Bringing Antiretroviral Therapy (ART) services one step closer to people’s door
Nepal detected its first HIV case in 1988 and started antiretroviral therapy (ART) almost after more than a decade only. The ART programme was first started in Nepal in 2004 from Sukraraj Tropical and Infectious Diseases Hospital the central level referral hospital for all tropical diseases in Nepal. Since 2004 the ART programme has been expanded gradually and by the end of 2017 the ART services has been made available in all the 77 districts of Nepal.
All ART centres in Nepal are co-located either with the Central, Regional, Sub-regional, Zonal, District or sometimes even with peripheral health facilities (Primary Health Care Centres) with an exception of Sparsha and Maiti Nepal in Kathmandu (two NGO run ART centres). ART centres are the backbone of the National ART programme of Nepal. Most of the ART centres have a dedicated ART counsellor who supports in ART initiation, dispensing medicines; maintaining records and logistics; coordinating for CD4, viral load and other tests for the clients.
Nepal is a country with very difficult geographical terrain. As most of the ART centres are co-located with the hospitals which are most of the times in the district headquarter; it is often time consuming and difficult for clients to travel monthly to the ART centre for their pill pick up. This sometimes results in non-adherence if the clients miss their visit schedule to the ART centre. Also the financial costs associated with travel and other expenses during the course of travel adds extra economic burden to the families of People living with HIV.
In 2016; National Centre for AIDS and STD Control (NCASC) came with the idea of “Dispensing Centre” so as to bring the ART services to as close as peoples door. The concept is very simple; those clients who are well on ART and stable; will be transferred to a peripheral health facility with trained health providers who will then refill the ARV medicines for the clients. These Dispensing centres will not initiate ART but only refill the ARV medicines for stable clients. The Dispensing centre works under the supervision of ART centres. NCASC has developed standard operating procedures for the dispensing centre and these are closely monitored by the ART centre and from NCASC.
Kanchanpur is a district in Province no 7 of Nepal that is around 700 KM far away from the capital city Kathmandu. The ART centre located in Mahakali Zonal Hospital in Kanchanpur is providing ART services to 257 People living with HIV (PLHIV). Dodhara & Chandani are two villages pretty far from the district headquarter of Kanchanpur from where around 50-60 clients are currently taking ART from Mahakali Zonal Hospital. Reaching to the district headquarter for PLHIVs living in Dodhara & Chandani is not easy. These two villages are often referred to as the only villages of Nepal that are on the other side of Mahakali river; the river which is border between Nepal and India in Far western region. For the people of Dodhara and Chandani to reach the district headquarter they have to make a journey through multiple means of transportation. They have to walk for some hours; take a bike ride on the dodhara chandani bridge (the second longest suspension bridge in Asia) and take tuk-tuk (Auto Rikshaw) on the other side of the bridge to reach the district headquarter. For the convenience of PLHIVs of this area; A Dispensing Centre has been recently opened in Dodhara Primary health Care Centre. Thirty six PLHIVs who used to go to the Mahakali Zonal Hospital every month have already accessed the ARV medicine from this Health Centre. Mr Jaya Bahadur Mahara a Public Health Inspector in this Primary Health Care Centre (PHCC) has worked day and night to establish the dispensing centre in this PHCC. There are 36 clients who are already receiving ART from this site. Mr Mahara believes that this number will increase slowly as the people from around this area who are receiving ART from the Mahakali Zonal Hospital will be transferred to this site slowly. Mr Prem Joshi another health worker from the centre shares “this site is very convenient for the clients as their one whole day and transportation cost will be saved which they had to expenses in the past just to access ARV medicines”. In the near future the centre is planning to do sample collection for viral load testing in the site itself and transport the samples to Seti Zonal Hospital (Another nearby district where viral load testing service is available).
“In the past we used to allocate one whole day and used to expense certain amount of money just to fetch our ARV but now we can refill our monthly ARVs from the health facility just next to our home. This is very helpful for us” shares one of the PLHIV who has been taking ARV from Mahakali Zonal Hospital since last five years.
Since NCASC started the practice of opening dispensing centre; 25 dispensing centres have already been opened across the country. Out of 25 dispensing centre; six are in far western region. Far western region of Nepal is one of the region with most difficult geographic terrain and the region that is badly affected by the HIV epidemic. In the hilly districts of this region there are many pocket areas with high HIV burden and reaching to the district headquarter from some areas takes one or two days and costs a lot. So the concept of dispensing centre in this region is much more relevant than in any other region of the country. Dispensing centres have already been established in Kamal Binayak and Chaurmandu of Achham district; Jogbudha of Dadeldhura; Sanagaon of Doti; Melauni of Baitadi and many are in the process of opening. All these are helping in bringing ART services to as close as people’s door.
Sanjeev Raj Neupane, Sujan Joshi and Keshav Bhatt
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