The HIV/AIDS Prevention and Control Act 2017 states that “Every person in the care and custody of the state shall have right to HIV prevention, testing, treatment and counselling services”. People living in prisons are particularly vulnerable to increased risk of HIV infection due to suboptimal access to preventive and care services, overcrowding and poor prison conditions, neglect and denial, gang violence and lack of protection for younger inmates. While HIV preventive programmes are working fairly well in prison settings, ART initiation for the newly detected cases has been challenging due to various factors including the unavailability of medical officers in the prison clinics and limited availability of security personnel and vehicles at the prison as the inmates are required to be taken to the ART centre a few times before ART initiation for preparedness and baseline investigations. This results in delayed ART initiation. Moreover, many of the undertrials are released before starting ART.

When I-TECH India started working in the North-eastern state of Mizoram in 2017, the central prison in the capital city of Aizawl was struggling to initiate its HIV positive inmates on ART due to the challenges mentioned above. Out of 87 confirmed cases during Oct 2016 – April 2018, only 22 could be put on ART. To address this issue, it was initially planned to establish a Link ART Centre (LAC) in the prison. But, as the LAC structure in the national program was designed only for the dispensation of ART to the stable clients and not for the initiation of ART, the need for a special intervention to start ART initiation in the prison was felt.

Subsequently, in consultation with the key stakeholders, I-TECH India developed a plan to ensure timely ART initiation at the prison. Sensitization meetings with the prison authorities were conducted and the staff were trained on the Basics of ART and monitoring treatment adherence.

There were 38 inmates waiting for ART at that time. Their samples were collected and sent to a private lab in Aizawl for baseline investigations. Thereafter, those who found eligible were initiated on ART at the prison with the help of the medical officers from ART centre, Civil Hospital, Aizawl. Later, I-TECH team constituted a mobile ART team with a doctor, counsellor and lab technician to take care of ART initiation in the prison and other closed settings, as and when required. Besides, a mechanism was established to draw samples from clients due for ART initiation and transport them to the ART centre, Civil Hospital, Aizawl for baseline investigations.

In addition to the provisions for baseline investigations and timely ART initiation, I-TECH India rolled out the following activities in the prison with the objective of providing a comprehensive package of
HIV services to the inmates:

• Sample collection for routine viral load testing
• Regular clinical consultations for OI/side effects management
• Prevention, diagnosis, and treatment of TB
• Post-release linkage support: Those who are released from the jail are linked to an ART
  centre of his/her choice to continue to avail treatment

During 2020-21, I-TECH India expanded its prison interventions to the districts of Champhai, Lunglei, Kolasib and Mamit, covering 6 out of 9 prisons in the state with services ranging from HIV screening to viral load testing. As of June 2021, nearly 300 prisoners – both convicts and undertrials – received regular ART refills and other need-based services through the prison interventions of I-TECH India in Mizoram.

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