Confidential Approach to AIDS Prevention (CAAP)
Center for HIV/AIDS Information, Counseling, Testing, Care and Support
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Care, treatment and support unit

ART Programme
In 2005 when CAAP started providing ART to the HIV/AIDS patients it was the only organisation to do so. From that period CAAP has become the ray of hope for a number of patients who were able to live their lives longer than expected. At present, with 119 (please put the current figure) on ART CAAP has the ability to treat 500 patients with the experience and expertise of their staff their well-established diagnostic and treatment facilities. In a successful ART programme, all patients should remain on the 1st line treatment for as long as possible. This goal can only be achieved by emphasising on quality of counselling and treatment! One of the indicators of this could be good drug adherence. The drug adherence rate of patients receiving ART from CAAP is very good with more than 90% adherence. CAAP tries to find out the root causes for non-adherence and address the problem accordingly. CAAP programme for ART includes all investigation necessary for ART, adherence counselling for drug compliance, follow up and management of side effects of ART as the very important tasks.

HIV/AIDS/ART is probably the most difficult and challenging chapter of infectious diseases: HIV is a systemic disease which can affect any organ, ARVs are of the most toxic drugs used in medicine, and ongoing research at a very high pace and on a large scale makes things changing continuously! That is why every ART programme needs a backup of an experienced HIV clinician because it has to be based on clinical requirements and needs. In respect to that CAAP has a clinical review committee consisting of representative from national AIDS and STD Programme (NASP, GOB), experts from donor agencies and national experts, who meets once a year or whenever needed to review the treatment protocol.

PMTCT
The majority (90%) of children infected by HIV acquire their infection through parent to child transmission of HIV (PPCT), which can occur during pregnancy, delivery and through breast milk. Infected children die early if no preventive measures are taken. Early diagnosis of HIV infection, ART, safer obstetric practice and safer infant feeding can reduce the risk of HIV transmission.

CAAP provides antenatal care services to HIV positive pregnant mothers through its out patient clinic. Both pregnant mother and their neonates are treated with Anti Retro Viral Drugs as prophylaxis during pregnancy and labour to reduce the risk of HIV transmission. For safer management of labour and delivery, CAAP refers the HIV positive pregnant mothers to either government hospital or to Marie Stopes Clinic Society for delivery. In such cases CAAP bears the expenses of treatment. Breast milk substitutes are provided to babies born to HIV positive mothers in order to minimise further chance of postnatal HIV infection according to National guideline.

A. Out patient clinic
The centre provides treatment; care and counselling to HIV infected persons and their families through out patient clinic in order to prevent further spread of the disease, to give them relief of illness they suffer and to live a healthy life. HIV positive persons have free access to this clinic at a scheduled date and time and whenever they need it. Support for management of opportunistic infection/STI and other inter current infections including medicines are provided free of cost. Positive living educations on healthy living hygiene and nutrition are provided to people living with HIV/AIDS (PLWHA) routinely. Clinical services for any other diseases and syndromic management of STI with minimum charge are provided for poor who displays risky behaviour. Service provided by the out patient clinic are:

• General health care of PLHIV
• Management of opportunistic infection (OI)
• OI prophylaxis
• ART with follow up care and adherence counselling
• Syndromic treatment for STI
• Treatment of any other diseases of any patient
• Positive living education
• Prevention of mother to child transmission (PPTCT)

B. Indoor clinic (stabilisation ward)
A mini indoor facility/clinic with provision of 5 beds are maintained by CAAP for patients who needs intravenous rehydration/blood transfusion and hospitalised treatment of comparatively less complicated opportunistic infection, side effects of ART and other ailments. Complicated cases are referred to IDH at Dhaka and other government/private hospitals. A referral mechanism has been developed for treatment. The indoor Health Care Clinic provides the following services:

• Intravenous Hydration, Blood transfusion
• Intravenous antibiotic treatment
• Treatment for complicated OI
• Treatment of side effects/complication of ART
• Treatment for any other HIV related sickness
• Referral of complicated cases to support hospital

C. Mobile VCT service
The twice a week mobile VCT service by CAAP enabled people to be aware about HIV/AIDS and to know their HIV/AIDS status at their doorsteps. Rapid tests for HIV/AIDS and pre and post-test counselling are the key activities of the mobile VCT services. CAAP is collaborating with various government and non-government organisations dealing with patients to organise VCT at their STI clinics in and around Dhaka. In addition, health camps are organised at different slums and provided treatment where most patients complained about general diseases e.g. peptic ulcer, weakness, burning sensation and dizziness. Following are some services provided by the mobile VCT service:

• Site specific health service delivery
• Voluntary rapid testing of blood for HIV
• Pre-test and post-test counselling to encourage behaviour change
• Promotion of use of condom
• Group discussion to improve the perception of risk
• Information material distribution
• HIV stigma and discrimination reduction

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