Bi-national Commission for Collaboration on Health Guyana and Suriname.

Presenter

Mr. Nicholas Persaud –National HIV Care and Treatment Coordinator.

GuyanaMinistry of Health

National AIDS Programme Secretariat

National Response to the HIV/AIDS Epidemic

Since the first reported case of AIDS in 1987, the GoG has been cognizant of the effects of

HIV/AIDS. The GoG has demonstrated strong political will in combating the HIV/AIDS epidemic.

In 1998, the GOG established:

• National AIDS Programme (NAP) under the Ministry of Health.

• Gentio Urinary Medicine (GUM) Clinic which is now known as the National Care and

Treatment Centre ( Premier Treatment site)

• The National Laboratory for Infectious Disease (NLID)

• The National Blood Transfusion Service (NBTS)

In 1992, the National AIDS Programme Secretariat (NAPS) was established and charged with

the role of coordinating the national response to the HIV/AIDS epidemic.

ProjectImplementation

Unit (PIU)

Ministry ofHealth (MOH)

NAPS

MoF

DonorsPresidential Panel OnHIV/AIDs (PPHA) Cabinet

UN HIV/AIDS ThemeGroup

National AIDSCommittee (NAC)

TechnicalSupport Unit

Line Ministries

NGOs and CivilSociety

Population

Private Sector

MOH - Central LevelDepartments/Units

Regional HealthAuthorities

Implementing agencies

Implementing agencies

Consultants, ServiceProviders.Suppliers,

Contractors

Guyana Response • Female Commercial Sex Workers, Men Sexing Men (MSM)Miners and Loggers are

prioritized in the HIVision 2020 as key populations at Higher risk for HIV

• Biological Behavioural Surveillance Survey (BBSS) being conducted among miners & loggers in 2013 and includes testing for HIV/STI, Malaria, Dengue, anemia, HepB.

• Prevention: PMTCT,VCT, IEC,HIV Hotline, CSW and MSM Special Project, Condoms, Blood Screening and Safe Injection.

• Treatment: ARV, OI and STI Management and Laboratory Monitoring• Care and Support: HBC Services, Orphans and Vulnerable Children, Food Bank Services

NB :Guyana is participating in a study “Control of Histoplasmosis on HIV-infected patients in the Guiana Shield” -Increasing awareness of the problem of American Histoplasmosis in HIV-positive patients in the Guiana Shield,

· Diagnostic capacity building for histoplasmosis improved in the Guiana Shield,· Clinical practice in HIV patients in the Guiana Shield improved,· Strategy for Histoplasmosis control developed,· Network of trained health professionals reinforced in the Guiana Shield.

Overview of the National HIV Care and Treatment Programme.

Historical Progress of the National HIV Responses

Firs

t AID

S Ca

se

1987

Elisa Testing

1989

GUM

CLI

NIC

1998

VCT

PMTCT AR

VS

Guid

elin

es,

CD4

testi

ng

Gene

ric im

port

ed A

RVs,

Pe

diat

ric

ARVs

Vira

l loa

d te

sting

, He

alth

qual

2005200420022001 20092008

Rapid testing SDN, Locally Manufactured,

LSN

Guid

elin

es re

vise

d

PMS

2007 2010

HIV

DR

Surv

eilla

nce,

Pati

ent

Satis

facti

on S

urve

y &

HQ

2

Roun

d

Third

Wav

e D

ata

Colle

ction

, 2nd

Revi

sion

Guid

elin

es. 2

ndCl

ient

Sati

sfac

tion

Surv

ey,

Four

th W

ave

of D

ata C

olle

ction

and

De

velo

pmen

t of C

onsu

mer

Adv

isory

Boa

rd

2011-12

TB Patients

MSM

FSW

Prisoners

Miners

Security Guards

Adult Prevalence

Pregnant Women

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

29.0%

19.4%

16.6%

5.2%

3.9%

2.7%

1.1%

0.8%

HIV Prevalence among different populations

HIV Prevalence

Year of prevalence: Pregnant women, TB patients- 2012, Adult Prevalence, 2011; FSW and MSM- 2009; Security Guards and Prisoners- 2004; Miners- 2003

Epidemiological Over View

1. NCTC2. SJHM3. Davis Memorial Hospital4. Dorothy Bailey Health

Centre5. Campbelville Health

Centre6. West Demerara Hospital7. Suddie Hospital8. Wismar Upper Demerara

Hopsital9. Rosignol Health Centre10. New Amsterdam Family

Health Clinic11. Skeldon Hospital12. Bartica Hospital13. Mobile Clinic Region

#1,7,8,914. Enmore Poly Clinic15. Beterverwagting Health

Centre.16. Georgetown Chest Clinic17. East La Penitance Health

Centre

NCTC CHC DBHC DMH SJMH B'TCA WDRH WUDH SUD'H NAFHC S'KDH R'NOL BVHC EPC Chest Mobile ELHCNational 0

200

400

600

800

1000

1200

1400

1600

1800

2000

Graph Showing Total Number of Adults on Treatment -March 2013

Treatment SIte

# on

Tre

atm

ent

Overview of the National HIV Care and Treatment Programme.

NCTC CHC DBHC DMH SJMH B'TCA WDRH WUDH SUD'H NAFHC S'KDH R'NOL BVHC EPC Chest Mobile ELHC National 0

10

20

30

40

50

60

70

80

90

100

Graph Showing Total Number of Children on Treatment-March 2013

Treatment Sites

# on

Tre

atm

ent

0

200

400

600

800

1000

1200

Graph Showing Number of Adults In Care-March 2013

# In

Car

e

NCTC CHC DBHC DMH SJMH B'TCA WDRH WUDH SUD'H NAFHC S'KDH R'NOL BVHC EPC Chest Mobile ELHCNational 0

2

4

6

8

10

12

14

16

Graphg Showing Number of Children In Care-March 2013#

In C

are

NCTC CHCDBHC

DMHSJM

HB'TC

AW

DRHWUDH

SUD'H

NAFHC

S'KDH

R'NOLBVHC

EPC

ELHC

Mobile GCCTo

tal0

50

100

150

200

250

300

350

400

Graph Showing a Comaprison of the Number of Adults Reciveing a Second Line Regime at Care and Treatment Sites 2010, 2011 & 2012.N

umbe

r of P

erso

ns

2006 2007 2008 2009 2010 2011 2012Average on Second Line

(2nd )

Number of Persons on Second Line (2nd ) 58 69 169 262 296 287 366

Total Number on Treatment

1611 1956 2473 2662 3059 3432 3717

Percentage of Population on Second Line (2nd ) 3.6% 3.5% 6.8% 9.8% 9.7% 8.3% 9.8%

7.4%Adult proportion on Second Line (2nd) 9.1% 9.6% 12.1% 10.3%Pediatric proportion on Second Line (2nd) 18.1% 10% 6.9% 11.7%

National Cohort 2011-2012Start-Original Cohort 12 Month End Point

Male Female Male Female 0-14

15+

0-14 15+ Total

0-14

15+

0-14

15+ Total

A. Number of person initiated on ART 13 221 15 276 525 13 221 15 276 525

B. Number of transfers IN − − − − − 1 19 2 17 39

C. Number of transfers OUT − − − − − − 6 − 13 19

D.Net Cohort (A+B-C) 13 221 15 276 525 14 234 17 280 545

E. Number died - − − − − − 23 − 15 38

F. Number stopped − − − − − − 7 1 13 21

G. Number dropped (LTF) − − − − − 1 15 − 26 42

H. Number on original first-line regimen 13 221 15 276 525 13 176 16 207 412

I. Number on alternate first-line regimen − 0 − 0 0 − 12 − 15 27

J. Number on second line regimen (switched) − 0 − 0 0 − 1 − 4 5

K. Percent of cohort alive and on ART at 12 months (H+I+J)/D*100

100% 100% − 100% 100% 92.9% 80.8% 94.1% 80.7% 81.5%

0102030405060708090

100

Graph Showing Comparison of Twelve Months Surviability Measure

2009-102010-112011-12

Perc

enta

ge %

2009-10 2010-11 2011-12

7.69.6

7.7

9.1 8.76.9

2.81.3

3.9

Graph showing the comaprions of three outcomes after twelve months on treatment .

LTFU (Drop) Died Stopped

Challenges

•Retention in Care ; adherence to clinical appointment and medications

•TB/HIV Co-infection

•Third Line Regimen need; the future cost

•Sustainability of the response

THANK YOU