Current ECHO India Initiatives:
- Fully train and empower the newly-established ECHO India Replication Office as an ECHO “SuperHub” to provide technical assistance and support to ECHO projects throughout India, build and train new ECHO hubs and grow the ECHO movement across the country. This ECHO India office was launched in the fall of 2014. They are already providing technical assistance to existing ECHO hubs in India, and have recruited and signed partnership documents with two new ECHO replication partners. We expect them to be fully staffed, trained and operating at a very high level as a super-hub by the end of 2015.
- In the mid-2000s the national government began a more aggressive strategy to expand access to antiretroviral treatment and reduce the rate of spread of the HIV/AIDS and intervene in the growing Indian AIDS epidemic. To accomplish this goal, the National AIDS Control Organization (NACO) established a network of antiretroviral treatment (ART) centers throughout the country.
This network has done much to reduce the rate of transmission of the AIDS virus in India. A central limitation, however, is the ability to easily train partners in this network and maintain a mechanism for on-going mentorship and learning. The DISHA-ECHO projects are designed to meet this need by working to expand and enhance patient care, teaching, and research activities at the antiretroviral treatment (ART) centers through ongoing mentoring via use of the ECHO model. Project DISHA-ECHO is derived from the concept of DISHA (Decentralizing and Intensifying Services for High quality ART) and Project ECHO’s model to expand access to specialized care for vulnerable populations and underserved areas through the state of the art telehealth technology and clinical management tools. After trial runs proved successful, the first project officially took off in July 2010. The DISHA-ECHO project is a joint collaboration between Maulana Azad Medical College, the ECHO Institute and the Department of AIDS Control / National AIDS Control Organization (NACO), Ministry of Health and Family Welfare, Govt. of India.
The hub at Maulana Azad Medical College, New Delhi is currently linked to 14 ART Spokes: Lok Nayak Hospital, AIIMS, RML Hospital, Baba Saheb Ambedkar Hospital, DDU Hospital, LRS Hospital, Safdarjang Hospital, Guru Teg Bahadur Hospital, SMS Jaipur, Medical College Aligarh, Medical College Dehradun, District Hospital Haldwani, Medical College Bhopal, and LLRM Medical College Meerut through teleECHO sessions.
- The second DISHA-ECHO project at B.J.Medical College launched in mid-2014. This is an HIV-focused ECHO at a large medical college. The hub is connected to the various hospitals in the state of Gujarat. Equipment has been provided to connect 20 spokes to the hub at the medical college. They are holding clinics every month and currently 17 spokes are connected.
- Availability of treatment of Substance Use Disorders (SUDs) is severely limited in India and is concentrated primarily at academic medical centers located in urban settings.
A few facilities do offer similar SUDs treatment, but they are also located in cities and are extremely costly, making them inaccessible to the general population. One reason for the growing gap between need and availability of SUDs treatment services is a lack of training for PCPs. Many physicians and other healthcare providers are reluctant to provide care, and often SUDs related issues are not addressed even in hospitalized patients. Further complicating matters is the stigma and cost that are associated with visiting a mental health or SUDs service center, which can lead to decrease treatment acceptance.
Project ECHO and the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India have launched a teleECHO clinic based at NIMHANS in Bangalore, India. This project will increase access to SUDs treatment services in India by training Primary Care Providers (PCPs) to deliver care, and will help develop a model for expanding high quality chronic disease care more generally in India. Currently 40-60-community provider “spokes” are joining the weekly NIMHANS teleECHO clinics.
- In 2007, a school for children with Autism and special needs in Lucknow, India (PYSSUM) came in contact with the UNM Center for Development & Disability (CDD) and ENVISION NM through Project ECHO and have since been collaborating to organize free training workshops for teachers working with special-needs students. These workshops have also been extended to HR heads to oversee the employability of adults with autism. The objective of the India Autism ECHO Project (IAEP) is to establish a broader network of teleECHO sites in India for training teachers, pediatricians, therapists and psychologists to improve their knowledge and skills in working with children with autism and other developmental disabilities.
This collaboration has spread to cities such as Chandigarh and Bombay to conduct training programs on autism. The specially designed training programs utilizing the Project ECHO model have been received with great enthusiasm in special education and rehabilitation circles in these cities.
These three participating IAEP sites will be developed as fully independent hubs, each connected to a network of multiple schools and care organizations working with autistic children and adults. The PYSSUM team will travel to the ECHO Institute in January for training as a new ECHO autism hub.
- New partnerships and initiatives: since its inception in mid-2014, the ECHO India Office has been engaged in actively disseminating the ECHO model via education and outreach to government, academic, medical and philanthropic organizations. These efforts have resulted in recruiting and signing (as fully authorized ECHO replication partners) two additional organizations with large capacity as hubs and with the financial means to not only support their own ECHO activities but with the potential to become supporters of the broader ECHO India activities. These partners are Jindal Steel and Power Limited Foundation and the Karuna Trust. Teams from these two organizations will travel to the ECHO Institute in January for training as ECHO replication hubs.
Project ECHO maintains a growing database of curriculum materials, surveys and templates that will be available to all Indian participants. Particularly in the field of substance abuse, Project ECHO has considerable experience and a wealth of training tools to share with our Indian counterparts.
In addition to existing materials, expansion in India and to new subject fields such as autism will require significant work with our partners to develop new curriculum materials that are appropriate for the Indian context. Once these materials have been developed, they too will become part of the ever growing database of materials made available to ECHO partners interested in starting new teleECHO clinics in India or elsewhere.
Director of Project ECHO, Sanjeev Arora, MD, FACP is the Director and Founder of Project ECHO. He is a Distinguished Professor of Medicine n the Department of Internal Medicine at UNMHSC. He has been involved in management of viral hepatitis for over 20 years and helped to develop and implement the Hepatitis C Disease Management Program at UNMHSC. While he was pleased with the success of the program he was also frustrated by his inability to see all patients afflicted with the disease, due to the sheer volume. As a solution to the need for new and improved ways to serve patients in need of specialized care, he developed the innovative Project ECHO model to share his medical knowledge and broaden healthcare access.
Nick Shroff, MD
Chair AAPI Charitable Foundation 2012-2014