SUMMARY

The Andhra Pradesh AIDS Consortium (APAIDSCON), a consortium of 15 private medical colleges, plans

to continue activities under this program area including: training of medical providers on positive deliveries,

managing integrated counseling and testing centers (ICTCs) in each of its 15 member medical colleges,

and motivating and following HIV-positive pregnant women to access and use PMTCT services through the

use of peer educators/outreach workers. The focus will be on improving the number of HIV-positive

pregnant women provided with Nevirapine prophylaxis and delivered in an institutional setting.

BACKGROUND

In India, over 80% of curative health care is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established APAIDSCON, a

consortium of 15 private medical colleges. Recently, as an effort to reach out to the private for-profit health

sector, 25 private small to medium size hospitals were added to the consortium. Fundamentally,

APAIDSCON was established as a mechanism to strengthen the organizational capacity of its member

institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULTS

FY07 activities for PMTCT will continue with FY08 funding. They will center on monitoring the progress of

the PMTCT program in the 15 private medical colleges and 5 nursing homes in the Consortium, through

support for staff and ongoing supervision and monitoring. PMTCT activities also include motivating

pregnant women to access counseling and testing for HIV with informed consent, using the test results to

make decisions about PMTCT, and providing appropriate referrals for follow-up care, treatment, and

support, including family planning guidance. The target population is predominantly rural in areas catered to

by the respective private medical colleges.

The objective of the PMTCT program is to make these services available to as many pregnant women as

possible. In addition to this, the program encourages institutional deliveries, especially for HIV positive

women so that prophylaxis with antiretrovirals can be administered to a mother and baby pair and

subsequent follow up is ensured.

ACTIVITY 1: Monitoring and Administration of PMTCT Program Sites

APAIDSCON is in charge of monitoring the progress of the PMTCT program in the 15 Private Medical

Colleges and 5 nursing homes (small hospitals). A counselor and a laboratory technician are placed by the

Andhra Pradesh State AIDS Control Society (APSACS) in all the institutes to provide the basic PMTCT

services. These two personnel will report to the Integrated Counseling and Testing Centers (ICTC) director

of the institute. A Field Coordinator and Program Manager are supported by APAIDSCON at state level,

who make frequent visits to the institutes to guide the counselors and laboratory technicians in providing

services in accordance with the National AIDS Control Organization (NACO) guidelines. The supervisory

staff is also responsible for data management of the PMTCT centers at the State level and for sending

regular reports to APSACS. The program is expected to cover a population of approximately 38700

antenatal mothers in FY2008.

APAIDSCON serves as a conduit for test kits, delivery kits, laboratory technicians and counselors provided

by APSACS in the 15 private medical college hospitals. The funds for these staff and commodities have

been leveraged from APSACS and are valued at over $125,000 per year. This will continue in FY2008.

ACTIVITY 2: Appointment of Peer Counselors

In FY08, to strengthen the follow up procedure for ANC mothers, 15 peer counselors will be placed in

APAIDSCON partner institutes in order to strengthen Ante-Natal Care (ANC), peri-natal prophylaxis in

infected mothers and follow up. The peer counselors' work will be field-based and they will report to the

ICTC director of each institute. As a result, it is expected that the percentage of pregnant women identified

as HIV positive who deliver in an institution and receive single dose Nevirapine (NVP) will increase from

under 50% currently to at least 70% by the end of FY08.

ACTIVITY 3: Demand Generation

Awareness will be created in the regions surrounding the medical institutes and nursing homes (small

hospitals) to encourage more and more pregnant women to access the PMTCT services provided at the

centers. To achieve this objective Information Education Communication (IEC) material in the form of

posters, flip charts, leaflets, and booklets will be supplied to the centers on a regular basis. The institutes

will conduct regular outreach activities in the community to make them aware of the facilities available at the

institute. The outreach activities will include such activities as street plays, puppet shows, and door-to-door

campaigns.

ACTIVITY 4: Training of Medical Providers

In FY08, APAIDSCON will provide OB/GYN physicians and nurses with advanced clinical training as well

refresher sessions to overcome fear and reduce stigma and discrimination. This will encourage them to

conduct more positive deliveries and provide NVP to the mother and baby pair. APAIDSCON will continue

Activity Narrative: to explore creative ways to encourage more active participation in the PMTCT program by physicians and

hospital management.

In addition, all counselors and laboratory technicians will continue to be trained on the basics of PMTCT

services. Quarterly review meetings of the counselors and the laboratory technicians will be organized at

the state level. In these review meetings/refresher courses, the skills counselors and the laboratory

technicians will be upgraded and they will be kept current with NACO guidelines.

SUMMARY

Red Ribbon clubs (RRC) are an on-campus, voluntary educational intervention among college youth. This

approach is implemented with the twin objectives of reducing HIV infection among youth by raising their risk

perception and preparing youth to be peer educators and agents of change. APAIDSCON and its partnering

institutes through their respective Social and Preventive Medicine (SPM) departments have formed Red

Ribbon clubs. A staff at the SPM department in these colleges acts as the prime trainer of student peer

educators and acts as a coordinator RRC activities. APADISCON till date has promoted RRC in 12 of the

15 private medical colleges where in student volunteers are motivated to address HIV and other sexual

health issues among their age group of students and youth in community.

RRC are provided with seed funds to conduct out reach activities in the community adopted by the medical

colleges .The outreach activities are aimed at HIV prevention education and stigma-reduction programs

both in the college campus and outside in the communities. The educational campaigns organized by

students encourage community members to utilize counseling and testing services offered at the medical

colleges. In FY08, RRC activities will become more standardized including the introduction of a sexuality

curriculum, peer educator training convention, and monitoring system.

BACKGROUND

In India, 80% of curative health care is provided in the private sector where facilities range from state of the

art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established a consortium of 15

private medical colleges named Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an effort to

reach out to the private for-profit health sector, 25 private small to medium size hospitals were added to the

consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the organizational

capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1,500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULTS

The first RRC supported by APAIDSCON was formed in 2006. Currently, there are 12 RRC with a volunteer

strength of above 300, who reach out to over 6000 students and youth in various higher educational

institutions and in the local community. RRC serve as an ideal social support platform for youth to

understand the myths and misconceptions about sexual health and make the right choices at the right time.

In FY08, it is planned to add three more RRC among medical students and 15 amongst nursing students

and include outreach to communities adopted by these institutions. These RRC will directly reach 750

medical/nursing students in FY08 to promote HIV/AIDS prevention through abstinence and be faithful

messages.

ACTIVITY 1: Celebrating Life: Curriculum on Sex and Sexuality

A curriculum on sex and sexuality targeted at youth encompassing the issue of HIV/AIDS, STI,

vulnerabilities to HIV and life skills to overcome those vulnerabilities was developed by CDC and its

partners in FY07. The staff trainer in the SPM department will be trained to use the curriculum and module

to train peer educators. The curriculum will be introduced in FY08 (this academic year). It has two

components: the first is designed to be used in large groups as a three-hour primer, the second is for small

groups and has ten one-hour skill-building modules. The curriculum has been pilot tested with both urban

and rural college youth, with many finding it engaging, informative, and practical. A formal evaluation of the

impact of the curriculum on sexual risk perceptions, self-efficacy to make informed sexual decisions, and

behavior is being planned.

APAIDSCON will implement the primer and the ten modules in all RRCs and expects all "active" RRC

members to complete this curriculum in FY08 (approximately 450 students). The number of students/youth

covered will be gradually increased with the goal of reaching out to all medical college and nursing students

by the end of FY09. In collaboration with Nandamuri Taraka Ramarao Medical University, CDC and

APAIDSCON will focus on efforts to mainstream the curriculum within the medical education system at a

university level.

ACTIVITY 2: Peer Education Convention

The Red Ribbon Club program aims to create a pool of peer educators with the objective of creating in-

house agents of change. Peer to peer strategies are especially important in an environment where sex is

not openly discussed, yet the need for information, advice, and support is great. 10 peer educators will be

identified and trained in each medical college institution (combined nursing students and medical students).

A training convention for about 100 peer leaders will be held in FY08 and repeated annually.

ACTIVITY 3: Networking

Networking with other medical and non-medical institutions will help us reach out to the youth population

effectively and spread the concept of Red Ribbon Clubs. RRC will work closely with district-level positive

networks and initiate programs with positive speakers. It is also planned to network with established student

bodies like student unions to reach out to institutional youth more effectively.

Activity Narrative: ACTIVITY 4: Community Outreach by RRC

One of the advantages of the RRC design is that out of school youth in the nearby communities can also be

reached through this "army of volunteers". In FY08, APAIDSCON and CDC will work to expand and

document these community-level activities.

ACTIVITY 5: Monitoring and Evaluation (M&E) of RRC Programs

For the RRC effort to be successful and sustainable, a rigorous monitoring system down to the RRC level

must be strengthened. Program indicators and reporting formats have been developed. In FY08, all SPM

department coordinators in medical colleges will be trained in M&E, targets will be established, and

performance reviews will be largely based on the degree to which accurate data is being collected and

targets have been reached. As important, HHS/CDC in collaboration with APAIDSCON will continue to

advocate for better and more periodic HIV risk assessments among 18-23 year olds in colleges and for out-

of-school youth in the community.

ACTIVITY 6: Targeted "Pilot" Programs for High Risk Youth

To date, it has been difficult to identify and target the sub-population of college youth engaged in high-risk

behaviors. Youth in India are generally not comfortable discussing their personal sexual behaviors with

others, including their peers. RRC, peer educators, and the sexuality curriculum are all helping to change

this. As youth open up, opportunities to develop more targeted interventions for high-risk youth will emerge.

SUMMARY

The Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to strengthen palliative care services

within the consortium and beyond by conducting advanced clinical trainings, supporting the development of

one-two centers of excellence, establishing a low cost central pharmacy, developing partnerships with

community care centers, hiring peer educators/counselors, and strengthening HIV-focused medical

education systems.

BACKGROUND

In India, over 80% of curative health care is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established APAIDSCON, a

consortium of 15 private medical colleges. Recently, as an effort to reach out to the private for-profit health

sector, 25 private small to medium size hospitals were added to the consortium. Fundamentally,

APAIDSCON was established to strengthen the organizational capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome. The formation of a

consortium has led to more substantive system strengthening, including the successful completion of joint

training programs, curriculum sharing, advocacy for government funded HIV testing and counseling centers

in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1,500 annually) as well

as nurses and allied health professionals are trained to address HIV/AIDS. APAIDSCON builds

collaborative programs with private entities as well as government agencies, promotes the implementation

of national guidelines and best practices and supports a comprehensive multi-disciplinary strategy to

combat the HIV/AIDS epidemic.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Training in Care

With FY08 funding, APAIDSCON will provide high-quality HIV palliative-care training to its health-care staff

and to the community at large. In India, there is thought to be a high variability in the quality and practices of

HIV care. APAIDSCON has developed two-day palliative-care curricula training specific to medical officers,

nurses, medical students, and house-keeping staff, that will equip participants with basic HIV care

knowledge and skills in accordance with national and international standards. Over 70% of medical and

nursing faculty and over 50% of housekeeping staff have been trained to date; the remaining staff will be

trained with FY08 funding.

APAIDSCON believes in intensive, hands-on training for medical personnel if the goal is to provide quality

HIV care services. Post training follow-up and refresher workshops are important. APAIDSCON has

developed and pilot tested a five-day hands-on training program based on this principle. The training, which

includes skills-based instruction (case-studies, bedside teaching, mentored clinical care opportunities),

teaches best practices for the prevention and treatment of opportunistic infections (OIs) associated with

HIV/AIDS. Other topics include: HIV staging, routine clinical monitoring and management of HIV/AIDS

complications, symptom diagnosis and relief, and psycho-social support, including organization of basic

necessities such as nutrition, financial assistance, legal aid, mental health services, and bereavement

support for family members. Special emphasis is placed on the cross training of these care providers on

ART screening and management.

With FY08 funding, APAIDSCON will continue to conduct these hands-on trainings for 15-20 physicians at

least quarterly. A Level 2 training program will be developed for those caring for People Living with

HIV/AIDS (PLHA) who need additional skills-based training. Level 1 and Level 2 trainings are designed to

reach members of consortium institutions in order to build their skills. However, some physicians from

NGOs and government who are providing HIV care and support services will also participate. All physicians

trained by APAIDSCON who are part of the consortium will receive quarterly follow-up visits (mentorship

visits) to ensure that acquired care and treatment skills are incorporated into practice.

ACTIVITY 2: Development of HIV Care and Training Centers

In FY08, APAIDSCON will devote time and resources to developing one or two HIV care and training

centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS), APAIDSCON and

CDC will likely focus on building an existing government HIV/ART center into a NACO center of excellence,

by providing technical inputs, staffing support, and training expertise while leveraging NACO/APSACS

resources to develop infrastructure, better operational systems, and a more functional and updated

laboratory. A specific center (Government Chest Hospital, Hyderabad) has been identified and relationships

between this hospital, APSACS, CDC, and APAIDSCON have grown.

A second HIV care and training center may be developed in one of the 15 medical colleges. A full

assessment of the capacities, interest, and needs of the better performing medical colleges to develop such

a center will be completed in FY08. Based on this assessment, a cost-feasible investment in strengthening

one medical college as a referral center and training center for the consortium will be considered.

ACTIVITY 3: Increase Access to HIV Care and Treatment in the Private Sector

To increase access to HIV care and treatment in the private healthcare sector, APAIDSCON will collaborate

with APSACS to establish a central pharmacy for APAIDSCON facilities and partners. The objective will be

to provide high-quality, low-cost medicines (via high-volume purchasing) to PLHAs accessing services at

APAIDSCON and partner facilities. With FY08 funding, APAIDSCON will support a pharmacy coordinator

and appropriate space for the procurement, storage, and distribution of medicines for HIV/AIDS care

(cotrimoxazole, TB treatment regimens) and treatment (ARVs).

ACTIVITY 4: Expand Care and Treatment Services

In FY08, APAIDSCON will continue to expand its care and treatment services. To date, mainstreaming of

Activity Narrative: HIV services into young, developing medical college institutions has been more difficult than expected.

Resistance remains high due to HIV-related stigma, poor technical skills to manage HIV, limited ability to

generate net income from HIV services, and poor access to affordable medication, especially ARVs.

APAIDSCON will continue to address these fundamental issues. At the same time, alternative strategies

that do not require these medical college hospitals to provide comprehensive services to huge number of

PLHAs will be implemented.

In FY08, APAIDSCON will develop closer relationships and linkages to NACO-funded community care

centers and ART centers. APAIDSCON will support their local HIV community care centers by requiring

faculty and students to rotate through these centers and provide specialty consultations. APAIDSCON will

also create ways for consortium member institutions to provide laboratory and radiological support services

to these centers. This process will also help create better linkages between institutions and will help develop

the technical capacities of the community care centers.

ACTIVITY 5: Strengthen Follow-Up

In FY08, to strengthen the follow up procedure for those who test positive, 15 peer counselors will be placed

in the partnering institutes. The job of the peer counselors will be to provide follow-up counseling support to

any PLHA seeking services in the institution. Both the peer counselors and the testing center counselor will

be provided with the CDC follow up counseling toolkit and taught how to use it as a teaching aid. This will

help ensure and standardize PLHA support services such as mental health counseling, prevention for

positives, partner notification, and dealing with stigma and discrimination. As a result of this effort, the

percentage of PLHAs who notify their partner of their status and return to the institution for follow up

counseling services will substantially increase by the end of FY08.

ACTIVITY 6: Strengthen Training Approaches

APAIDSCON has developed a HIV curriculum for medical students that is being implemented in many of

the 15 private medical colleges as an elective. In FY08, this curriculum will be strengthened based on

feedback from students and faculty. APAIDSCON and CDC will work to mainstream this as a required

module in all 15 consortium medical colleges and advocate for it to be included as a statewide module or

elective in all medical colleges.

APAIDSCON will also work to ensure that 4th and 5th year medical students and advanced year nursing

students have an opportunity to care for PLHAs on the wards or in the clinics as part of their clinical

experience. To do this, access to PLHAs and faculty bedside teaching skills related to HIV must be

improved. This will accomplished by either increasing the number of PLHAs being cared for in the medical

college hospital or making it easier for students to visit HIV care centers in the community. APAIDSCON will

also set up an elective for students to work at a tertiary HIV care and training center. In FY08, APAIDSCON

hopes to send 200 students (nursing and medical) to such centers.

SUMMARY

The Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to strengthen TB-HIV services within

the consortium and beyond by conducting advanced clinical trainings, supporting the development of one to

two centers of excellence, establishing a low cost central pharmacy and developing partnerships with

community care centers. Linkages between TB services and HIV testing and treatment will be

mainstreamed within the care delivery system for each partnering institution in FY08. Many of these TB

activities are also described under the Palliative Care program area.

BACKGROUND

In India, over 80% of curative health care is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established APAIDSCON, a

consortium of 15 private medical colleges. Recently, as an effort to reach out to the private for-profit health

sector, 25 private small to medium size hospitals were added to the consortium. Many of these hospitals are

designated as microscopy centers under the Revised National TB Control Program (RNTCP).

Fundamentally, APAIDSCON was established as a mechanism to strengthen the organizational capacity of

its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1,500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV/AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Training in TB/HIV

In FY08, APAIDSCON plans to use its position within the private health care sector as well as its

relationship with the public health care system to provide high-quality TB-HIV training to its health care staff

and to the community at large. In India, there is thought to be a high variability in the quality and practice of

HIV care. APAIDSCON has developed a two-day curricula training specific to medical officers, nurses,

medical students, and housekeeping staff, that will equip participants with basic TB-HIV care, knowledge

and skills in accordance with national and international standards. To date, over 70% of medical and

nursing faculty have been trained. With FY08 funding, the remaining medical and nursing faculty will be

trained.

APAIDSCON believes in the value of more intensive, hands-on training for medical personnel if the goal is

for these trainees to provide quality HIV care services. Post training follow-up and refresher workshops are

equally important. APAIDSCON has developed and pilot tested a five-day hands-on training programs

based on this principle. The training, which includes skills-based (case-studies, bedside teaching rounds)

instruction from HIV/AIDS technical experts from around the world, teaches best practices for the prevention

and treatment of opportunistic infections (OIs) associated with HIV/AIDS, with a special focus on TB-HIV co-

infection. Trainees are informed on the clinical, epidemiologic, and programmatic overlap of the TB and

HIV/AIDS epidemics (TB/HIV). Standard practices for regular screening, diagnosing, and treating TB among

HIV-infected patients are taught. Special emphasis is also placed on the referral and screening of TB/HIV

patients for ART care.

In FY08, APAIDSCON will continue to conduct these hands-on trainings for 15-20 physicians at least

quarterly. A Level 2 training program will be developed for those caring for People Living with HIV/AIDS

(PLHA) who require and want additional skills-based training. Level 1 and Level 2 trainings are designed to

reach consortium members in order to build their skills and capacities. However, some select physicians

from NGOs and government who are providing HIV care and support services will be allowed to participate.

All physicians trained by APAIDSCON who are part of their consortium will receive quarterly follow-up visits

(mentorship visits) to ensure that acquired care and treatment skills are retained and incorporated into

practice. All personnel will also come from centers that have been approved by the RNTCP to provide TB

treatment as per national guidelines (that is, using DOTS).

ACTIVITY 2: Development of Training Centers

In FY08, APAIDSCON will devote substantial time and resources into developing one-two HIV care and

training centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS),

APAIDSCON and CDC will likely focus on building an existing government HIV/ART center into a NACO

center of excellence, by providing technical inputs, staffing support, and training expertise while leveraging

NACO/APSACS resources to develop infrastructure, better operational systems, and a more functional and

updated laboratory. A specific center (the government Chest Hospital in Hyderabad) has already been

identified and relationships between this hospital, APSACS, CDC, and APAIDSCON have grown. The

Chest Hospital currently provides extensive TB management. Its faculty is chest physicians with expertise in

TB and to some degree TB-HIV.

A second HIV care and training center may be developed in one of the existing 15 medical colleges,

following a full assessment. This center will also include an extensive program and training in TB

management.

ACTIVITY 3: Establishment of Central Pharmacy

APAIDSCON will collaborate with APSACS to establish a central pharmacy for APAIDSCON facilities and

Activity Narrative: partners. The objective of this central pharmacy will be to provide high-quality, low-cost medicines (via high-

volume purchasing) to PLHAs accessing services at APAIDSCON and partner facilities. In FY08,

APAIDSCON will support a pharmacy coordinator and appropriate space for this pharmacy for the

procurement, storage, and distribution of medicines for HIV/AIDS care (cotrimoxazole, TB treatment

regimens) and treatment (ARVs).

ACTIVITY 4: Expanding Care and Treatment Services

In FY08, APAIDSCON will continue to find ways to expand its care and treatment services. To date,

mainstreaming of HIV services into young, developing medical college institutions has been more difficult

than expected. Resistance remains high due to HIV-related stigma, poor technical skills to manage HIV,

limited ability to generate net income from HIV services, and poor access to affordable medication,

especially ARVs. APAIDSCON will continue to address these fundamental issues. At the same time,

alternative strategies that do not require these medical college hospitals to provide a huge number of

PLHAs comprehensive services will be implemented.

In FY08, APAIDSCON will develop closer relationships and linkages to NACO-funded community care

centers and ART centers. APAIDSCON will support local HIV community care centers by requiring faculty

and students to rotate through these centers and provide specialty consultations. APAIDSCON will also

create ways for consortium member institutions to provide laboratory and radiological support services to

these centers, with a special focus on TB diagnostic services. This process will also help create better

linkages between institutions and will help develop the technical capacities of the community care centers.

SUMMARY

APAIDSCON manages and supervises quality delivery of services in integrated counseling and testing

centers (ICTCs) in each of its 15 member medical colleges. The funds for these centers have been

leveraged from APSACS and are valued at over $125,000 per year. APAIDSCON focuses on provider-

initiated testing within the hospital setting. Streamlining the process of testing among at-risk patients is a

key FY08 activity.

As per NACO guidelines, counseling will remain an important part of the testing process. The focus of the

counseling sessions is on risk assessment, risk reduction, partner notification and testing, and linkages to

care, treatment, and support. Couple HIV Counseling and Testing (CHCT) and follow-up counseling of

PLHAs are important services provided by these ICTCs. These activities will continue in FY2008.

BACKGROUND

In India the majority of health care (~80%) is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of Government Medical

Schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established a consortium of 15

Private Medical Colleges named Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an effort

to reach out to the private for-profit health sector, 25 private small to medium size hospitals were added to

the consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the

organizational capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Support for Direct CT Services

APAIDSCON is in charge of monitoring the progress of the CT program in the 15 Private Medical Colleges.

A counselor and a laboratory technician are placed in all the institutes to provide the basic CT services.

These two personnel report to the Integrated Counseling and Testing Centers (ICTC) director of the

institute. A Field Coordinator and Program Manager are supported at state level and make frequent visits to

the institutes to guide the counselors and laboratory technicians in providing services in accordance with

National AIDS Control Organization (NACO) guidelines. These consultants are also responsible for data

management of the CT centers at the State level and for sending regular reports to Andhra Pradesh State

AIDS Control Society (APSACS). The program is expected to cover a population of approximately 54,000

with FY08 funding.

APAIDSCON serves as a conduit for test kits, delivery kits, laboratory technicians and counselors provided

by Andhra Pradesh AIDS Control Society (APSACS) in the 15 private medical college hospitals. The funds

for this have been leveraged from APSACS and are valued at over $125,000 per year. This will continue in

FY08. As TB services are provided at these hospitals under the same roof, clients are cross-referred

between the CT and TB services.

ACTIVITY 2: Appointment of Peer Counselors:

In FY08, to strengthen follow up procedures for those who test positive, 15 peer counselors will be placed in

the partner institutes. The job of the peer counselors will be to provide follow-up counseling support to any

PLHA seeking services in the institution. They will report to the ICTC director of the institute. As a result,

the percentage of PLHAs who notify their partner of their status and return to the institution for follow up

counseling services is expected to increase substantially by the end of FY08.

ACTIVITY 3: Demand Generation:

To achieve this objective Information Education Communication (IEC) material in the form of posters,

leaflets, and booklets will be supplied to the centers on a regular basis. In addition, the institutes will

conduct regular outreach activities to make the community aware of the facilities available at the institute.

The outreach activities will include street plays, puppet shows, and door-to-door campaign. In FY08,

APAIDSCON will provide technical assistance and funding to individual medical colleges (specifically, the

community and social medicine departments) to manage this activity.

ACTIVITY 4: Training of Counseling and Testing Staff

In addition, all counselors and laboratory technicians will continue to be trained on the basics of CT

services. Quarterly review meetings of the counselors and the laboratory technicians will be organized at

the state level. In these review meetings/refresher courses, the skills of counselors and the laboratory

technicians will be upgraded, and they will be kept abreast of NACO guidelines.

SUMMARY

The Andhra Pradesh AIDS Consortium (APAIDSCON) of 15 private medical colleges have tertiary care and

treatment hospitals offering general and specialized medical and surgical services. APAIDSCON envisages

engaging these hospitals in offering both inpatient and out patient care, support and ART treatment services

to People Living with HIV/AIDS (PLHA) both as direct ART facilities as well as developing linkages with the

existing government sector ART services. APAIDSCON will also develop private sector models of ART

treatment services in partnership with NACO and APSACS.

BACKGROUND

In India, over 80% of curative health care is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established a consortium of 15

private medical colleges named the Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an

effort to reach out to the private for-profit health sector, 25 private small to medium size hospitals were

added to the consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the

organizational capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1,500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULTS

ACTIVITY 1: Training in ART

In FY 08, APAIDSCON plans to utilize its position within the private health care sector as well as its

relationship with the public health-care system to provide high-quality ART training to its health-care staff

and to the community at large. In India, there is thought to be a high variability in the quality and practices

towards ART management. APAIDSCONS has developed two-day curricula training specific to medical

officers, nurses, medical students, and house-keeping staff, that will equip participants with basic HIV care

and treatment knowledge and skills as per national and international standards. To date, over 70% of

medical and nursing faculty have been trained and over 50% of housekeeping staff have been trained. In

FY08, the remaining medical and nursing faculty and housekeeping staff will be trained.

APAIDSCON fundamentally believes in the value of more intensive, hands-on training for medical personnel

if the goal is for these trainees to provide quality HIV care services, including ART management. Post

training follow-up and refresher workshops are equally important. APAIDSCON has developed and pilot

tested a 5 day hands-on training programs based on this principle. The training, which includes skills-based

(i.e. case-studies, bedside teaching, clinical care opportunities) instruction from HIV/AIDS technical experts

from around the world, teaches best practices for the management of HIV, with a focus on ART. Specific

topic areas include: routine clinical monitoring and management of ART and its complications, diagnosis

and treating of immune reconstitution syndrome, diagnosis and management of ART drug failure, and how

to assess and encourage medication adherence.

In FY08, APAIDSCON will continue to conduct these hands-on trainings for 15-20 physicians at least

quarterly. A level 2 training program will be developed for those caring for PLHAs who require and want

additional skills-based training. Level 1 and level 2 trainings are designed to reach consortium members in

order to build their skills and capacities. However, some select physicians from NGOs and government who

are providing HIV care and support services will be allowed to participate. All physicians trained by

APAIDSCON who are part of their consortium will receive quarterly follow-up visits (mentorship visits) to

ensure that acquired care and treatment skills are retained and incorporated into practice.

ACTIVITY 2: Development of Training Centers

In FY08, APAIDSCON will devote substantial time and resources into developing 1-2 HIV/ART care and

training centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS),

APAIDSCON and CDC will likely focus on building an existing government HIV/ART center into a NACO

center of excellence, by providing technical inputs, staffing support, and training expertise while leveraging

NACO/APSACS resources to develop infrastructure, better operational systems, and a more functional and

updated laboratory. A specific center (Government CHEST Hospital, Hyderabad) has already been

identified and relationships between this hospital, APSACS, CDC, and APAIDSCON have grown.

A second HIV care and training center may be developed in one of the existing 15 medical colleges. A full

assessment of the capacities, interests, and needs of the better performing medical colleges to develop

such a center will be completed in FY08. Based on this assessment, a cost-feasible investment in

strengthening one medical college as a referral center and training center for the consortium will be

considered. APAIDSCON and USG would work with NACO to provide free ART to this non-governmental

medical college as part of this strategy.

ACTIVITY 3: Development of Central Pharmacy and Low-Cost ART Package

APAIDSCON will collaborate with APSACS to establish a central pharmacy for APAIDSCON facilities and

partners. The objective will be to provide high-quality, low-cost medicines (via high-volume purchasing) to

PLHAs accessing services at APAIDSCON and partner facilities. In FY08, APAIDSCON will support a

pharmacy coordinator and appropriate space for this pharmacy for the procurement, storage, and

Activity Narrative: distribution of medicines for HIV/AIDS care (e.g. co-trimoxazole, TB treatment regimens) and treatment

(ARVs).

As a related strategy, APAIDSCON will attempt to develop a low cost monthly ART package and market it

to PLHAs who cannot or do not want to receive ART through the government system. Private sector

physicians trained by APAIDSCON would be eligible to take part in this system. Patients would be offered a

package of standard ART services include first line drugs, periodic CD4 testing, basic labs, counseling

support, nutrition support, and physician fees for a standard monthly fee. The fee would have to be

significantly cheaper than the current market price for these services, which may be possible with bulk drug

purchases and a centralized subsidized lab service as exists in APAIDSCON. If successful, this could serve

as an important model for the state and India.

ACTIVITY 4: Expanding Treatment Services

In FY08, APAIDSCON will continue to find ways to expand its care and treatment services. To date,

mainstreaming of HIV services into young, developing medical college institutions has been more difficult

than expected. Resistance remains high due to HIV-related stigma, poor technical skills to manage HIV,

limited ability to generate net income from HIV services, and poor access to affordable medication,

especially ARVs. APAIDSCON will continue to address these fundamental issues. At the same time,

alternative strategies that do not require these medical college hospitals to provide huge number of PLHAs

comprehensive services will be implemented.

Consequently, in FY08, APAIDSCON will develop closer relationships and linkages to NACO-funded

community care centers and ART centers. APAIDSCON will support their local HIV community care center

by requiring faculty and students to rotate through these centers and provide specialty consultations.

APAIDSCON will also create ways for consortium member institutions to provide laboratory and radiological

support services to these centers. This process will also help create better linkages between institutions and

will help develop the technical capacities of the community care centers as ART link centers (ART down

referral centers under NACP3).

ACTIVITY 5: Increase Hands-On Training in ART

APAIDSCON will increase the clinical exposure of 4th and 5th year medical students and advanced year

nursing students, to caring for PLHAs on the wards or in clinics, including experience of ARV diagnosis and

treatment. To do this, faculty bedside teaching skills related to HIV and access to PLHAs will have to be

improved. This will accomplished by either increasing the number of PLHAs being cared for in the medical

college hospital or making it easier for students to visit HIV ART centers in the nearby community.

APAIDSCON will also set up an elective for students to work at a tertiary HIV care and training center. In

FY08, APAIDSCON hopes to send over 200 nursing and medical students to such centers for more in depth

HIV teaching and sensitization.

SUMMARY

SHARE India through the Andhra Pradesh AIDS Consortium (APAIDSCON) will continue to support the

delivery of HIV/AIDS diagnosis and management services through a networked approach in which

advanced HIV-related tests will be performed at one institution but made available to the entire consortium

via a rapid specimen distribution system. This system is already in place for CD4 testing as described

below. In FY 08-09, viral load testing and opportunistic infection diagnostics may be added. A system to

expose students and post-graduates interested in microbiology and pathology to HIV-related tests and

pathogens will also be a focus.

BACKGROUND

In India the majority of health care (~80%) is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of Government Medical

Schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, Science Health Allied Research and Education (SHARE)/MediCiti established a consortium of 15

Private Medical Colleges named Andhra Pradesh AIDS Consortium (APAIDSCON). Recently, as an effort

to reach out to the private for-profit health sector, 25 private small to medium size hospitals were added to

the consortium. Fundamentally, APAIDSCON was established as a mechanism to strengthen the

organizational capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

A need for increased laboratory activities has been documented through a recent laboratory assessment at

the national level. This increase is a response to the recommendations of that assessment.

ACTIVITIES AND EXPECTED RESULTS

Activity 1: CD4 Testing Reference Laboratory

One of the prime objectives of APAIDSCON leadership was to provide the consortium members the facility

of performing CD4 test at an affordable rate for their patients. The CD4 test is a basic minimum test that is

required by an attending physician to provide optimum care for the patient infected by HIV. However, the

current market cost ($20-35 per test) is prohibitively expensive and well beyond the reach of most patients.

APAIDSCON, by providing CD4 counts at a subsidized rate of Rs 200/- per test ($5 per test), has made it

possible for an expanded number of patients to get tested and seek appropriate treatment. The lower price

is attainable because: 1) the CD4 flow cytometry was provided free of cost; 2) reagent costs have been

brought down due to bulk purchase and negotiations with suppliers; 3) lab directorship is subsidized by

USG funds; 4) specimen collection systems are provided free of charge by partner institutions and overnight

delivery services are provide at no charge by a leading mail service company; 5) profits have been

removed; and 6) USG provides a subsidy of approximately $4 per test to bring the cost down to $5 per test.

The subsidized CD4 count testing is offered to patients who are registered with any of APAIDSCON's 15

partner medical colleges. The newly added small and mid-sized hospitals will also be given access to this

CD4 testing system but possibly at a slightly higher charge per test, since their HIV clients may have greater

purchasing power than the average medical college client.

Generally all samples are analyzed within few hours of receipt and no later than 24 hours. A robust system

for the timely reporting of results to both the patient's care institution and APAIDSCON has been developed.

To ensure the quality and reliability of the CD4 tests APAIDSCON had to create a system to collect and

transport samples for CD4 testing to the central lab without deterioration of the sample due to the high

summer temperatures in India. A special transport bag was designed for this purpose. SHARE/MediCiti,

APAIDSCON's prime partner, has also collaborated with Gati Ltd to arrange the logistics of clinical

specimen transport from various partnering institutes to the central laboratory and has obtained grant

funding from Gati Ltd to provide free transport of the clinical specimens.

In FY08, these activities will continue, as a cost-efficient model for high quality laboratory testing in India. It

is expected that approximately 2000 CD4 tests will be conducted in FY08. Efforts to showcase this system

to medical college leaders, government officials, and NGO directors in Andhra Pradesh and neighboring

states will be a USG priority, especially with the CD4 testing needs in India likely to increase dramatically in

the next few years.

ACTIVITY 2: Viral Load Testing

APAIDSCON is planning to acquire the capability to perform viral load testing for HIV and offer a service

similar to the CD4 reference laboratory to partnering institutes of the consortium. It is anticipated that

approximately 200 tests will be performed in Year 3? PCR equipment will not be purchased using USG

funds. USG funds will be used to pay staff to obtain equipment and supplies, develop protocols and quality

control systems, and leverage funds from private and government sources to make this affordable to most

persons with HIV. USG funds may be used to subsidize the patient cost of viral load testing but only if

deemed strategically necessary and an efficient use of the funds.

ACTIVITY 3: Opportunistic Pathogens

Activity Narrative:

APAIDSCON plans to implement a system of providing reference laboratory services for the diagnosis of

opportunistic and unusual pathogens causing infections in individuals with HIV / AIDS. USG support will be

used to train a select number of microbiologists, pathologists, and technicians on the laboratory

identification of specific pathogens and conditions commonly found in HIV patients. USG funds may also be

used to develop a specimen transportation and reporting system and for salary support to specific staff in

this reference laboratory. USG funds may also be used to provide essential reasonably priced reagents

(i.e., serologies, antigen testing kits) and equipment.

As part of the strategy to build laboratory capacity within this network of private medical colleges,

APAIDSCON will support the development of a module to teach medical students the laboratory and

pathology aspects of HIV medicine. Students will have the opportunity to spend time in this reference

laboratory. This will be especially important as some of these medical colleges develop post-graduate

training programs (equivalent to residency programs in the US) in microbiology and pathology.

SUMMARY

MediCiti's Science Health Allied Research and Education (SHARE) project has established an innovative

"consortium" structure (the Andhra Pradesh AIDS Consortium [APAIDSCON]) to reach out to private

medical colleges in Andhra Pradesh (AP). This consortium will continue to be strengthened in FY08 and in

doing so, will be able to participate in a number of important system strengthening activities and policy

initiatives across the state. These include providing seed funding to member institutions, developing

training centers in AP, and advocacy for improved medical curricula.

BACKGROUND

In India, over 80% of curative health care is provided in the private sector where facilities range from state

of the art to barely adequate. Traditionally medical education has been the preserve of government medical

schools; however in the last five years there has been an explosive growth of private medical schools and

over the next decade the bulk of newly trained medical graduates will come from the private sector.

In 2005, SHARE/MediCiti established APAIDSCON, a consortium of 15 private medical colleges. Recently,

as an effort to reach out to the private for-profit health sector, 25 private small to medium size hospitals

were added to the consortium. Fundamentally, APAIDSCON was established as a mechanism to

strengthen the organizational capacity of its member institutions.

The fact that 15 independent and often competing private medical colleges came together and formed a

consortium to address HIV and medical education issues is a noteworthy initial outcome and model for the

country. The formation of a consortium has led to more substantive system strengthening, including the

successful completion of joint training programs, curriculum sharing, advocacy for government funded HIV

testing and counseling centers in all 15 colleges, and a linkage system for subsidized CD4 testing.

The primary aim of the consortium is to ensure that future medical graduates (over 1500 annually) as well

as nurses and allied health professionals are well trained to address HIV AIDS. APAIDSCON builds

collaborative programs with private entities as well as Government agencies, promotes the implementation

of national guidelines and best practices in addressing the HIV AIDS epidemic, and is supporting a

comprehensive multi-disciplinary strategy to combat the HIV/AIDS epidemic in the state with the highest

estimated burden of HIV in India.

ACTIVITIES AND EXPECTED RESULSTS

ACTIVITY 1: Strengthening the Consortium Institutional Model

In FY08, APAIDSCON will continue to strengthen the concept of a health care consortium, which is

relatively new and underutilized in India. Consortium by-laws will be updated and strengthened to give the

consortium more authority in allocating budget, hiring staff, and monitoring progress. The role of the

consortium is evolving as individual member institutions and their representatives become more familiar

with this novel consortium concept and gain more trust and confidence in this mechanism for enacting

change. The consortium's steering committee will continue to meet quarterly. Mechanisms will be created

to build representation of the newly joined small and mid-sized private hospitals on the steering committee

and to allow them some decision-making responsibilities.

Each of the 15 medical college members will establish a HIV core committee made up of the head of all

clinical departments, a representative from management, and a representative from the housekeeping staff.

This core committee will meet at least 4 times a year to review progress on HIV-related services and

address staffing and system issues. Each core committee will also select their representative to the

APAIDSCON steering committee and review his/her performance annually. The core committee will be

expected to advocate for more comprehensive and higher quality HIV services in the institution and will be

leaders in efforts to train medical and nursing students in HIV clinical care. Newly joined mid-sized

hospitals will also be encouraged to establish core committees made up of clinicians, nurses, management,

and housekeeping staff.

ACTIVITY 2: Dissemination of Information

In FY08, APAIDSCON will continue to produce a quarterly newsletter, Awakenings, as a tool to share

information on consortium activities and provide HIV medical updates to all members and others in the

medical community. This will be part of a broader objective of reaching out to local community physicians to

sensitize them in HIV care and treatment needs and develop testing and referral linkages.

ACTIVITY 3: Seed Funding to Member Institutions

In FY08, APAIDSCON will develop and initiate mechanisms to provide seed funding to member institutions

to develop or strengthen prevention, testing, and/or care initiatives in their institutions or in the nearby

community. This will encourage member institutions to take more ownership of the program. APAIDSCON

will also build the capacities of individual institutional faculty members by teaching them to write proposals,

create a workplan and budget, and manage a new public health activity.

ACTIVITY 4: Develop Training Centers

In FY08, APAIDSCON will devote substantial time and resources into developing 1-2 HIV care and training

centers. In collaboration with the Andhra Pradesh State AIDS Control Society (APSACS), APAIDSCON

and CDC will likely focus on building an existing government HIV/ART center into a NACO center of

excellence, by providing technical inputs, staffing support, and training expertise while leveraging

NACO/APSACS resources to develop infrastructure, better operational systems, and a more functional and

updated laboratory. A specific center has already been identified and relationships between this hospital,

APSACS, CDC, and APAIDSCON have grown. An amount of $250,000 to support the development of the

training center has been leveraged through a partnership with the AP chest hospital in Hyderabad.

A second HIV care and training center may be developed in one of the existing 15 medical colleges. A full

assessment of the capacities, interests, and needs of the better performing medical colleges to develop

such a center will be completed in FY08. Based on this assessment, a cost-feasible investment in

strengthening one medical college as a referral center and training center for the consortium will be

considered.

ACTIVITY 5: Advocacy for Improved Medical Curricula on HIV/AIDS

Activity Narrative: As noted in the Palliative Care section, in FY08, APAIDSCON will continue to advocate for greater

emphasis on HIV within the medical school curriculum both at a national/state level and at an individual

institutional level. APAIDSCON will focus on the concept that HIV must be taught as a pre-clinical topic

within microbiology, pathology, immunology, pharmacology, etc as well as an essential component of the

clinical rotations in years 4 and 5. APAIDSCON has developed a HIV curriculum for medical students that

is currently being implemented in many of the 15 private medical colleges as an elective. In FY08, this

curriculum will be strengthened based on feedback from students and faculty. APAIDSCON and CDC will

work to mainstream this as a required module in all 15 consortium medical colleges and advocate for it to

be included as a statewide module or elective in all medical colleges. APAIDSCON will also work to ensure

that 4th and 5th year medical students and advanced year nursing students have an opportunity to care for

PLHAs on the wards or in the clinics as part of their clinical experience.