AIM: To create awareness for prevention of Hepatitis C amongst the marginalized and less deserved members of the community.
1. Orientation to Hepatitis C and counseling for prevention
2. Screening for surveillance
Both women and men are affected equally though in India, 7% of the population within the ages of 20-29 have been surveyed to have chronicity of the virus estimating its cause to intravenous drug use (Patel, Patel & Nerurkar, 2017). Though this data was collected from patients having access to a tertiary centre, it raises a question on actual numbers not having access to a hospital and lack of awareness due to the asymptomatic nature of the disease. Further to this, it also raises a question mark on those marginalized communities that engage in folk medicine and rituals that may risk transmission to children from the ages of 10-19 years onwards. Patel, Patel & Nerukar (2017) have attributed this to 3% in this age range to establish it exists, justifying a community intervention.
We propose to carry out the strategy on Easterbrook’s (2016) lines, which will involve education, counselling and screening among marginalized, slum dwellers of men, women, adolescents and transgender that are believed to rely on folk medicine and rituals as part of their daily lives. These rituals also risk in apparent parental or per-mucosal exposure strongly suspected to cause transmission of the hepatitis C Virus. These groups fit in with the AASLD Guidelines (2015) that list intravenous drug users; MSM persons engaging in high risk sexual practices and incarcerated persons, which are included in our project. Also along these lines, awareness through education and counselling is also given to build capacity and create awareness amongst persons who also engage in livelihoods that that risk transmission of the Hepatitis C virus. These include beauty parlours engaged in carrying out manicures, pedicures and other treatments involving breaking the skin barrier; barber shops relying on used razors, and unsterilized implements are used; folk medicine practitioners involved in dental extractions, unsafe circumcision practices, providing multivitamin drips and injections with unsterilized needles; tattooists and body piercing artists who use unsterilized needles; transgender and persons engaging in males having sex with males (MSM).
1. Education and Counselling Module will include the following preparation process
a) Mobilization- The targeted group of individuals will be mobilized with the help of partner NGO, who have received training on how to conduct an education, capacity building, counselling and screening session. This NGO will map out a key intervention area and will link up and invite another NGOs already working at the grassroots level i.e. within a slum community amongst the high-risk groups to attend the monthly orientation program organized by the partner NGO that will focus on explaining the program objectives and role and responsibilities of all stakeholders. Opportunities to teach, counsel and screen can be initiated through mother’s meet, at the industrial level, at localities focussed with prisoners; drug users; community sex workers and transgender.
i. The Partner NGO: The Liver Care Foundation (LCF) was established in 2005 as a nonprofit organization with a view to contribute to society by connecting with the public, patient and provider, as a part of its focus towards prevention of liver disease(s). The Liver Care Foundation has already conducted 319 awareness programs on liver health in various parts of Delhi and also been able to vaccinate 25000 children successfully (6-17 years) in the underprivileged communities of Delhi. LCF has been trained to educate, counsel and screen for HCV.
b) Management Orientation Programs- These are training programs for capacity building and training coordinators of the grass root NGOs and champions recruited at orientation during the education and counselling process within the community. These persons will be explained the need to mobilize communities for education, counselling and screening. Coordinators and Champions will be mobilized during the training to understand the importance of a suitable venue for recommendation in the areas they work in, advertisement of a program in her area, identification of the various high-risk groups in the coordinator’s area of work such as beauticians; barbers; community sex workers; nearest prison and the nearest transgender locality. The coordinator will also be taught to identify champions within these high-risk groups and motivate them to get enrolled as part of a community intervention program so that the trickledown effect within the community can be affected. Each of these champions will be “Surajmukhi” certified with a framed certificate put up at their workplace as authorized persons to help organize more education programs within the community on prevention of Hepatitis C. The coordinator will also help to organize general education, counselling for prevention and screening programs within the general population of women, men and youth on prevention of Hepatitis C using door-to-door methods for a batch of 50 participants an education, counselling and screening program.
c) Workshops for Professionals- These are capacity building programs for training those in the community including beauticians, barbers, folk doctors, tattooists and body piercing artists, who need to be educated and counselled on the need to include safety measures at their work place that can contribute to prevent the Hepatitis C virus transmission. These professionals would be mobilized by the grassroots NGOs who are involved at the community level and who have been trained at the management orientation programs. These professionals would be certified with a “Surajmukhi” certification of being trained and provided with standard operating guidelines on hepatitis C prevention for transmitting the virus as well as their joining in with the campaign on surveillance held through the liver care foundation, at given schedules. Number of referrals to an education and screening camp by a champion professional will be rewarded by a wall painting at his place of work. This will enhance his/her profession with advertisements using the mural wall painting’s that will carry the message on hepatitis C prevention and acknowledgement of the professional as a champion for the cause.
2. Education and Counselling process within the Community: This involves educating, counselling and screening both local populations and special populations mentioned for Hepatitis C, which are mobilized by the grass root N A trickledown effect will be used by identifying champions for advocacy, who will be trained and encouraged to participate in future education sessions. The Liver Care Foundation have developed education material to support the education process using
i. A flipchart with pictures and slogans that helps a lay public member understand the dangers of the virus Hepatitis C, its origin, a leading cause of liver disease such as cirrhosis and liver cancer
ii. The Risk Factors that contribute to its transmission
iii. Awareness for methods available to prevent infection, which will be supported by distribution of toothbrush, razor and nail cutter to emphasize “no sharing”
iv. Importance of screening for HCV especially with high risk populations.
v. Leaflets are to be disseminated with sample toothbrushes, toothpaste and razors to emphasize No Sharing.
vi. Posters and Education material to be put up as part of education.
vii. Wall paintings within the community recommending getting tested for Hepatitis C to be put with slogans at the strategic areas where the professionals have been trained and certified for public awareness.
vii. Use of interactive methods such as “Potli game” and “Snakes and Ladders” to dispel the myths and misconceptions around Hepatitis C.
3. Screening Strategy
a. All persons accepting to screen themselves following an education counselling session and a patient information sheet will provide written consent to allow the workers of the Liver Care Foundation or other recruited experts to take a blood sample, following which their names and contact details will be noted along with a unique number given. Persons accepting to screen themselves will also be invited to participate in a study that will involve a surveillance of collated data from all the screening camps that would have taken place with assurance of their confidentiality maintained.
b. The Liver Care Foundation workers who have already been trained at the Department of Virology on how to take blood samples safely and store them on paper using safe aseptic techniques or a certified laboratory technician will draw the blood using a capillary tube for the purposes of a dry blood sample testing, which will be transported for testing and evaluation of a positive or negative status of the Hepatitis C virus at the Institute of Liver and Biliary Sciences
c. Collected samples will be taken to ILBS along with the used capillary tubes, blades and other consumables which shall be packed according to standardized instructions and disposed along with the laboratory waste in the hospital incinerator as permitted by the head of department of Virology, ILBS.
d. Reports will be shared by call and SMS, however where results are seen as positive, a home visit by the Liver Care Foundation workers will be planned and the person will be referred to the Institute of Liver and Biliary Sciences or any other certified Mohalla centre or hospital for further follow up and care. The contact number of the Liver Care Worker will also be given for any other assistance needed as part of follow up care, as part of a telephone helpline support.
|Date||NGO||Location||No of Screening|
|7th January||Aradhya (TPDDL)||Shakurpur||53|
|9th January||SPID Society||Nangloi||68|
|11th January||Rakshaks Foundation||Matiyala Extension||82|
|16th January||Chetnalaya||Savda -JJ Colony||52|
|17th January||Ramky Foundation||Model Town||79|
|21st January||Dhani Foundation||Mukundpur||56|