A pilot project that started in Navi Mumbai’s Taloja jail — setting up ART (Antiretroviral Therapy) centres to help prisoners living with HIV — is being replicated across the state. The Maharashtra State AIDS Control Society (MSACS) has already helped set up such a facility in Yerawada jail in Pune.
The project is based on the premise that access to HIV care and treatment is vital in reaching specialised populations like prisoners. “A major challenge we faced was ensuring initiation and regular visits by HIV positive jail inmates to ART centres (HIV clinics) at government hospitals. This has resulted in loss of continuous care and an urgent need of having a client-centric ART dispensation model for prison inmates at a place of their convenience,” MSACS Project Director Tukaram Munde told The Indian Express.
MSACS plans to replicate the same model in five more prisons in Maharashtra. A Training of Trainers (TOT) was organised in Pune in September this year for five major prisons — in Pune, Nashik, Aurangabad, Raigad and Nagpur — with the help of the India unit of International Training and Education Center for Health (I-TECH), an organisation based in the USA.
Maharashtra has nine central prisons, 31 district prisons, 19 open prisons, one open colony and 172 sub-prisons. According to data from the Maharashtra prison department, there are approximately 36,500 inmates in the state’s prisons. About 500 of them are living with HIV and are on treatment, as per MSACS data.
Prisoners face various hurdles while trying to access HIV medicines, such as difficulty in getting a police escort as most prisons are overcrowded and HIV patients may not get priority. Even if they reach ART centres, blood investigations and X-Rays may not get completed on the same day and repeat visits are required in the future. This results in non-initiation or delayed initiation for HIV medicines, said Munde.
While India has an estimated 2.1 million people living with HIV, the epidemic is concentrated among key populations, including sex workers, men who have sex with men and intravenous drug users. In Maharashtra, more than 3 lakh people are living with HIV and receiving treatment. The MSACS, along with support from I-TECH India, has developed strategies to strengthen the health systems at the ART centres to enhance treatment adherence for achieving viral load suppression. Through Multi Month Dispensation (MMD), ART drugs are now being dispensed for three months to stable clients (who have good treatment adherence) at the ART centres. “MMD has helped us address the barriers of travel time, cost and long waiting hours at the ART centre” said Munde.
Now, the project — the Prison model of Differentiated Service Delivery Models (DSDM) — has ensured provision of ART drugs in the prison setting.
“We started initiation of HIV medicines in Taloja prison on April 24 this year. The assessment visit was done by District AIDS Prevention and Control Unit before starting this centre. I-TECH India supported on-site training of prison medical officers and other prison staff, with the help of medical advisers and programme mentors,” said Munde.
MSACS officials said currently, 20 prisoners in Taloja jail have been initiated on HIV medicines.
Munde pointed out that in case of undertrial prisoners released on bail or acquitted, further tracking is of utmost importance. “Robust mechanisms are needed to prevent prisoners becoming defaulters after their release,” he said. I-TECH India has developed a ‘post-release action plan’, the first-of-its kind in India, so that prisoners understand that HIV medicines need to be taken for the rest of one’s life, adherence is crucial and continuing treatment after release from prison is essential.