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Integrated Management of Adolescent and Adult Illness (IMAI) in Karur district, Tamil Nadu

Integrated Management of Adolescent and Adult Illness (IMAI) is a training package that has been developed by the World Health Organization (WHO) to facilitate district-level decentralization of care. It has been implemented extensively in African and Asian countries. SAATHII was selected by WHO to adapt the IMAI curriculum for the Indian context and pilot the project in Karur district of Tamil Nadu. Simultaneously, Karnataka Health Promotion Trust (KHPT) piloted the IMAI in Davangere district of Karnataka. From 2007 to 2008, SAATHII implemented this training project based on an earlier model of mainstreaming care and support, which it had piloted earlier in Salem district with support from APAC-VHS/USAID.

The program’s objective was to increase access to quality care and treatment services to HIV positive individuals in Karur district of Tamil Nadu by mainstreaming medical care and support into the existing health care system, down to the primary care centers. It also aimed to train health care providers in acute, chronic, and palliative care, at district headquarters and subdistrict (taluk, PHC) levels, using a standardized curriculum. Moreover, the project strengthened the various service delivery components, filled gaps, and created a sustainable model through resource mobilization, community involvement, and networking, while also establishing sound documentation and reporting systems to consolidate information, assess impact, and facilitate replication and scale-up of the program.

IMAI helped train and develop expert patient trainers (EPTs). The EPTs included 61 PLHIV from Karur district and eight neighboring districts. They were given a two-day training on suspecting HIV, patient education, self-care, and availability of services.


  • Number Trained by EPTs: 108 doctors & 296 paramedicals- including 243 nurses, 25 counselors, and 28 lab technicians
  • Number Referred to ART from Peripheral Centers for HIV Treatment: 130
  • Number Referred from ART Center to Peripheral Centers for follow-up care: 54
  • All 252 PLHIV referred by EPTs have reported receiving treatment without hesitation from providers. Health-care providers now refer clients to the ART Center and positive networks and have contributed to a doubling of network enrollment since the initiation of IMAI (575 enrolled in ten months following launch of IMAI).
  • Fourteen of 61 EPTs also received employment in the government and NGOs.

Post-training, the EPTs encouraged their PLHIV peers to attend the outpatient clinics of primary health centers.  The EPTs also visited peripheral health facilities to see what kind of care was being provided and continued networking with healthcare providers. EPTs built rapport with healthcare providers and enhanced their readiness to treat PLHIV.

Learnings from the IMAI pilot programs were subsequently used to facilitate decentralization with a focus on PLHIV and Injecting Drug User care in West Imphal.

This project received funding from the World Health Organization.

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  • Aug 29 2012