Version 1
: Received: 13 October 2024 / Approved: 17 October 2024 / Online: 18 October 2024 (10:54:08 CEST)
How to cite:
Darswal, M.; Gupta, A. K.; Joshi, B. C.; Kumar, P. Incentive Based Continuum of Care for People Living With HIV including Orphan Vulnerable Children- The Delhi Model. Preprints2024, 2024101415. https://doi.org/10.20944/preprints202410.1415.v1
Darswal, M.; Gupta, A. K.; Joshi, B. C.; Kumar, P. Incentive Based Continuum of Care for People Living With HIV including Orphan Vulnerable Children- The Delhi Model. Preprints 2024, 2024101415. https://doi.org/10.20944/preprints202410.1415.v1
Darswal, M.; Gupta, A. K.; Joshi, B. C.; Kumar, P. Incentive Based Continuum of Care for People Living With HIV including Orphan Vulnerable Children- The Delhi Model. Preprints2024, 2024101415. https://doi.org/10.20944/preprints202410.1415.v1
APA Style
Darswal, M., Gupta, A. K., Joshi, B. C., & Kumar, P. (2024). Incentive Based Continuum of Care for People Living With HIV including Orphan Vulnerable Children- The Delhi Model. Preprints. https://doi.org/10.20944/preprints202410.1415.v1
Chicago/Turabian Style
Darswal, M., Bipin Chandra Joshi and Parveen Kumar. 2024 "Incentive Based Continuum of Care for People Living With HIV including Orphan Vulnerable Children- The Delhi Model" Preprints. https://doi.org/10.20944/preprints202410.1415.v1
Abstract
Background: Delhi State AIDS Control Society (DSACS) addressed critical integration of services for Orphan and Vulnerable Children (OVC) in context of HIV. They bridged the policy and implementation divide by formulating a multisectoral-strategy in April 2012, creating a model of "Continuum-of-Care for People-Living with HIV (PLHIV), OVC & Children-Affected-by-HIV (ChABH)” in Delhi. With input from the National Commission for Protection of Child Rights, DSACS sensitized political and administrative machinery about needs and challenges related to HIV/AIDS. DSACS developed an incentive-based system for Antiretroviral Therapy (ART) adherence, incorporating safeguards and robust monitoring. Delhi Government's sustained financial commitment and DSACS programmatic-innovation provide a scalable blueprint for India and global initiatives.
Description: This ongoing Delhi Government's scheme focuses on household-economic-strengthening of PLHIV as an incentive for broader behaviour change based-on specific eligibility conditions. Beneficiaries fall into four categories: PLHIV, including children on ART; double orphan HIV positive children (OCI); destitute children living with HIV/in institutional care (DCI); and double orphan ChABH in community-based care in Delhi. Category-wise fixed-monthly financial assistance is released to beneficiaries via direct-bank-transfers leveraging Aadhaar-platform to eliminate corruption. Adherence to treatment is mandatory to continue cash-transfers. Linkages with other schemes established to maximize impact.
Lessons learned: In its 11-year evolution, Delhi model has grown from 1110 to 6467 beneficiaries, including 6383 PLHIV, 34 double OCI, 50 DCI, and 27 double orphan ChABH, with 5875 (90.8%) currently active excluding beneficiaries who expired (n=328), migrated/ transferred out of Delhi (n=115), opted-out ART/or lost-to-follow-up (n=135), and 14 CABA who turned major. Steady progress and 98% ART adherence mark positive outcomes. DSACS eased eligibility criteria in 2018, facilitating hurdle-free enrollment, while responding to cost-inflation by enhancing financial assistance, showcasing program adaptability. Achieving >95 ART adherence has significantly boosted survival rates, underscoring program's positive impact on beneficiary health. The scheme's INR 14,69,35,600 expenditure in 2022-23, just 0.13% of Delhi Health Department's plan-outlay, signals a cost-effective investment. Extrapolating this nationally would represent 1.5% of India's Health Ministry's current plan-outlay.
Conclusions/Next steps: This innovative model is implementable on large-scale in India and around the globe but requires not only financial commitment but also coordinated efforts, policy adjustments, and collaboration between various stakeholders.
Keywords
Orphan vulnerable children; Children Affected by HIV; People Living with HIV; Antiretroviral Therapy; Cash Transfer Scheme; Continuum of Care; Household economic strengthening
Subject
Public Health and Healthcare, Health Policy and Services
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
