White Card Updates in Reaching out untested Children and Adults (Spouses) An experience from Mumbai

Jul 2017  Photo credit:

During the inception of this project there were no exact estimation of Children affected by AIDS (CABA) in the intervention districts. Counsellors in the ART, due to high patient loads were unable to regularly update patient details. A two-page update sheet for the white card as a snap shot tool was developed in consultation with MDACS. The white card updating process was done between Aug 2015 to Dec, 2016. A total of 25,870 white cards were updated.

 Outcomes:

  • In Mumbai there are 24,670 CABA (Boys: 13,138 and Girls: 11,532) of which 11% are Children living with HIV (CLHIV); 80% are negative and remaining 9% children’s HIV status is unknown.
  • Close to 3/4th of these are adolescents (10 to 18 years) and for every CLHIV there are 9 affected/ untested children.
  • At the family level 15,902 couples were identified of which 5,924 were concordant couples (39%), 7329 were discordant couples (49%) and in 1839 (12%) the spouse HIV status was unknown.
  • The program referred 857 of untested spouse for HIV screening and 267 were screened for HIV and found to be living with HIV. 134 of these spouses were identified as required to be immediately initiated on ART.
  • Of the untested children referred for testing 5% were detected to be living with HIV and 57% were in need of immediate initiation of ART.

The white card updated exercise has informed the national program of HIV untested hidden populations such as adults (spouses) and children of currently On ART clients and enhanced scope to realize reaching its 90-90-90 goal.

Sion ART Counselor Prakash Gaikwad expressed that “New updated addresses and mobile number of Patients has helped to tracking and following-up of ART clients and ensure spouse testing. Now the process of updating addresses and new mobile phone in the system in on going.”

At an individual level the white card analysis results helped in reaching out to untested children and adults (spouses) and linking them to HIV testing services and linking them into the continuum of care.

At the State level this has bought new awareness to this hidden population and has resulted in the innovation being scaled up across the state.

At National Level the exercise has informed program/policy makers and experts of this hidden population who have noted this as a missed opportunity to rapidly reach 90-90-90 vision of the country’s AIDS program.

The PEPFAR – USAID funded KHPT ‘HIV/AIDS Orphans and Vulnerable Children Social Protection project’ has implemented this innovation in collaboration with Mumbai District AIDS control Society. The project Objective emphasises the need to identify and profile children affected by AIDS and their families. The white card initiative under this program has helped in estimating and identifying CABA and their families in Mumbai. This has resulted in linking CLHIV and PLHIV (spouses) to care, treatment and support. This has made significant contribution towards PEPFAR’s goal 90-90-90. The findings of the white card details and its value addition was shared to DDG TI – NACO in the PEPFAR partners meeting in March, 2017. DDG acknowledged these outcomes and instructed SACS to focus on spouse testing who are currently registered in all the ART centres.

The updated white cards snap shot tool is available at ART centers (they are attached to the existing white cards). The detail line list of all the spouses and children and their HIV status is available at the project level and same data is shared with MDACS. The State order mentioning the DDG NACO instruction to SACS has reference of KHPT white card analysis and its value addition to the program is available.

MDACS, ART Counselors, ART Medical officer of the ART centers were involved in this process. KHPT deputed two social workers and one Data Entry Operator. Training was provided on updating white card using the snap shot tool by KHPT. An excel based sheet was developed where DEOs entered the updated information in that sheet. Regular monitoring was done under the guidance of MDACS.

MDACS, KHPT team, ART medical officer, counsellors were regularly involved in this process right from inception till its completion.

As next steps, as instructed by NACO, MSACS has already initiated white card updates and spouse testing in all their ART centres. The pilot white card exercise done 10 centres has shown good results in spouse testing and yield. MSACS as per the instruction of NACO has scaled up this tool in all 60 ART centers in entire state. This translate into updates of close to 1.5 lakh PLHIV which would significantly help in reaching out to untested children and adults (spouses) and link them to care, treatment and support services. This contributes to Global/National/State 90-90-90 strategy to zero down new HIV infections.