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Integrated Management of Adult and
Adolescent Illness (India)
The World Health Organization
(WHO) Integrated Management of Adult and Adolescent Illness (IMAI) is an
integrated approach to scale up the comprehensive continuum of HIV/AIDS
prevention, care, support and treatment within the framework of the existing
health system.
Salient features of IMAI:
· Integration of
HIV/AIDS management into routine health services
· Integration of prevention and care of adulthood
illnesses into a single health care package (Malaria, TB, pneumonia, STI,
chronic diseases, HIV and so on)
· Establishment of
linkages and referrals between the health system and the community
IMAI in India
- Introduction
India has the highest burden
of persons living with HIV/AIDS (PLHA) in Asia, and third in the world with
2.5 million people living with HIV/AIDS (UNAIDS 2007). Though the HIV
epidemic in India
indicates a stabilizing pattern, it is estimated that the need for HIV and
antiretroviral therapy (ART) care will increase since persons infected 6-8
years ago will now start developing HIV/AIDS-related illnesses.
The National AIDS Control Programme is scaling up its care and treatment services
to 178 ART Centers
and 159 Community
Care Centers
nationally; covering medical colleges and district headquarter hospitals and
instituting linkages with the various NGO services. Decentralized HIV
services, including integrated counseling and testing (ICTC) services and
prevention of parent to child transmission (PPTCT) services are established
at district and sub-district levels (up to taluk,
CHC and 24-hour PHC) There is, therefore, a need for preparing the district
and sub-district level (primary health care level) health system to deliver
HIV prevention and care services. Recently the National AIDS Control
Organization (NACO) has initiated the concept of “Link ART Center” or LAC which will further
decentralize delivery of ART to sub-district levels. The LACs
would be linked to nodal ART centers.
Under the National AIDS
Control Programme Phase III (2007-2012), the basic
implementation unit would be the district level and, therefore,
capacity building and convergence with
the other national programmes such as NRHM, RCH
and TB is required at this level.
The IMAI approach in India
paves the way for:
· Preparing the district and sub-district level
(primary health care level) health system to deliver HIV care, thus mainstreaming HIV services
into the existing health care system
· Effective linkages with other national programmes
at district level
IMAI uses a standardized,
structured training package to train health care providers such as doctors,
nurses, counselors, laboratory technicians, peer educators, auxiliary nurse
midwives (ANM) who each have a role in the delivery of specific HIV/AIDS care
in their normal routine work.
Some examples of specific roles in the delivery of
HIV/AIDS care at primary level include:
A primary level doctor should have:
· a
high index of suspicion if the patient exhibits HIV/AIDS –related symptoms
· appropriate
referral for HIV testing and counseling
· appropriate
referral to STI services, RNTCP services
· she/he
should be able to provide basic primary care to a PLHA at primary level
clinics
A nurse/counselor/ANM should:
· be
able to understand the basics of HIV/AIDS care
· provide
information and education to the patient
· give
supportive counseling to the PLHA especially adherence to antiretroviral
therapy
· refer
them to other NGO services, if required
· she/he
should be able to counsel and refer all antenatal pregnant women for HIV
testing or to the doctor, especially when women exhibit HIV/AIDS-related symptoms
· similarly,
she/he should be able to refer children for HIV testing in case they exhibit
HIV/AIDS-related symptoms
The IMAI training also
incorporates chronic care principles which are relevant to not only HIV, but
also to the management of diabetes, hypertension, epilepsy, cancer etc.
IMAI pilot in India
 During the period
of April – December 2007, IMAI in India
was piloted in two districts, Davangere in
Karnataka and Karur in Tamilnadu
through implementing partners TANSACS, KSAPS, St.John’s
Medical College, KHPT, SAATHII, ITECH and
State/District level positive network.
This 8.5 months
pilot programme successfully trained district and
sub-district doctors, nurses and counselors in HIV chronic care and acute
care, using the PLHA network as “expert patient –trainers”.
In these two pilot districts,
it was envisioned that the IMAI training will support primary health care
management and allow most care, treatment and prevention services to be
delivered near the patient’s home.
Also, simple problems could be addressed and managed by the care
providers themselves and complicated cases could be referred to the district
hospital or ART centre.
Final evaluation of the IMAI
pilot programme is underway and the results would
be disseminated at the end of 2008.
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