TB work is also a long standing medical programme and  Arogya Agam has had small grants under the Revised National Programme (RNTCP) since inception in 2000. The work takes place as  a ‘designated microscopy centre’ (DMC) – licensed to diagnose and treat TB, all drugs and materials are supplied by government. Out of 585 suspects with cough, 77 were sputum positive - Arogya Agam treated 20 directly and referred the others and followed up their treatment in PHCs. HIV positive patients are tested routinely and of 335 tested 37 were sputum positive, most were referred. On the other hand, efforts are made to screen all TB patients also for HIV, of those 23 tested two were positive. 116 TB cases were admitted or whom 93 were TB/HIV co-infections.

The nature of the TB work has shifted to advocacy and Arogya Agam will now work in three of the District’s eight Blocks where renewed attempts will be made to integrate work with TB, HIV, and HIV affected children. Patients in selected areas and all co-infected patients are entered into an operations research study conducted with VST-DACT partners.

The major ward and field work has centred around HIV for the past five years and more. The Community Care Centre (CCC) supports 20 beds, ward staff, counsellors  and four outreach workers which cover four of the District’s eight Blocks. There are a further 6 outreach workers and a supervisor under the TB programme. All HIV related work is done with TDNP+, the  positive network. NACO supports this programme and they graded 37 CCCs in the state, Arogya Agam's is one of only 11 graded in the top ‘A’ grade. In addition the TB WHO consultant is highly appreciative of the TB and HIV work, at his suggestion AA has applied for HIV/TB co-infection project under RNTCP.  Arogya Agam works very closely with the excellent government run District ART centre, patients are send there daily by van.  A few highlights from this work with HIV positive people include:

• 394 newly registered PLHIV and counselled
• 374 referred for CD4 testing and 231 started on ART, including fifteen children (9 boys and 6 girls)
• 1167 admissions for 8163 bed days

Since Arogya Agam has appointed a medical officer on a regular basis outreach clinics are now possible. These are combined with HIV child programme monthly meetings at three locations. Outpatients work has again increased – skin 6810, general 3498, HD 1069, PLHIV 2942, STI 52 and TB 92.

TDNP+ TDNP+ , the positive network started as a discussion group in Arogya Agam – although is is now fully registered and independent,  the importance of Arogya Agam's collaboration with them cannot be overstated. After untimely death of their leader, Mr Pitchaimani there was some faltering but they have successfully elected new trustees led by Mr. Mariappan. They have independent funding, and funding through VST-DACT. The major cooperation is in CCC, TB and children’s programme and there are links with work with sexual minorities.

The health and medical programme has adequate funding from NACO, RNTCP, VST-DACT (DFID back donor) and Damien foundation.    

Arogya Agam was the first to work with sex workers from about 1994. Since 2004 the work increased to District level has been undertaken under the BMG funded TAI project. The project aims to improve the quality of life for sex workers through improved health seeking behaviour and advocacy. Avoidance of unsafe sex, condom use and regular medical check up are key features of the programme which covers 1372 women sex workers and 339 TG/MSM. The project works through 65 ‘peer jeevans’ and for the first time this year female condoms are being introduced.  

TNSACS carried out an evaluation by interviewing sex workers and comparing with project data. An excellent 96% accuracy was recorded. Since the project has covered more than 85% of profile updating the staff were given prizes.

Another important feature of this programme is that Arogya Agam is responsible for sentinel surveillance of sex workers for HIV for the third year running, thus the project data feeds into estimation of numbers of HIV cases in Tamilnadu and India. In addition to a clinic for sex workers run in Theni by this project, Arogya Agam cooperates with the new master health check up facility in Theni GH, so far 548 have taken the check up. Certainly great strides have been made in condom use. Independent studies all show good coverage of sex workers and a declining trend of HIV in sex workers, STI patients and ANC women in the district.
  

Tai Vizhudugal is the CBO under the project and some of the functions are being handed over to them. The previous CBO, Snegham was active in advocacy but unfortunately Tai Vizhudugal is not very active in this regard. When there are problems with the police, for instance harassment in the Bodi area was common, it is usually senior staff that sort out the problem since these staff have trained the police and are known to them. This is a disappointment and needs to be looked into.

This project is jointly undertaken by Arogya Agam and TNVHA (6 districts each in Tamilnadu), SPAD (6 districts in Karnataka) and PWN+ (three districts in Rajesthan). The project funding from European community is through Christian Aid.  Arogya Agam's programme works through 178 volunteers and 32 positive speakers. The project has established rapport with 153 ICTCs. Positive women’s networks have been formed in all six districts but they are able to give support in only three.

55 private nursing homes were trained and now 8 conduct positive deliveries and another  13 are willing to conduct, rather than  refer HIV positive ANC mothers for delivery. Advocacy to various branches of the health services is an important part of the project. The worst case was that of the district HQ hospital in Manaparai which refused positive deliveries, advocacy has redressed this.

In 18 months 164 positive pregnant women were identified and followed up, virtually all, together with their children were given nevirapine prophylaxis, 176 were given this so far. An initiative of the project is to interact with husbands, this is often not easy. Between January to June 2010 out of 86 Positive pregnant women there was good interaction with 54 husbands and some interaction with another 22.

Because there are some doubts regarding the programme Arogya Agam was commissioned to devise a format and to collect data from all the partners. Some important findings in the 6 districts covered by Arogya Agam include:

• The estimated yearly incidence of pregnant positive women in the 6 districts is 680 but only 164 were registered so far.
• There are officially 154 PPTCT centres but only 45 conduct deliveries for positive women and refer the others to bigger centres.
• Nearly all private centres refer to government, and some are lost to PPTCT.
• There is no reliable data on percent of ANC tested – it is estimated that testing is between 60 to 80%, the gap is mainly due to hard to reach areas/ populations.
• Of those who test positive between 90 to 95% receive prophylaxis.

The conclusion is  that in most districts (except Nilgiris) the services are fairly adequate. There is a need to concentrate on private facilities since they conduct 50% of the deliveries. Also Positive women’s networks need strengthening.