Service sites:
AMDA Nepal has set-up Three service site;

1. Birtamod, Jhapa
2. Itahari, Sunsari
3. Biratnagar, Morang
 
These service sites provides regular static clinical services (non-mobile clinic located in strategic location accessible to KPs that provide service daily) in Jhapa, Morang and Sunsari districts. The services that the static clinics provide include HTC, syndrome-based treatment of STIs, syphilis screening and treatment, and presumptive cervicitis treatment for FSWs. All HIV-positive individuals identified in the clinic are enrolled in pre-ART for care, counseling, clinical staging, Tuberculosis (TB) screening and facilitated referral to ART centers as well as TB diagnosis and treatment and/or isoniazid preventive therapy to all PLHIV in its static clinics.

All clients receiving HIV testing and counseling at static clinics are offered STI management services following a syndrome-based approach. They also be screened for syphilis and all reactive cases are treated on the same day based on the approved national guidelines and project’s Standard Operating Procedures (SOPs).  In addition, considering the asymptomatic nature of STIs and the high possibility of cervical infections, FSWs are offered presumptive treatment of cervicitis. All HIV tests go through quality testing under the National External Quality Assurance Scheme (EQAS) of National Public Health Laboratory (NPHL).

In order to bring the services closer to the KP communities and to increase HIV-positive yield through the diagnosis of new cases, AMDA-Nepal, in collaboration with Sahara Nepal, run mobile clinics in sites selected by outreach workers working in prevention based on the number of KPs reached by outreach workers. CBOs of national network of FSWs-Jagriti Mahila Maha Sangh (JMMS)- also help Sahara Nepal to identify and select sites for mobile clinics.

Registration at these clinics is supported by the outreach workers of prevention partner Sahara Nepal in Jhapa, Morang and Sunsari districts. All clients receive group pre-test information before HIV testing. Consent is taken on an individual basis. Rapid HIV testing is carried-out by laboratory personnel following the national algorithm, and confirmed report is provided to the client after individual post-test counseling.

All newly diagnosed PLHIV are linked to services at the government clinical service points so that they get the comprehensive pre-ART services and also get enrolled into ART as early as possible through facilitated referral. All HIV-positive individuals identified in static and mobile clinics receive facilitated referral, mostly accompanied referral, for further investigation and treatment to ART center in the district.

AMDA-Nepal maintain regular and strong coordination with ART centers and other referrals sites for referral services. AMDA-Nepal coordinate with Sahara Nepal to mobilize Community-Based Supporters (CBS) and Peer Navigators (PNs) to provide the facilitated referrals for enrollment in pre-ART or ART services. While providing the facilitated referrals, the accompanying staff  also make the appointment with service providers of the health facilities too, and provide required on-site support to PLHIV. AMDA-Nepal liaise with the CBOs of National Association of PLHIV in Nepal (NAP+N) and National Federation of Women Living with HIV and AIDS (NFWLHA) so that required support for the facilitated referrals and follow-up services are made available for PLHIV. Where specialized care is needed, appropriate referrals (not facilitated) is also made from static or mobile clinics, such as for TB, Antenatal Care (ANC), hospitalized care, family planning etc. AMDA-Nepal maintain and regularly update a referral directory of service providers and referral sites with address and the contact details.

AMDA-Nepal refer HIV exposed children for Early Infant Diagnosis (EID) to SACTS or to the nearest EID sample collection sites managed by NPHL. All HIV-positive infants as well as all seriously ill HIV exposed babies are referred to ART sites to enroll in ART.  CBS, PNs, and NAP+N CBO staff are mobilized for referral and follow-up. AMDA-Nepal also participate in and support any new initiatives of LINKAGES Nepal for HIV testing and other HIV-related care, support and treatment services (using oral fluid for self-testing, using mobile phone technology for HIV testing and interpretation of results and test for triage).

The HIV care, support and treatment services are consistent with the current, approved national guidelines and SOPs during the course of this sub-agreement. A reference list of guidelines and SOPs is shared by the FHI 360 LINKAGES Nepal team through memo. Clients/patients’ rights, privacy, confidentiality and appropriate/effective communication between service providers and clients is ensured.

AMDA-Nepal  access drugs, tests kits, condoms and other supplies required for HIV care, support and treatment services from the national supply systems. AMDA-Nepal is also responsible for ensuring an adequate and steady supply of the commodities for the clinical site through national supply system and a continuous stock of forms and ledgers, and SBC materials for the service sites. Drugs, test kits, condoms and other restricted items is not purchased with funds from this sub-agreement. AMDA-Nepal maintain standard record keeping of commodities and report on the stock status of the essential commodities to FHI 360 Nepal Country Office on a bi-monthly basis.

AMDA-Nepal maintain universal precautions and workplace safety including PEP in the event of an exposure. PEP services is also provided to individuals presenting to AMDA-Nepal from non-LINKAGES service sites in the event of an exposure, including those involved in care of PLHIV. AMDA-Nepal also provide PEP to female and transgender sex workers facing sexual violence. AMDA-Nepal manage the provision of Hepatitis B vaccination to all staff who engages in exposure prone procedures. The health care waste generated in the clinical sites (both static and mobile) is disposed of using non-incineration and environment friendly techniques, according to the LINKAGES Nepal Environmental Mitigation & Monitoring Plan. The concerned staff follow the safe injection practices according to the SOP.