli
Mumbai
Mumbai
Hingoli
KEM Hospital
BLY Nair Hospital
LTMG Sion Hospital
Government Medical College, Sangli
Medical college, Akola
B.J. Medical college
Medical College, Yawatmal
Govt. Med. College, Nagpur
Medical College, Ambejogai
NARI, Pune
RCSM Government Medical College
Medical College, Aurangabad
Govt. Medical College, Solapur
Medical College, Dhule
Govt. Medical College
Civil Hospital and Govt. Medical College
BILT, Chandrapur
District Hospital ART Centre, Chandrapur
Godrej Mumbai
Vithal Sayanna General Hospital, Thane
Civil Hospital, Nashik
District Civil Hospital, Ahmednagar
District Civil Hospital, Satara
District Civil Hospital, Ratnagiri
ART Centre Civil Hospital, Wardha
Civil Hospital, Parbhani
Civil Hospital, Jalgoan
Osmanabad DH
Bharati Vidyapeeth Sangli
Reliance DAH Patalganga
AFMC Pune
IGMC Nagpur
NMMC Vashi
Jalna DH
Bhandara DH
Bajaj Auto ITD YCMH Pimpri
Nandurbar ART Center
GADCHIROLI ART Center
L&T Health Centre
LTMG Sion Hospital,Regional Pediatric ART Centre
ART Center, Civil Hospital, Risala Bazar, Darga Ro

Facilitator Guide
Page 407
S.No. State Name
District Name
ART Centre
79
80
81
82
83
84
85
86
Buldana
Amravati
Satara
Thane
Kolhapur
Washim
Solapur
Gondiya
ART Centre, District General Hospital

ART Centre, District Civil Hospital
ART CENTER KARAD
Central Hospital Ulhasnagar 3
Sub District Hospital,Gadhinglaj
WASHIM DH
ART Center Sub District Hospital, Pandharpur
ART Centre, Gondia
Hyderabad
Guntur
Visakhapatnam
Anantapur
Krishna
Cuddapah
Chittoor
Prakasam
East Godavari
Rangareddi
Warangal
Karimnagar
Hyderabad
Nizamabad
West Godavari
Srikakulam
Khammam
Mahbubnagar
Kurnool
Nellore
Nalgonda
Vizianagaram
Medak
Adilabad
Hyderabad
East Godavari
Guntur
Visakhapatnam
Chittoor
Hyderabad
Krishna
West Godavari
Khammam
Osmania Medical College, Hyderabad

Govt. Medical College, Guntur
Govt. MC (King George Hospital), Vizag
GGH, Anantapur
GGH, Vijayawada
RIMS, Kadapa
SVRR GGH, Triupati Chittoor
Government District Hospital, Ongole
GGH, Kakinada , East Godavari
Gandhi Med College, Secundarabad
Medical College, Warangal
Govt. District Hospital, Karimnagar
Govt. Gen. Chest hospital, Hyd
District Head Quarters Hospital, Nizamabad
District Head Quarters Hospital, Eluru
District Head Quarters Hospital, Srikakulam
District Head Quarters Hospital, Khammam
District HQ Hospital, Mehboobnagar
Government General Hospital, Kurnool
District Head Quarters Hospital, Nellore
District HQ Hospital, Nalgonda
Government Medical College
District Headquarter Hospital,Medak
District HQ Hospital, Adilabad
Nillofer Hospital
Rajahmundry ART Centre
Area Hospital, Tenali
ART Center Anakapalli
District Hospital Chittoor
DH, King Koti, Hyderabad
DH, Machilipatnam,Krishna
Tadepalligudem ART center
Bhadrachalam ART center
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
Andhra Pradesh
Facilitator Guide
Page 408

S.No. State Name
District Name
ART Centre
120
121
122
123
124
Prakasam
Cuddapah
Krishna
Guntur
Guntur
Markapur ART center

Produtur ART center
Tandur ART center
Guntur ART center
Narasaraopet ART center
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
Karnataka
BANGALORE
Mysore
Bellary
Dharwad
Raichur
Davanagere
Chikmagalur
Bijapur
Gulbarga
Belgaum
Kolar
Bagalkot
BANGALORE
Koppal
Chamarajanagar
Mysore
Gulbarga
Dakshina
Uttara
Udupi
Bidar
Tumkur
Haveri
Shimoga
BANGALORE
BANGALORE
BANGALORE
Mandya
Gadag
Chitradurga
Kodagu
Ramanagaram
Chikballapur
Bowring & Lady Curzon Hosp., Bangalore

Mysore Medical College
VIMS, Bellary
KIMS ART Centre, Hubli
District hospital, Raichur
District hospital, Davangeri
District hospital, Manglore
District hospital, Bijapur
District hospital, Gulburga
District hospital, Belgaon
District hospital, Kolar
District hospital, Bagalkot
IG Inst. of Child Health, Bangalore, (IGICH)
District Hospital, Koppal
District Hospital, Chamrajnagar
District Hospital, Hassan
Voluntary Counseling and ART Center, Wadi
Kannada District Hospital, Chikmagalur
Kannada District Hospital, Karwar
District Hospital, Udupi
District Hospital, Bidar
District Hospital, Tumkur
District Hospital, Haveri
District Hospital, Shimoga
St. John Hospital
Victoria hospital
KIMS Bangolare
District Hospital ART Center ,Mandya
District Hospital ART Center, Gadag
District Hospital, Chitradurga
District Hospital, Kodagu
District Hospital, Ramanagara
District Hospital, Chikballapur
158
159
160
Manipur
Thoubal
Imphal West
Imphal East
ART CENTRE, DISTRICT HOSPITAL Thoubal

ART CENTRE, RIMS HOSPITAL, Imphal West
J.N. HOSPITAL, ART CENTRE, IMPHAL EAST

Facilitator Guide
Page 409
S.No. State Name
District Name
ART Centre
161
162
163
164
Ukhrul
Ukhrul
Churachandpur
Imphal East
ART CENTRE, DISTRICT HOSPITAL Chandel

ART CENTRE, DISTRICT HOSPITAL UKHRUL
ART Centre, District Hospital Churachandpur
J.N. Regional Pediatric ART Centre,Imphal East
165
166
167
168
Nagaland
Dimapur
MOKOKCHUNG
Kohima
Tuensang
Ditrict Hospital, Dimapur,

ART Centern, Imkongliba Memorial Hospital
Naga Hospital Authority, Kohima
Civil Hospital, Tuensang
169
170
171
172
173
174
175
176
177
Delhi
NEW DELHI
Central
NEW DELHI
WEST
NORTH EAST
South
South
NEW DELHI
NORTH
RML Hospital, New Delhi

LNJP Hospital, New Delhi
AIIMS, New Delhi
DDU Hospital, New Delhi
GTB Hospital, Delhi
LRS institute of TB, New Delhi
SAFDARJUNG HOSPITAL
Kalawati Saran Children Hospital
Dr. Baba Saheb Ambedkar Hospital
178
Chandigarh
Chandigarh
PGIMER
179
180
181
182
183
Rajasthan
Jaipur
Bikaner
Jodhpur
Udaipur
Kota
SMS Hospital, Jaipur

Bikaner, SP Medical College
SNMC, Jodhpur
RNT Medical College, Udaipur
Medical College
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
Gujarat
Ahmedabad
Surat
Rajkot
Bhavnagar
Mehsana
Surat
Vadodara
Surendranagar
Jamnagar
Junagadh
Kachchh
Surat
Ahmedabad
Banaskantha
Amreli
B.J. Medical College, Ahmedabad

Govt. Medical College, Majura Gate, Surat
Pandit Din dayal Upadhyay Hospital Rajkot
Medical Collage, Bhavnagar
Medical Collage, Mashana
Mora Choriyasi, Reliance HIV & TB Control Center
SSG Hospital ART Center
Mahatma Gandhi Smruti Hospital Surendranagar
G G HOSPITAL JAMNAGAR
General Hospital Junagadh
ART Center Bhuj
SMIMER HOSPITAL SURAT
ART Center V. S. G. Hospital
ART Centre, General Hospital, Palanpur
General Hospital, Amreli
199
200
West Bengal
Medinipur
Kolkata
Medinapur Medical College, Medinapur

School of Tropical Medicine
Facilitator Guide
Page 410

S.No. State Name
District Name
ART Centre
201
202
203
204
205
206
207
Darjiling
BARDDHAMAN
Kolkata
Maldah
Kolkata
Kolkata
Uttar Dinajpur
North Bengal Medical College, Siliguri

Medinapur Medical College, Burdwan
R.G.Kar Medical College
Malda District Hospital
Medical College,Regional Pediatric ART Centre
M.R. Bangur District Hospital
Islampore SD Hospital, (Room No. 10 & 11)
208
209
210
211
212
213
214
215
216
217
Uttar Pradesh
Varanasi
Lucknow
Allahabad
Meerut
Aligarh
Gorakhpur
Agra
Etawah
Kanpur Nagar
Jhansi
Banaras Hindu University, Varanasi

KGMC, Lucknow
MLN Medical College, Allahabad
LLRM Medical College
J N Medical College, Aligarh
BRD Medical College, Gorakhpur
SN Medical College Hospital
ART Centre UP RIMS & R, Saifai,
I.D. Hospital, GSVM Medical College, Kanpur
MLB Medical College
218
Goa
NORTH GOA
Government Medical College, Bambolim
219
220
221
222
223
224
225
Kerala
Thiruvananthapuram
Kottayam
Palakkad
Kozhikode
THRISSUR
Alappuzha
Ernakulam
Hospital Trivandrum
Medical College Kottayam
USHUS District Hospital
ART Centre, Kozhikode
ART Centre, Thrissur
Medical College Allepy
ART Centre,General Hospital Ernakulam
226
227
Himachal Pradesh
Shimla
Hamirpur
IGMC, Shimla
ART Center R.H Hamirpur
228
Pondicherry
Pondicherry
Govt General Hospital
229
230
231
232
233
234
Bihar
Muzaffarpur
Patna
Darbhanga
Bhagalpur
Patna
Gaya
SKMCH, Muzaffarpur
PMCH, Patna
Dharbhanga Med Col, Laheriasarai,Darbhanga
J L N Medical Collge,Bhagalpur
ARTC, RMRI
ARTC, ANMMCH
235
236
237
238
239
Madhya Pradesh
Indore
Jabalpur
Bhopal
Ujjain
Rewa
M Y Hospital, Indore
Medical College, Jabalpur
Gandhi Medical College, Bhopal
R D G Medical College Ujjain (M.P)
ART Centre Rewa

Facilitator Guide
Page 411
S.No. State Name
District Name
ART Centre
240
241
East Nimar
Gwalior
ART Center District Hospital KhanDwa

Department of Medicine, J.A. Hospital Gwalior
Kamrup
Dibrugarh
Cachar
Guwahati Medical College Hospital

AMC, Dibrugarh
Silchar Medical College & Hospital
242
243
244
Assam
245
Arunachal Pradesh Papum Pare
ART Centre, General Hospital, Naharlagun
246
Mizoram
Aizawl
Civil Hospital, Aizawal
247
248
249
250
251
Punjab
Jalandhar
Patiala
Amritsar
Ludhiana
Gurdaspur
Civil Hospital, Jalandhar

Medical Collage, Patiala
GMC, Amritsar
ART Centre, Lord Mahavir, Civil Hospital
ART Centre, Civil Hospital, Pathankot
252
Sikkim
East
STNM HOSPITAL
253
254
Jharkhand
Ranchi
Purbi Singhbhum
RIMS, Ranchi
MGM Medical College, Jamshedpur
255
Haryana
Rohtak
PGIMS
256
257
Uttaranchal
Dehradun
Nainital
Doon Hospital
Dr. Susheela Tiwari Memorial Forest Hospital,
Haldwani
258
Tripura
West Tripura
Agartala
259
260
Jammu & Kashmir
Jammu
Srinagar

Sher-i-Kashmir Institute of Medical Sciences (SKI)
261
262
263
264
Orissa
Cuttack
Ganjam
Sambalpur
Koraput
S C B Medical Collage Cuttak

MKCG Medical College and Hospital, Berhampur
V.S.S. Medical College. ART Centre
BILT ART Centre DHH
265
266
267
268
Chhattisgarh
Raipur
Durg
Bastar
Bilaspur
Govt
ART
ART
ART
269
Meghalaya
East Khasi Hills
Shillong
Facilitator Guide
Page 412
Medical Collage, Art Center, Raipur

Centre, District Hospital
Center Jagdalpur
Centre CIMS Bilaspur

Annexure 39 : List of Community Care Centres (CCCs)
The CCC plays a critical role in enabling PLHIV to access ART as as providing monitoring, follow up
and counselling support to those who are initiated on ART, positive prevention, drug adherence,
nutrition counselling etc. The monitoring of PLHIV, who do not require ART as yet (Pre ART) will also
be a critical function that needs to be carried out by CCC.
A Community Care Centre (CCC) is a place with facilities for Out Patient and In-Patient treatment where
a PLHIV receives the following services:
All PLHIV started on ART (at the ART Centre) will be sent to the CCC for a minimum of 5 days
of In patient care and be prepared for ART
Treatment of OIs
Appropriate referrals to ICTC,PPTCT and ART Centres
Out Patient Services
Home Based Care
Some CCCs will serve as Link ART Centres
Condom Distribution
Staff at CCC comprises of;

Doctor 1 Full time or 2 Part time
Project Coordinator 1 Full Time
Counsellor 1 Full Time
Out Reach Workers 4
Laboratory Technician 1 Part Time
Nurses 3
Cook 1
Helper 1
Janitor 2
Under NACP III, it is proposed to set up 350 CCC over a period of 2007-2012 through PLHIV networks,
NGOs and other Civil Society Organizations
The CCCs are being established on priority,in districts which have high levels of HIV prevalence and
high level PLHIV plod and will be linked to the nearest ART centre.

Facilitator Guide
Page 413
List of 235 Community Care Centers (19 March 2009)

S.
No.
State
Name of
the CCC
District
District
Category
Address
Contact
Person
Phone No.
Andhra Pradesh
ASSISI
Dermatological
Centre
Krishna
ASSISI Nagar,
Konkepudi,
Via Pedana
Krishna-621366
SR. PR. Prashanti Mary
08672-08248335 /
9490635110 /
9441193550
Andhra Pradesh
Bethesda
Leprosy
Hospital
West Godavari
Rustumbada,
Narsapur,
West Godavari-534275
Dr. V. Rajeev Prasad,

Medical Officer Incharge,
V. Paul Raju
08814-274618 /
9440984979
Andhra Pradesh
Canossa
Hospital
Srikakulam
Veeraghattam,
Nadukooru, Srikakulam
Sr. Mercy Vullayil
8941-239878 /
239915 /
9490447068
Andhra Pradesh
Damian Leprosy
Centre
West Godavari
Vegavaram,
Gopannapale,
Sr. Mary
08812-226132 /
9490744875
Andhra Pradesh
Hand of Hope
Methodist
Hospital
Mahaboobnagar
Doulathabad Mandal,
Chandrakal,
Mahaboobnagar-509336
Prerana Maddela
8505-287947 /
287994 /
9849642457
Andhra Pradesh
Holy Family TB
Sanatorium
Guntur
Sathenapalli,
Guntur-522004
Sr. Anthony
9849114127
Andhra Pradesh
Mother Vanninni
Hospital
West Godavari
Kadakatla, K.N.Road,
Tadepalligudam,
Sr. Teresita Naralaly

Administrator/
Sr.Catherine
8818-244121 /
9395347991 /
9490789682
Andhra Pradesh
Raja Foundation
Kadapa
Mylavaram, Kadapa
Raja, Sleeva Reddy
9440650619 /
9290461051 /
08560-273881
Andhra Pradesh
Sivananda
Rehabilaitation
Home
Hyderabad
Kukatpally,
Hyderabad-500095
Dr. Rishikesh
040-23057679 /
9866337152
Meera: 9246160251
10
Andhra Pradesh
Soloman
Hospital
Complex
Prakasam
Soloman Gram
Panchayat, Soloman
Center, Chirala,
Prakasam-523155
Dr. A.Davidson,
S.Solomon
08594-237199 /
Dr. David
Cell: 9848129546
11
Andhra Pradesh
St. Anns Society, Krishna

Central Province
Nunna, Vijiyawada,
Krishna-520004
Sr. Teresa,
Administrator
0866-2852231
12
Andhra Pradesh
St. Catald
Rehabilitation
Centre
Krishna
Vattigudipadu
P.O., Teresanagar,
Nuzivid, Krishna-521224
Sr. Dr. Vincenza Mary,

Project Holder
8656-232611 /
9590607452
13
Andhra Pradesh
St. Marys
Hospital
Nalgonda
Srirangapuram,
Kodad, Nalgonda
Sr. Mercilla, Sr.Lilly
95863-255204 /
9848371137
14
Andhra Pradesh
St. Vincents
Hospital
Prakasam
Medharametla
P.O, Prakasam-523212
Vimal Rose, Sr. Saley
8593-252652 /
9985263137 /
9985263137
15
Andhra Pradesh
St. Xaviers
Hospital
Guntur
Nirmala Nagar,
Vinukonda, Guntur
Sr. Dr. Alphensa,

Sr. Felicita
8646-272084 /
9849788014
16
Andhra Pradesh
Suma Hospital
Adilabad
Bheemaram P.O,
Jaipur Mandal,
Adilabad-504204
Sr.Emi, Sr.Sancta Rose
48737-244029/
9440594517
17
Andhra Pradesh
Women
Development
Trust
Ananthpur
Bathallapalli,
Ananthapur
Sirappa
08559-242746
Cell: 98490 15677
Facilitator Guide
Page 414

S.
No.
State
Name of
the CCC
District
18
Andhra Pradesh
Women
Development
Trust
Ananthpur
19
Andhra Pradesh
Rotary Abhaya
20
Andhra Pradesh
21
Address
Contact
Person
Phone No.
Kanekal Mandal,
Ananthapur
Sirappa
08559-242746
Cell: 98490 15677
Vijayanagaram
Rotary Abhaya
Modavalasa Village
Denkada Mandal
Mr. Kumaran /
S.Hanumantharao
9393100585 /
9440190979
Srinivasa
Voluntary
Organisation
Vijayanagaram
Srinivasa Voluntary
Organisation,
D.No. 59-112, Konki
Street, Salur
Dr. B.S.N. Murthy /

B. Padmavathi
9440183216 /
08964-252270
Andhra Pradesh
Emmanuel
Ministries
Association
Visakhapatnam
Emmanuel Ministries
Association,
Kondalaagraharam,
Makavarapalem Mandal
K. Jeevan Roy
08932-222531,
222231, 222236,
9440147329
22
Andhra Pradesh
NATURE
Visakhapatnam
NATURE, # 38-37-38/2,
Bhaskar Gardens,
Marripalem - 530018
S. Balaraju
08936-249228,
249408, 9441825181
23
Andhra Pradesh
St. Anns Social

Service Society
Krishna
St. Anns Social Service

Society, Prashanth
Bahvan (Care & Support
Center), Deshrajpally X
Roads, Velichala,
Ramadugu Mandal
Sr. Cyril
Sr. Joyce
Sr. Sudha
0878-2284404,
9989558912
9963459078
(Sr. Joycy)
24
Andhra Pradesh
Medak Catholic
Mission
Medak
Medak Catholic Mission,

(Asha Jyothi), Pregnapur
(po), Gajwel
Fr. Bali Reddy SVD,

Director
Mr. Anandhan
9440226823
9866998727
9885782599
08454-211289
25
Andhra Pradesh
David & Lois

Rees Hospital
Chittoor
David & Lois Rees

Hospital,
Yerpedu - 517619
P.T. Mohanadoss,
Deputy Director
Emrys I. Rees
9989799947
26
Andhra Pradesh
Arogyavaram
Medical Centers,
Union Mission
Tuberculosis
Sanatorium
Chittoor
Arogyavaram Medical
Centers, Union Mission
Tuberculosis Sanatorium,
Arogyavaram,
Madanapally,
Chittoor District.
Dr. B Wesley,
Director
08571-222228
9440893669
27
Andhra Pradesh
AIDS Patients
Care & Support
Center, Bhavani
Educational
Society
Nellore
AIDS Patients Care &

Support Center, Bhavani
Educational Society,
Mungamur Cross Road,
Near Kavali
K. Simhadri Rao
V. Bhavani
08626-657493
9440277524
08626-212434
28
Andhra Pradesh
St. Josephs
Care Center
Khammam
St. Josephs Care

Center, Asha Niketan
Hospital, Near Swarna
Bharathi Eng. College,
Collectorate P.O.,
Khammam
Sr. Therese Marie,

Project Holder
Sr. Annie
08742-255763
9440869648
29
Andhra Pradesh
St.Josephs
Hospital,
Prathipadu533432
Via Samalkot
East Godavari
St. Josephs Hospital,

Prathipadu-533432
Via Samalkot
Sr. Karuna
Sr. Vincentina
08868-246659,
9849520542
9963269271

District
Category
Facilitator Guide
Page 415
S.
No.
State
Name of
the CCC
District
30
Andhra Pradesh
Rural India Slef

Development
Trust
East Godavari
31
Andhra Pradesh
Mariyanilayam
Social Service
Society
32
Andhra Pradesh
33
Address
Contact
Person
Phone No.
Rural India Slef

Development Trust,
PB No-56, # 90-1-5/1,
Swaraj Nagar,
A.C. Gradens,
Rajamandry -533101
N. Slesser Babu,
Coordinator
Mr. R. Praveen Das
0883-2425367,
2420094,
9848185494,
9440456772
Kurnool
Mariyanilayam Social
Service Society,
Gargeyapuram, Kurnool.
Sr. Samestha DSS,

Incharge
Sr. Deepthi
9849517026
9441336003
08518-200245
Perali Narasaiah
Memorial &
Charitable Trust
Nizamabad
Perali Narasaiah
Memorial & Charitable
Trust, C/O Sree Rama
Eye Hospital,
Khaleelwadi, Nizambad
Dr. P.B. Krishna Murthy

R. Venkat Gopi
08462-231060
9849290234
9490065888
Andhra Pradesh
Freedom
Foundation
Secundrabad
Freedom Foundation,
21, Cariappa Road,
Alwal, Bolarum,
Secundrabad.
Jayasingh Thomas
Kishore Kumar
9908582655
9848602446
040-27861023
34
Andhra Pradesh
Rakshana
Deepam
Ranga Reddy
Rakshana Deepam,
44-15/2, Survey No.113,
Himayat Nagar (Village),
Via CBIT
Sr. K. Clarit,
Project Holder
Sr. Swarnalatha
9441958720
9959543227
08413-235130
35
Andhra Pradesh
Viswakaruna
Dermotoligical
Center
Warrangal
Viswakaruna
Dermotoligical Center,
Fathima Nagar, NIT Post
Fr. Jyothish
Sr. Pennamma
9849571049
9440945756
08711-223457
36
Andhra Pradesh
Rajiv Gandhi
Asian Studies of
Immunology
(RASI)
Guntur
Rajiv Gandhi Asian

Studies of Immunology
(RASI) (CCC),
D.No.13-8-147, 8th Line,
G.V. Thota, Opp. R.T.C.
Dr. Venkatappa Reddy,

Director
Smt. M. Malleswari
9885623718
9848213718
0863-2223023
37
Andhra Pradesh
Ganne
Subbalakshmi
Medical
East Godavari
Ganne Subbalakshmi
Medical College (GSL)
Dr. Ganesh
B.V. Soma Sastry
Dr. Jammy Rajesh
9959999805
9959999802
9989924783
040-30421517/18/19
38
Andhra Pradesh
Kamineni Institute Nalgonda

of Medical
Sciences (KIMS)
Kamineni Institute of
Medical Sciences (KIMS),
Nalgonda
39
Andhra Pradesh
APAIDSCON
Medak
Dr. Ganesh
B.V. Soma Sastry
Dr. Jammy Rajesh
9959999805
9959999802
9989924783
040-30421517/18/19
40
Chandigarh
Chandigarh
Community
Care Center
Chandigarh
Khuda Ali Sher,

Opposite Shivalik
Nursery
Mr. Sachin Sharma

09463456747,
0172-2786040
09872888177
(Personal),
2786040 (Office)
41
Delhi
Ashraya Holistic
Care Centre
South
ASHRAYA - Holistic
Care Center, Multi
Purpose Community
Center, Village Rajokari,
Delhi-Gurgaon Highway,
(Near Shiv Murti),
New Delhi-110038.
Ms. Nafisa Ali

(9818449999),
Mr. Henry :
[email protected]
9811548345
(Henry, PC)
9810398059
Facilitator Guide
Page 416
District
Category

S.
No.
State
Name of
the CCC
District
42
Delhi
Akankshya /
Chelsea
North East
43
Delhi
Bhartiya
Parivartan
Sansthan
44
Delhi
45
Address
Contact
Person
Phone No.
Community Care Centre,

C-120, Gali No. 2,
Near Police Station,
Bhajanpura,
Delhi 110053
Tel: 325 66703.
[email protected]
wagchelsea@wagch
elsea.org
Project coord. Mr. Harish

Varma (9810571911),
Mrs. Doe Nair
9810705450,
[email protected],
[email protected]
Mr Sumit Verma
coordinator: 9810255143
Dr Umesh Bhatnagar:
9811213747
Mrs Doe Nair:
9810705450
Tel: 22130451,
22130452
New Delhi
BPS-Care Home
C-42, Conductors
Colony, Burari,
New Delhi-110084
Tel: 22351052,
22351053,
[email protected]
Project Coord. Ms. Pooja

(22356852, 9818233876),
Mr. Dinesh Kumar
(980064598)
Deepati
Foundation
West
H.No 8, Indira Service

Station, Main Dhansa
Road, Najafgarh 43
Mr. Joy Jacob
9910360825
Delhi
Aradhya
North West
H.No. 15, Bhalaswa

Colony, Harijan Basti,
Near Basti, Near G.T.
Road, Karnal Bypass
Mr. Umesh
9213429305
46
Delhi
Sahara Center
for Residential
Care &
Rehabilitation
Central
1765, Pataudi House,

Kucha Dakhni Rai,
Daryaganj,
New Delhi 110002
Ms. Riti
9818474619,
41639167
47
Delhi
Snehsadan/Child
Survival India
North West
SNEH SADAN - Care

Home, House No. 618,
Prahladpur Road,
Village Khera Khurd,
Delhi 110082,
[email protected]
Projct coord.
Ms. Sheela Mann
(9810986101),
Ms. Deepa Bajaj
(9810647807)
Tel:27874740,
27874182
48
Haryana
Red Cross
Society, Rohtak
Rohtak
Arpan Institute, Near

Govt. Sr. Sec. School,
Gandhi Nagar,
Rohtak 124001
Mr. Nahar Singh Deswal
01262- 310107
49
Karnataka
Accept,
Bangalore
Bangalore
AIDS Care Counseling

Education and
Prevention Training
(ACCEPT) 245m KRC
Road, (Next to Visthar),
Dodda Gubbi Post,
Bangalore - 562149.
Mr. Raju K Mathew
9448619619,
acceptindia@
gmail.com
50
Karnataka
Moolika
(Hariappa
Hospital),
Sanvruddhi
Shimoga
Moolika Samvrudhi
Arogyabhivrudhi
Prathishthana, Hariyappa
Hospital, R.P. Road,
Sagar Taluk,
Shimoga - 577401.
Dr. Chandrashekar
0818326618

District
Category
Facilitator Guide
Page 417
S.
No.
State
Name of
the CCC
District
District
Category
Address
Contact
Person
Phone No.
51
Karnataka
Samraksha
Kushtagi
Asha Jyothi Samraksha # 10,

Gundi Road, NH 13,
Kushtagi - 584 121.
Ms. Sulekha
9448458301,
[email protected]
52
Karnataka
SVYM, Mysore
Mysore
Swamy Vivekananda
Youth Movenent,
Handhipura Road,
Sangur, H.D. Kote Taluk,
Mysore - 571121.
Dr. Bindu
9448872708
53
Karnataka
Freedom
Foudation,
Bangalore
Bangalore
Freedom Foundation
# 180, Hennur Cross,
Bangalore - 560 035.
Ms. Madhuri
9945216412
54
Karnataka
Freedom
Foudation,
Bellary
Bellary
Freedom Foundation
#30B, Infantry Road,
Opp. T.B. Hospital,
Bellary Contonment,
Bellary- 583 102.
Ms. Rathi Kapadia
9880055140
55
Karnataka
Snehadan
Bangalore
Snehadaan,
St. Camillus Home of
Charity, Sarjapura Road,
Ambedkar Nagar,
Carmelaram Post,
Banglore - 560 035.
Fr. Sunny Joseph
9448242730
56
Karnataka
Snehasadan
Mangalore
Snehasadan,
St. Camillus Rotary
Rehavilitation Centre,
Kinnikambla Post,
Kaikamba,
Mangalore - 574151.
Fr. Joy George
9448118119
57
Karnataka
Sri Shakti
Belgaum
Sri Shakathi Association,

Sri Shakthi Multi
Speciality Hospital,
Belgaum.
Mr. Shashikumar
9945221004
58
Karnataka
Assissi Hospital
Raichur
Vidyanagar,
Raichur - 584103
Sr. Felicia Mary
08532-240991 /
240944
59
Karnataka
Holy Cross
Hospital
Chikmagalur
Holy Cross Hospital,

Jyothi Nagar,
Chikamagalur - 577102
Dr. Bhagyalakshmi
9448130268 /
08262-220077 /
220017
60
Karnataka
Holy Cross
Hospital
Chamarajnagar
Kamagere, Kollegal,
Chamarajnagar - 560068
Sr. Regi John
9740664598 /
08224-263681
61
Karnataka
Dayabhavan
Tumkur
Bhaktharahalli, Kunigal
Taluk, Tumkur - 572120
Fr. Jinesh Varkey
9448371298 /
08132-320909 /
9242620548
62
Karnataka
St. Marys
Hospital
Bellary
OPD Road, Cantonment,

Bellary 583 104
Sr. Mary Varghese
9449536191 /
08392-242641
63
Karnataka
Lourdes
Hospital
Dharwad
# 14337, Shanti Sadan,

Ward 13, Block No. K A
19/2429, Nirmal Nagar
12th Cross Road,
Dharwad - 580003
Sr. Nirmala Dsilva
9449483074 /
0836 -2448224
Facilitator Guide
Page 418

S.
No.
State
Name of
the CCC
District
District
Category
64
Karnataka
C G Hospital
Belgaum
Cardinal Gracias Hospital Sr. Tessy

Nirmal Nagar, Modage,
Belgaum 591103
9448194244 /
0831-2418244
65
Karnataka
St. Luke Hospital
Gulbarga
Aurad - B,
Gulbarga - 585316
Dr. K A Abraham
9448042663 /
08472 -211831
66
Karnataka
Support
Bangalore
Magadi Road,
Sumanahalli,
Vishavaeedam Post,
Bangalore 560091
Fr. George K
9845811515 /
9945333122 /
23485317
67
Karnataka
Karwar Diocesan
Development
Council
Karwar
Bishops House,
Baithkol Road, Karwar,
UK - 581302
Fr. Lawrence Fernandes
9448129063 /
08382-220563
68
Karnataka
Haemophilia
Society
Davangere
No 352/1, 9th Cross,

P J Extn, Behind Mothi
Veerappa JR College,
Davanagere - 577002
Dr. Suresh Hanagavadi
9341004109
69
Karnataka
St Annes
Hospital
Bijapur
#54, Centre for Non

Fr. Vincent Crasta
Formal Education (CNFE),
Station Road,
Mukund Nagar,
Bijapur - 586104
9448308585 /
08352-256453
70
Karnataka
Freedom
Foundation
Udipi
Freedom Foundation
#3/3A, Survey No. 14/1,
C-2, Moolur Village,
NH 17, Post Uchila,
Udupi District - 574117
Mr. Manohara
9449167897 /
2530312
71
Karnataka
HEERA, (Health,
Education,
Empowerment,
Rehabilitation
Association)
Chitradurga
Community Care Center,

City Multispeciality
Hospital Premises,
Turuvanur Road,
Chitradurga
Dr. Nagendra Gowda.

M.R.
08194-230658,
9880096765,
9243205726
72
Karnataka
(ORBIT)
Organisation for
Bidar Integral
Transformation
Bidar
Asha Deepa, ORBIT

Community Care Centre,
Kristhashrama,
Kaudiyal (s) ,
Basavakalyan Raluka,
Bidar District
Fr Santhosh Dias
08483 271032
73
Karnataka
Our Lady of
Mercy SAB
Trust
Kolar
Nava Jeevan Health

Centre, Opp K.P.T.C.L,
M.B. Road, Mulbagal,
Kolar
Sr. Josena
8152223418
74
Karnataka
Sri Sai
International
Charitable Trust
Chikballapur
ARAIKE, Anakur,
off Siddlagatta Main
Road, Chikkaballapur
Ms. Rashmi R.
9945080817
75
Karnataka
Dakshina
Kannada Rural
Development
Society
Dakshina
Kannada
Navajeevana Care and

Fr. Thomas K.C.
Support Centre, Kakkinje,
Charmady P.O.,
Belthangady, D.K.,
Karnataka

Address
Contact
Person
Phone No.
9008606605 /
9448656926
Facilitator Guide
Page 419
S.
No.
State
Name of
the CCC
District
District
Category
76
Karnataka
Asha Kiran
Hospital
Mysore
Asha Kiran Hospital,

Mr. Gururaja
CA-1, Ring Road,
Hebbal Industrial Housing
Area, Next to JK Tyres
Plant, Hebbal,
Mysore - 570016
9980055905 /
984511058
77
Maharashtra
Bel-Air Hospital,
Panchgani,
Satara
Satara
Bel Air Hospital,

Panchagani,
Satara - 412805
Fr. Tomy
09422606672,
02168241109
78
Maharashtra
Acharya Vinobha
Bhave Rural
Hospital, Wardha
Wardha
DMDPGMER, Sawangi
(Meghe), Wardha
Dr S Z Quazi, Dr Abhay
Gaidhane
09370043029,
9325191810,
07152- 320750
79
Maharashtra
Krupa Prasad
Kendra, Nasik
Nasik
Krupa Prasad Kendra,

Old Mumbai, Agra Road,
Behind Vasan Showroom,
Mumbai Naka,
Nasik 422001
Dr Dimple Chauhan,
kkrupaprasad@
yahoo.co.in,
digimol_2006@
yahoo.co.in
0253- 2595586
9422759960
80
Maharashtra
G.M. Priya
Hospital, Latur
Latur
G M P Hospital,
Dapegaon, Taluk Ausa,
Dist Latur - 413572
Dr D William
02383- 226069
81
Maharashtra
Jan Kalyan
Samiti, Sholapur
Sholapur
C/O Chaitanya Hospital,

538 Vithal Arcade,
North Kasba,
Sholapur - 413001
Mr. J Shilgekar
0217-2741870,
2741874, 2741872
82
Maharashtra
Nirmaya Niketan,
Mumbai
Mumbai
V N Purav Marg,
Dhobighat, Trombay,
Mumbai - 400088,
<chairman@nirama
yniketan.org>
Mr. John Lobo, Mr. A.S.

Gaikwad, ChairmanMr. Santan DSouza,
Eduljee Framjee Allbless
Niramay Niketan,
V.N. Purav Marg,
Dhobi Ghat, Trombay,
Mumbai-400088
022-25513314,
Fax:91-022-25581450
Tel: 91-022-2551
3314 (OPD)
Mob. No. Chairman 9869682397,
Treasurer 9867618832,
Co-ordinator (CCC) 9869289347
83
Maharashtra
Sarvodaya
Hospital,
Mumbai
Mumbai
Lal Bahadur Shastri

Marg, Ghatkopar (W),
Mumbai
Mr. Krishnan
022-25152237
84
Maharashtra
Snehalaya,
Ahmaednagar
Ahmednagar
Block No 239, Near

Super Ammonia Plant,
Shree Tile Chowk,
MIDC, Nimblak,
Ahmednagar-414001
Mr. Ambadas Chavan,

Mr. Anil Gawde
0241-2778353,
2327593,
9881946116
9890306407
85
Maharashtra
Priyadarshani
Rural and Tribal
Upliftment
Foundation,
Akola
Akola
Sant Tukaram Hospital,

Gorakshan Rd,
Tukaram Chowk,
Akola - 444001
Dr. Jagannath Dhone,

Anand Janotkar
0724-2433092
9923584209
86
Maharashtra
Godavari
Foundation,
Jalgaon
Jalgaon
Godavari Foundations
CCC, Mahesh Housing
Society, Near Hotel Step
Inn, Jalgaon - 425001
Dr. Ulhas Patil

Mr Yogesh Mahajan
0257-2200830
9371616716
Facilitator Guide
Page 420
Address
Contact
Person
Phone No.

S.
No.
State
Name of
the CCC
District
District
Category
87
Maharashtra
Lotus Medical
Foundation,
Kolhapur
Kolhapur
Sona Towers, Survey

Dr. Kimaya Shah
No 644, Plot No. 143/B1,
YP Pawar Nagar Chowk,
Jawaharnagar Rd,
Kolhapur-416008
0231-2692411
9422051305
88
Maharashtra
Balvikas Mahila
Mandal, Latur
Latur
Swadhar Mahila
Vastigruh, Sudarshan
Colony, Indra Nagar,
Latur - 413512
Mr. Vilas Deshpande
02382-228773
02382-240418
89
Maharashtra
Mure Memorial
Hospital, Nagpur
Nagpur
Maharajbagh Road,
Sitabuldi,
Nagpur-440001
Mr. Vilas Shende
0712-2522370
90
Maharashtra
Bhartiya Adim
Jati Sevak
Sangh, Nagpur
Nagpur
Mr. R.K. Malviya

Amruta Joshi
0712-2290421
9372543322
9422804228
91
Maharashtra
Dhanvantri
Vaidyakiya
Pratishthan,
Nanded
Nanded
Infront of Water Tank,

Mahavir Society,
Nanded - 431602
Dr. B.K. Kardile
02462-234330
9422186245
92
Maharashtra
Sai Sneha
Hospital, Pune
Pune
Sai Sneha Hospital,

A/P Khed Shivapur
(Bagh) Near Police
Station, Tal. Haveli,
Dist. Pune-412213
Dr. Sunil Jagtap
020- 26959208,
9822036736
93
Maharashtra
Loknete
Rajarambapu
Patil Hospital
and Research
Centre, Sangli
Islampur
Loknete Rajarambapu
Patil Hospital and
Research Centre,
Islampur Sangli Rd,
Islampur-415409
Dr. Pramod Patil
02342-225792
94
Maharashtra
Sangli Mission
Society, Sangli
Sangli
Dilasa House, Darga

Mohalla, Aman Nagar,
Malgao Rd, Miraj,
Dist Sangli-416410
Fr. Sabu
0233-2211292,
9420678520
95
Maharashtra
Loknete Rajaram
Bapu Hospital &
Research Centre
Sangli
96
Maharashtra
Param Prasad
Charitable
Society
Pune
Dr. Jal Mehta Foundation Fr. Shaju

Campus, Survey No. 1,
Yevlewadi, Pune
0-9970963246
97
Maharashtra
Sai Prem
Gramina Vikas
Sanstha
Yavatmal
Dhanashre Rugnalay,
Behind Basaveshwar
Mangal Karyalaya,
Darwha Rd., Yavatmal
0723-2322929
98
Maharashtra
Kamlini Nilmani
Charitable Trust
Mumbai
Goel Hospital, J B Nagar, Ravi Patil

Andheri (East),
Mumbai - 400 059
022 28323659 /
28349714
982013653
99
Maharashtra
Jyotish
Charitable Trust
Raigad
Jyothis Care Centre,

Sector 11, Plot No 4,
Kalamboli, Navi Mumbai
022-27423399

Address
Contact
Person
Reeta Bhawnae
Sr. Infanta
Phone No.
Facilitator Guide
Page 421
S.
No.
State
Name of
the CCC
District
District
Category
Address
Contact
Person
Phone No.
100
Maharashtra
Jeevan Vikas
Sanstha
Amravati
Navjeevan Care Centre,

C/O Leprosy Relief &
Rehabilitation Centre,
Nimbhora Khurd,
Badnera P.O.,
Amravati Dist. - 444701
Fr.Jolly
07223 221352 /
221576 / 07223 /
223740 /
09422156032
101
Maharashtra
Dhanvantaris
Organization for
Socio Health
Transformation
Parbhani
DOST CCC, Sadguru

Nagar, Old Pedgaon Rd,
Parbhani-431401
Dr.Jawade
(02452) 241122
9970764224
102
Maharashtra
Shanti Mandal Vimala Sadan
Aurangabad
Vimala Sadan Social

Service Centre, New
Shantiniketan Colony,
Jalna Road,
Aurangabad - 431005
Sr.Sheeba
103
Maharashtra
Diocese of
Chanda Society
Chandrapur
Christ Hospital,
Jyoti Nagar, Tukum,
Chandrapur- 442401
Dr. Gregory Ellyadom
07172-264387,
264389,
09423115594
104
Maharashtra
Shri Gajanan
Maharaj Krishi
Va Shishanak
Santha
Jalna
Shrikrishna Clinic,
Mantha Road, Jalna
Ganesh Sonunae
07261-232226,
232393,
9422880291,
9881719227
105
Maharashtra
Sangli Mission
Society
Ratnagiri
Navajeevan Arogya
Kendra, St. Thomas
Church Campus, MIDC
PO, Karwanchi Wadi
Road, PB-12,
Ravindranagar,
Ratnagiri - 415639
Fr. Siju
094211-22204
106
Maharashtra
DOSTHingoli-CCC
Hingoli
Hingoli
DOST-CCC Hingoli,
Near Civil Hospital,
Hingoli, Dist. Hingoli
9970764224
107
Maharashtra
Hope Centre
Mumbai
Andheri
The Catholic Nurses

Guild of India., C.N.G.I.
National Secretariate &
Hope Centre,
Mhatarpada Road,
Amboli, Andheri West,
Mumbai - 400058
9892950509
108
Maharashtra
Sparsh Hospital
Osmanabad
Sastur
SPARSH Rural Hospital,

At Sastur, Taluka Lohara,
Dist. Osmanabad-413606
094220 95053
109
Maharashtra
Ashakiran
Hospital
Pune
Pune
Ashakiran Jubilee Hope

Centre, Survey No. 138,
Chinchwad (East),
Near St. Andrews School,
Pune - 411018
020-27482626,
020-65320462
110
Maharashtra
Vanchit Vikas
CCC
Pune
Pune
Mogal Market, 2nd Floor,

CTS No: 1003, Budgwar
Peth, Pune - 411002
020 24454658/
24483050
Facilitator Guide
Page 422

S.
No.
State
Name of
the CCC
District
111
Maharashtra
Late Shriram
Dhule
Ahirrao Memorial
Trust- Dhule-CCC
112
Maharashtra
Late Shriram
Ahirrao Memorial
TrustNandurbar-CCC
Nandurbar
113
Maharashtra
Sant Gulab Baba

CCC
Bhandara
114
Maharashtra
Yuva CCC
Beed
115
Manipur
Centre for
Organising
Labours
Development
(COLD)
Canchipur
Centre for Organising

Labours Development
(COLD), Canchipur,
Imphal West
116
Manipur
LEWS
Imphal
Leprosy Patients Welfare A. Tolen Singh

Society, Lei-Ingkhol,
Imphal
2421363(O),
94360-20161,
94360-27065
Email: lews2003man
@yahoo.co.in
117
Manipur
RUSA, Moreh
Moreh
Rural Service Agency

(RUSA), Moreh, Ward
No.9, Near Trade Center
98622-78785,
2231145
Email: rusapalace
compound@
yahoo.com
118
Manipur
SHALOM
Churchanpur
Society for HIV/AIDS and Ms. Lalruatpuii Pachuau

Lifeline Operation in
Manipur (SHALOM),
Churachandpur Bazar
953874-33891,
953874-22531,
953874-33541
Email: shalomccp@
yahoo.co.in
119
Manipur
Kha Manipur
Yoga and
Nature Cure
Thoubal
Kha Manipur Yoga and

Nature Cure, Kakching
Thoubal District
Dr. M. Rajkumar Singh
98620-88092,
953848-261320
Email: ayncrh@
yahoo.co.in
120
Manipur
PRDA
Bishnupur
Peoples Resources
Development Association
(PRDA), Ningthoukhong
of Bishnupur District
L.Suranjoy Singh
98561-92762
Email: prda@
rediffmail.com

District
Category
Dhule
Address
Contact
Person
Phone No.
CCC - Late Shriram

Ahirrao Memorial Trust,
Betawad, Tal. Sindkheda,
Dist.: Dhule
Pin: 425403
9422788421
Nandurbar
Jai Prakash Narayan

Hospital Compound,
Near Meera Agency,
Main Road,
Nandurbar
9422788421
Bhandara
Doctors Colony,
Takia Ward,
Behind MSEB Office,
National Highway-6,
Bhandara - 441904
9823593554
Late Suwalalji Wakekar

Community Care Center,
Parli (V), Near Over
Bridge, beside
Khandinala Complex,
Hindnagar, Parli (V),
Dist. Beed - 431515
(02446) 222891
Parli
Th. Promila
Y. Surchandra Singh
98562-15673,
2406411
Facilitator Guide
Page 423
S.
No.
State
Name of
the CCC
District
District
Category
Address
Contact
Person
Phone No.
121
Tamil Nadu
YRG Centre for

AIDS Research
and Education
(YRG CARE)
Chennai
YRG Centre for AIDS

Research and Education
(YRG CARE), Voluntary
Health Services (VHS)
Campus, Taramani,
Chennai - 113
Thiru. SK. Satish Kumar
9381006380
[email protected],
[email protected]
122
Tamil Nadu
Sneha Sadan
Dharmapuri
Sneha Sadan,
Selliampatty Village &
Post, Palacode Taluk,
Dharmapuri
District - 636809
Sr. Shobhana,
9486091091,
snehasadan2007@
gmail.com
123
Tamil Nadu
The Association
of Arulagam
Hospice
Dindigul
The Association of
Arulagam Hospice,
Bangarapuram,
Reddiarchatram Post,
Dindigul District - 624622
Dr. Margret Kalaiselvi,

margaret_larbeer@
yahoo.com,
[email protected],
[email protected]
9944210076
124
Tamil Nadu
Family Planning
Association of
India (FPAI)
Dindigul
Family Planning
Thiru. A.K. Serumalai
Association of India
[email protected]
(FPAI), Plot No. 69-70,
9952118640
AJMG Nagar, 4th Lane,
Opp. to Beschi College,
Karur Road,
Dindigul District - 624001
9952118640
125
Tamil Nadu
Centre for Action Erode

and Rural
Education (CARE)
Centre for Action and

Rural Education (CARE),
No. 6, Kambar Street,
Teachers Colony, Erode
9443736367
126
Tamil Nadu
Family Planning
Association of
India (FPAI),
Madurai
Family Planning
Dr. Louis S. Paulraj,
Association of India
9442035900,
(FPAI), Madurai Branch, [email protected]
FPAI Bhavan, FPAI Road,
TNHB Colony,
Ellis Nagar, Madurai,
Madurai District - 625010
9442035900
127
Tamil Nadu
Meenakshi
Mission Hospital
and Research
Centre
Madurai
Meenakshi Mission
Hospital and Research
Centre, Lake Area,
Melur Road,
Madurai District - 625107
Thiru. S. Palaniappan,
9842161185,
[email protected],
palaniappan_law@
yahoo.co.in
9842161185
128
Tamil Nadu
HIV Positive
Namakkal
People Welfare
Society (HPPWS)
HIV Positive People

Welfare Society (HPPWS)
No.119-28B, Madha Koil
Street, Trichy Road,
Namakkal - 637001
Ms. S. Kausalya,
9840693679
9840693679,
[email protected]
<[email protected]>
129
Tamil Nadu
Human Uplift
Trust (HUT)
Perambalur
Human Uplift Trust (HUT) Dr. Raja Venkat

Meikandar Complex,
9842414711
Kalpalayam Road,
[email protected]
Mannachanallur,
Trichy - 621005
9842414711
130
Tamil Nadu
Sri Ponnalagi
Amman Trust
Pudhukottai
Sri Ponnalagi Amman

Trust, Thottiampatty,
Ponnamaravathy,
Pudukottai District
9344545449
Facilitator Guide
Page 424
Thiru. Charles Prabhu,

9443736367,
[email protected]
Dr. A. Alegesan,
9344545449,
[email protected],
[email protected]
<[email protected]>

S.
No.
State
Name of
the CCC
District
131
Tamil Nadu
Immaculate
Conception
Women
Development
Social Service
Society of
Sivagangai
Province Sirpi &
St. Joseph
Hospital
Sivagangai
132
Tamil Nadu
Mass Action
Network India
Trust (MAN)
133
Tamil Nadu
134
Address
Contact
Person
Immaculate Conception
Women Development
Social Service Society
of Sivagangai Province
Sirpi & St. Joseph
Hospital, Pulial,
Pulial (Post),
Devakottai (via),
Sivagangai - 630 312
Sr. Motchalangaram,
9486013389
9486013389,
[email protected]
<[email protected]>
Thiruvallur
Mass Action Network

India Trust (MAN), No.14,
1st Floor, West Sivan,
Kovil Street, Vadapalani,
Chennai - 600029
G. Babu,
9444275762,
massaction@
rediffmail.com
9444275762
St. Joseph
Leprosy Hospital
and HIV/AIDS
Care Centre
Tuticorin
St. Joseph Leprosy

Hospital and HIV/AIDS
Care Centre,
Arokyapuram,
Thoothukudi
Sr. Rose Francis,

9442948815,
[email protected] ,
Sr. Dr. Rita
9442948815
Tamil Nadu
Holy Family
Hansenorium
Trichy
Holy Family
Hansenorium,
Fathima Nagar (Post),
Trichy - 620 012
9443401125,
[email protected]
9443401125
135
Tamil Nadu
Sri Meenakshi
Educational and
Development
Organization
(SMEDO)
Ramnad
Sri Meenakshi
Educational and
Development
Organization (SMEDO),
No. 3/622 A3,
Bagawath Singh Road,
Paramakudi - 623707,
Ramanathapuram District
Dr. S. Sundarraj,
9443155181,
[email protected]
9443155181
136
Tamil Nadu
Tamilnadu
Network of
Positive People
(TNP+)
Villupuram
Tamilnadu Network of
Positive People (TNP+),
No. 10, Kalaignar,
Karunanidhi Street,
Chennai Main Road,
Villupuram - 605 602
Thiru. Rama Pandian,

944040469,
[email protected]
944040469
137
Tamil Nadu
N.A.A.DT. People Vellore

Welfare Service
Society
N.A.A.DT. People
Welfare Service Society,
Dharma Nagar, Vellore
Hospital back side,
Adukkambarai,
Vellore District
Thir. M.S. Rajendran,

9790571391
9790571391,
[email protected]
138
Tamil Nadu
Community of
People Living
with HIV/AIDS in
Tamilnadu
(CPT+)
Community of People
Living with HIV/AIDS in
Tamilnadu (CPT+),
No. 5/74C, Katpadi Main
Road, Senrayanapalle,
Katpadi Taluk,
Vellore District
Mr.Pandian, 9894807208, 9894807208

[email protected]
<[email protected]>
Vellore

District
Category
Phone No.
Facilitator Guide
Page 425
S.
No.
State
Name of
the CCC
Address
Contact
Person
Phone No.
139
Tamil Nadu
Sri Narayani
Vellore
Hospital &
Research Centre,
Sri Narayani Hospital &

Research Centre,
Thirumalaikodi,
Vellore District - 632055
Dr. J. Sundra Babu,

9952416822
[email protected],
suresh1980edp@
gmail.com
9952416822
140
Tamil Nadu
Society of the
Sisters of the
Presentation of
the Blessed
Virgin Mary
Community
Health
Department
Theni
Society of the Sisters

of the Presentation of
the Blessed Virgin Mary
Community Health
Department, No. 5/73,
Theni District,
Theni - 625 531
Sr. Anestesia,
9443862311
9443862311
141
Tamil Nadu
Ramana
Maharishi
Rangammal
Hospital
Thiruvannamalai
Ramana Maharishi
Rangammal Hospital,
Shiva Nagar, Athiyandal
Village, Thiuvannamalai
District - 606603
Thiru. F. Jayaraj,
9442274235
9442274235,
[email protected]
142
Tamil Nadu
Society for
Education and
Economic
Development
(SEED)
Nagapattinam
Society for Education

and Economic
Development (SEED)
No.3/273, Main Road,
Thirumarugal,
Nagapaatinam
Tmt. A.G. Manimekalai,

9443847312,
[email protected]
9443847312
143
Tamil Nadu
Indo Srilankan
Development
(Island) Trust
The Nilgiris
Indo Srilankan
Development (Island)
Trust, No. 14/56,
Club Road,
Kothagiri - 643217
Mr. Alphone Raj M.L.,

9443371224,
[email protected]
9443371224
144
Tamil Nadu
TCNR
Padmavathi
Ammal Free
Medical Charties
(TCNRP),
Virudhunagar
TCNR Padmavathi
Dr. Kamalasekarn,
Ammal Free Medical
94431 22784,
Charties (TCNRP),
[email protected]
Bo. 121B, Hospital Road,
Rajapalayam - 262117
9443122784
145
Tamil Nadu
Selvi Memorial
Illam Society,
Kancheepuram
Selvi Memorial Illam

Society, No. 9, 2nd Main
Road, Jaya Nagar,
Tambaram Sanitorium,
Chennai - 600 047
Ms. Mary Thomas,

9840541108,
[email protected],
[email protected]
9840541108
146
Tamil Nadu
We Care Social
Service Society
Kancheepuram
We Care Social Service

Society, No. 4/98,
Nethaji Road,
Singaperumal Koil Post,
Kancheepuram
District - 603 204
Mr. Antony, 9340001000,

[email protected]
9340001000
147
Tamil Nadu
Arogya Agam
Theni
Arogya Agam,
Palakombai Road,
Aundipatty,
Theni - 625 512
Mr. John Dalton

9842115449/
9842115449/9842142306, 9842142306
[email protected],
[email protected]
148
Tamil Nadu
Indian Red
Cross Society
(IRCS),
Krishnagiri
Krishnagiri
Indian Red Cross Society Mr. P. Shanmugam,

(IRCS), No.8, Krishnappa 944331118
Layout,
Krishanagiri - 635001
Facilitator Guide
Page 426
District
District
Category
9443331118

S.
No.
State
Name of
the CCC
District
149
Tamil Nadu
Vailankanni
Society for Rural
Construction and
Technical
Education
(VIRTUE)
Thiruvarur
Vailankanni Society for

Er. S. Xavier,
Rural Construction and
9842452597,
Technical Education
[email protected]
(VIRTUE), No.18/94-V,
Hospital Street,
Tiruthuraipoondi - 614713
9842452597
150
Tamil Nadu
Anbalayam
Thanjavur
Anbalayam, No. 6/142,

Natarajapuram South,
10th Cross Street,
Thanjavur - 613 007
Thiru. K. Senthil Kumar,

9443167607,
anbalayam2001@
yahoo.co.in
9443167607
151
Tamil Nadu
Freedom
Foundation
Chennai
Freedom Foundation,
No. 15, Redhills Road,
United Colony, Kolathur,
Chennai - 600 099
Mr. Varadhan,
9444041619
9444041619
152
Tamil Nadu
Preshistha
Service Society
Coimbatore
Preshistha Service
Society, Unjavelampatty,
Pollachi Taluk,
Pollachi - 03,
Coimbatore District
Fr. Seby Vellanikaran,

9443006094,
[email protected],
[email protected]
9443006094
153
Tamil Nadu
Isha Yoga
Foundation,
Coimbatore
Isha Yoga Foundation,

Grama Puthunarvu
Iyyakkam, No. 13/24,
North End Road,
Krishnasamy Nagar,
Coimbatore - 45
Dr. Bhavani Balakrishnan 9840804496

9840804496,
isha.healthservices@
gmail.com,
bhavani.balakrishnan@
gmail.com
154
Tamil Nadu
Sharanalayam
Coimbatore
Sharanalayam, No. 34,

Thiruvengada Nagar,
Pollachi - 642 001,
Coimbatore District
N. Chandran,
94443054204,
[email protected],
sharanalayam@
rediffmail.com
94443054204
155
Tamil Nadu
PEACE TRUST
Tirnelveli
PEACE TRUST, No. 15,

Kurichi Road,
Kulavanigar Puram,
Palayamkotta - 627 002
Dr. R. Anburajan,
9442612138,
anburajandoctor@
gmail.com
9442612138
156
Tamil Nadu
Modern
Educational
Social Service
Society (MESSS)
Karur
15/2 11th Cross Street,

1st Floor,
Sengunthapuram,
Karur - 2
R. Thirumal@
Rajanmessscuddalore@
yahoo.co.in
93676 20313
94424 40747
157
Tamil Nadu
Saraswathi
Women
Educational
Service
Training
Improvement
Center
(SWESTIC)
Dindigul
Saraswathi Women
Educational Service
Training Improvement
Center (SWESTIC),
Opp. to Lokayarkottai,
Solaipudur (Post),
Oddanchatram - 624619,
Dindigul District
S. Kalaiarasi
9442641104
[email protected]
158
Tamil Nadu
James Memorial
Charitable Trust
Kanniakumari
James Memorial
Charitable Trust,
Colachel Post,
Kannyakumari
District - 629 251.
G. Frederick Raja Sekhar

9443326327
[email protected]

District
Category
Address
Contact
Person
Phone No.
Facilitator Guide
Page 427
S.
No.
State
Name of
the CCC
159
Tamil Nadu
Centre for
Kanniakumari
Human Resource
and Rural
Developmental
Programmes
(CHARDEP)
Centre for Human

[email protected]
Resource and Rural
Developmental
Programmes (CHARDEP),
No. 21B, Sargunaveedi,
Cross Street,
Ramavarmapuram,
Nagercoil - 1,
Kanyakumari District
G. Manikandan
9942979160
160
Tamil Nadu
The Modern
Educational &
Social Service
Society (MESSS)
Cuddalore
The Modern Educational

& Social Service Society
(MESSS), No. 10,
Srinivasa Pillai Street,
Pudupalayam,
Cuddalore - 1
R. Thirumal @ Rajan
messscuddalore@
yahoo.co.in
93676 20313
94424 40747
161
Tamil Nadu
Doctor Typhagne
Memorial
Charitable
(DTMC) Trust
Salem
Doctor Typhagne
Memorial Charitable
(DTMC) Trust, SMMI
Convent Staff Quarters
Arisipalayam,
Salem - 636 009
[email protected]
[email protected]
A. John Paul,
9894137826
Sr. Francina,
9443221482
162
Mizoram
Joy Adventist
Aizwal
Seventh Day Tlang,

Aizawl
[email protected]
Dr. Eileen (94361-43503), (0389) 234-0326,

Cathy Lalnunpuii
94361-97768
(98630-42694)
163
Mizoram
Presbytarian
Hospital
Duruthalang
Presbytarian Hospital,
Dururthlang
Dr. Sanghluna
164
Jharkhand
Snehdeep,
Hazaribagh
Hazaribag
Snehdeep Holy
Cross CCC, Sitagarh,
Hazaribagh
Dr. Sandeep Mukerjee
165
Jharkhand
Ashadeep,
Ranchi
Ranchi
Ashadeep CCC,
Hefag Hatia, Ranchi
166
Himanchal
Pradesh
Swami Sri
Harigiri Hospital
and CCC,
Chamba
Chamba
Swami Shri Hari Giri

Hospital Cum Research
Centre, Kakira,
Distt. Chamba
167
Punjab
Community Care Amritsar

Center for people
living with
HIV/AIDS,
Amritsar
Inside Guru Nanak

Dev Hospital, Near
De-Addiction Centre,
Majitha Road,
Amritsar - 143001
168
Punjab
Community Care
Center Patiala
Information not received
169
Punjab
Community Care Kapurthala

Center Jalandhar,
Kapurthala
Information not received
170
Kerela
St Johns Health
Services
Trivandrum
St Johns Health Services Fr Jose Kizhakkedath

Pirappancode, Trivandrum,
0472-2872047
0472 2872047
171
Kerela
Amrita Kripa
Sagar Care
Centre
Trivandrum
Amrita Kripa Sagar Care

Centre, Nedumangad,
Trivandrum,
Phone: 0472 2891237
9447090075
Facilitator Guide
Page 428
District
Patiala
District
Category
Address
Contact
Person
Phone No.
(0389) 236-1222,
0-94361-41739
Ph. 0183-2572401
Br Amarnath

S.
No.
State
Name of
the CCC
District
172
Kerela
Snehatheeran
Care Centre
Ernakulam
173
Kerela
174
Address
Contact
Person
Phone No.
Snehatheeran Care
Centre, West
Kadungallor, Aluva
10 Ernakulam Dist
Fr Naveen Mathew
9495676232
Asha Kiran,
Kottayam
Pampady, Near
KG College
Kottayam 686502
0481 2500431
Pampady,
Near KG College,
Kottayam - 686502
Ms Isha Jacob
0482 2500431
Kerala
Nazarath Care
and support
Center
Palakkad
Narareth Sabs Centenary srtessinmynatty@

Charitable Trust,
gmail.com
Kinasery PO,
Muthukad - 678707
0491-2910035
175
Kerala
Institute of
Palliative
Medicines
Calicut
Medical College PO,

Kozikode - 673008
dr.suresh.kumar@
gmail.com
9349113532
176
Assam
Borukha Public
Trust, Guwahati
Guwahati
[email protected]
Mr. Ratul Kalita,

Dr. J.N. Bhattacharya
98642-16627,
0361-223-1104,
0361-223-4104
177
Assam
Anubhuti
Community
Care Center
Silchar
Deshasandhu Club,
Sahid Bazar, Sibburi
Road, Silchar, Cachar
Mousami Roy
communitycarecenter
[email protected]
178
Assam
Astha CCC
Dibrugarh
Chiring Chapori,
Opposite Bhattacharjee
Press, Behnid Assam
Tribune,
Dibrugarh-786001
Ranjita Tayeng
Dr. H Das
03732316917,
03732310060,
9435112933
179
Goa
CARITAS
Goa
Near Church Cavelossim, Sr. Vinita Joseph

Salcete, Goa - 403802
0832-2871745
180
Goa
Freedom
Foundation
Goa
105/A-2, Opp. Hotel

Green Park, Sorvem,
Guirim, Bardez,
Goa 403507 (North Goa)
0832-2264262
181
Nagaland
ECS Hospice
Tuensang
Eleutheros Christian
Dr. Panker,
Society (ECS) Tuensang, M - 09436658220
Nagaland PO Box -51
Tel: 0361-220127
0361-220127 /
09436658220
182
Nagaland
HIV/AIDS Care
Hospice
Kohima
Naga Mothers
Association (NMA)
HIV/AIDS Care Hospice
Cradle Ridge, Seithogei,
PO Box No. 160,
Kohima- 797001,
Nagaland
Tel: 0370-2800356
Dr. Kekhrievilhou Nakhro

Mobile No. 09856150359
0370-2800356 /
09856150359
183
Nagaland
Impur Christian
Hospital,
Mokokchung
Mokokchung
Impur Christian Hospital,

Mokokchung.
Mr. Talitemsu, Manager

M-9436408316
0369-2262441

District
Category
Ms. Zinya DSouza
Facilitator Guide
Page 429
S.
No.
State
Name of
the CCC
District
District
Category
184
Nagaland
Western Sumi
Community
Development
Project
(WSCDP)
Dimapur
Dimapur
Western Sumi Community Khekiho Katy

Development Project,
(Development Officer)
Akuvuto, P.O. Box-34,
9856544303 (M)
Thakhekhu
Village-797112, Dimapur
E-mail: wsbak_
[email protected]
(03862)245033 (R)
185
Uttar Pradesh
Umang CCC
Foundation
for Social Care
Lucknow
Near Petrol Pump,

Andhe ki Chowki,
Hardoi Road
Mr. Arif
9935859534 /
9935451159
186
Uttar Pradesh
Umang CCC
Adarsh Sewa
Samaiti
Merrut
B-104, Takshila Colony,

Garh Road, Meerut
Mr. Arun Kumar
(0121) 3208543
187
Uttar Pradesh
Umang CCC
Centre for Social
Research
Varanasi
Umang Community Care

Centre, Plot No.17,
Sukhi Sansar Colony,
Giri Extention,
Mahmoorganj,
Varanasi
Ms. Kanchana Singh
09415223387,
09336747468
188
Uttar Pradesh
Umang CCC
Gramin Seva
Sansthan
Gorakhpur
C-362, Raptinagar,
Phase-4, P.O.
Charaganva,
Gorakhpur
Mr. Arvind Kumar
0551-2506064
189
Uttar Pradesh
Umang CCC
Society for
Welfare &
Advancement of
Rural
Generations
(SWARG)
Allahabad
21 Shivpur,
P.O. Dhoomanganj,
Allahabad 211010
Mr. Manoj Kumar
0532-232845
190
Uttar Pradesh
Umang CCC
Kanpur
191
Uttar Pradesh
Umang CCC
Agra
192
Rajasthan
SAMBAL CCC
Bal Sansar
Ajmer
Swasti B-88, Sarswati

Marg, Bajaj Nagar,
Jaipur
Mr. Bhanwer Govind

Singh
0145-2600415,
09461478052
193
Rajasthan
Jeevan Prakash
CCC Gramin
Vikas Evam
Paryavaran
Sanstha
Bikaner
Basadi-Boroda,
Post Udawala,
via Sainthal,
District Dausa,
Rajasthan
Ms. Nisha Seezo
0151-2110285
194
Rajasthan
Seva Mandir
CCC Seva
Mandir
Udaipur
Old Fatehpura,
Udaipur- 313004,
Rajasthan
Ms. Ratan Paliwal
0294-2451041,
2450960
195
Rajasthan
Jeevan Asha
Jaipur
196
Rajasthan
Jeevan Anand
CCC St. William
Educational and
Social Welfare
Society
Jodhpur
Facilitator Guide
Page 430
Address
Contact
Person
776/17 E, Housing Board Mr. Kuldeep Chaudhary

Chopashni, Jodhpur
Phone No.
0291 2707498

S.
No.
State
Name of
the CCC
District
197
Gujarat
Karuna Shakti
CCC Kaira
Social Service
Society
Ahmerdabad
198
Gujarat
Navjeevan Trust
CCC
199
Gujarat
200
Address
Contact
Person
Phone No.
Karuna Shakti CCC,

Matikhan Talawadi,
Ramol Gatrad Road,
Nr. Toll-tax Bridge,
Ring Road, Ahmedabad
[email protected],
[email protected]
Sr. Elizabeth
079-22861216/49 &
079-65442593
Rajkot
Jamnagar Road,
Opp. Morbi House,
Post Box No. 36,
Rajkot, Gujarat
Fr. C.C. Jose CMI
0281-2490916
Navjeevan CCC
Navjeevan
Welfare Society
Bhavnagar
Our Lady Pillar

Disceinsary, Plot No.
428/F, Prabhudas Talav,
Ruvapari Road,
Bhavnagar
Sr. Dr. Scholastica

Macwan
(0278) 2573559
Gujarat
Sphoorti
Sabarmati
Samruddhi
Seva Sangh
Mehsana
Sabarmati Sammrudhi
Seva Sangh,
C/o Catholic Ashram,
Post Box No.3,
Ramosana Road,
Mehshana - 384002
Ms. Hemlata
(079) 23227856
201
Gujarat
Jeevan Jyoti
Kripa Foundation
Vadodara
Jeevan Jyot CCC,

Ms. Susan
C/O Kripa Rehabilitation
Centre,At & Post Amodar,
Taluka-Vaghodiya,
Vadoara - 390019
(0265) 5596970
202
Gujarat
Santwana CCC
Jamnagar
203
Gujarat
Sarvjanik CCC
Surat
Sarvjanik Medical
Trust
Pastagia Street,
Nr. Rampura Petrol
Pump, Rampura,
Surat - 395003 (Gujarat)
M. M. Amla
0261-2492678
204
Chattisgarh
Lifeline CCC
Model Bastar
Integrated Rural
Development
Society (BIRDS)
Bastar
C/o MPM Hospital,

Aghanpur, Jagdalpur,
Bastar DT.,
Chhattisgarh - 494005
Fr. K.T. Thomas
07782 229030,
229032
205
Chattisgarh
Holy Cross
Pavitra Cruz
Sisters Society
Sarguja
Holy Cross CCC,

Holy Cross Hospital,
Ambikapur,
DistrictSarguja,
Chattisgarh - 497001
Sr. Juliet Jacob
(+91-79363660)
(+91-9425255922)
206
Chattisgarh
Karuna CCC
Durg
Karuna CCC, Karuna

Hospital, Nandini Road,
Khurispar, Bhillai,
Durg - 490002
Sr. Sushila
0788 - 2296486;
9752898960
207
Chattisgarh
Maria Sahay
CCC
Bilaspur
Maria Sahaya CCC,

Sipat Road, Sarkanda,
Bilaspur - 495006
Sr. Kusum
0775 -22733673;
98983396495

District
Category
Facilitator Guide
Page 431
S.
No.
State
Name of
the CCC
Address
Contact
Person
Phone No.
208
Chattisgarh
Jeevodaya CCC Raipur

Jeevodaya Social
& Leprosy
Rehabilitation
Center
Jeevodaya CCC, Social

& Leprosy Rehabilitation
Center, P.O. Abhanpur,
Dt. Raipur,
Chattisgarh - 493661
Fr. Abraham
Thylammanal SAC
0771 2120131
209
Madhya Pradesh
Saathi CCC
Kripa Social
Welfare Society
Ujjain
MIG A 5/16 Mahakal

Vanijyik Kendra,
Ujjain - 456010
210
Madhya Pradesh
Asha Kiran
Jabalpur
Diocesan for
Social Service
Society
Jabalpur
M-54, 7th Lane,

Behind Gupta Hotel,
Sharda Colony,
Shakti Nagar, Jabalpur
Avinash Pillai
9425873616
211
Madhya Pradesh
Maitri Asha
Niketan
Bhopal
Gandhi Bhavan,
Shyamla Hills
Mr. Shaji Chacko
0755-4273848
212
Madhya Pradesh
Vishwas CCC
Pavitra Atma
Sevika Sangh
Indore
R-847, Near Poineer

Convent, Mahalaxmi
Nagar, Indore
Sr. Geeta
0731-2556372
213
West Bengal
Arunima CNI
Calcutta
Diocesan
Central Fund
Kolkatta
81, Diamond Harbour

Road, Barisha,
Kolkata - 700 008
Mr. Suvobrata Das
(033) 6450 8840
214
West Bengal
Snehalaya
Gandhi Mission
Trust
Midnapur
Vill - Dihibaliharpur,
Mr. Badal Maharana
Post - Daspur,
Dist - Paschim Medinipur,
West Bengal - 721211,
India
03225-254217
215
West Bengal
Sparsha
SPARSHA
Howrah
Vill. - Majerati, Banitabla,

P.O. Jadurberi,
P.S. Uluberia, Howrah
Mr. Surja Kanta Ghosh
33 2661 1815
216
West Bengal
Jeshu Ashram
Jesu Ashram
Siliguri
Vill Matigara,
P.O. Matigara,
Dist Darjeeling,
West Bengal
Mr. Ratan Lama
3536453470
217
West Bengal
Chetna CCC
Bardwan
Asansol Burdwan
Seva Kendra
Jhinguti, P.O.- Phagupur,

Burdwan
Mr. Rahul Sonkar
9832713315
218
West Bengal
Sewa Kendra
Sewa Kendra
Kolkotta
Kolkatta
Seva Kendra, Community Mukul Haldar

Care Centre, Seva
Kendra, Calcutta
Extension, Dum Sum,
93, P.K. Guha Road,
Kumarpara,
Dum Dum Cantonment,
Kolkata 700 028
(033) 30239384
219
West Bengal
ASHAAR ALO
CCC Social
Welfare Institute
Malda
P.O. - Phulbari,
Manaskamana Road,
Dist. Malda - 732101,
West Bengal
03512-340900
Facilitator Guide
Page 432
District
District
Category
0734-2533246
Mr. Selestion Minz

S.
No.
State
Name of
the CCC
District
220
West Bengal
Bhalobasha,
Bhoruka
Jalpaiguri
Bhoruka Bhalobasha,
Tamali Dutta
C/o Mr. Sushil Chandra,
Farm More, Mohit Nagar,
Post - Jalpaiguri-735101
9733263805
221
West Bengal
Anugalaya CCC
Anugyalaya
DDSSS
Darjeeling Hills
4, Mall Villa.,
C.R. Das Road,
Darjeeling - 734101
Mr. Albert Rai
9749091420
222
Bihar
Nai Asha
Nazareth CCC,
Mokama
Nazareth
Hospital Society
Mokama
Nazareth Hospital,
Mokama P.O.,
Patna Dist., Bihar
Sr. Nirmala Mulackal
06132232367 /
233014
223
Bihar
Holy Family,
Bhagalpur
Bhagalpur Holy
Family, Bhagalpur
The Poreyahat Holy

Family Society,
Holy Family Convent,
Tilakmanjhi, Bhagalpur,
Bihar - 812001
Sr. Grace
224
Bihar
Sanjeevani
Sanjeevani
Darbhanga
Darbhanga
Sanjeevini Community
Care Centre,
Hospital Road, Beta,
P.O. Leheriasaria,
Dist. - Darbanga, Bihar
Er. Kaushendra Sanjay

Kumar
225
Bihar
Jeevan Sagar
Fakirana Sisters
Society
Muzaffarpur
Fakirana Sisters Society, Sr. Mary Elise

Sacred Heart Convent,
Bettiah, District West
Champaran, Bihar
0621-2280196
226
Bihar
Navjeevan Kurji
Holy Family
Hospital
Patna
Kurji Holy Family

Hospital, Bihar - 800010
Sr. Francina
0612-2262156
227
Orissa
Ashray LEPRA
Society
Koraput
Behind Collectorate,
Hati Line, Koraput,
Orissa
Mr. Rajendra Chowdhury
06658-252352
228
Orissa
SATHI TSRDS
Ganjam
At/Po- Bahadurpeta,
Dr. P.C. Mahapatra
(On the way to
Gopalpur-on-Sea)
Via- Bhanjabihar, Ganjam
0657-2425999
229
Orissa
Astha CCC
The Medics
Khurda
Near Kalinga Vihar

Phandi, Kalinga Vihar
Phase II, Plot No.
HIG-358, Patrapada,
Bhubaneswar-19
Dr. Dilip Kumar Pradhan
06764-234075;
09437018075
230
Orissa
Kiran CCC Utkal

Sevak Samaj
Cuttack
Plot No. 191, Mahanadi

Vihar, Nayabazar,
Cuttack, Orissa-753004
0671-2444984
[email protected]
Mr. Amiya Bhusan Biswal 0671-2444984
231
Orissa
Jyothi CCC
Balasore
NA
Jyoti CCC,
Post - Kuruda,
Balasore - 756054
Pretheep Jose/ Fr. Paul

District
Category
Address
Contact
Person
Phone No.
(+91-9308004404)
06782 - 256173
Facilitator Guide
Page 433
S.
No.
State
Name of
the CCC
District
232
Tripura
Hepititis
Foundation of
Tripura, Agartala
Agartala,
West Tripura
233
Tripura
Udaipur Bignan
O Sanskriti
Mancha, Udaipur
234
Pondicherry
Shanti Bhavan
Facilitator Guide
Page 434
District
Category
Address
Contact
Person
Phone No.
Anandlok, Indra Nagar,

Agartala, Tripura West
Shri Snehangshu
Sekhar Dutta,
9436463337
3812321166
South Tripura
Aaswas,
Nehru Supermarket,
House No. 47/48,
Udaipur, South Tripura
Shri Jaglul Ahsan,

9436521882
0381-223117,
09856140969
Pondicherry

Annexure 40: Ice Breakers & Energizers

Remember these are more fun when the trainers join in!
1. SHAKE ALL HANDS:
Everyone in the room shakes everyone elses hand within a strict time limit of one minute. This gets energy
up, and obliges each participant to acknowledge everyone else.
2. SPACE ON MY RIGHT:
Participants are seated in a circle. The facilitator arranges for the space on their right to remain empty. They
then ask a member of the group to come and sit in the empty space; for example, I would like Lili to come
and sit on my right. Lili moves and there is now a space on the right of another participant. The participant
who is sitting next to the empty space calls the name of someone different to sit on his or her right. Continue
until the entire group has moved once.
3. WHAT WE HAVE COMMON:
The facilitator calls out a characteristic of people in the group, such as having children. All those who have
children should move to one corner of the room. As the facilitator calls out more characteristics, such as
likes football, people with the characteristic move to the indicated space.
4. THE SUN SHNES ON:
Participants sit or stand in a tight circle with one person in the middle. The person in the middle shouts
out the sun shines on... and names a colour or articles of clothing that some in the group possess. For
example, the sun shines on all those wearing blue or the sun shines on all those wearing socks or the
sun shines on all those with brown eyes. All the participants who have that attribute must change places
with one another. The person in the middle tries to take one of their places as they move, so that there
is another person left in the middle without a place. The new person in the middle shouts out the sun
shines on... and names a different colour or type of clothing.
5. BODY WRITIING:
15 Body writing Ask participants to write their name in the air with a part of their body. They may choose
to use an elbow, for example, or a leg. Continue in this way, until everyone has written his or her name
with several body parts.
6. TIDES IN / TIDES OUT:
Draw a line representing the seashore and ask participants to stand behind the line. When the facilitator
shouts Tides out!, everyone jumps forwards over the line. When the leader shouts Tides in!, everyone
jumps backwards over the line. If the facilitator shouts Tides out! twice in a row, participants who move
have to drop out of the game.
7. SIMON SAYS :
The facilitator tells the group that they should follow instructions when the facilitator starts the instruction
by saying Simon says... If the facilitator does not begin the instructions with the words Simon says, then
the group should not follow the instructions! The facilitator begins by saying something like Simon says
clap your hands while clapping their hands. The participants follow. The facilitator speeds up the actions,
always saying Simon says first. After a short while, the Simon says is omitted.

Facilitator Guide
Page 435
8. WHAT SOUND IS THIS?

Someone makes a sound and everyone else tries to identify it the person who guesses right makes
another sound. Sounds could include animal and bird noises, machines, vehicles or food preparation.
9. WHERE WERE YOU?
Ask each participant to pull a coin out of their purse and look at the year on the coin. Give them one minute
to think about where they were and what significant event took place during that year. Ask few or all
participants (depending on time) to share their memories in one or two sentences.
10. REFLECTING ON THE DAY:
To help people to reflect on the activities of the day, make a ball out of paper and ask the group to throw
the ball to each other in turn. When they have the ball, participants can say one thing they thought about
the day.
11. WRITING ON BACKS:
At the end of a workshop, ask participants to stick a piece of paper on their backs. Each participant then
writes something they like, admire or appreciate about that person on the paper on their backs. When they
have all finished, participants can take their papers home with them as a reminder
12. TREASURE HUNT
Material Needed: Any object eg Book/ Hand bag/Vase etc. (Treasure)
A thin dupatta to blind fold
Steps:
Ask for a participant to volunteer, without telling the purpose of the game ( Volunteer should trust the
Trainer).
Take her out of the room and blindfold her.
In the meantime, come back and ask the other participants to rearrange the furniture in the room to
create enough space and to make the game more interesting.
Bring the volunteer back in the room, make her feel the treasure and put it at some accessible location
in the room.
Instruct her to hunt for it in the room.
Do not give any explicit instructions to the volunteer or the group on whether she can seek the help
from the group or whether the group can guide her.
Make sure that the volunteer does not hurt herself while hunting for the treasure; If you observe that
the volunteer is finding it difficult to locate the treasure ,keep it at a more convenient location.
Observe the group behavior ie whether they remain silent or assist the volunteer in locating the treasure
(by providing her appropriate directions) - both while you are present in the room or when you move
out; do they wait for instructions from you to guide the volunteer or do they themselves take the
initiative.
Ultimately, when the volunteer is able to successfully hunt for treasure, congratulate her on her efforts
and remove the blindfold.
13. PAPER DANCE (Achieving Maximum with Minimum resources)

Resources Needed: Double page or half page same size old news papers, (depending upon the number
of participants examples for 30 participants take 15 papers).
Process:
Make the group count 1,2,1,2

Divide all the 1s and 2s in two groups and pair them
Facilitator Guide
Page 436

Distribute one paper to each pair and make them stand comfortably and dance on the paper. Instruct
them to make sure that their feet remain inside the paper only.
After few minutes, ask them to fold the paper in half and dance, with their feet remaining inside the
paper.
Ask the participants to repeat the process, as many times as they can, by folding the paper half every
time (some would be able to do it by folding the paper 5 or 6 times, where as some would stop at 3
or 4 times only)
In the end, ask the participants:
Q 1 qualities needed to do this exercise
Q 2 their feelings during the excercise, and write them on the flip chart
Q 3 What made some of the pairs carried on with the exercise for long?
Write their responses on a flip chart.
SAMPLE ENERGIZERS:
The following can be carried out to music, with brief stops in the music to signal that the movement/role
should change.
Divide the participants into pairs, one person in the front and the other person behind. Get the person
at the back to rub the shoulders of the person in front. The pair turns around and exchange roles.
Get participants of the same size and preferably same gender, to stand back to back. Each person
drops her/his head on the other persons shoulder and relaxes.
Participants can form a semi-circle with the person at the far end bending forwards from the waist,
hands forward and inhaling, and exhaling while coming up, everyone follows suit.
Everyone does spot jogging while facing her/his partner.
Get a small group to stand on either side of a person. The person in the middle gets gently pushed
from one group to another. The person in the middle should not resist or move voluntarily, but just relax
and let others take care of her/him.

Facilitator Guide
Page 437
Annexure 41 : Role of Nurse at ART and CCCs

Roles and Responsibilities of Nurses at ART Centres
One or two nurses (depending upon the volume of patients) should be deputed to the ART center by the
hospital (or institution). There should beone contractual nurse, in addition, supported by NACO (qualification
being same as far appointment of nurses in the hospital).
Nurses play a very important role at the ART center and their responsibilities include the following:
Dispensing of ARV drugs (till a pharmacist isadded to the team)
Counselling of patients at the ART Centre and the attached hospital
Assisting in record keeping and maintenance of patient documents of HIV+ patients at the ART Centre and
the attached hospital.
Streamlining and guiding patients at theART center and helping the center to run efficiently and in an
orderly fashion
Coordinating and tracking the referrals made within the hospital by establishing linkage with various
departments and in-patient wards
Nursing care and follow-up of patients admitted in the hospital
Supervise the Infection Control practices at the ART Centre and the attached hospital
Ensure provision of PEP to all the nurses /Health Care staff at the ART Centre and the attached hospital
and the management of relevant records
Management of the ART Centre,
Roles and Responsibilities of Nurses at CCCs
The candidate should be a Diploma in nursing from a recognized nursing school/college with experience of
providing nursing care for preferable two years in a public or private health institution.
Nursing Care
Nursing care required for inpatients
Take the vital signs and follow-up readings of the patients as perrequirement
Maintaining follow-up charts
Provide medicine intake to the patients as per doctors prescription
Watch out for any changes in condition and report to the doctor
Assist the doctor in OP clinic as well as during ward rounds
Counsel patients on different aspects such as treatment adherence,drug intake as per regimen prescribed,
nutrition and safe sexual behaviour, positive prevention and positive living, reproductivehealth choices
Provide Anti-natal and Post-natal care
Provide nutritional supplements as required
Maintenance of patient records and case sheets
Administrative Responsibilities
Coordinate and track the referrals from and to other medical facilities
Report on the referred cases from other facilities
Report on stocks of medicines and other consumables
Provide data on the formats required for monitoring
Maintain the drug dispensed register and the stock of drugs received
Function as case manager for overview of the referrals and linkagesincluding integrated care of the PLHIV
case.
In-charge of coordinating the outreach workers to follow the treatment and follow up plan as has been decided
for the PLHIV by the clinical team
Other Responsibilities
Practice Universal precaution principles
Participate in the staff meetings and provide feed back
Facilitator Guide
Page 438

Annexure 42 : Patient Treatment Card ART White Card

Pre ART No. or ART Registration No. __ __ __ __ __ __ __ __ __ __
ID No. as per child health card __ __ __ __ __ __ __ __ __ __
ART Registration Number : __ __/__ __/__ __/__ __ __ __

Date of start of ART : __ __/__ __/__ __/__ __ __ __
PATIENT TREATMENT RECORD

(To be stored in a locked cabinet at the ART centre and arranged serially by registration number to be filled for all patients)
1. Identification Data (Write complete information)

Date of Registration: ____________________
Treatment status at registration: On ART Not on ART
Name of ART Centre / City: _____________________
ART Centre Code _____________________
State _____________________
Name of patient: _____________________
Age: ____________ (date of birth: __ __ / __ __ / __ __ __ __ )
Sex: Male Female TG/TS*
Patients phone number: _____________________
Address: _____________________________________________________________________________
City/village: __________________ District: __________________ State/province: ___________________
Caregivers name: ______________________________________________________________________
Caregivers address and phone number: ____________________________________________________
______________________________________________________________________________________
Date confirmed HIV+ test: __ __ / __ __ / __ __ __ __
Place of HIV Test: _____________________
Entry point (services referring the patient for HIV care): 1-VCTC 2-TB/RNTCP 3-Outpatient 4-Inpatient
5-Paediatric 6-PPTCT 7-STI clinic 8-Private practitioner 9-Other NGO 10-Self referred
11-IDU outreach 12- Sex worker outreach 13-PLHA network 14 MSM 15-other__________________
Patient transferred in on ART from: ARTC Private
Name of previous clinic: _________________________
Date transferred in : _________________________
2. Personal History (tick all applicable)

Risk
Factor
HIV

For IDUs
If yes, type:
Substitution therapy Y N
Education:

Employed:
Yes No Occupation: ___________
1
2
3
4
5
6
7
Heterosexual
MSM
Injecting drug use (IDU)
Blood transfusion
Mother to child
Probable unsafe injection
Unknown
Non-literate
Primary school _________________________
Secondary school
College & above
Instruction: Sections 1-3 to be filled by Counsellor. Sections 4-13 by Physician/Doctor.

* TG/TS Transgender/Transexual ** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing A Ambulatory = Able to perform activities of daily living but not able to work B Bedridden = Not able to perform activities of daily living.
National AIDS Control Organization (NACO), Ministry of Health and Family Welfare, Government of India, February 2007

Facilitator Guide
Page 439
3. Family History
Marital status:
Married
Widowed
Single
Divorce/separate
Live-in
Family members:
partner/children
Age /
sex
Estimated monthly
household income:
HIV
+//unknown
ART
Y/N
Regist. No
if in care
4. Antiretroviral treatment history

Were ARVs received ?
Yes No
Initial CD4 count No. _____ % ____
Place of ART: Private Govt NGO
Drugs and duration:

If yes, PMTCT ART
PEP
5. Clinical and Laboratory Investigations (Summary)

Date
(dd/mm/yy)
WHO
clinical
stage
Weight
(kg)
Height
(cm)
Functional
Status WAB**
CD4 count
No.
At 1st visit in clinic

At ART medical eligibility
At start of ART
At 6 months ART
At 12 months ART
At 24 months ART
At 36 months ART
At 48 months ART
Facilitator Guide
Page 440

6. Antiretroviral Treatment (Summary)

Treatment Started
SUBSTITUTION within 1st line, SWITCH to 2nd line, STOP, RESTART
STV + LMV + NVP

STV + LMV + EFV
Date
Substitution,
switch or stop
Reason
(code)
Date
restart
New
regimen
ZDV + LMV + NVP

ZDV + LMV + EFV
Others : __________
_________________
Reasons SUBSTITUTE: 1. Toxicity / side effects, 2. Pregnancy, 3. Newly diagnosed TB,

4. New drug available, 5. other reason (specify) ________________________________
Reasons for SWITCH only: 1. Clinical treatment failure, 2. Immunological failure, 3. Virologic failure
Reasons STOP: 1. Toxicity / side effects, 2. Pregnancy, 3. Treatment failure, 4. Poor adherence,
5. Illness hospitalisation, 6. Patient lack of finance, 7. Patient decision, 8 others: ______________________
7. Tuberculosis treatment (RNTCP) during HIV care
Diseases class (tick)
TB Regimen (tick)
TB registration (tick)
Pulmonary TB
Category I
District:
______________________
Smear-positive
Category II
TB Unit:
______________________
Smear-negative
Category III (if applicable)
Health Centre: ______________________
Other specify:
TB number:
Extrapulmonary
Past history of TB
site:
______________
______________
______________________
NonDOTS
Rx for MDR
Date start TB Rx:
___/___/______
Treatment outcome: Cure Rx completed

Rx failure Died Default Transfer out
Date: ____/____/_____
8. Reasons for Stopping ART

Death
Date of death: ____/____/______
Transferred out
Date last visit: ____/____/______
New ART centre name: _________
On medical advice
Date:
___________________________
Lost to follow-up (>3 months)
Date last visit: ____/____/______

____/____/______
Facilitator Guide
Page 441
9. Medical History
Habit of Alcohol use:
Habit of Smoking:
Habitual Social Never
Current smoker Past smoker Never
HBV carrier
Yes No Unknown
HCV carrier:
Yes No Unknown
STI Diabetes Hypertension Cardiovascular disease

Coexisting conditions :
Current Medication :
Drug allergy:
Contraception :
1. Condoms
2. Oral contraceptives
3. IUD
4. Tubal ligation
5. Vasectomy
6. None
GYNECOLOGICAL HISTORY
G ______ P ______ A ______ Last Menstrual Period: ____ day ____ month ______ year
PAP smear:
Pregnant now: Yes No
Gynecological exam:
Refer to PPTCP: Yes No
Other Remarks :
10. Linkages to NGOs/Care Institutes

Date
Name of Institute / Organization

and type*
Purposes **
*1. NGO; 2. Community Care and Support; 3. PLHA network; 4. Others**

1. Adherence; 2. Retention; 3. Psychosocial support; 4. Others
Facilitator Guide
Page 442

11. Pediatric Patients (under 15 years of age)

Staying with:
Guardian / Caregiver:
Sex : Male Female
1. Own family
2. In a center but contact with family
3. In a center but no family contact
4. Others _______________________
1. Self
2. Parents
3. Relatives
Age: ________years
4. Friends
5. Others __________
Date of birth: ___ day ____month ____ year
Guardian/Caregivers highest education:

Non-Literate Primary School Secondary School College and above
Birth History :
1. Normal 2. Caesarean 3. Vacuum 4. Forceps
Birth Weight : _____________________________ Neonatal complications : _______________________

Infant feeding :
1. Breast (stop_______ months of age)
DNA PCR results :
1st ______________________________
2. Replacement
3. Mixed
2nd _____________________________
Others _____________________________________________________________
Neurodevelopment Normal : Yes
No __________________________________________
Immunization Record
Age
Birth
Vaccine
Due on
Given on
Age
Vaccine
BCG
15-18
MMR
OPV 1
months
DPT 1 booster
HBV 1
DPT 1
6 weeks
10 weeks
14 weeks
Given on
OPV 6
5 years
OPV 2
DPT 2 booster
OPV 7
HBV 2
10 years
TT 3
DPT 2
15-16 yrs
TT 4
OPV 3
Due on
Others vaccines
DPT 3
OPV 4
6-9 mths.
OPV 5
HBV 3
9 months
Measles
& Vit. A

Facilitator Guide
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Facilitator Guide
Page 444

12. Investigations
Test \ date
//
//
//
//
//
//
//
//
//
//
//
//
Hb
TLC
DLC
Essential Laboratory: blood, serology, urine
ESR
PLT
MCV
S. Creatinine
S. Bilirubin
Blood Urea
SGOT
SGPT + Alk. PO4
Amylase
Blood Sugar
Cholesterol
Triglycerides
VDRL
HBsAg
Anti-HCV
Others (Imaging,
culture, etc.)
Additional
labs.
CD4 count/CD4 %
Viral Load
Pap smear
Mantoux Test
CXR (PA view)
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:
Date & Finding:

Facilitator Guide
Page 445
13. Patient Follow-up
Sl.
No.
Date
of
visit*
Date
of
next
visit
Weight Height Func(kg) (cm) tional

of
Status
child WAB**
WHO
OppotDrugs prescribed for
Clinical tunistic
Opportunistic Infections
Stage Infections Prophylaxis (Dosage) Rx
(code)*
CTX
Other
10
Antiretroviral
drugs
and dose
prescribed
11
12
13
14
15
16
17
18
19
Adher to
Any
TB
ART
ConPreg- Condoms Remarks/ Staff
ART##
other treatment Side
current nancy
given Referrals Signature
(No. of medicine Y / N
effects condition (y / n)
Y/N
doses
code$ e.g. STI of FP
missed)
method***
10
11
12
13
Instructions and codes:
* Date: Write the date of actual visit starting from the 1st visit for HIV care ALL DATES: DD/MM/YY
** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing: A Ambulatory = Able to perform activities of daily living but not able to work/go to school/play B Bedridden = Not
able to perform activities of daily living
*** FP: family planning; 1 condoms, 2 oral contraceptive pills, 3 injectable/implantable hormones, 4 diaphragm/cervical cap, 5 intrauterine
device, 6 vasectomy/tubal ligation/hysterectomy
# Opportunistic infections: Enter one or more codes Tuberculosis (TB); Candidiasis (C); Diarrhea (D); Cryptocococal meningitis (M);
Pneumocystis Carinii Pneumonia (PCP); Cytomegalovirus disease (CMV); Penicilliosis (P); Herpes zoster (Z); Genital herpes (H);
Toxoplasmosis (T); Failure to thrive (FTT), Recurrent respiratory infectious (ARI), Mycobacterium avium-intracellulare complex (MAC),
Cardiomyopathy (CMP), AIDS-Nephropathy (AN), Molluscum contagiosum (MDL), Parotitis (PAR), Lymphoid interstitial pneumonitis
(LIP), Lymphadenopathy (LAD) Hepatosplenomegaly (HSM), Delay in or missing developmental milestones (DEV), Other-specify
## Adherence: Check adherence by asking the patient if he/she has missed any doses. Also check the bottle/blister packet. Write the
estimated level of adherence (e.g. >95% = < 3 doses missed in a period of 30 days; 80-95% = 3 to 12 doses missed in a period of 30
days; < 80% = >12 doses missed in a period of 30 days)
$ Side effects: Enter one or more codes S=Skin rash; Nau-nausea; V=Vomiting; D=Diarrhoea; N=Neuropathy;J=Jaundice; A=Anemia;
F=Fatigue; H=Headache; Fev=Fever; Hyp=Hypersensitivity; Dep=Depression; P=Pancreatitis; L=Lipodystrophy; Drows=Drowsiness;
O=Other Specify
Facilitator Guide
Page 446

13. Patient Follow-up
Sl.
No.
Date
of
visit*
Date
of
next
visit
Weight Height Func(kg) (cm) tional

of
Status
child WAB**
WHO
OppotDrugs prescribed for
Clinical tunistic
Opportunistic Infections
Stage Infections Prophylaxis (Dosage) Rx
(code)*
CTX
Other
10
Antiretroviral
drugs
and dose
prescribed
11
12
13
14
15
16
17
18
19
Adher to
Any
TB
ART
ConPreg- Condoms Remarks/ Staff
ART##
other treatment Side
current nancy
given Referrals Signature
(No. of medicine Y / N
effects condition (y / n)
Y/N
doses
code$ e.g. STI of FP
missed)
method***
14
15
16
17
18
19
20
21
22
23
24
25
26
Instructions and codes:
* Date: Write the date of actual visit starting from the 1st visit for HIV care ALL DATES: DD/MM/YY
** Functional status: W Working = able to perform usual work in or out of the house, harvest, go to school or, for children, normal
activities or playing: A Ambulatory = Able to perform activities of daily living but not able to work/go to school/play B Bedridden = Not
able to perform activities of daily living
*** FP: family planning; 1 condoms, 2 oral contraceptive pills, 3 injectable/implantable hormones, 4 diaphragm/cervical cap, 5 intrauterine
device, 6 vasectomy/tubal ligation/hysterectomy
# Opportunistic infections: Enter one or more codes Tuberculosis (TB); Candidiasis (C); Diarrhea (D); Cryptocococal meningitis (M);
Pneumocystis Carinii Pneumonia (PCP); Cytomegalovirus disease (CMV); Penicilliosis (P); Herpes zoster (Z); Genital herpes (H);
Toxoplasmosis (T); Failure to thrive (FTT), Recurrent respiratory infectious (ARI), Mycobacterium avium-intracellulare complex (MAC),
Cardiomyopathy (CMP), AIDS-Nephropathy (AN), Molluscum contagiosum (MDL), Parotitis (PAR), Lymphoid interstitial pneumonitis
(LIP), Lymphadenopathy (LAD) Hepatosplenomegaly (HSM), Delay in or missing developmental milestones (DEV), Other-specify
## Adherence: Check adherence by asking the patient if he/she has missed any doses. Also check the bottle/blister packet. Write the
estimated level of adherence (e.g. >95% = < 3 doses missed in a period of 30 days; 80-95% = 3 to 12 doses missed in a period of 30
days; < 80% = >12 doses missed in a period of 30 days)
$ Side effects: Enter one or more codes S=Skin rash; Nau-nausea; V=Vomiting; D=Diarrhoea; N=Neuropathy;J=Jaundice; A=Anemia;
F=Fatigue; H=Headache; Fev=Fever; Hyp=Hypersensitivity; Dep=Depression; P=Pancreatitis; L=Lipodystrophy; Drows=Drowsiness;
O=Other Specify

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Page 447
Annexure 43 : Counselling Checklists : Checklist for the

Nurses, for various Counseling sessions
Checklist No.1 : Self Assessment of Effective Counselling
Note: You can check your own progress in counselling clients at the clinic
Always
Symptoms and effects of the problem

Possible technical/factual solutions
Rumours, misconceptions and relevant facts
Need for treatment, continuity, behavior
change, or referral, if necessary
Causes of the problem or potential problem
You clarify or check the clients understanding

of the facts (causes, effects, solutions and
possible next step) by:
The problem, the issue, or concern

under discussion
Its effects on his or her health and /or family/child
You explain facts about the problem

or issue, especially:
Asking open-ended questions and

using encouraging remarks
Listening attentively and observing
without interrupting or writing
Encouraging the client to talk and ask questions
You find out what the client knows about:
Greeting your client in a culturally acceptable way

Arranging for client privacy
Sitting facing or close to your client
You maintain two-way interaction by:
Rarely
You create rapport by:
At times
Asking the client to repeat (or re state) the basic

factual information in his/her own words
Clarifying misunderstood information
Asking the client if he/she has any questions

Answering the clients questions politely
and completely
Facilitator Guide
Page 448

Always
Rarely
You help the client determine what to do about

the problem , or issue, or concern by:
At times
Encouraging the client to consider the

need to act on the problem; explain
the consequences if it is ignored
Encouraging the client to make a
decision that is safest and most
practical in the circumstances
Provides required service or referral
when appropriate
You genuinely invite the client to return to

the clinic whenever they need to, e.g. if they
have more questions. You also tell the client
about the suitable hours of service.
Checklist No 2. Assessment of Risk of the Client
RISK EVALUATION FORM
Client code:_____________
Client has a regular partner:
Yes/No
Regular partners status: HIV-positive/unknown/HIV-negative

Date of last test: ___________
Client/partner* indicates history of STI infection:
Yes/ No
Treatment referral required:
Yes/ No
Client/partner* reports
Symptoms of TB:
Yes/ No
Treatment referral required:
Yes/ No
Occupational Exposure:
Yes/NO
Date
Window Period :
Yes/ No
Tattoo, scarification:
Yes/ No
Date:
Window Period:
Yes/No
Blood products:
Yes/ No
Date:
Window period:
Yes/No
Vaginal intercourse:
Yes/ No
Date:
Window period:
Yes/No
Oral sex:
Yes/ No
Date:
Window period:
Yes/No
Anal intercourse:
Yes/ No
Date:
Window period:
Yes/No
Sharing injecting equipment:
Yes/ No
Date:
Window period:
Yes/No
Client risk was with a known HIV-positive person:
Yes/ No
Client is pregnant:
Yes/ No
If Yes, Stage of pregnancy:

Client/partner* is using contraception regularly:

1st trimester/2nd trimester/3rd trimester

Yes/ No
Facilitator Guide
Page 449
Checklist No 3. Pre-test Counselling Form

PRE-TEST COUNSELLING FORM
Note to counsellor: Confidentiality of the client information should be strictly maintained at all times.
1. Date: ___ /___ /___
2. Time: (start of session): _________
3. PID number: ________
4. ICTC code___________________
5. Age: ___ years
6. Sex: M / F / Transgender
7. Education: standard: illiterate/1.5/6.8/8.10/11.12/Graduate/Post-graduate

8. Occupation: ________ (Migrant/ Non-migrant)
9. Monthly income in Rs: 0.2,500/2,501.5,000/5001.7,000/7,001.10,000/ more than 10,000
10. Marital status: unmarried/ married/widowed/divorced/separated/living together
11. Referred by: Self/Doctor/NGO/CBO/Spouse/Family/Friends/Others ______
12. Medical history: (Does your client currently have any medical problems or symptoms?]
Nil/Recurrent fever/weight loss/cough/diarrhoea/STIs/TB/OIs/Others ______
13. Currently on treatment: ______
14. Tested before for HIV: How many times? ___ Last test (month/year): ___ /___
Where (Place): ___________________________ Result: _________________
The form is to be filled in AFTER the counselling session with whatever information was discussed.
Counsellor instruction: Please explore the following issues with your client:
15. Risk assessment of the past six months: (perception of risk to self)
Q: Why has the client presented for counselling and testing?
__________________________________________________________________________________
__________________________________________________________________________________
Q: Why does your client think he/she is at risk of HIV?
__________________________________________________________________________________
__________________________________________________________________________________
(a) No risk (b) Perinatal (from mother to child)
(c) Contaminated blood through:
Blood transfusion .IDU
Organ transplant .Tattoo
Needle stick injury
(d) Unprotected sex:___ Vaginal___ Anal
(e) Partner or family member infected
__________________________________________________________________________________
16. Development of a risk reduction plan
(a) Increase condom use
(b) Reduce number of sexual partners
(c) Reduce needle sharing
(d) Reduce alcohol or drug use
(e) Discussion with spouse/partner
(f) Others
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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17. Client.s vulnerabilities:

(a) Unprotected sex with Males Females Hijras CSW
(b) Use of drugs/alcohol during or before sex
(c) Gender related (violence, rape, etc.)
18. Client.s current psycho-social stressors
Q. What are currently your client.s major worries in life?
(a) Finances/debt
(b) Addictions (alcohol/drugs)
(c) Family
(d) Violence
(e) Loss of work or occupation
(f) Sex related
(g) Serious illness/death
(h) Social
(i) Others
List issues and psycho-social stressors discussed:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
19. Client.s anticipated psycho-social stressors
Q. What are anticipated concerns of your client in case of a positive HIV Test result?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
(a) Prior history of self harm/suicide attempt
(b) Harm to others in case of positive test result
(c) Signs of suicidal thoughts
(Feeling of hopelessness/helplessness/overburdened/no options/social withdrawal)
20. Clients coping mechanisms
Q. How has your client coped with a crisis in the past, e.g. loss of job, death of Spouse or partner, or relationship
issues? Who helped your client?
List coping strategies discussed (including alcohol, violence, attempted suicide):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
What plans does your client have for managing the crisis associated with HIV/AIDS?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Facilitator Guide
Page 451
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
21. Client.s social support systems
Q. In case your client has a crisis in his/her life, who provides support to him/ her?
(a) Immediate family (Spouse)
(b ) Extended family
(c) Friends
(d) Others
Q. Who will accompany the client to pick up the HIV test result?
(a) Immediate family (Spouse)
(b) Extended family
(c) Friends
(d) No one
(e) Others
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
22. Client.s readiness to undergo HIV test
Q. Would your client like another appointment before deciding on the HIV test?
__________________________________________________________________________________
__________________________________________________________________________________
23. Clients readiness to involve partner
Q. Will your client bring his/her spouse or partner for counselling? If not, explain why?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
24. Date for follow-up visit given: ___ /___ /___
25. List of referrals given: (counsellor should have a referral list prepared)
__________________________________________________________________________________
__________________________________________________________________________________
26. Counsellor.s checklist:
___________ Client.s understanding of STI/HIV/AIDS addressed
___________ Information about STI/HIV/AIDS provided including
a. modes of transmission
b. nature of HIV/AIDS
___________ Misconceptions corrected
___________ Information about HIV test provided
a. Nature of test and testing process
b. Benefits and consequences
What plans does your client have for managing the crisis associated with HIV/AIDS?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
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Page 452

c. What does a positive result mean

d. What does a negative result mean
e. Window period
___________ Client.s emotional preparedness for HIV test result assessed
___________ Checked for suicidal ideation
___________ Importance of post-test counselling explained
___________ Information on .living with HIV.provided (nutrition, ARVs) provided
___________ Risk reduction counselling done
a. Safer sex practices
b. Condom use
c. Safe needle use (for IDUs)
___________ Prevention counselling provided
___________ Condom demonstration done and condoms provided
Willingness to involve partner in follow-up assessed
___________ Informed consent obtained
___________ Identification of TB symptoms undertaken
___________ Referrals discussed and given
___________ Follow-up arrangements discussed (date provided)
27. Counsellor.s remarks:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
28. Time (end of session): ______________
29. Length of session (minutes):__________
30. Counsellor.s signature and date:____________________________________
Checklist No 4. Post-test Counseling Form
POST-TEST COUNSELLING FORM (NACO)
Note to counsellor: Confidentiality of the client information should be strictly maintained at all times.
1. Date: ___ /___ /___
2. Time: (start of session): _________
2. PID number: ________
4. VCTC code number: _________
5. Type of visit: Post-test counselling/follow-up visit

6. Test result: positive/negative/indeterminate
7. Age: ___ years 8. Sex: M/F/Transgender
The form is to be filled in AFTER the counselling session with whatever information was discussed

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Page 453
For NEGATIVE Result

9. Initial reaction
Surprise/resentment/guilt/happy/relaxed/others
Observe and discuss with client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
10. Assessment of any concerns (Window period)
Summary of discussions with the client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
11. Development of a risk reduction plan
(b) Reduce number of sexual partners (c) Reduce needle sharing
(d) Reduce alcohol or drug use (e) Discussion with spouse/partner
(f) Others
List risk reduction plan developed:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
12. Willingness to change behaviour to decrease vulnerability ___Yes/___No
13. Need for HIV test after window period discussed ___Yes/___No
For POSITIVE Result
14. Initial reaction
Acceptance/shock/fear/denial/suppressed emotion/anger/violence/grief/sadness/depression/anxiety/crying
spells/suicidal ideation/withdrawal/resentment/others
Observe reaction and discuss with client:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
15. Assessment of immediate concerns
Stigma/fear of rejection (discrimination)/loneliness/loss of prestige/loss of job/
loss of income/loss of self esteem/family disclosure/fear of death/loss of health
Summary of discussions with the client
__________________________________________________________________________________
__________________________________________________________________________________
Facilitator Guide
Page 454

__________________________________________________________________________________
__________________________________________________________________________________
16. Assessment of other concerns
(a) Marriage counselling
(c) Disclosure to spouse or family
(e) STI medical follow-up
(g) Nutrition counselling
(i) Social/psychological support follow-up
(k) Rights and responsibilities
(b)
(d)
(f)
(h)
(j)
(l)
Partner notification and testing

Concerns about support systems
TB follow-up
Sex with spouse/partner
Social support and referrals
Others
Summary of discussions with the client

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
17. Risk-reduction strategies discussed
(c) Reduce needle sharing
(e) Others
(b) Reduce number of sexual partners

(d) Reduce alcohol or drug use
Summary of discussions with the client:

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
18. Willingness to increase safer behaviour _____Yes /_____No
19. Referrals* and follow-up given (*counsellor
(a) Individual counselling
(c) Within the hospital
(e) Psychiatric intervention
(g) Intervention and workplace
(i) TB/MC center
(k) IDU interventions
(m) Marriage counselling
should have a referral list prepared)

(b) Family counselling
(d) To medical doctor (nonhospital)
(f) Support groups/PLHA
(h) Community intervention
(j) ANC
(l) Needle stick
(n) Legal
List referrals made (types and places):

__________________________________________________________________________________
__________________________________________________________________________________
20. Agreed to disclose HIV status to spouse/partner _______
Client.s issues associated with disclosure to spouse/partner
__________________________________________________________________________________
__________________________________________________________________________________
21. Willingness to bring spouse/partner for counselling _______
Summary of discussions:
__________________________________________________________________________________
__________________________________________________________________________________
Facilitator Guide
Page 455
For POSITIVE and NEGATIVE result

22. Date for follow-up visit given: ___ /___ /___
23. List of referrals given: (counsellor should have a referral list prepared)
__________________________________________________________________________________
__________________________________________________________________________________
24. Counsellor checklist
For negative result:
___________ Result given
___________ Immediate concerns/questions assessed
___________ Window period explained
___________ Risk reduction strategy developed
___________ Willingness to change behaviour assessed
___________ Need for an HIV test after window period discussed
___________ Follow-up appointment given
For positive result:
___________ Result given
___________ Discussion of the meaning of the result for the client
___________ Dealt with immediate emotional concerns
___________ Client able to understand and absorb the result
___________ Discussion of personal, family and social implications
___________ Checking of availability of immediate support
___________ Discussion of follow-up care and support
___________ Partner evaluation
___________ Risk reduction strategy developed
___________ Willingness to change behaviour assessed
___________ Immediate plans, intentions and actions reviewed
___________ Discussion of symptoms of TB and importance of early referral
___________ Further support and referrals given (ANC, TB, STI)
___________ Rights and responsibilities discussed
___________ Legal support discussed
___________ Follow-up appointment given
___________ Disclosure discussed
___________ Bring spouse for counselling discussed
25. Counsellor.s remarks
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
26. Time (end of session): ____________________________________
27. Length of session (minutes): ___________________________________
28. Counsellor.s signature and date:____________________________________
Facilitator Guide
Page 456

Checklist No 5. Adherence Counselling form

ADHERENCE COUNSELLING CHECKLIST 1
Name of the client
Date of counselling session
Assess the patient
Medical history
Knowledge of HIV/AIDS
Prior use of ART
Determine the social support
Disclosure.have they disclosed to anyone?
Alcohol/drug use
Mental state
Review the health status
OIs
CD4/viral load
Review living conditions and employment
Housing
Employment/income
Describe the treatment programme and importance of adherence
Drug regimen.name/frequency/storage/dietary instructions/not to share pills
What ART does.suppresses virus/improves immunity/lessens OIs/not a cure
Cost
Side-effects and what to do
Follow-up
Importance of adherence and consequences of non-adherence
Discuss adherence promotion strategies
Buddy reminder.discuss role of support person
Pill diary
Other reminder cues
Identify barriers to adherence Yes No
Poor communication
Low literacy
Inadequate understanding about HIV/AIDS
Lack of social support
Failure to disclose the HIV-positive status
Alcohol and drug use
Mental state
Schedule the next counselling session and complete the appointment card
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Page 457

Name of the client
Review client.s understanding of HIV/AIDS
What is HIV and AIDS?
What are opportunistic infections?
What do they understand by CD4 counts/viral load?
What are the effects of treatment?
Review the treatment programme and importance of adherence
Drug regimen
Dummy pill demonstration
What ART does.improves immunity/lessens OIs/ART is not a cure?
Need for continued prevention.use of condoms
Follow-up
Importance of adherence and consequences of non-adherence
Review proposed adherence promotion strategies
Buddy reminder.discuss the role of a support person
Review the pill diary
Other reminder cues.discuss HAART
Review barriers to adherence and the progress made so far
Poor communication skills
Low levels of literacy
Inadequate understanding about HIV/AIDS
Mental state
Take the client.s address and establish contact system
Name of the client
Assess the client.s understanding of the disease and readiness to start
What is HIV disease?
What are opportunistic infections?
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What is meant by CD4 count/viral load

What are the effects of treatment
What is their level of commitment to adherence
Review the treatment programme and importance of adherence
Drug regimen
Dummy pill demonstration
What ART does.improves immunity/lessens OIs/ART is not a cure
Need for continued prevention.condom use
Follow-up
Link between adherence and successful outcome
Review proposed adherence promotion strategies
Other reminder cues.discuss HAART
Fill the ART register, schedule the next appointment and complete the appointment card
Refer to the Pharmacy/Chemist
Name of the client
Review the patient.s experience with treatment and adherence over the past month
Drug regimen and adherence.pill counts, self-report
Discuss the side-effects and the actions taken
Discuss the need for continued prevention.use of condoms
Review the experience with a follow-up plan
Discuss the follow-up plan for the next month
Review the patient.s goals and success at achieving them
Review barriers to adherence
Review barriers to adherence
Poor communication skills
Low levels of literacy
Inadequate understanding of HIV/AIDS
Facilitator Guide
Page 459

Mental state
Fill the ART register, schedule the next appointment and complete the appointment card
Refer to a pharmacy/chemist
Checklist No 6. Home Care counseling form
HOME VISIT DATA SHEET
Name of the patient Registration No
Sex: M/F
Purpose of home visit
Observed emotional and physical status of the patient
Chief caregiver
Observed dynamics at home
Observed dynamics with the caregiver
Locality and neighbourhood
Socioeconomic situation as observed
Expressed concerns/issues/opinions
Home visit conducted by
Visit requested by
Visit commissioned by
Date of request Date of visit
Checklist No 7. Suicidal risk assessment form
SUICIDE RISK ASSESSMENT GUIDELINE EXERCISE
Use assessment format given below for assessing the clients risk for suicide.
Note:
The suicide risk assessment provides a guideline for professionals on how to interview persons at risk
for suicide. As guidelines rather than a ready-to-use questionnaire, many questions would need more
exploration and probing in order to evaluate the subjective reality of each individual at risk.
1. Do you sometimes feel so bad/hopeless/helpless you think about suicide?
YES /NO
Follow this up with the following explorations:

2. How often?
a. Are you currently thinking of suicide?
YES / NO
b. Have you thought of how would you do it?
YES / NO
3. Do you have a plan?
YES / NO
a. How lethal is the planned method?

(EXPLORE the perception of the person at risk!)
Facilitator Guide
Page 460

4. Do you have the means? EXPLORE

5. Have you decided when you would do it? EXPLORE
6. Have you ever tried suicide before? EXPLORE
If yes check whether previous attempt was:

a. Impulsive?
b. Planned?
c. Did you use any booster to make you do it, such as alcohol/drugs?
7. If you have tried suicide before, what difference, if any, did it make
Write down the clients answer. Generally, any positive change perceived by the Client makes the risk
higher.
Check for symptoms of clinical depression.
a. Neuro-vegetative symptoms:
Sleep disturbances
Loss of appetite
Tiredness/lack of energy
Agitation/slowing down
Loss of interest in sex
b. Mood and motivation
Prolonged unhappiness
Loss of interest or pleasure
Hopelessness/helplessness
Difficulties performing at work
Difficulties carrying out routine activities
Withdrawal from friends and social activities
Check for somatization (pains, aches, physical discomfort without any organic cause)

Facilitator Guide
Page 461

Facilitator Guide Section 4 Annexures

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SECTION FOUR

HIV/AIDS and ART Training for Nurses

ANNEXURE 1: BASELINE ASSESSMENT

HIV/AIDS and ART Training for Nurses

III. Chief complaint

VI. Relevant sexual history

HIV/AIDS and ART Training for Nurses

Annexure 2: Quick Reference Steps in Using a Male and

Check expiry date

Use condom correctly and consistently

Store condoms in the sun

Use each condom only once

Use the teeth or nails to tear the condom packet

Use water based lubricants

Use oil-based lubricant

Think of dual protection

Use condoms made with natural products

HIV/AIDS and ART Training for Nurses

Steps in Using the Female Condom

Fig. 2.7 How to use a female condom for vaginal sex

HIV/AIDS and ART Training for Nurses

Annexure 3: Referral Linkage Organogram

Annexure 3: Referral Linkage Organogram

Annexure 4: Disinfection of Needles and Syringes with Bleach

Fill the needle and syringe completely with clean water

Cleaning and disinfecting should be done at two points of timeonce

HIV/AIDS and ART Training for Nurses

Annexure 5: Hand Hygiene Checklist

Ensure short finger nails

HIV/AIDS and ART Training for Nurses

Annexure 6: Guidelines for Disposal of Used Disposable

Wash the containers properly for reuse

Make a proper record of generation, treatment and disposal of waste

HIV/AIDS and ART Training for Nurses

Annexure 7: Guidelines for Disinfection and Sterilization

Steam under pressure,

Ethyl or Isopropyl Alcohol

Ethyl or Isopropyl Alcohol

Ethyl or Isopropyl Alcohol

HIV/AIDS and ART Training for Nurses

Annexure 8: Situational Guide - Cleaning up a Blood Spill on

Remove gloves and dispose into red bin.

HIV/AIDS and ART Training for Nurses

HIV/AIDS and ART Training for Nurses

Annexure 9: Situational Guide - Care of the Body after Death

Protect self by using PPE and avoiding

Give bath to the dead body.

HIV/AIDS and ART Training for Nurses

Annexure 10 : NACO PEP Policy: Procedure to be followed

Remove gloves, if appropriate

Wash the exposed site thoroughly with

Do not put pricked finger in mouth

Irrigate with water or saline if exposure sites

Do not squeeze wound to bleed it

Wash skin with soap and water

Do not use Bleach, Chlorine, Alcohol, Betadine,

** Do - Consult the designated physician immediately as per institutional guidelines for

Step 1: Management of Exposure Site First Aid

After a splash of blood or body fluids:

Step 2: Risk assessment