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CMgWkameraK bBaðaTMnak;TMngpøÚvePT nig suxPaBbnþBUC

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4

matikar GarmÖkfa .................................................................................................................................................................................................. 2 esckþIEføgGMNrKuN ............................................................................................................................................................................ 3 niymn½y ................................................................................................................................................................................................... 6 1> esckþIepþIm ......................................................................................................................................................................................... 7 2> sniTanPaB (Rationale) ........................................................................................................................................................... 9 3> eKalbMNg.................................................................................................................................................................................... 10 4> viFIsaRsþedIm,IsMerc)annUveKalbMNg ................................................................................................................................ 10 5> skmμPaB ........................................................................................................................................................................................ 15 6> karRKb;RKgviFIsaRsþeqøIytbrYmKña ....................................................................................................................................... 16 6>1 GñksMrbsMrYlkareqøIytbrYmKñafñak;extþ .................................................................................. 18 6>2 GñksMrbsMrYl Cluster sMrab;karGnuvtþn_viFIsaRsþeqøIytbrYmKña .............................................. 19 6>3 CMnYykarGñksMrbsMrYl Cluster ............................................................................................... 19 6>4 GñksMrbsMrYl Hub .................................................................................................................... 20 6>5 m®nþIRKb;RKgkarpÁt;pÁg; sMPar³brikçar ........................................................................................ 20 6>6 m®nþIRKb;RKgTinñn½yenA Hub ..................................................................................................... 20 6>7 GñksMrbsMrYl PMTCT b¤ MCH .............................................................................................. 21 7> karKaMRTbec©keTs .................................................................................................................................................................... 21 8> KMeragbgðajviFIsaRsþeqøIytbrYmKña ..................................................................................................................................... 23 ]bsm<½n§ ]bsm<½n§ 1 ³ b½NÑbBa¢Ún (Referral Card) .......................................................................................................................... 30 ]bsm<½n§ 2 ³ b½NÑtamdan (Follow-up Card) ................................................................................................................ 31 ]bsm<½n§ 3 ³ EpnTIkEnøgpþl;esvaEfTaMsuxPaBkñúgextþéRBEvg/ qñaM 2005 ............................................................. 34 ]bsm<½n§ 4 ³ eKaledArbs; PMTCT enAextþéRBEvg ..................................................................................................... 35 ]bsm<½n§ 5 ³ suc©nkrsMrab;tamdanviFIsaRsþeqøIytbrYmKña (Linked Response Monitoring Indicators)

................................................................................................................................................................................................................. 36 ]bsm<½n§ 6 ³ KMnUsbMRBYjBIviFIsaRsþeqøIytbrYmKña (Linked Response Diagram) ................................... 37 ]bsm<½n§ 7 ³ KMnUsbMRBYjBIviFIsaRsþeqøIytbrYmKña Tak;Tgnwg PMTCT ..................................................... 38

5

taragBakübMRBYj AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care ART Anti-retroviral Treatment ARV Anti-retroviral AZT Zidovudine CAC Comprehensive Abortion Care CBO Community Based Organization CDC-GAP Center for Disease Control-Global AIDS Programme from United States of America CHAI Clinton Foundation for HIV/AIDS Initiative CoC Continuum of Care CPN+ Cambodian People Living with HIV and AIDS Network DBS Dried Blood Spot DFID United Kingdom Department for International Development FBO Faith Based Organization FP Family Planning HAART Highly Active Antiretroviral TherapyHBC Home-based Care HC Health Center HIV Human Immunodeficiency VirusHPITC Health Provider Initiated Testing and CounselingHR Human Resource IEC Information, Education and CommunicationKHANA Khmer HIV/AIDS NGO AllianceM & E Monitoring and EvaluationMMM Mondul Mith Chuoy Mith (Friends Helping Friends) Support GroupMNH Maternal and Newborn HealthMoH Ministry of Health NCHADS National Center for HIV/AIDS, Dermatology and STDNGO Non-Governmental OrganizationNMCHC National Maternal and Child Health CenterNVP Nevirapine OD Operational District OI Opportunistic Infection PAC Pediatric AIDS Care PHD Provincial Health DepartmentPLHA People Living with HIV and AIDSPLHASG People Living with HIV and AIDS Support GroupPMTCT Prevention of Mother-to-Child Transmission (of HIV)RACHA Reproductive and Child Health Alliance RH Referral Hospital RHAC Reproductive Health Association of CambodiaSOP Standard Operating ProceduresSTD Sexually Transmitted DiseasesSTI Sexually Transmitted InfectionTB Tuberculosis TBA Traditional Birth Attendant UA Universal Access UN United Nations UNAIDS The Joint United Nations Programme on HIV/AIDSUNFPA United Nations Population FundUNICEF United Nations Children’s FundUSAID United States Agency for International Development VCCT Voluntary Confidential Counseling and TestingWHO World Health OrganizationWOMEN Women Organization for Modern Economy and Nursing

6

niymn½y Cluster: KWCacegáammnÞIreBTü nigmNÐlsuxPaBenAkñúgTItaMgPUmisaRsþkMNt;mYyEdlGacbegáIt)anCabNþaj énkareqøIytbrYmKña ("linked response" network) . Hub: KWCamnÞIreBTübEg¥kenAkñúg cluster Edlpþl;esvaEfTaM nigBüa)alesIÞrEtRKb;RCugeRCaydl;GñkCMgW. Hub

P¢ab;TMnak;TMngrvagmnÞIreBTü nigmnÞIrBiesaFn_fñak;CatienATIRkugPñMeBj nigCaTUeTA Hub KWCakEnøgEtmYyKt;Edl Gacpþl;nUvesva OI/ART sMrab;kumar. Hub k¾CakEnøgEdl)anbMBak;]bkrN_mnÞIrBiesaFn_TMenIb². Satellite: KWCamnÞIreBTübEg¥kenAkñúg cluster Edly:agehacNas;Gacpþl;esvaeFVIetsþQamrkemeraKeGds_ edays μ ½RKcitþnigrkSakarsMgat;/ esvaEfTaMépÞeBaH/ nigesvabgáarkarcMlgemeraKeGds_BImþayeTAkUn. CaTUeTA mnÞIreBTümanesvaeFVIetsþQamrkemeraKeGds_edaysμ ½RKcitþ nigrkSakarsMgat;rYcCaeRsc. Sub-satellite: KWCa mNÐlsuxPaBenAkñúg cluster EdlRtUv)aneRCIserIsCakEnøgeFVIetsþQamrkemeraKeGds_ edays μ ½RKcitþnigrkSakarsMgat;/ nigpþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_dl;mþaypÞúkemeraKeGds_ nigTarkpgEdr. kareRCIserIsEp¥kelIsmtßPaBrbs;buKÁlik rcnasm<½n§EdlmanRsab; TItaMgPUmisaRsþEdlbgá lkçN³gayRsYldl;GñkCMgWmkTTYlesva.

7

niyaménEbbbTsMrab;GnuvtþviFIsaRsþeqøIytbrYmKña edIm,Ibgáar EfTaM nig Büa)alGñkpÞúkemeraKeGds_-GñkCMgWeGds_ nig CMgWkameraK

bBaðaTMnak;TMngpøÚvePT nig suxPaBbnþBUC

1> esckþIepþIm

kareqøIytbrYmKñarvagsuxPaBbnþBUC CMgWkameraK nigCMgWeGds_RtUv)aneKTTYlsÁal;CaGnþrCatifa mansar³sMxan; Nas;kñúgkarEfTaM nigBüa)aledayRKb;RCugeRCaycMeBaHGñkCMgWEdlRtUvkarnUvkarEfTaMenHRsbeBlCamYyKñanwg karEfTaMsuxPaBepSg².

enAkñúgRBHraCaNacRkkm<úCa manmCÄNÐlCatiBIrEdlmankarTTYlxusRtUvelIbBaðasuxPaBbnþBUC. mCÄmNÐl CatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK TTYlxusRtUvelIkargarbgáar nigBüa)alCMgWkameraK-GñkCMgWeGds_ -GñkpÞúkemraKeGds_enAkñúgvis½ysuxaPi)al. karBüa)alCMgWkameraK nigCMgWeGds_)anbRBa¢abcUlkñúgRbB½n§EfTaM suxPaBEdl)anGnuvtþenAfñak;RsukRbtibtþitamry³karEfTaM nigBüa)albnþ . kBa©b;skmμPaBenH rYmman kareFVI etsþQamrkemeraKeGds_edays μ ½RKcitþnigrkSakarsMgat;cMeBaHburs-RsþI nigRsþImanépÞeBaH EdlCacMNuccab;epþIm énkareRbIR)as;esvabgáarkarcMlgemeraKeGds_BImþayeTAkUn nigesva OI nig ART sMrab;GñkCMgWeGds_Edlmk TTYlkarBüa)alenAmnÞIreBTü. kBa©b;skmμPaBEfTaM nigBüa)albnþ k¾pþl;pgEdrnUvesvaEdlmanTMnak;TMngrvag esvasuxPaB nigshKmn_ ¬RkumEfTaMtampÞH/ mNÐlmitþCYymitþ RkumKaMRTGñkCMgWeGds_-GñkpÞúkemeraKeGds_¦ nigkarbgáarkarcMlgemeraKeGds_. mCÄmNÐlCatiKaMBarmata nigTark TTYlxusRtUvelIesvasuxPaBbnþBUCdUc Ca esvaEfTaMépÞeBaH esvabgáarkarcmøgemeraKeGds_BImþayeTAkUn esvasMralkUnedaysuvtßiPaB esvasuxPaB mata nigTark esvaEpnkarRKYsar nigesvaEfTaMeRkayeBlsMralkUn.

RbB½n§suxaPi)albc©úb,nñrbs;RbeTskm<úCaeyIgpþl;lT§PaBTTYl)ankareRbIR)as;nUvesvaEfTaMCMgWeGds_-GñkpÞúk emeraKeGds_/ esva OI/ART, esvaBinitü nigBüa)alCMgWkameraK/ esvaEfTaMépÞeBaH/ esvaEpnkarRKYsar nig esvasuxPaBmata nigTark. eTaHCay:agNak¾eday esvasuxPaBEdlBak;B½n§TaMgenH minmanenARKb;kEnøgpþl; esvaEfTaMsuxPaBenaHeT ehIyenAkariyal½ysuxaPi)alRsukRbtibtþimYycMnYnk¾minGacmanlT§PaBpþl;esvaEfTaM suxPaBRKb;RCugeRCay)anEdr BIeRBaHbuKÁliksuxaPi)alEtgmanCMnajbec©keTserog²xøÜn ¬EpnkarRKYsar/ karRKb;RKg nigBüa)alCMgWkameraK/ karEfTaMépÞeBaH .l.¦ BYkeKGac)at;bg;»kaspþl;B½t’manRKb;RCugeRCay nigeFIVkarbBa¢ÚnGñkCMgWeTAkan;mNÐlsuxPaBBak;B½n§edIm,I TTYl)ankarBüa)alsmRsb .

dUecñH karP¢ab;TMnak;TMngrvagesvasuxaPi)alEdlmanRsab; k¾dUcCaTMnak;TMngrvagesvasuxaPi)al nigshKmn_ enAmanlkçN³Tn;exSay. GñkCMgWxøHminGacEsVgrkeRbIR)as;esvasuxaPi)al)aneT edaysarmankarlM)ak

8

EpñkFnFan nigTItaMgPUmisaRsþ. dUecñHehIykarTTYl)annUvesvaEfTaM nigBüa)alsuxPaBRKb;RKgRKb;RCugeRCay enAmankgVHxat.

PaBrwgmaMrbs;kmμviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn KWCaktáasMxan;edIm,IFanakareRbIR)as;CasklnUv esvaEfTaM nigBüa)albnþ. kmμvIFIenH)ancab;epþImGnuvtþenAkñúgqñaM 2000 eday)anbegáItRkumkargarbec©keTs nigelxaFikardæan. KMeragsakl,génkm μviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn RtUv)anbegáIteLIgenAkñúg qñaM 2001 enAmCÄmNÐlCatiKaMBarmata nigTarkedaymanesvapþl;RbwkSaGMBICMgWeGds_ nigeFVIetsþQamrkem eraKeGds_CUnRsþImanépÞeBaH nigédKUrbs;BYkeK nigpþl;»sf Nevirapine kMritEtmYydUs dl;RsþICamþayEdlpÞúk emeraKeGds_enAeBlsMralkUn nigTarkeTIbekIt. enAkñúgqñaM 2003 KMeragsakl,g)anBRgIkdl;cMnYn 8 kEnøg eTot. naExkBaØa qñaM2005 eKalkarN_ENnaMsMrab;Büa)albgáareday»sfRbqaMgemeraKeGds_RtUv)anEksMrYl Ep¥kelIGnusasn_rbs;GgÁkarsuxPaBBiPBelak.

enAdMNac;Exvicäika qñaM2007 manmNÐlpþl;esvabgáarkarcMlgemeraKeGds_BImþayeTAkUncMnYn 77kEnøg enAkñúg RbeTskm<úCa. enAkñúgqñaM2006 cMnYnsrubRsþIEdlmkTTYlesvaEfTaMépÞeBaHelIkdMbUgmancMnYn 308/277nak; kñúgenaHRsþImanépÞeBaHcMnYn 29/677nak; )anTTYlkareFVIetsþQamrkemeraKeGds_enAmNÐlpþl;esvabgáarkar cMlgemeraKeGds_BImþayeTAkUn.

cMnYnsrubRsþImanépÞeBaHEdlpÞúkemeraKeGds_cMnYn 644nak; RtUv)ancuHbBa¢IesvaEfTaMépÞeBaHenAmNÐlpþl;esva bgáarkarcMlgemeraKeGds_BImþayeTAkUn ¬392nak;)aneFVIeraKvinicä½y famanpÞúkemeraKeGds_enAesvaEfTaMépÞ eBaH¼esvabgááarkarcMlgemeraKeGds_BImþayeTAkUn nig252nak; EdlkalBImun)andwgfamanpÞúkemeraKeGds_ ehIyRtUv)anbBa¢ÚneTAkan;mNÐlpþl;esvabgááarkarcMlgemeraKeGds_BImþayeTAkUn¦. mCÄmNÐlCatiKaMBarmata nigTark )aneFVIkar)a:n;sμanfa enAqñaM 2006 kmμviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn)aneFVIetsþQam rkemeraKeGds_ es μInwg 7>4° énRsþIkñúgRbeTskm<úCa nig 7>3° énTarkTaMgGs;EdlekItBImþayEdlpÞúkemeraK eGds_)anTTYlnUvEfTaM nigBüa)albgáareday»sfRbqaMgemeraKeGds_.

kmμviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUnbc©úb,nñenH RsþImanépÞeBaHEdleFVIeraKvinicä½y famanpÞúkemeraK eGds_enAmNÐlpþl;esvabgáarkarcMlgemeraKeGds_BImþayeTAkUnnwgRtUv)anbBa¢ÚnbnþeTATTYlesva OI/ARTEdl sßitenACitbMputedIm,ITTYlkarBüa)al b¤karBüa)albgáareday»sfRbqaMgemeraKeGds_ehIyRtUv)anelIkTwkcitþ eGayeTAsMralkUnenAmnÞIreBTübEg¥k b¤mNÐlsuxPaBEdlmanesvabgáarkarcMlgemeraKeGds_BImþayeTAkUn EdlenACitbMput. B½t’mansþIBIkarbgáarCabzmRtUv)anpþl;CUnRsþI nigédKUrbs;Kat;EdlmanlT§pletsþGviC¢man. esvaEfTaMépÞeBaH esvaEpnkarRKYsar nigkartamdankumar¼karcak;va:k;saMgcMeBaHTarkRtUv)anpþl;CUnenARKb; mNÐlsuxPaBTaMgGs; . b:uEnþktáamYycMnYnxageRkamenH KWmUlehtuEdlbNþaleGaymankareRbIR)as;esvaxag elImankMrwtTab ³

9

• y:agehacNas; 25° énRsþImanépÞeBaHenAkñúgRbeTskm<úCa min)anmkTTYlesvaEfTaMépÞeBaH

saFarN³ .

• PaKeRcInénkEnøgpþl;esva PMTCTEdlmanRsab;Gacpþl;esvaEtenAkñúgtMbn;RKbdNþb;b:ueNÑaH vadUc KñaeTAnwgmNÐlsuxPaB b¤mnÞIreBTübEg¥kEdlmanesva PMTCT b:uEnþmankarlM)akkñúgkarmkTTYl esvaeFVIetsþQamrkemeraKeGds_cMeBaHRsþIEdlenAeRkAtMbn;RKbdNþb; .

• 25° énRsþIEdlmkTTYlesvaEfTaMépÞeBaHenAmNÐlpþl;esva PMTCT enAkñúgRtImasTI1 qñaM2007 min)aneFVIetsþQamrkemeraKeGds_ .

• eTaHCamankarbBa¢ÚnRsþImanépÞeBaHpÞúkemeraKeGds_BImNÐlpþl;esva PMTCT eTAesva OI/ART edIm,IeFVIkarBüa)aleday»sfRbqaMgemeraKeGds_muneBlsMralRtUvGnuvtþ)anTUlMTUlayk¾edayk¾ Kat;RtUvRbQmmuxnwgbBaðameFüa)ayeFVIdMeNIr nig]bsKÁepSg²eTotEdlCamUlehtuénkarFøak;cuH cMnYnRsþImanpÞúkemeraKeGds_Edl)aneFVIetsþQamrkemeraKeGds_enAmnÞIreBTübEg¥k b¤mNÐlsux- PaB kñúgkarmkTTYl»sfRbqaMgemeraKeGds_muneBlsMral)ansmRsb.

• RsþImanépÞeBaHEdlpÞúkemeraKeGds_RtUv)anelIkTwkcitþeGayeTAsMralkUnenAmnÞIreBTübEg¥k b¤mNÐl suxPaBEdlmanesva PMTCT b:uEnþmanEt 50° Edl)anGnuvtþ. karsMralkUnenApÞHenAEtmankar eBjniymBIsMNak;RsþImYycMnYnFM CaBiessenAtMbn;CnbT. »sf Nevirapine sMrab;Büa)albgáarRsþI TaMgenaH nigTarkeTIbekIt nig AZT/3TC min)anpþl;CUneTsMrab;karsMralkUnenAeRkARbB½n§esvasuxa- Pi)alEdlman PMTCT .

• elIsBI70° énRsþIEdlmksMralkUnenAesvasuxaPi)alEdlmanesva PMTCT min)andwgGMBIsßan-PaBpÞúkemeraKeGds_enAeBlsMraleT. kareFVIetsþQamrkemeraKeGds_minRtUv)anGnuvtþenAkMLúg eBlsMral nigeRkaysMralry³eBlxøIeT.

viFIsaRsþeqIøytbrYmKña eFVIeGayRbesIreLIgnUvTMnak;TMngrvagesvaTaMgenHenAfñak;RsukRbtibtþi KWRtUvBRgwgynþkar bBa¢Ún nigtamdan (Refer and Follow-up) GñkCMgWbnþenAkñúg nig rvagesvaKaMRTkñúgshmn_ nigesvaEdlpþl;eday RKWHsßansuxaPi)al. viFIsaRsþenHnwgFanadl;GñkCMgWkñúgkarTTYl)annUvesvasuxPaBbnþBUCRKb;RCugeRCay nig kar bgáarkarcMlgemeraKeGds_/ karEfTaM nigBüa)alCMgWkameraK ehIyRtUvepþatkarykcitþTukdak;elIkarBRgwg nig BRgIkesva PMTCT/ esvaBnüakMeNIt/ esvaEfTaMépÞeBaH esvasMralkUnedaysuvtßiPaB/ nigesva OI/ART .

2> sniTanPaB (Rationale)

ehtuGVI)anCaRbB½n§eqøIytbrYmKñaénesva OI/ART, esvaEfTaM nigBüa)alCMgWkameraK esvaEfTaMépÞeBaH esva sMralkUnedaysuvtßiPaB esvaEpnkarRKYsar esvaEfTaMsuxPaBkumar nigesvasuxPaBmata nigTark RtUv)an begáIteLIg nigeFVIsmahrNkmμeTAkñúgRbB½n§EfTaMsuxPaBenAfñak;RsukRbtibtþi ³

10

• naeBlbc©úb,nñ manGñkCMgWCaeRcIn)an)at;bg;»kaskñúgkarTTYlesvaEfTaMRKb;RCugeRCay. tamry³kareqøIy tbrYmKña nigRbB½n§bBa¢Únd¾rwgmaM Gñkpþl;esvaTaMgLaynwg)anTTYlGñkCMgWCaeRcIn. RbB½n§eqøIytbrYmKñanwg elIkTwkcitþeGayGñkCMgWd¾eRcIneGayEsVgrkesvaBüa)alenARKbesvaTaMgGs;. ]TarhN_³ KøInikBinitü nig Büa)alCMgWkameraK/ mNÐleFVIetsþQamrkemeraKeGds_edays μ ½RKcitþ nigrkSakarsMgat; nigesvaEfTaMépÞ eBaHnwgTTYlGtifiCneRcInmkeRbIR)as;esvaenH CaBiessGñkbMerIkargarenAesvakMsanþsb,ay.

• bc©úb,nñenH karmkTTYlesva PMTCT enAmankMrwtTab. dUcEdl)anerobrab;xagedImkm μviFI PMTCT KWCaktáa sMxan;mYykñúgkarTb;sáat;karrIkraldalénemeraKeGds_BImþayeTAkUn.

• RbB½n§suxaPi)alCaTUeTA enARbeTskm<úCaeyIg KWenAmankMrit edaysarkgVHFnFan. bc©úb,nñ GñkCMgWPaKeRcIn min)antamdankarBüa)aleT edaysarBYkeKminmanfvikaRKb;RKan;sMrab;cMNaykñúgkareFVIdMeNIreRcIndgmk kan;mNÐlsuxPaB. kareqøIytbrYmKñad¾rwgmaMmYy rbs;RkumKaMRTkñúgshKmn_ RkumEfTaMtampÞH RkumGb;rMpÞal; enAmNÐlsuxPaB nigesvaEfTaMenAkñúgmNÐlsuxPaBnwgCYysMrYldl;karbBa¢Ún karGb;rM nigdwkCBa¢ÚnGñkCMgW eTAkan;esvaEfTaMEdlsmRsb.

enAeBlEdlRbB½n§eqøIytbrYmKñadak;eGayGnuvtþ RbB½n§enHnwgCYysMrYleGaycab;epþImesvaEfTaMsuxPaBEdl bc©úb,nñenHenAminTan;man dUcCa karEfTaMsuxPaByuvv½y. esvaEfTaMsuxPaBf μ I²nwgman»kasTTYleCaKC½yeRcIn bnÞab;BIkarcab;epþImnUvRbB½n§bBa¢ÚnGñkCMgWbnþd¾xøaMgmYy.

3> eKalbMNg

eKalbMNgsMxan;énkarGnuvtþn_viFIsaRsþeqøIytbrYmKñaKW ³

• cUlrYmcMENkkñúgkarBRgwgRbB½n§suxaPi)alRbeTskm<úCaCaTUeTA edayrYmbBa©ÚlRbB½n§suxaPi)alenAfñak;Rsuk Rbtibtþi.

• BRgwgesvasuxPaBbnþBUCEdlmanRsab;.

• begáInkarTTYl)annUvesvaGb;rMbgáarkarcMlgemeraKeGds_-CMgWeGds_/ kareFVIetsþQamrkemeraKeGds_eday s μ ½RKcitþ nigrkSarkarsMgat;/ karEfTaM nigkarBüa)al.

4> viFIsaRsþedIm,IsMerc)annUveKalbMNg

viFIsaRsþeqøIytbrYmKñanwgRtUvGnuvtþedaymankar ³

cUlrYmkñúgkarGb;rM nigpþl;B½t’man³ buKÁlikEfTaMsuxPaB ¬evC¢bNÐit Kilanub,dæak-yikar q μb¦ nwgpþl;B½t’man GMBIkareRbIR)as;;viFIsaRsþeqøIytbrYmKñaeGay)anl¥bMput edIm,Ipþl;nUvkarEfTaMRKb;RCugeRCayCUnGñkCMgW. kargar enHGaceFVIeTA)antamry³karEksMrYlÉksarbNþúHbNþalbc©úb,nñeGayTan;sPaBkarN_ nigtamry³sikçasala tMrg;Tis. buKÁlikEfTaMsuxPaB nigRkumEfTaMtampÞHenARsukRbtibtþiEdlGnuvtþRbB½n§eqøIytbrYmKñanwgTTYl)ankar

11

bNþúHbNþalsþIGMBIkareFVIetsþQamrkemeraKeGds_edays μ½RKcitþnigrkSakarsMgat; nigkarpþl;B½t’man GMBIkmμviFI PMTCT ¬karBüa)aleday»sfRbqaMgemeraKeGds_ karciBa©wmkUnedayTwkedaH .l. ¦ nigkarRbmUlsMNak Qams¶Üt (DBS).

bRBa¢abnUvB½t’mannanaGMBI esvaeqøIytbrYmKñakñúgsMPar³Gb;rMpSBVpSay nig TMnak;TMng (IEC) ³ sMPar³Gb;rMpSBV pSay nig TMnak;TMng (IEC) RtUveFVIeGaymanPaBsuIKñarvagesvaBak;B½n§nanakñúgviFIsaRsþeqøIytbrYmKña.

o minRtUveGaymankarplitsMPar³Gb;rMpSBVpSaydUcKñaeT .

o RtUvCUndMNwgdl;esvasuxPaBepSg²GMBIsMPar³Gb;rMpSBVpSayEdlmanedIm,Ikat;bnßynUvfvikakñúgkar plitsMPar³Gb;rMpSBVpSayfμ I² .

BRgwgkarRKb;RKgTinñn½y nigkarEfrkSaB½t’manGñkCMgW tamry³RbB½n§eqøIytbrYmKña CaBiessB½t’manEdlTak;Tg nwgRsþImanépÞeBaHpÞúkemeraKeGds_ nigTarkEdlRbQmmuxnwgkarqøgemeraKeGds_. karEksMrYlb½NÑbBa¢ÚnGñk CMgW/ karcuHbBa¢IGñkCMgW/ eKalkarN_ENnaMsMrab;tamdanGñkCMgWsMrab;buKÁlikEfTaMenAkñúgRKwHsßansuxaPi)al nig enAshKmn_/ nigeFVITMrg;r)aykarN_eGayTan;sPaBkarN_KaMRTdl;eKalbMNgviFIsaRsþeqøIytbrYmKñaenH.

BRgwgesvabBa¢Ún rvagesva HIV/AIDS, esva OI/ART, esvaBinitü nig Büa)alkameraK/ esvaEfTaMépÞeBaH/ esvaEpnkarRKYsar/ esvarMlUtkUnedaysuvtßiPaB esvasuxPaByuvv½y nigesvasuxPaBmata nigTark k¾dUcCa BRgwgkarRKb;RKgsMPar³brikçar nigkarRKb;RKgTinñn½y. RKb;smasPaBénesvasuxaPi)alRtUvGnuvtþeGayman lkçN³dUcKña(Consistent).edayRkeLkemIlelIcegáamskm μPaBcMbgeyIgGackt;sMKal;eXIjfa etIesvaTaMg enaHGacBRgIk)anedayrYmbBa©ÚlnUvesvaepSg²eToty:agdUcemþc.

esvaEfTaMépÞeBaH RtUvGnuvtþcegáamskmμPaBcMbgrbs;esvaenH. edIm,IKaMRTviFIsaRsþeqøIytbrYmKña RKb;RsþIman- épÞeBaHTaMgGs;RtUv)anelIkTWkcitþeGayEsVgrkesvaEfTaMépÞeBaHmun nigeRkayeBlsMralkUn nigRtUvbBa¢ÚneTA kan;esvapþl;RbwkSaGMBIEpnkarRKYsar. cMeBaHGñkCMgwEdlmaneraKsBaØaCMgWkameraKRtUv)anBüa)altamry³kar Büa)alCMgWkameraKedaycegáameraKsBaØaenAmNÐlsuxPaB b¤ bBa¢ÚneTAKøInikBinitü nigBüa)alCMgWkameraK. cMeBaHGtifiCnEdlmindwgBIsßanPaBCMgWeGds_RtUv)anelIkTwkcitþeGayeFVIetsþQamrkemeraKeGds_ . qμb b¤ Kilanub,dæayikarEdlbMerIkarenAesvaEfTaMépÞeBaH RtUvbBa©ÚlskmμPaBRbyuT§nwgCMgWeGds_eTAkñúgskmμPaBcuHcak; fñaMbgáar (Immunization outreach) CaRbcaMrbs;BYkeKenAfñak;PUmi. GnþraKmn_enH RtUveFVIeLIgsMedAelIPUmiNaEdl mancm¶ayy:agehacNas;10KILÚEmRtBImNÐlsuxPaB. vamansar³sMxan;kñúgkardwgBIsßanPaBpÞúkemeraKeGds_ elIsmaCikRKYsarTaMgmUl edayRtUvelIkTwkcitþeGaymankarcUlrYmy:agskmμBIédKUburskñúgkarEfTaMRsþImanépÞ eBaHmuneBlsMraledIm,IbegáIteGaymankareFVIetsþQamrkemeraKeGds_cMeBaHburs. -RsþIEdldwgGMBIsßanPaBpÞúkemeraKeGds_ RtUv)anbBa¢ÚnbnþeTAkan;esva OI/ART EdlenACitbMput edIm,IcuHbBa¢Ikñúg esvaEfTaM nigBüa)albnþ nigkareFVIetsþ CD4. RsþIEdlmancMnYnekasika CD4 elIsBI 350 RtUvTTYl)ankar

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Büa)albgáareday»sfRbqaMgemeraKeGds_ enAmnÞIreBTüEdlmanesva OI/ART énRbB½n§eqøIytbrYmKña. RsþIman épÞeBaHEdlmanpÞúkemeraKeGds_RtUvTTYl)annUvB½t’man GMBIsar³sMxan;énesva PMTCT EdlmanRsab;.

mNÐleFVIetsþQamrkemeraKeGds_edays μ ½RKcitþ nigrkSakarsMgat; (VCCT) RtUvGnuvtþcegáamskmμPaBsMxan;² rbs;xøÜn. edIm,IKaMRTkareqøIytbrYmKña VCCT RtUvGb;rMdl;GtifiCnTaMgGs; ¬mnusSeBjv½y nigmnusSv½yCMTg; RsI-Rbus¦ GMBIeraKsBaØaCMgWkameraK nigGMBIesvaBinitü nigBüa)alCMgWkameraK. RbsinebIGtifiCnerobrab;faman eraKsBaØaBak;B½n§nwgCMgWenH RtUvbBa¢ÚnKat;eTAkan;KøInikBinitünigBüa)alCMgWkameraK ¬KøIniksuxPaBRKYsar¦. Rbsin ebIGtifiCnmanpÞúkemeraKeGds_ Gñkpþl;RbwkSaenA VCCT RtUvbBa¢ÚnGtifiCneTAkan;esva OI/ART nigRkumEfTaM tampÞH. eKRtUvelIkTwkcitþGtifiCnEdlmanpÞúkemeraKeGds_eGaynaMédKUrYmePTmkmNÐl VCCT edImI,eFVI etsþQamrkemeraKeGds_. RKb;RsþITaMgGs;Edlmk VCCTRtUv)anbBa¢ÚneTAesvaEpnkarRKYsar. RsþITaMgGs; EdlmanlT§pletsþQamrkemeraKeGds_viC¢man ehIymanépÞeBaH b¤GacnwgmanépÞeBaH RtUv)anbBa¢ÚneTAesva EfTaMépÞeBaHsMralEdlmankmμviFI PMTCT . RKb;GtifiCnTaMgGs;EdleFVIetsþQamrkemeraKeGds_ehIyman lT§plGviC¢manRtUv)anpþl;B½t’mansþIBIviFIsaRsþkñúgkarbgáar nigbBa¢ÚnbnþeTAkan;esvaepSg²eTotEdlcaM)ac;. yuvv½yRtUv)anbBa¢ÚneTAesvaEfTaMsuxPaByuvv½y enAkEnøgEdlGacrkesvaenH)an.

esvaEfTaMBüa)alCMgWkameraK RtUvGnuvtþcegáamskmμPaBrbs;xøÜn. edIm,IKaMRTkarGnuvtþn_viFIsaRsþeqøIytbrYmKña RKb;GtifiCnTaMgGs;nigédKUrbs;BYkeKRtUv)anelIkTwkcitþeGayeFVIetsþQamrkemeraKeGds_. cMeBaHGtifiCnCa RsþIRtUvelIkkMBs;karyl;dwgBIkarbgáarRtYtKña TaMgkarbgáarkarqøgCMgWkameraKnigkarBnüakMeNIt. cMeBaHRsþIEdl sg½Sy famanépÞeBaHRtUv)anelIkTwkcitþeGayEsVgrkesvaeFVIetsþbBa¢ak;BIkarmanKt’. RsþIsßit enAkñúgGayuEdl GacmankUnRtUv)anelIkTwkcitþeGayeTArkesvaEpnkarRKYsar nigRsþIEdlmanépÞeBaHRtUvelIkTwkcitþeGayeTArk esvaEfTaMépÞeBaH. mnusSv½yCMTg;RtUvbBa¢ÚneTAkan;esvasuxPaBsMrab;yuvv½yEdlGacEsVgrk)an b¤esvaepSg eTotEdlmanerobrab;xagelI.

esvaEpnkarRKYsar¼BnüakMeNIt RtUvGnuvtþcegáamskmμPaBsMxan;rbs;xøÜn. edIm,IKaMRTkarGnuvtþn_viFIsaRsþeqøIy tbrYmKña esvaEpnkarRKYsarRtUvGb;rMRsþITaMgLayGMBIkarBnüarkMeNIt karbgáarkarqøgemeraKeGds_nig CMgWkam eraK nigGMBIesva PMTCT. RKb;GtifiCnTaMgGs;RtUv)anelIkTwkcitþeGayTTYlkareFVIetsþQamrkemeraKeGds_.

RKb;RsþImanépÞeBaHRtUv)anbBa¢ÚneTArkesvaEfTaMépÞeBaHmuneBlsMral . RsþImanépÞeBaHpÞúkemeraKeGds_RtUvbBa¢Ún eTAkan;kEnøgEdlmanesva PMTCT nigesva OI/ART. ekμgRsIv½yCMTg;RtUv)anbBa¢ÚnbnþeTAesvaTaMgLayNa Edl Bak;B½n§dUc)anerobrab;xagelI.

esvaEfTaMrMlUtRKb;RCugeRCay (Comprehensive Abortion Care–CAC) RtUvGnuvtþcegáamskmμPaBsMxan;rbs;xøÜn . esvarMlUtkUnedaysuvtßiPaB nigesvaEfTaMeRkayrMlUt (SAPAC) GacrYmbBa©ÚlkñúgRbB½n§eqøIytbrYmKñaedIm,I KaMRTdl;karEfTaMRKb;RCugeRCaysMrab;RsþITaMgenaH. SAPAC RtUv)anelIkTwkcitþGtifiCnrbs;xøÜneGayEsVgrk

13

esvaEpnkarRKYsar nigelIkkMBs;kareFVIetsþQamrkemeraKeGds_ nigCMgWkameraKsMrab;RsþInigédKUrbs;BYkeKenA mNÐleFVIetsþQamrkemeraKeGds_edays μ½RKcitþ nigrkSakarsMgat; nigenAesvaBinitüBüa)alCMgWkameraKEdl enACitbMput.

esvaEfTaMsuxPaByuvv½y GacrYmbBa©ÚlkñúgRbB½n§bBa¢ÚnénviFIsaRsþeqøIytbrYmKña .edIm,IbegáInkarTTYleRbIR)as; esvaenH nigbegáInKuNPaBénkarBüa)al nigEfTaMsuxPaByuvv½y. bc©úb,nñ enAkñúgRbeTskm<úCamanesvaKMrUBIr )anesñIeLIgedIm,Ipþl;esvaEfTaMsuxPaByuvv½y. esvaKMrUTI1RtUv)anGnuvtþedayGgÁkarminEmnrdæaPi)altamsh- Kmn_kñúgtMbn; nigRkumpþl;esvaEfTaMtampÞHEdlpþl;esvaGb;rM nigbBa¢ÚnyuvCn¼narIeTAmnÞIreBTübEg¥kedIm,ITTYl esvaEfTaMRKb;RCugeRCay. esvaKMrUTI1enH KWBwgEp¥kelIkarpþl;B½t’mandl;yuvCn¼narInigKaMRTdl;karpþl;RbwkSaenA tammnÞIreBTübEg¥k. esvaKMrUenHRtUv)anGnuvtþedaymNÐlmitþPaByuvv½yEdlKaMRTedayGgÁkarminEmnrdæaPi)al enAkñúgshKmn_ nigmNÐlsuxPaByuvv½ynwgbegáItenAmnÞIreBTübEg¥kEdlman Gñkpþl;RbwkSaCayuvCnEdlGac ENnaMmitþP½RkeKeGayeTAkan;esvaepSg²enAmnÞIreBTübEg¥k. esvaKMrUTI2KW karpþl;B½t’mannigpþl;RbwkSaKaMRT enAkñúgmnÞIreBTübEg¥k. KMrUTI2enH RtUv)anGnuvtþedaybegáInsmtßPaByuvv½yeGaykøayCaGñkpþl;RbwkSaEdlGac CYyENnaMGtifiCneKeRbIR)as;esvasuxaPi)alepSg²enAkñúgmnÞIeBTübEg¥k. esvamitþPaBsuxPaBbnþBUCyuvv½y (Adolescent Friendly Reproductive Health) RtUv)aneFVIkarsakl,genAmNÐlsuxPaBmYycMnYn.

esvaEfTaMsuxPaBmatanigTark RtUvGnuvtþcegáamskmμPaBsMxan;rbs;xøÜn. edIm,IKaMRTdl;viFIsaRsþeqøIytbrYmKña GtifiCnTaMgGs;RtUv)anelIkTwkcitþ[TTYlkareFVIetsþQamrkemeraKeGds_edayRtUvbBa¢ÚnRsþImanépÞeBaH ¬b¤ sM NakQam¦ eTAmNÐleFVIetsþQamrkemeraKeGds_. esvaEpnkarRKYsarRtJUv)anelIkkMBs;karyl;dwgdl;mþay RKb;rUb. kareFVIetsþQamrkemeraKeGds_nwgRtUv)anelIkTwkcitþcMeBaHRsþImanépÞeBaH EdlminTan;dwgBIsßanPaB emeraKeGds_ehIymksMralkUnenAeBlmat;s,ÚneTIbebIk)anticCag 6 s/m .

RsþICamþayEdlmanpÞúkemeraKeGds_RtUv)anTTYlkarBüa)albgáareday»sfRbqaMgemeraKeGds_enAeBlQWeBaH sMral nigeRkayeBlsMraltamkarENnaMrbs;kmμviFICati. cMeBaHTarkekItBImþaypÞúkemeraKeGds_RtUvTTYlkar Büa)albgáareday»sfRbqaMgemeraKeGds_d¾smRsbmYy nigbBa¢ÚneTAesvaEfTaMkumarpÞúkemeraKeGds_ b¤ kEnøgRbmUlsMNakQams¶Üt (DBS) nigesvapþl;»sf Cotrimoxazole sMrab;kartamdanbnþPøam² ehIymþay pÞúkemeraKeGds_RtUvbBa¢ÚneTAesva OI/ART edIm,IcuHeQμaHkñúgesvaEfTaM nigBüa)albnþ.

esva OI/ART RtUvGnuvtþcegáamskmμPaBsMxan;rbs;xøÜn . edIm,IKaMRTdl;viFIsaRsþeqøIytbrYmKña esva OI/ART RtUvbBa¢ÚnGtifiCnEdlpÞúkemeraKeGds_ nigsgS½yfamanCMgWrebgeTABinitüRsavRCavrkemeraKrebg. RsþIpÞúk emeraKeGds_RtUv)anbBa¢ÚneTAesvaEpnkarRKYsar nigesvaEfTaMépÞeBaH¼esvabgáarkarcMlgemeraKeGds_BImþay

14

eTAkUn RbsinebImanépÞeBaH. CakarRbesIr esvaTaMgenH RtUvmanenAkñúgmnÞIreBTübEg¥k. edIm,IFanadl;kargarenH RtUvEtbegáIteGaymanTMnak;TMngkarbBa¢Únbnþrvag OI/ART nigmNÐlsuxPaBenAkñúgtMbn;RKbdNþb;.

RkumEfTaMtampÞH RtUvEtbegáInsmtßPaBbMeBjkargarcuHGb;rMpÞal;dl;shKmn_k¾dUcCakarcUlrYmbBa¢Ún nigtamdan rkGñkCMgWeGds_. RkumEfTaMtampÞHRtUvEtbegáItTMnak;TMngd¾rwgmaMmYyCamYyRkumEfTaMtampÞHepSgeTotenAkñúgtMbn; rbs;BYkeK edIm,IFananUvkarshkarl¥kñúgcMeNamédKUkargar nigRKbdNþb;eBjeljcMeBaHRbCaCnenAkñúgtMbn; RKbdNþb; (catchment population). BYkeKnwgbMeBjkargary:agCitsñiT§CamYymnÞIreBTübEg¥k nigmNÐlsuxPaB edIm,IbegáIncMnYnbBa¢Ún nigpþÜcepþImkarBinitütamdan. RkumEfTaMtampÞHRtUvmanTMnak;TMngCamYymnÞIreBTübEg¥k nig mNÐlsuxPaBedIm,IkMNt;GñkCMgWfμ IEdlRtUvtamdan. BYkeKGacnwgRtUvGeBa¢IjeGaycUlrYmKaMRTRkumGb;rMpÞal;enA kEnøgedIm,IerobcMesvaenHenAfñak;PUmi. RkumenHRtUvCYy]btßmÖdl;kareFVIdMeNIr b¤CYysMrYldl;kardwkCBa¢ÚnGñk CMgWmkmnÞIreBTübEg¥k nigmNÐlsuxPaBedIm,ITTYl)anesvaEfTaMBüa)albEnßmeTot. RkumEfTaMtampÞHk¾pþl; B½t’manpgEdrdl;GñkCMgWGMBIevla nigTIkEnøgEdlGñkCMgWRtUveTATTYlkartamdan nigBüa)albnþ. RkumEfTaMtam pÞHRtUvEtelIkTwkcitþeGayGñkCMgWelb»sfeGay)anCab;lab; eTogTat; nigRtwmRtUveTAtamrUbmnþBüa)alrbs; RksYgsuxaPi)al.

kareFVIetsþQamrkemeraKeGds_edays μ ½RKcitþ nig rkSakarsMgat; EdlpþÜcepþImedaymRnþIsuxaPi)al (Health

Provider Initiated Testing and Counseling–HPITC) KWmansar³sMxan;Nas;sMrab;erobcMeGaymankarEfTaM eBjeljmYypþl;CUnGtifiCnEdlmkBinitüsuxPaBenAkEnøgEdlminmanmNÐleFVIetsþQamrkemeraKeGds_ edays μ ½RKcitþ nigrkSakarsMgat;. RKb;mRnþIsuxaPi)alTaMgGs; ¬evC¢bNÐit Kilanub,dæak-yika qμb nigTnþeBTü¦ RtUvelIkTwkcitþGtifiCneGayeFVIetsþQamrkemeraKeGds_enAtammNÐleFVIetsþQamedays μ ½RKcitþ nigrkSakar sMgat;EdlenACitenaH. esvaEfTaMépÞeBaH nigesvaBüa)alGñkCMgWrebgRtUvelIkTwkcitþGtifiCneGayeFVIetsþQam rkemeraKeGds_. muneBleFVIetsþQamrkemeraKeGds_ buKÁliksuxaPi)alEdlbMerIkargarenAEpñksmÖB EpñkKøInik BinitünigBüa)alCMgWkameraK EpñkBüa)alCMgWrebg EpñkBüa)alCMgWkumar nigEpñkBüa)alCMgwqøg RtUvpþl;B½t’manCUn GtifiCnGMBIsar³RbeyaCn_énkardwgGMBIsßanPaBpÞúkemeraKeGds_rbs;Kat;. cMeBaHGñkCMgWmkBinitüBüa)alenA mNÐlsuxPaBEdlminmanmNÐl VCCT RtUvbUmQamrbs;Kat;ehIyykeTAeFVIetsþenAmnÞIrBiesaFn_rbs;VCCT

EdlCitbMput. ynþkardwkCBa¢ÚnsMNakQameTAmNÐl VCCT nwgRtUvbegáIteLIgsMrab;RsukRbtibtþinimYy².

karcuHGb;rMpÞal;dl;Gñks μ ½RKcitþEfTaMsuxPaBenAtamPUmi q μbburaN (TBA) nigeBTüÉkCnenAtamshKmn_ mansar³RbeyaCn_Nas;eRBaHCaGñkedIrtYsMxan;kñúgkarnaMGñkCMgWeTAkEnøgpþl;esvaEfTaMsuxPaBedIm,IeFVIetsþQam rkemeraKeGds_ TTYlkarRbwkSa EfTaM nigBüa)al. CaTUeTA Gñksμ ½RKcitþTaMgenaH nigGñkpþl;esvaEfTaMsuxPaBman TMnak;TMngCitsñiT§CamYyshKmn_rbs;BYkeKehIyGtifiCnrbs;BYkeKmankareKarB nigeCOCak;elIkarpþl;RbwkSa rbs;GñkTaMgenaH. karbMeBjkargarCitsñiT§CamYyGñkTaMgGs;enaHnwgGacCYydl;mRnþIsuxaPi)alenARKwHsßanEfTaM

15

suxPaBGackMNt;)annUvcMnYnGñkCMgWEdlRtUvkaresvaEfTaM nigBüa)alRBmTaMgbegáInkarelIkTwkcitþGñkCMgWeGay EsVgrkesvasuxaPaBenAkñúgRbB½n§eqøIytbrYmKña.

5> skmμPaB

• sMPar³epSg² ³ cegáamskmμPaBbNþúHbNþalcMbgGMBI kareFVIetsþQamrkemeraKeGds_edays μ ½RKcitþ nigrkSakarsMgat;/ karbgáarkarcmøgemeraKeGds_BImþayeTAkUn/ karBinitünigBüa)alCMgWkameraK/ karEfTa MépÞeBaH/ EpnkarRKYsar/ karEfTaMBüa)alCMgWeGds_dl;kumar/ karEfTaMmatanigTark karEfTaMrMlUtRKb;RCug eRCaynigkarRbmUlsMNakQams¶Üt-DBS RtUvGnuvtþeTAtamtMrUvkar nigEbgEcksMPar³ nigkarbNþúHbNþal epSg²RsbeTAtamskmμPaB. mCÄmNÐlCatiRbyuT§nwgCMgWeGds_esIEs,k nigkameraK nigmCÄmNÐlCati KaMBarmata nigTark nwgminbegáItkmμviFIbNþúHbNþaldac;edayELkenaHeT b:uEnþnwgbegáItvKÁbNþúHbNþalrYmKña sMrab; VCCT nig PMTCT. eKalbMNgénkarerobcMkmμviFIenH KWedIm,IP¢ab;TMnak;TMngnigeFVIeGayTan; bc©úb,nñPaBnUvB½t’man edIm,IeGayB½t’manTaMgenaHGacEsVgrk)an. pÞaMgrUbPaBpSBVpSayGMBIviFIsaRsþeqøIytb rYmKñarbs;km μviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn nwgRtUveFVIkarEksMrYledIm,IbgðajGMBIkarEfTaMnig Büa)alf μ Ibg¥s;sMrab;RsþImanépÞeBaH nigTarkeTIbekItBImþaypÞúkemeraKeGds_. eKalkarN_ENnaMsMrab;Büa )al nigkarBinitütamdanénkm μviFI PMTCT nwgRtUvbegáIteLIgsMrab;RKwHsßanpþl;esvaEfTaM nigRkumEfTaM tampÞHedIm,ICaCMnYy kñúgeBlEfTaMmþaypÞúkemeraKeGds_ nigTarkeTIbekIt. TMrg;bBa¢IcuHeQμaHEdlmanRsab; b½NÑbBa¢Ún nigr)aykarN_RbcaMExnwgRtUvBinitüeLIgvij nigEksMrYledIm,IKaMRTdl;karGnuvtþn_skm μPaBviFI saRsþeqøIytbrYmKña.

• sikçasalatMrg;Tis ³ sikçasalatMrg;Tisnwgpþl;CaevTikarmYysMrab;mRnþIsuxaPi)alkñúgkarBiPakSa GMBIcegáam skmμPaBcMbgEdlTak;Tgnwgesvarbs;BYkeK nigCa»kassMrab;bgðajCUndl;buKÁlikTaMgGs;GMBITsSn³énviFI saRsþeqøIytbrYmKña. kñúgsikçasalatMrg;TisEdlmanry³eBl2éf¶enH édKUkargarBak;B½n§sMxan;²nwgTTYl )ankarBnül;GMBIcMNucsMxan;én HIV/AIDS, OI/ART, esvaBinitünigBüa)alCMgWkameraK esvaEfTaMépÞeBaH esvaBnüakMeNIt esvaEfTaMCMgWkumar nig esvaEfTaMeRkayrMlUt esvaKaMRTsuxPaBmatanigTark. »kasén karbBa¢Únfμ InwgRtUvGnuvtþedayGñkpþl;esvaEfTaMsuxPaBTaMgGs; edIm,IKaMRTdl;skmμPaBénviFIsaRsþeqøIytb rYmKña. sikçasalaenHnwgerobcMeLIgsMrab;buKÁlikpþl;esvaEfTaMTaMgGs;enAkñúg cluster EdlbMerIkargarenA esva OI/ART, esvaBinitünigBüa)alCMgWkameraK/ esvaEfTaMépÞeBaH/ esvaBnüakMeNIt/ esvaEfTaMCMgWkumar esvaEfTaMeRkayrMlUt nigesvaKaMRTsuxPaBmata nigTark. CakarRbesIr tMNagmñak;mkBImCÄmNÐlCati RbyuT§nwgCMgWeGds_esIEs,knigkameraK nigmñak;mkBImCÄmNÐlCatiKaMBarmatanigTark manvtþmanenARKb; vKÁsikçasalaTaMgGs;. cMnYnsikçakamcUlvKÁsikçasalatMrg;TiskñúgvKÁnimYy² minRtUvelIsBI 25-30nak;eT.

16

sikçakamTaMgGs;RtUv)anpþl;CUnnUvbBa¢IeQμaHcegáamskmμPaBcMbgEdlBak;B½n§enAeBlmkcUlrYmsikçasala enH. sikçasalabnþeTotnwgerobcMsMrab;buKÁlikEfTaMsuxPaBTaMgGs;. kñúgsikçasalabnþenHnwgRtUvelIkyk mkBiPakSaGMBIskþanuPaBnigbBaðaTak;TgnwgkarbBa¢ÚnkñúgRkumesvanimYy² edIm,IbegáInnUvcMeNHdwgbEnßmeTot dl;buKÁlikEfTaMsuxPaBGMBIkarTMnak;TMngesvaTaMgenH.

• karepþImKMnitcuHGb;rMpÞal; ³ kic©xitxMRbwgERbgenHnwgERbRbYlBIRsukRbtibtþimYy eTARsukRbtibtþimYyeTot GaRs½yelIsßanPaBkñúgtMbn;. CaBiess GgÁkarminEmnrdæaPi)alEdlbMerIkargarelIbBaðapøÚvePT nigsuxPaB bnþBUC RkumEfTaMtampÞH buKÁlikmNÐlsuxPaB RtUverobcMkic©RbCMupþl;B½t’mandl;q μbburaN nigeBTüÉkCn tamshKmn_kñúgtMbn;rbs;BYkeK. kic©RbCMuTaMgenHRtUvGb;rMGñkcUlrYmGMBIRbB½n§eqøIytbrYmKña nigesvaEdlpþl; CUnehIyelIkTwkcitþBYkeKeGayeFVIkargarCamYyRbB½n§kargarsaFarN³ edIm,Ipþl;nUvKuNPaBEfTaMx<s;dl;Gñk CMgWrbs;BYkeK. viFIsaRsþmYyRtUvbegáIteLIgedIm,IelIkTwkcitþ kic©shkar rvagesvaEfTaMsuxPaBTaMgBIr RbePTenHenAfñak;shKmn_.

• karbBa¢Únbnþ ³ taragB½t’manCak;lak;rbs;RsukRbtibtþiedaybgðajB½t’manlMGit BIkEnøgEdlGñkCMgWRtUvbBa¢Ún bnþ RtUvBüÜr nigdak;elItukBa©k;rbs;Gñkpþl;esvaEfTaMsuxPaB. taragB½t’manenH RtUvdak;taMgenAkEnøggay RsYlemIleXIj nigmancMnYnRKb;RKan;sMrab;Gñkpþl;esvaEfTaMsuxPaBTaMgGs;. Tak;TinnwgkarbBa¢ÚnGñkCMgW eTAkan;kEnøgpþl;esvaEfTaMsuxPaBepSgeTot Gñkpþl;esvaRtUvmanbBa¢IeQ μaHkEnøgpþl;esvaEfTaM nig Büa)al CMgWkameraK/ esva OI/ART esva VCCT esvaEfTaMépÞeBaH esva PMTCT esvaBnüakMeNIt esvaEfTaM CMgWkumar esvasuxPaBmatanigTark nig esvaCMgWrebgEdlenACitbMputedIm,IgayRsYldl;GñkCMgWkñúgkarEsVg rkesvaTaMgenaHedaycMNayeBleFVIdMeNIrEtmYyelIk. Gñkpþl;esvaEfTaMenAtamesvanimYy²RtUvskmμkñúg karelIkTwkcitþGñkCMgWeGayecHTajykplRbeyaCn_BIesvaepSgeTot EdlmanenAkñúgRKwHsßansuxPaBTaMg enaH. RbsinebI esvasMxan;²xøHminmanenATIenaHRtUvbBa¢ÚnGñkCMgWeTAkan;kEnøgdéTeTotEdlmanpþl;esva EdlRtUvkar.GñkCMgWRtUv)anpþl;CUnnUvb½NÑbBa¢Únsþg;damYyEdlmanB½t’mancugeRkaybg¥s; ¬]bsm<½n§ 1¦ nig RtUv)anR)ab;GMBImeFüa)ayEdleFVIdMeNIreTAkEnøgTaMgenaH[)anqab;. RKWHsßanEfTaMsuxPaBRtUvbegáIteGay manTMnak;TMngrvagGgÁkarnigGñkCMgW RbsinebImanRkumKaMRTtamshKmn_ nigRkumEfTaMtampÞHEdlGacCYy ]btßmÖfvikaeFVIdMeNIr.

6> karRKb;RKgviFIsaRsþeqøIytbrYmKña

mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK nigmCÄmNÐlCatiKaMBarmata nigTarknwgeFVIkarshkar CamYyédKUkargarepSgeTotedIm,IGnuvtþKMeragbgðajviFIsaRsþeqøIytbrYmKñaenAkñúgextþéRBEvg nigtMbn;Edl)an eRCIserIsedaysarEtRbPBFnFannigehdæarcnasm<½n§enAmankMrit.

17

RbB½n§eqøIytbrYmKñaenAfñak;kNþalnwgRtUv)ansMrbsMrYledaymCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK nig mCÄmNÐlCatiKaMBarmata nigTarkehIyenAfñak; Cluster rcnasm<½n§RKb;RKgnwgEcgdUcxageRkam³

GñksMrbsMrYl Cluster ³ CaRbFanRsukRbtibtþi énRsukRbtibtþi Hub CMnYykarGñksMrbsMrYl Cluster ³CaGñksMrbsMrYlkargarRbyuT§nwgCMgWeGds_fñak;RsukRbtibtþiénRsukRbtibtþi Hub GñksMrbsMrYl Hub ³CaRbFan b¤ GnuRbFanmnÞIreBTübEg¥k Hub RkumkargarRKb;RKg nigbuKÁlikCMnYyEpñkbec©keTsnwgRtUvsßitenAkñúgmnÞIreBTübEg¥k Hub .

GñksMrbsMrYlkareqøIytbrYmKñaenAfñak;esvarNb KWCaRbFan b¤GnuRbFanRsukRbtibtþi. buKÁlikenAfñak; sub-

satellite TTYlxusRtUvcMeBaHskmμPaBrbs;BYkeKCaRkum.

GñksMrbsMrYl Cluster TTYlxusRtUvkñúgkarerobcMkic©RbCMuRbcaMRtImasral;3ExmþgCamYyGñkpþl;esvaEfTaMsuxPaB TaMgGs;enAkñúg Cluster. GñkRKb;RKgfñak;CatimkBImCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK tMrUvRtUvcUlrYmkic©RbCMuenH .

GñksMrbsMrYlkargarRbyuT§nwgCMgWeGds_fñak;RsukRbtibtþi¼GñkRKb;RKgkareqøIytbrYmKñaenA Satellite TTYlxusRtUv kñúgkarerobcMkic©RbCMural;RbcaMRtImassMrab;RsukRbtibtþirbs;Kat;. GñkcUlrYmkñúgkic©RbCMurYmmanGñkpþl;esvaEfTaM suxPaB RkumKaMRTtamshKmn_ RkumEfTaMtampÞH GgÁkarminEmnrdæaPi)al nigPaKIBak;B½n§déTeTot. kic©RbCMuenH RtUverobcMmuneBlkic©RbCMuRbcaMRtImasenA cluster edIm,Ipþl;mtikñúgkarBiPakSa nigkalviPaKRbCMu cluster. kic©RbCMu enAfñak;CatiCamYyGgÁkarminEmnrdæaPi)al nigédKUkargarsMxan;²epSgeTotnwgRtUveFVIeLIgeTAtamkarcaM)ac;.

18

rcnasm<½n§énkareqøIytbrYmKña

kMNt;sMKal;³ rcnasm<½n§enHnwgmineRbIR)as;eToteT enAeBlEdlRsukRbtibtþinimYy²GacTTYlxusRtUvelIskmμ PaBeqøIytbrYmKña enAkñúgtMbn;rbs;xøÜn .

tYnaTI nigkarTTYlxusRtUvrbs;GñksMrbsMrYl Hub 6>1 GñksMrbsMrYlkareqøIytbrYmKñafñak;extþ

6/1/1 CYysMrYldl;karGnuvtþn_skm μPaBénviFIsaRsþéneqøIytbrYmKñaeGayRbRBwtþeTAmanPaBrlUn sMerc)an tameKalbMNg nigedaHRsayral;bBaðaTaMgLayEdlekIteLIg.

6/1/2 sMrbsMrYldl;kargarRKb;RKgTUeTA nigkarpÁt;pÁg;»sf OI/ARV Rbtikr sMPar³brikçar sMrab;eRbIR)as; RbB½n§r)aykarN_sMrab;extþ.

6/1/3 sMrbsMrYl nigerobcMRbB½n§bBa¢Ún nigRbB½n§tamdanenAkñúgmnÞIreBTü RbB½n§bBa¢Ún nigRbB½n§tamdan rvagmnÞIreBTü¼mNÐlsuxPaB nigGgÁkarminEmnrdæaPi)alelIkargarbgáar nigkarEfTaMtampÞH KaMRTdl;karbBa¢Ún nigkartamdanGñkpÞúkemeraKeGds_nigCaBiessepþatkarykcitþTukdak;cMeBaHRsþImanépÞeBaHEdlEsVgrkesvaEfTaM

19

épÞeBaH esvasMralkUn esvaBüa)albgáareday»sfRbqaMgemeraKeGds_edayshkarCamYyGñksMrbsMrYlkmμ viFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn .

6>1/4 cUlrYmkic©RbCMusMrbsMrYlerobcMedayRsukRbtibtþiEdl)anGnuvtþKMeragenH . 6>1/5 clnaRbPBFnFan sMPar³ nigfvikaKaMRTdl;KMerag . 6>1/6 pþl;r)aykarN_ nigbTBiesaFn_énkarGnuvtþn_KMeragdl;mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k

nigkameraK nigmCÄmNÐlCatiKaMBarmata nigTark .

6/2> GñksMrbsMrYl Cluster sMrab;karGnuvtþn_viFIsaRsþeqøIytbrYmKña

6>2/1 sMrbsMrYlkargaredIm,IFanaeGaykarGnuvtþn_viFIsaRsþeqøIytbrYmKñaenAfñak; Cluster RbRBwtþeTAeday PaBrlUn edaHRsayral;bBaðaTaMgLayEdlBak;B½n§ edIm,IsMerc)aneKaledA .

6>2/2 eFVIm©as;kar nigpþÜcepþImbegáItEpnkarskmμPaB nigkMNt;eKaledA . 6>2/3 sMrbsMrYldl;kargarRKb;RKgTUeTA karpÁt;pÁg;sMPar³brikçar »sf OI/ARV Rbtikr sMPar³eRbIR)as;

RbB½n§r)aykarN_sMrab; Hub 6>2/4 erobcMRbB½n§bBa¢Ún nigRbB½n§tamdanenAkñúgmnÞIreBTü RbB½n§bBa¢Ún nig RbB½n§tamdan rvag mnÞIreBTü¼

mNÐlsuxPaB nigGgÁkarminEmnrdæaPi)alelIkargarbgáar nigkarEfTaMtampÞH. KaMRTdl;karbBa¢Ún nigkartam danGñkpÞúkemeraKeGds_ edayepþatkarykcitþTukdak;CaBiess cMeBaHRsþImanépÞeBaHEdlmkTTYlesvaEfTaMépÞ eBaH esvasMralkUn/ esvaBüa)albgáarnig esvaBüa)aleday»sfRbqaMgemeraKeGds_ .

6>2/5 erobcM nigdwknaMkarRbCMuCaeTogTat;RbcaMRtImasenA Hub nigGgÁkarminEmnrdæaPi)alEdlcUlrYmpÞal; kñúgkarGnuvtþn_viFIsaRsþrYmKña .

6>2/6 clnaRbPBFnFanmnusS/ sMPar³ nigfvikaedIm,IKaMRTKMerag . 6>2/7 pþl;r)aykarN_ nig Gnusasn_énkarGnuvtþn_KMeragCUnmnÞIrsuxaPi)alextþ km μviFIRbyuT§nwgCMgWeGds_

extþ mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK nigmCÄmNÐlCatiKaMBarmata nigTark .

6/3> CMnYykarGñksMrbsMrYl Cluster

6>3/1 CYydl;GñksMrbsMrYl Cluster edIm,IFanaeGaykarGnuvtþn_viFIsaRsþeqøIytbrYmKña enAfñak;Rsuk Rbtibtþi Hub RbRBwtþeTAedayPaBrlUn/ edaHRsayral;bBaðaTaMgLayEdlBak;B½n§ nigsMerc)aneKaledA.

6>3/2 sMrbsMrYldl;kargarRKb;RKgTUeTA karpÁt;pÁg;»sf OI/ARV Rbtikr sMPar³brikçar eRbIR)as;RbB½n§ r)aykarN_sMrab; Hub,

6>3/3 CYysMrbsMrYldl;RbB½n§bBa¢Ún nigtamdankarGnuvtþn_viFIsaRsþeqøIytbrYmKñaenAkñúgmnÞIreBTü/RbB½n§ bBa¢Ún nigRbB½n§tamdanrvagmnÞIreBTü¼mNÐlsuxPaB nigGgÁkarminEmnrdæaPi)alelIkargarbgáar nigkarEfTaM tampÞH/ KaMRTdl;karbBa¢Ún nigkartamdanGñkpÞúkemeraKeGds_edayepþatkarykcitþTukdak; CaBiess cMeBaH

20

RsþImanépÞeBaHEdlmkTTYlesvaEfTaMépÞeBaH/ esvasMral/ esvaBüa)albgáar nig esvaBüa)aleday»sfRbqaMg emeraKeGds_ .

6/3/4 erobcM nigraykarN_GMBIkic©RbCMusMrbsMrYlRbcaMRtImasrbs; Hub nigGgÁkarminEmnrdæaPi)alEdl cUlrYmedaypÞal;kñúgkarGnuvtþn_viFIsaRsþeqøIytbrYmKña.

6/3/5 sMrbsMrYldl;kareFVIclnaRbPBFnFanmnusS/ sMPar³nigfvikaedIm,IKaMRTdl;viFIsaRsþeqøIytbrYmKña. 6/3/6 pþl;r)aykarN_ nigGnusasn_énkarGnuvtþn_viFIsaRsþeqøIytbrYmKñadl;mnÞIrsuxaPi)alextþ kmμviFI

RbyuT§nwgCMgWeGds_extþ nig mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK .

6/4> GñksMrbsMrYl Hub 6/4/1 FanaeGay)anfaRbB½n§bBa¢Ún nigkartamdanGñkCMgWEdlbBa¢ÚnBI Hub, mNÐlsuxPaB nigshKmn_

mkTTYlesvananaenAmnÞIreBTübEg¥k nigFanafaRKb;krNIbBa¢ÚnbnþRtUv)anGnuvtþenAkñúgRbB½n§kargarEdlGacnwg RtUvtamdan nigvaytMél.

6/4/2 sMrbsMrYl nigtamdankarbBa¢ÚnbnþRsþImanépÞeBaHpÞúkemeraKeGds_BIshKmn_ BImNÐlsuxPaB eTA TTYlesvaEfTaM nigBüa)al nig esvamnÞIrBiesaFn_enAkñúgmnÞIreBTübEg¥k .

6/4/3 cUlrYmkic©RbCMusMrbsMrYlenARsukRbtibtþi Hub . 6/5> m®nþIRKb;RKgkarpÁt;pÁg; sMPar³brikçar

6/5/1 kMNt;BItMrUvkarEdlRtUvpÁt;pÁg; edayEp¥kelITinñn½yEdlpþl;edaym®nþIRKb;RKgTinñn½y. 6/5/2 RKbRKgkarpÁt;pÁg;»sf Rbtikr nigsMPar³brikçarenA Hub . 6/5/3 tamdankgVHxatrbs;sþúk kalbriecäTputkMNt;kareRbIR)as;sMPar³eRbIR)as;/ »sf/ nig Rbtikr nig

karesñIsMuedIm,IbMeBjkgVHxatsþúk . 6/5/4 erobcMsMeNIsMu»sf Rbtikr nigsMPar³brikçarBIXøaMg»sfkNþal . 6/5/5 pþl;B½t’manRtLb;eTAGñksMrbsMrYl Hub edIm,IEsVgrk»sf Rbtikr nigsMPar³brikçarBIesvaepSgmk

eRbIR)as;CabeNþaHGasnñ .

6/6> m®nþIRKb;RKgTinñn½yenA Hub 6/6>1 RbmUl nigbBa©ÚlTinñn½yEdlTTYl)anBI esva OI/ART, esvaeFVIetsþQamrkemeraKeGeds_eday

s μ ½RKcitþnigrkSakarsMgat;/ esvaEfTaMépÞeBaH¼esvabgáarkarcMlgemeraKeGds_BImþayeTAkUn esvasuxPaBbnþBUC/ esvaBnüakMeNIt/ esvaEfTaMkarBnøÚtkUnRKb;RCugeRCay/ esvaBüa)alCMgWkameraK, nig BIRbPBepSgeTotebImanBI Hub eTAkñúgRbB½n§Tinñn½ykMuBüÚT½rEdlmanRsab;.

21

6/6/2 pþl;r)aykarN_CaeTogTat;dl;RKb;esvaBak;B½n§TaMgGs;enAkñúgRsukRbtibtþiEdlGnuvtþviFIsaRsþeqøIy tbrYmKña CUnmnÞIrsuxaPi)alextþ¼mCÄmNÐlCatiRbyuT§nwgCMgWeGds_esIEs,knigkameraK nigCaBiess m®nþI Hub RKb;RKgkarpÁt;pÁg;sMPar³brikçar edIm,IerobcM nig):an;s μanBItMrUvkarpÁt;pÁg; .

6/7 GñksMrbsMrYl PMTCT b¤ MCH 6/7/1 P¢ab;TMnak;TMngrvagesvabgáar nig Büa)alCMgWeGds_ eTAnwgesvaBüa)alCMgWkameraK nigesva

suxPaBbnþBUC . 6/7/2 cUlrYmkic©RbCMusMrbsMrYlEdlerobcMedayRsukRbtibtþiNaEdlGnuvtþviFIsaRsþeqøIytbrYmKña.

7> karKaMRTEpñkbec©keTs

enAfñak;Cati³ mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK nwgpþl;karKaMRTEpñkKøInik enARKb;kEnøg TaMgGs; EdlGnuvtþviFIsaRsþeqøIyrYmKña nigGñkpþl;esvaTaMgGs;. karBRgwgKuNPaBCabnþbnÞab; KWCaeKalbMNg rbs;viFIsaRsþeqøIytbrYmKñaenARKb;TidæPaBTaMgGs; .

mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK nigkmμviFIRbyuT§nwgCMgWeGds_extþ nwgEckCUn r)aykarN_eTARKb;édKUkargarTaMgGs; ehIynwgpSBVpSayr)aykarN_TaMgenaHenAkñúgeKhTMB½r rbs;mCÄmNÐl CatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK.

enAfñak; Cluster karKaMRTEpñkbec©keTsdl;RbB½n§kargarenAkEnøgrYmman ³

m®nþIRKb;RKgkarpÁt;pÁg;sMPar³brikçar m®nþIRKb;RKgTinñn½y karRKb;RKgTinñn½y ³ mNÐlsuxPaB Sub-Satellite nwgraykarN_BIskmμPaBénkarGnuvtþn_viFIsaRsþeqøIytb rYmKñaCUnRsukRbtibtþi¼mnÞIreBTübEg¥krNb. RsukRbtibtþirNbnwgraykarN_mkkan;RsukRbtibtþi¼mnÞIreBTübEg¥k

Hub EdlmanGñkRKb;RKgTinñn½y nigRkumkargarRKb;RKgkmμviFItaMgenA. bc©úb,nñenH RsukRbtibtþimYycMnYnmin mansmtßPaBRbmUlTinñn½yeT. eyIgmaneKalbMNgBRgwgRsukRbtibtþi¼mnÞIreBTübEg¥krNbnaeBlGnaKt edIm,IbegáInkarTTYlxusRtUv nig bMeBjkargaredaym©as;karenAfñak;extþ. mnÞIreBTübEg¥kénRsukRbtibtþi Hubs nwgRKb;RKgTinñn½yrhUtdl;mnÞIreBTübEg¥kénRsukRbtibtþirNbGacBRgwgsmtßPaBelIkarRKb;RKgninñn½yeday xøÜnÉg)an. GñkRKb;RKgTinñn½ykñúgKMeragkareqøIytbrYmKña nwgRbmUlTinñn½yBIRKb;RbPBEdlBak;B½n§TaMgGs;enA fñak;RsukRbtibtþimunnwg bBa¢ÚnmkRkumkargarRKb;RKgkmμviFI nigmnÞIrsuxaPi)alextþ . RkumkargarenA Cluster nwgeFVIkarGnum½t nigcgRkgTinñn½ymuneBlbBa¢Únmkkan;mCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK ¬sUmemIlKMnUstagxag eRkam¦ .

22

karRKb;RKgelIkarpÁt;pÁg;sMPar³brikçar ³ RsukRbtibtþi hubs nwgKaMRTdl;RsukRbtibtþirNbtammeFüa)ay dUcxageRkam ³

RsukRbtibtþi¼mnÞIreBTübEg¥k (Hubs) ³

• karRKb;RKgelIkarpÁt;pÁg;sMPar³brikçar

• karFanaKuNPaB nigkarBRgwgKuNPaB

• karRtYtBinitüKuNPaBedIm,IKaMRTdl;mnÞIrBiesaFn_ • karRKb;RKgTinñn½y .

karRKb;RKgelIkarpÁt;pÁg;sMPar³brikçar RtUvmanTMnak;TMngCitsñiTCamYykarRKb;RKgTinñn½y nigkarRKb;RKgEpñk hirBaØvtßú ehIyRsukRbtibtþi¼mnÞIreBTübEg¥k Hub RtUv):an;s μanBItMrUvkarsMrab;RsukRbtibtþi satellite nig sub-

OD/RH Satellite

OD/RH Hub

OD Sub-Satellite

OD/RH Satellite

OD /RH Satellite

OD Sub-Satellite

PHD / PAO

NCHADS

RbB½n§bBa¢ÚnTinñn½yedIm,IKaMRTdl;skm μPaBénviFIsaRsþeqøIytbrYmKña (Data Flow to Support the Linked Response)

OD Sub-Satellite

OD Sub-Satellite

HC HC HC HC HC HC HC HC

23

satellite erogral;3Exmþg edayelIkmkBiPakSaenAkñúgkic©RbCMusMrbsMrYlRbcaMRtImas. eFVIEbbenHnwgmanpl RbeyaCn_dl;kareRbIR)as;»sfkñúgkarBüa)albgáar nigecosvagkarK μan»sfenAkñúgXøaMgrbs;RsukRbtibtþi¼mnÞIr eBTübEg¥kHub . ¼mnÞIreBTübEg¥kHub RtUvEtCamnÞIreBTübEg¥kEdlmanesvaEfTaM nigBüa)alGñkpÞúkemeraK eGds_GñkCMgWeGds_ esvaBüa)alTMnak;TMngpøÚvePT nigsuxPaBbnþBUC nig manFnFanmnusSsmRsb.

b½NÑbBa¢Únsþg;da nwgCYysMrYldl;karbBa¢ÚnrvagesvananaenAkñúgkarGnuvtþn_viFIsaRsþeqøIytbrYmKña. b½NÑenH nwgeRbIR)as;sMrab;bBa¢ÚnGñkCMgWeTAkan;esvaBak;B½n§dUcCa ³ esvaeFVIetsþQamrkemeraKeGds_edays μ ½RKcitþnigrkSa karsMgat;/ esvaBinitünigBüa)alCMgWkameraK/ esvaEfTaMépÞeBaH¼esvabgáarkarcMlgemeraKeGds_BImþayeTAkUn/ esvarebg¼eGds_/ esvaBnüakMeNIt/ esvasuxPaBmþaynigTark/ nig esva OI/ART . mCÄmNÐlCatiRbyuT§nwg CMgWeGds_ esIEs,k nigkameraK nwgeFVIkarEbgEcgb½NÑTaMgenH edaymankarsMrbsMrYlCamYymCÄmNÐlCati epSgeTotEdlBak;B½n§ ¬dUcCa mCÄmNÐlCatikMcat;eraKrebg/ mCÄmNÐlCatiKaMBarmata nigTark¦. b½NÑenHnwg RtUVveRbIR)as;edIm,ItamdanfaetI esvamYyNa)anbBa¢ÚnGñkCMgW)ansmRsb nigbBa¢ÚnGñkCMgWkñúgkrNIcaM)ac;Edl RtUvbBa¢Ún.

8> KMeragbgðajviFIsaRsþeqøIytbrYmKña

Hub ³ - esvaGñkCMgW ³

RH hub Edl)aneRCIserIsRtUvTTYlGñkCMgW)aneRcIn nigpþl;esva }eBjelj{ (one-stop

service) rYmman esvaOI/ART, esvaEfTaMkumar/ esvaEfTaMépÞeBaH¼esvabegáItkUneday suvtßiPaB/ esvaPMTCT, esvaBinitünigBüa)alCMgWkameraK/ esvaBnüakMeNIt/ esvaEfTaM suxPaByuvv½y nigmanmnÞIrBiesaFn_ EdlmansmtßPaBeFVIetsþrab;cMnYnekasika CD4.

Hub RtUveFVIkargaredIm,IBRgwgRbB½n§bBa¢ÚnrvagesvaEdlmanenAkñúgRKWHsßanBüa)alrbs;xøÜn nig BRgIgkic©shkarrvagesvarbs;xøÜnCamYyRkumEfTaMtampÞH¼bNþajRkumKaMRT tamshKmn_enA kñúgtMbn;rbs;xøÜn.

- karbBa¢Ún ³

Hub RtUvbBa¢ÚnRsþImanépÞeBaHEdlpÞúkemeraKeGds_EdlminTan;RKb;lkçx½NÐkñúgkarTTYl ART

RtLb;eTA Satellite b¤ Sub-satellite edIm,ITTYlkarBüa)albgáareday»sfRbqaMgemeraKeGds_ kartamdan nigkarsMralkUnedaysuvtßiPaB .

Hub RtUvbBa¢ÚnRsþImanépÞeBaHEdlpÞúkemeraKeGds_EdlTTYlkarBüa)aleday»sfRbqaMgem eraKeGds_CYrTI2mkkan;mnÞIreBTübEg¥kfñak;CatienATIRkugPñMeBjedIm,ITTYlkarBüa)alnigEfTaM.

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- karRKb;RKgkmμviFI¼karKaMRTdl; Satellites and Sub-satellites ³ CYyKaMRTEpñkbec©keTsTUeTA CYyKaMRTEpñkmnÞIrBiesaFn_ CYyKaMRTEpñkRKb;RKgelIkarpÁt;pÁg;sMPar³brikçar RbmUlsMNakQamBIRbB½n§kargarrbs; Satellite edIm,IbBa¢Únmkkan;mnÞIrBiesaFn_fñak;CatienATI

RkugPñMeBj erobcMkic©RbCMuRbcaMRtImassMrab;GñkEdlmantYnaTIsMxan;TaMgGs;³ RbFanRKWHsßanpþl;esvaEfTaM

suxPaB/ RbFanRsukRbtibtþi/ RkumEfTaMtampÞH/ RkumKaMRTtamshKmn_/ tMNagmnÞIrsuxaPi)al extþ/ tMNagmCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nig kameraK/GgÁkarminEmn rdæaPi)al nig GñksMrbsMrYlkm μviFI PMTCT .

Satellite: - esvaGñkCMgW ³

kareFVIetsþQamrkemeraKeGds_ nigkarpþl;RbwkSa/ esvaEfTaMRsIþmanépÞeBaH nig esvasMralkUn edaysuvtßiPaB/ karGb;rMGMBIkarciBa©wmkUn/ karBüa)albgáareday»sfRbqaMgemeraKeGds_ ¬AZT nig NVP sMrab;mþaynigTark¦ karRbmUlsMNakQams¶Üt (DBS), karBüa)albgáarCMgW »kasniymeday»sf Cotrimoxazole sMrab;kumar/ esvamnÞIrBiesaFn_ (HIV testing,

Hemoglobin/Hematocrit). Satellite RtUvEtbMeBjkargarBRgwgTMnak;TMngrvagesvaEdlmanenAkñúgRKwHsßanEfTaMBüa)al

rbs;xøÜn nigBRgIgkarsMrbsMrYlCamYyRkumEfTaMtampÞH nigRkumKaMRTshKmn_enAkñúgtMbn;RKb dNþb;rbs;xøÜn.

- karbBa¢Ún Satellite nwgbBa¢ÚnGñkCMgWEdlpÞúkemeraKeGds_eTA Hub edIm,I)anTTYlesva OI/ART nigeFVIkar

vaytMélelIlkçx½NÐkñúgkarcab;epþIm ART . Satellite nwgbBa¢ÚnTarkEdlmanpÞúkemeraKeGds_eTAkan; Hub edIm,IeFVIkarBinitü nigtamdankar

vivtþn_CMgWrbs;TarkenaH . Satellite nwgbBa¢ÚnGñkCMgWEdlmanCMgWkameraKeTAkan;esvaBinitüBüa)alCMgWkameraKenA Hub .

- karRKb;RKgkmμviFI¼KaMRTdl; Sub-satellites ³ RsukRbtibtþinwgerobcMkic©RbCMusMrbsMrYlRbcaMRtImas CamYyRKb;édKUkargarTaMgGs;mkBI

satellites nig sub-satellites, RkumEfTaMtampÞH nigRkumKaMRTtamshKmn_EdleFVIkargarCamYy

25

RKWHsßanEfTaMBüa)alTaMgenaH. mnÞIrsuxaPi)alextþ/ mCÄmNÐlCatiRbyuT§nwgCMgWeGds_esI Es,knigkameraKnigmCÄmNÐlCatiKaMBarmatanigTark GacGeBa¢IjeTAcUlrYmRbsin ebIcaM)ac;.

Satellites RtUvRbmUlTinñn½yBI Sub-satellite enAkñúgRsukRbtibtþirbs;xøÜnedIm,IepJICUneTA Hub. Satellites RtUvpþl;CMnYyEpñkmnÞIrBiesaFn_sMrab; VCCT nigeFVIetsþ hemoglobin/hematocrit dl;

Sub-satellites . Sub-Satellite:

- esvaEfTaMGñkCMgW ³ kareFVIetsþQamrkemeraKeGds_ nigkarpþl;RbwkSa/ esvaEfTaMRsIþmanépÞeBaH nigesvasMralkUn

edaysuvtßiPaB/ karGb;rMGMBIkarciBa©wmkUn/ karBüa)albgáareday»sfRbqaMgemeraKeGds_ ¬AZT nig NVP sMrab;mþaynigTark¦ karRbmUlsMMNakQams¶Üt (DBS), karBüa)albgáarCMgW »kasniymeday»sf Cotri- moxazole sMrab;kumar.

eFIVkic©snüaCamYyq μbedIm,Ipþl;CUn NVP EtmYydUsenAmNÐlsuxPaBEdlminmanesvaBüa)al bgáareday»sfRbqaMgemeraKeGds_.

rYmbBa©Úlesva VCCT sMrab;RsþImanépÞeBaHenAkñúgcegáamskmμPaBrbs;esva ANC nigesvacak; fñaMbgáarEdlGacpþl;CUnkñúgGMLúgeBlcuHGb;rMpÞal;dl;PUmidac;Rsyal.

- karbBa¢Ún Sub-satellite RtUvbBa¢ÚnGñkCMgWpÞúkemeraKeGds_eTA Hub edIm,IeFVIetsþ CD4. Sub-satellite RtUvbBa¢ÚnRsþIEdlmanépÞeBaHehIykMBugeRbIR)as;»sf AZT eTAkan; Satellite edIm,I

eFVIetsþBIPaBxVHRKab;QamRkhm. RbsinebIRsþIenaH KμanlT§PaBeFVIdMeNIreTAkan; Satellite RtUv erobcMbBa¢ÚnsMNakQameTAkan;mnÞIrBiesaFn_enA Satellite enaH.

Sub-satellite RtUvbBa¢ÚnsMNakQams¶Üt(DBS)rbs;TarkEdlRbQmmuxnwgkarqøgemeraKeGds_ eTAkan; Hub edIm,IepJImkeFVIetsþenAviTüasßanCatiRsavRCavsuxPaB saFarN³.

- karRKb;RKgkmμviFI ³ epJITinñn½yeTA OD Satellite edIm,IBinitütamdan cUlrYmRbCMuRbcaMRtImasCamYyédKUkargarenARsukRbtibtþi cUlrUmRbCMuRbcaMRtImasCamYy Hub nigédKUkargarTaMgGs;enAkñúgRsukRbtibtþi mnÞIrsuxaPi)al

extþ nigmCÄmNÐlCatiRbyuT§nwgCMgWeGds_ esIEs,k nigkameraK .

26

RkumEfTaMtampÞH (HBC) ³

- FnFanmnusS³ RkumEfTaMtampÞHEdlcUlrYmkargarenH RtUvRbKl;Par³kic©eGaybuKÁlikCaRsIþ edIm,Iepþatkaryk

citþTukdak;elIEpñksMxan;rbs;kmμviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUnEdlCaEp¥kmYyénkarbgáar karEfTaM nigkarBüa)alCMgWeGds_. Kat;RtUv)anbNþúHbNþalGMBIkarpþl;RbwkSaEp¥kelI kmμviFIbNþúHbNþal PMTCT rbs;fñak;Cati nigesvaepSg²Edlman kñúgviFIsaRsþeqøIytbrYmKña.

- P¢ab;TMnak;TMngshKmn_ ³ RkumEfTaMtampÞHRtUveFVIkargareGay)anCitsñiT§CamYyq μbburaN/ qμb/ nigeBTüÉkCnenAkñúg

tMbn;rbs;BYkeKedIm,IrkeGayeXIjRsþImanépÞeBaH nigshKmn_epSgeTotEdlmankarRbQm muxx<s;.

RkumEfTaMtampÞH RtUveFVIkargarCamYyRbFanPUmiedIm,IelIkkMBs;karGb;rMGMBIplRbeyaCn_rbs; kmμviFIbgáarkarcMlgemeraKeGds_BImþayeTAkUn suxPaBpøÚvePT nigkarEfTaMEpñksuxPaBbnþBUC.

RkumEfTaMtampÞH RtUvdwknaMkic©xitxMRbwgERbgCamYyq μbburaN, q μb nigGñkdwknaMshKmn_ edIm,I CYydl;karGb;rMRbCaCnGMBIplviC¢manénkargarbgáar nigGMBIsar³sMxan;rbs;kmμviFIEpnkar RKYsar.

RkumEfTaMtampÞHRtUvsMrbsMrYlkargarCamYyRkumEfTaMtampÞHepSgeTot nigRkumKaMRTtamsh- Kmn_enAkñúgtMbn;rbs;BYkeKedIm,IRKbdNþb;eGayeBjeljsMrab;tMbn; nigpþl;nUvkarRtYtBinitü nigkartamdanGñkCMgWeGay)anl¥.

RkumEfTaMtampÞH RtUvbBa¢ÚnGñkCMgWeTAesvaEdlenACitbMput ehIysßitkñúgviFIsaRsþeqøIytbrYmKña (sub-satellite, satellite, hub) edIm,ITTYl)anesvaEfTaMepSg².

RkumEfTaMtampÞHeFVIkargarCamYy Sub-satellite nigbuKÁlikmNÐlsuxPaBedIm,IKaMRTdl; :yuT§na karbIya:g : ¬sUmemIleKalneya)aykñúgKMeragsakl,genAextþéRBEvg¦ sMrab;karpþl;esva VCCT dl;RsþImanépÞeBaHtamry³shRbtibtþikarbegáItKMeragEpn karKaMRTEdlGacbMeBj bEnßmtMrUvkarenAkñúgtMbn;.

- KMeragEpnkar ¼ esvaGñkCMgW ³

RkumEfTaMtampÞH RtUvkMNt;eKaledACacMnYnRsþImanépÞeBaH EdlRkumEfTaMtampÞHmanEpnkarnwg EsVgrk nigKaMRTenAkñúgtMbn;RKbdNþb;.

RkumEfTaMtampÞHRtUveFVIkargarCaédKUCamYyRKwHsßanpþl;esvaEfTaMsuxPaBedIm,IbegáItnUvyuT§sa- RsþKaMRTdl;GñkCMgWeTAtammeFüa)aydUcxageRkam ³

27

• etsþGviC¢man ³ o eFVIkarya:gCitsñiT§CamYyGñkpþl;RbwkSaedIm,IGb;rMdl;GtifiCnGMBIkarbgáarkarcMlgem

eraKeGds_¼kameraK nigEpnkarRKYsar.

o bBa¢ÚnGtifiCneTAesvaEfTaMRsþImanépÞeBaH/ esvaEpnkarRKYsar b¤ esvaBinitüBüa)al CMgWkameraK ebIcaM)ac;.

• etsþviC¢man ³ o eFVIkarya:gCitsñiT§CamYyRKwHsßanpþl;esvaEfTaMsuxPaBedIm,IbBa¢ÚnGñkCMgWeTA hub edIm,I

eFVIetsþrab;cMnYnekasika CD4 nigpþl;karBüa)aleday»sfRbqaMgemeraKeGds_ RbsinebIGñkCMgWmanlkçN³vinicä½yRKb;RKan; .

o RbsinebIGñkCMgWminTan;RKab;lkçN³vinicä½y sMrab;TTYlkarBüa)aleday»sfRbqaMg emeraKeGds_eT RtUveFVIkarCamYyRKwHsßanpþl;esvaEfTaMsuxPaB edIm,ItamdanGñkCMgW nigeFVIetsþrkemIlPaBkgVHQamRkhm nigBüa)albgáareday»sf AZT CUnRsþIman épÞeBaH.

o KaMRTmþaypÞúkemeraKeGds_eGayEsVgrkesvasMralkUnedaysuvtßiPaB nigkarBüa)al bgáareday»sfRbqaMgemeraKeGds_EdlsmRsb sMrab;mþay nig kumar.

o KaMRTmþaypÞúkemeraKeGds_eGayRbkan;x¢ab;viFIsaRsþNamYysMrab;bMe)AkUn.

• TarkEdlekItBImþaypÞúkemeraKeGds_ ³ o CYyKaMRTkñúgkardwkCBa¢ÚneTAkan; hub edIm,IcuHbBa¢I OI/ART RbsinebITarkpÞúkemeraK

eGds_.

o CYytamdankarEfTaM nigBüa)alnanaEdlcaM)ac; edayEp¥kelIsßanPaB rbs; Tark.

- karRKb;RKgkmμviFI ³ RkumEfTaMtampÞH RtUvcUlrYmRbCMuRbcaMRtImasCamYyRsukRbtibtþiEdlBYkeKkMBugbMeBjkargar

ehIyenAkñúgviFIsaRsþeqøIytbrYmKñaTaMgRsugenA hub. RkumEfTaMtampÞHRtUvbMeBjeGay)annUvral;tMrUvkaredIm,IeFVIr)aykarN_CUnGñksMrb sMrYlénviFI

saRsþeqøIytbrYmKñaenA hub. RkumEfTaMtampÞHRtUvBinitüfvikarbs;xøÜneGay)anc,as;edIm,IFana)anfa BYkeKmanFnFanRKb;

RKan; edIm,IKaMRTRkumeKaledAenAkñúgtMbn;RKbdNþb;rbs;xøÜn.

28

krNIsikSa ³ Prey Veng Cluster RsukRbtibtþi 4 ³ GñkelOg/ RBHesþc/ kMBg;RtEbk/ emsag bc©úb,nñenHmanmNÐlsuxPaBcMnYn 38 kEnøg nig mnÞIreBTübEg¥kcMnYn 3 EdlmankmμviFIbgáarkarcMlg emraKeGds_BImþayeTAkUnEtcMnYn1 kEnøg nigmNÐleFVIetsþQamrkemeraKeGds_edaysμ ½RKcitþnigrkSakarsMgat; cMnYYn 5 kEnøgenAkñúgtMbn;enH . Hub: mnÞIreBTübEg¥kGñkelOg Satellites: mnÞIreBTübEg¥kemsag

mnÞIreBTübEg¥kRBHesþc

mnÞIreBTübEg¥kkMBg;RtEbk Sub-satellites: mNÐlsuxPaB

RsukRbtibtþiGñkelOg–sVayepøaH/ eCIgPñM ¬)aPñM¦

RsukRbtibtþiemsag–sVayRCuM RsukRbtibtþikMBg;RtEbk–éRBBYn

RsukRbtibtþiRBHesþc–kMBg;R)asaT ¬sUmemIlEpnTI ]bsm<½n§ 2¦

karbgðajGMBIKMeragenAkñúgextþéRBEvg ³

1> elIkkMrit CD4 edIm,Icab;epþIm ART sMrab;RsþImanépÞeBaHmanpÞúkemeraKeGds_. RsþIEdlmanekasika CD4 ticCag b¤esμ Inwg 350 cells count RtUvcab;epþIm ART ehIyRtUvbnþeRbI ART Cab;rhUtkñúgeBlbMe)AedaHkUn.

2> eFVIetsþ Intra-partum mþayEdlmksMralkUnenAesvasmÖB edaymindwgBIsßanPaBemeraKeGds_ nwgpþl;CUn nUvkareFVIetsþQamrkemeraKeGds_. cMeBaHmþayEdlmanlT§pletsþviC¢man RtUvTTYlkarBüa)albgáareday »sfRbqaMgemeraKeGds_ nigTarkpgEdr.

3> karpþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_ cMeBaHRsþIEdlsMralkUnenApÞH . q μbRtYvTTYl)an karbNþúHbNþal nigeFVIkic©snüakñúgkarpþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_ dl;RsþIsMralkUn enAxageRkARKwHsßanpþl;esvaEfTaMsuxPaB kñúgkrNIbnÞan; . RsþICamþayRtUv)anelIkTwkcitþeGaymksMral kUnenARKwHsßanpþl;esvaEfTaMsuxPaBedaymankarCYyBIRkumEfTaMtampÞH RbsinebIcaM)ac;.

29

4> yuT§saRsþbIya:gedIm,IbegáInkarmkTTYlesva VCCT sMrab;RsþImanépÞeBaH

4/1 RsþImanépÞeBaHnwgbBa¢ÚnbnþeTAkan;esva VCCT tamry³RkumEfTaMtampÞHenAkñúgshKmn_. RkumenH nwg CYysMrYl nig]btßmÖkareFVIdMeNIrrbs;RsþImanépÞeBaHEdlRkIRkeTA VCCT .

4/2 RsþImanépÞeBaHEdlmanvtþmanenAmNÐlsuxPaBEdlminmanesva VCCT nwgRtUvpþl;RbwkSamuneFVIetsþ nigbUmQamenAmNÐlsuxPaBenaHehIyRtUvepJIsMNakQamedaybuKÁliksuxaPi)al b¤ RkumEfTaMtampÞHedIm,I Fanafa sMNakQamnwgRtUv)andwkCBa¢ÚnedaysmRsbeTA VCCT edIm,IeFVIetsþrkemeraKeGds_eGay)an Tan;eBl. RkumEfTaMtampÞH RtUvCYysMrYldl;karbBa¢ÚnlT§pletsþBI VCCT eTAmNÐlsuxPaBvijpgEdr. lT§pletsþGviC¢mannwgpþl;CUnGtifiCnvijedaybuKÁlikmNÐlsuxPaB. lT§pletsþviC¢man nwgpþl;Cuneday q μb b¤Kilanub,dæayika EdlbMerIkargarenA Sub-satellite EdlmancuHkic©snüa nigbNþúHbNþalGMBICMnajén karpþl;RbwkSa.

4/3 buKÁliKmNÐlsuxPaB RtUvbBa©ÚlskmμPaBpþl;RbwkSa nigeFVIetsþQameTAkñúgkargarsuxPaBmata nig TarkenAeBlcuHcak;fñaMbgáarenAtamshKmn_. RkumEfTaMtampÞH RtUvcuHGb;rMeGayRsþImanépÞeBaH)andwgfa nwg manRkummNÐlsuxPaBcuHmkeFVItamshKmn_rbs;Kat;. buKÁlikmNÐlsuxPaBnwgbUmQamRsþImanépÞeBaH bnÞab;BIkarpþl;RbwkSamuneFVIetsþQamCaRkum eRkayBIGb;rMmþayenAkñúgPUmi. sMNakQamnwgRtUvdwkCBa¢Únmk esvaeFVIetsþQamenA Sub-satellite edIm,IeFIVetsþQamrkemeraKeGds_. ehIylT§pletsþnwgpþl;CunGtifiCn vijtamviFIBIrya:g³ viFITI1³ ebIlT§pletsþGviC¢mannwgpþl;CUnGtifiCnvij tamkarpþl;RbwkSaeRkayeFVIetsþenA eBlbuKÁlikmNÐlsuxPaBcuHtamPUmimþgeTot. RbsinebIGaceFVI)an lT§pletsþnwgpþl;CUnRsþIedayGñkpþl; esvaEdl)anbUmQamRsIþenaH. cMeBaHlT§pletsþviC¢man KWRtUvpþl;CUnGtifiCneday q μb b¤ Kilanub,dæayika EdlbMerIkargarenA Sub-satellite Edl)ancuHkic©snüa nigbNþúHbNþalGMBI CMnajkñúgkarpþl;RbwkSa .

30

]bsm<½n§ 1 ³ lixitbBa¢Ún (Referral Card)

31

]bsm<½n§ 2 ³ lixitBinitütamdanbnþ (Follow-up Card)

PMTCT FOLLOW-UP SHEET for HBC I- PRE-NATAL FOLLOW-UP Name or ID (PMTCT, OI/ART): …………………………….. Name of RH/clinic: ……………………..…………..…..Date enrolled: ……………..……………… Marital status: ……………………# of children: ….……... (#of HIV tested: ……….…… # of HIV+: …….……..)Expected week of delivery: ……..……………. CD4 test: No Yes. If yes, test 1: date……………………and result…………………, test 2: date…………………………and…………………result…………….. On HART: No Yes. If yes, date of initiating ………………On ARV prophylaxis: No Yes. If yes, date of initiating…………………………..

Service Received

Baseline

Pregnancy age Week

2 Week

4 Week

8 Week

12 Week

16 Week

20 Week

24 Week

28 Week

34 Week

34 Week

36 Hemoglobin test

Date Result

Hematocrit test

Date Result

ARV prophylaxis

Yes No

Infant feeding counseling

Date Provider

Infant feeding intention

Delivery intention

Home Facility (Name of the facility :………………………………………………………………………………………………………………………………..)

32

II- INTRA PARTUM AND POST NATAL FOLLOW-UP Delivery date: ……………………………..………… Location: ……………………………………………..…..…………………. Attended by: ……………………………………………………

MOTHER on HAART Mother Mother maintains HAART regimen through delivery? Yes No

Infant Mother on HAART <4 weeks before delivery: Infant completed four-week AZT regimen? Yes No Mother on HAART >4 weeks before delivery: Infant completed one-week AZT regimen? Yes No

MOTHER on 28-week AZT PROPHYLAXIS

Mother Mother received AZT and NVP prophylaxis? Yes No

Mother completed one-week AZT+3TC tail? Yes No

Infant

Infant received NVP prophylaxis during delivery? Yes No

If no, did infant receive NVP prophylaxis within 72 hours? Yes No Mother on AZT <4 weeks before delivery: Infant completed four-week AZT regimen? Yes No Mother on AZT >4 weeks before delivery: Infant completed one-week AZT regimen? Yes No

HIV+ MOTHER PRESENTED W/UNKNOWN STATUS

Mother Mother received NVP during delivery? Yes No

Mother completed one-week AZT+3TC tail? Yes No

Infant Infant received NVP during delivery? Yes No

If no, did infant receive NVP prophylaxis within 72 hours? Yes No

Infant completed four-week AZT regimen? Yes No Mother received infant feeding counseling after delivery: Yes No Infant feeding method initiated? BF FF Mother referred to _____________________________ for follow-up.Infant referred to ______________________________ for follow-up. III- INFANT FOLLOW UP Name or ID of Infant: ………………………………Date of Birth: …………………………………….. Name of Follow up Facility: ………………………………. INFANT FEEDING METHOD Month 1 Month 2 Month 3 Month 4 Month 5 Month 6

EBF EFF MF Weaned off breastfeeding at 6 months? Yes No If no, when?

33

INFANT DIAGNOSIS, CARE & TREATMENT

6 weeks DBS sample taken

DNA PCR results received

Status Initiated on Cotrim?

CD4% test CD4% Results received

Initiated on HAART?

Yes/No Date

7.5 months Infant weaned? DBS sample taken

DNA PCR results received

Status CD4% test? CD4% Results received

Initiated on HAART?

Yes/No Date

12/18 months HIV Antibody test

HIV Antibody results

Confirmed Status

CD4% test? CD4% Results received

Initiated on HAART?

Yes/No Date

INFANT IMMUNIZATIONS Birth 6 weeks 10 weeks 14 weeks 9 months

BCG, HBV1 OPV1, DTP1, HBV2 OPV2, DTP2, HBV3 OPV3, DTP3, HBV4 Measles

Yes/No

Date

Where? COUNSELING FOR MOTHER 1 session 2 sessions 3 sessions 4 sessions

Family Planning

Nutrition/Infant feeding

34

]bsm<½n§ 3 ³ EpnTIkEnøgpþl;esvaEfTaMsuxPaBkñúgextþéRBEvg/ 2005

Hub Satellite Sub-satellite

Cluster I

35

]bsm<½n§ 4 ³ eKaledArbs; PMTCT (PMTCT Targets) enAextþéRBEvg

qñaMTI 1 ³ ¬snμtfa 70° énRsþImanépÞeBaHnwgTTYl)ankareFVIetsþQamrkemeraKeGds_ ¦. • pþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_eBjeljdl;mþay nigTarkesμ Inwg 60° énRsþImanépÞeBaH

pÞúkemeraKeGds_ nigTarkeTIbnwgekItBImþaypÞúkemeraKeGds_. qñaMTI 2 ³ ¬snμtfa karekIneLIg xx ° énRsþImanépÞeBaHnwgTTYl)ankareFVIetsþQamrkemeraKeGds_¦

• pþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_eBjeljdl;mþay nigTarkes μ Inwg 70°énRsþImanépÞeBaHpÞúk emeraKeGds_ nigTarkeTIbnwgekItBImþaymanpÞúkemeraKeGds_.

qñaMTI 3 ³ ¬snμtfa karekIneLIg xx ° énRsþImanépÞeBaHnwgTTYl)ankareFVIetsþQamrkemeraKeGds_¦

• pþl;karBüa)albgáareday»sfRbqaMgemeraKeGds_eBjeljdl;mþay nig Tarkesμ Inwg 80° énRsþImanépÞeBaH pÞúkemeraKeGds_ nigTarkeTIbnwgekItBImþaypÞúkemeraKeGds_.

36

]bsm<½n§ 5 ³ suc©nkrsMrab;tamdankarGnuvtþn_viFIsaRsþeqøIytbrYmKña (Linked Response Monitoring Indicators) 1> cMnYnRsukRbtibtþiEdlmany:agehacNas;manmNÐlpþl;esva PMTCT saFarN³mYykEnøg.

2> cMnYn nigPaKryénRsþImanépÞeBaHenAkñúgviFIsaRsþeqøIytbrYmKñaEdl)aneFVIetsþQamrkemeraKeGds_ nig TTYl yklT§pletsþ.

3> cMnYn nigPaKryénRsþIEdllT§pletsþQamrkemeraKeGds_viC¢man.

4> cMnYn nigPaKryénRsþImanépÞeBaHEdlpÞúkemeraKeGds_ enAkñúgRsukRbtibtþiEdlGnuvtþyuT§saRsþeqøIytbrYmKña TTYl)ankarBüa)albgáareday»sfRbqaMgemeraKeGds_eBjelj .

5> cMnYn nigPaKrykumarEdlekItBImþaypÞúkemeraKeGds_ enAkñúgRsukRbtibtiþEdlmankmμviFI PMTCT TTYl )ankarBüa)albgáareday»sfRbqaMgemeraKeGds_ eBjelj tameKalkarN_ENnaMfñak;Cati.

6> cMnYn nigPaKrykumarEdlekItBImþaypÞúkemeraKeGds_ enAkñúgRsukRbtibtiþEdlmankmμviFI PMTCT TTYl )ankarBüa)albgáareday»sf Cotrimoxazole eBjelj tameKalkarN_ENnaMfñak;Cati.

7> cMnYnsrub én®sþI nigTarkeTIbnwgekIt enAkñúg RsukRbtibtþiEdlGnuvtþyuT§saRsþeqøIytbrYmKña EdlTTYl)an karKaMRTrbs;RkumEfTaMtampÞH.

8> cMnYn nigPaKryTarkEdlekItBImþaypÞúkemeraKeGds_ EdlmanlT§pletsþrkemeraKeGds_GviC¢man tamry³ etsþ³ DNA/PCR eRkayeBlpþac;edaH)an 6s)þah_ .

9> cMnYn nigPaKryénTarkEdlekItBImþaypÞúkemeraKeGds_ enAkñúg RsukRbtibtþiEdlGnuvtþyuT§saRsþeqøIytbrYmKña Edle)aHbg;kartamdanmunGayu 18 Ex.

10> cMnYn nigPaKryénTarkEdlekItBImþaypÞúkemeraKeGds_ enAkñúg RsukRbtibtþiEdlGnuvtþyuT§saRsþeqøIytbrYmKña ¬kareFVIeraKvinicä½yGMBI sßanPaBpÞúkemeraKeGds_elIkumar edayeRbIetsþ DNA/PCR enAeBlkumarGayuticCag 18 Ex b¤kareFVIetsþGgÁbdibkSR)aN enAeBlkumarGayuelIsBI 18 Ex edayeyaleTAtameKalkarN_ENnaM kñúgkarBüa)aleday»sfRbqaMgemeraKeGds_ sMrab;kumar Ex vicäika qñaM 2007¦ .

37

]bsm<½n§ 6 ³ Linked Response Diagram

Cambodia: Linked Response to HIV/AIDS/STI/RH/MNCH

Strengthen Health Care System

UA: HIV prevention and care and treatment

Community Based Participation:

•NGOs

•FBOs

•Self Support Group

Provide Comprehensive HIV/STI Prevention for all target groups

•Refer Community to relevant services

•Follow ups

•NAA

•MoH

•NCHADS –NCMCH

•Partners

•Advocacy

•Coordination

•Resource Mobilization

•Program Management:

- Policy- Strategy- WR- Logistic- Capacity- M & E

• HIV testing (HIV prevention)

•Strengthen Referral Hospitals / Maternal & Newborn child health

•Access for HIV/STI Care and Treatment

Maternal & Newborn Child Health

OI & ARV(PAC)

Voluntary Confidential

Testing & Counseling

Antenatal Care

Sexually Transmitted Infections

1) Core Package

2) Referrals & Information

1) Core Package

2) Referrals & Information

Adolescent care

Private Clinic

Other Services

Data Management

Nutrition

Laboratory Support

NGO Clinic

Health Service Delivery

Family Planning

•HIV (SS & Condom)

•CoC (+) Referral

38

]bsm<½n§ 7 ³ Linked Response PMTCT