HIV PROGRAM 2015 ST DAMIEN HOSPITAL, HAITI

Final Report

The establishment and the activities of the Andrea Bocelli Foundation find substance and inspiration from the thoughts of its founder: "it is for faith in love and justice that we are called to build a better world than we found, called upon to give back to the world the goodness we have received" Believing that the Andrea Bocelli Foundation wants to work to ensure that every individual and every community can express themselves to the best of their ability going beyond their limits. To become a living workshop, a pillar of support made up of many small and large players all tied by a passion for the music of Andrea Bocelli, who, from every part of the globe, join together encouraging generosity "so that even the most unfortunate or weak have the opportunity to experience a life full of opportunity and beauty so that the deserving find true energy and situations to give the best of themselves". Joining forces is the winning slogan of this exciting project: to be able to constructively help our neighbours, conquering the priceless privilege of being useful, ensuring the quality of actions.

The Andrea Bocelli Foundation works in two action programs: Break the Barriers and Challenges.

Break the Barriers stems from the desire to support projects contributing to breaking down barriers, be they economic or cultural, in Italy and in developing countries. Breaking down a barrier for the ABF means to be successful in the desire to offer every human being freedom and dignity to live the life they deserve.

In Challenges the Foundation operates within the area of scientific and technological research and social innovation, accepting major challenges in terms of both investments and results to be achieved in the willingness to allow anyone who experiences economic or social difficulties to express themselves.

In this program, the Foundation launches challenges involving high-risk investments and global interest that could contribute to improving the living

conditions of many people. ABF in Haiti Under the Break the Barriers program, the Foundation has chosen to work in Haiti respecting the desire of its founder, who before setting up his organisation has long championed the work of Father Rick Frechette, a priest of the Passionist order, and Director of NPH in Haiti. The ABF began work in Haiti in 2012 with the Virginia project which involved the expansion of the Neonatology Department of the St. Damien Paediatric Hospital in Port au Prince. The project was completed in 2013, and the Foundation decided to accomplish a mission to better understand the needs of the place in which it was called to work and to develop new projects in partnership. In the same year ABF has started the Wheat Project, incorporating 1,100 children and their families into the street school program of the Fondation Saint Luc. In addition to the educational programs, this partner organization was able to guarantee at least one hot meal per day, along with nutritional guidance for entire families. Since early 2014, in spite of the growing number of children enrolled, ABF has converted 3 street schools into permanent and functional structures. While serving as suitable classrooms, these structures are taking on a second life as secure community centers. In 2015 ABF started new projects for the 3 communities of Croix-the-Bouquets, Kenscoff and Abricot development through simple actions: solar lamps distribution, agriculture training and activities, water wells and towers. Other projects include the ABF water truck, ensuring the regular delivery of potable water in the slums of Cit Soleil. In 2016 the Foundation will work to give more educational opportunities, and eventual employment, in 2 more communities, Dame Marie and Jecmel, where the 2 street schools of Manataine Dame Marie and St. Raphael are situated. ABF will work to convert also this basic structure in functional and safe buildings able to host 400 students each. In short, ABF will bring forward the community empowerment program that gives hope for the possibility of a dignified life. Also since January 2015 ABF support the HIV Program of the St. Damien Hospital.

ABF's partner in HIV Program NPFS St. Demien Pediatric Hospital Hpital Saint Damien/Nos Petits Frres et Soeurs (HSD/NPFS) is a 150 beds, Catholic non-profit Pediatric and Maternity Hospital located in Tabarre, North of Port au Price, Haiti. The hospital is operated under the umbrella of the catholic organization: Nuestros Pequenos Hermanos It is regarded as the main pediatric referral hospital in the country. NPH was founded in 1954 in Mexico by Fr William Wasson, and American catholic priest. Today: NPH counts 9 orphanages in Latin American Countries, two orphanages a mother and children hospital in Haiti. The hospital mission is to care for vulnerable families with Christ compassion. Yearly: 3 500 children are hospitalized, 15 000 cared at the ambulatory clinic and almost 2 000 women deliver their babies whether physiologically or by cesarean section. The hospital was developed progressively since 1989 first as an ambulatory clinic then to a hospice and to a hospital. The staff includes 450 members.

ABF activities in Haiti

HIV PROGRAM The Foundation since January 2015 has been supporting the HIV program of the Hospital helping to grow its impact. The program started in 2005 when the hospital joined the network PEPFAR as one of the three pilot sites chosen for extending the management of children exposed and infected by HIV. The program has grown steadily given the poor performance of prevention of HIV from mother to child in the Country. In October 2011 the program was enhanced supporting also infants exposed/infected by the virus and pregnant women. Today in addition to these the program assists 550 children and adolescents treated with inhibitors and 70 patients in programs of prevention from mother to child. The program offers also full assistance, taking into account the burden that HIV / AIDS causes to families. The service is in the hospital, but the staff devoted specifically to this Program includes 40 people. The project is supported by the Foundation thanks to a fruitful collaboration with AMFAR, and by the US Center for Disease Control.

OBJECTIVES

Continue providing HIV clinical care services to pediatric patients, including patients on ART.

Reinforce PMTCT care to pregnant women infected with HIV Follow all newborns from these women until they reach 24 months of age Provide psychosocial and socio-economic support services to patients and

their families Implement data management tools and strategies, for monitoring quality of

individual-level patient care and for program monitoring and evaluation Number of beneficiaries 1,000 patients/month screening of adults and children About 800 patients in treatment 15-20 new patients (outgoing and incoming ) per month 40 dedicated staff members

2015 - RESUME OF THE ACTIVITIES This program is focus about a systemic screening for HIV and Syphilis for all pediatrics patients (children, newborns), pregnant women, parents and tutors receiving care at St Damien Hospital of NPSF Haiti. It covers more than 12 thousands people (children, adolescents and adults) annually. Every year more than 2.500 pregnant women screened and provide care service to more than 15 new patients (in and out patients) per month with known HIV/Aids or known exposure to HIV. The program is developing in different aspects. It bases on the counseling, psychosocial supports, comprehensive clinical care service and full treatment and prevent the transmission by the vertical transmission. The program has a good team worker (caregivers) well educated in the area of health. They organize meetings and seminaries for improvements of the quality and efficiency of the program and updates. ABF add to this program the Food Pack project. After enduring too much difficulties with out coming patients, and after the ABF and social assistants monitoring visit on June 2015 the team realize that a lot of children were not able to follow up the care (medications) because their parents dont have money to buy food. ABF created a possibility to improve the program adding since July a monthly food back benefits for 300 families asthe program is also focused on the nutrition, another related issue for the children who are taking these kind of strong drugs. The project manager of the program choose with criteria all the patients who really need this support to put them on the program up to a number of 300. It means clearly that the distribution of the food supplement rejoin the eligible patients meeting on the criteria for this nutrition program.

Works plan details for HIV program. Timing or period January - December 2015 Report

Output/Outcome/ Major activities

Description of the activities

Indicator of screening

numbers

Status /counseling

result.

1) HIV and Syphilis screening for parents /tutors and children receiving care at HSD/NPFS including HIV/RPR screening for PMTCT.

2) Provide care services.

3) Provide clinic-based counseling and psychosocial support to caregivers and patients, in support of disclosure of HIV status.

4) Increased participation in support groups.

5) Home visits to PLWHA.

6) PDSA cycle to improve quality of care.

7) Enroll 70 HIV (+) women on HAART for PMTCT Women to Deliver at the HSD maternity or another hospital.

8) Offer ART prophylaxis to all the newborn of these women.

9) PCR DNA

1) Offer systematic HIV/RPR screening to all pediatric patients, their family members or tutors, seen at general outpatient clinic and also the volunteers who wish to know their HIV status through a VCT. 2) Offer HIV/RPR Screening: to peripartum at HSD/NPFS maternity and the mothers of children coming for BCG vaccine. 3) Supervise treatment. 4) Assessment of Compliance to HAART at each appointment and reinforcement if needed. 5) Provide care services to 10 - 15 new patients (In/Out patients) per month with known HIV/AIDS or known exposure to HIV. 6) Provide psychosocial support to caregivers and patients. 7) One group meeting per month for parents/tutors, and for adolescents. 8) Conduct home visits at least monthly to all pediatric patients and PTMTCT on HAAR. 9) Enrollment of HIV (+) women coming from Clinic Manitane , the catholic clinic of Rosalie Rendu and Flicit Bontemps clinic in Cit Soleil). 10) Women in PMTCT to deliver at the HSD maternity or another hospital. 11) Counseling of number of newborns from these HIV (+) women receiving ART prophylaxis. 12) Do PCR DNA at 4 6 weeks for the Babies exposed to HIV.

1) 12,000 adults and children will be screened for HIV and Syphilis (annual goal). 2) 7,000 pregnant women will be tested for HIV and Syphilis. 3) Enroll 751 patients, including 550 on HAART 4) Approximately 15 -20 new patients (In /Out- patients) per month. 5) 100% patients from our cohort benefit psychosocial support regularly. 6) Adolescents and parents/ tutors from our cohort attend at least 1 meeting support group monthly. 7) One visit per family per month. 8) At least 1 or 2 reported PDSA cycles for each QI project 2 cycles. QI #1: Level of adherence with ART: goal: 85 %, QI #2 : Mental Health evaluation goal: 50 %. 9) 100 HIV (+) women on HAART. 10) 100 women delivering in HSD or another hospital. 11) 100 newborns from these HIV (+) women receiving ART prophylaxis at birth. 12) Do HIV/PCR DNA between 4-6 weeks of life for all these exposed to HIV babies.

A) 3,784 adults and children screened for HIV and Syphilis (72 people with HIV and 16 with a positive Syphilis result). B) 2,167 pregnant women screened for HIV and Syphilis from which 28 was HIV positive and 68 were Syphilis positive. C) 780 Children and adults received comprehensive clinical care, including the patients on HAART. D) 41 new patients received care services. E) 100 % of our patients received psychosocial support (Counselling, clinical interview, and disclosure of HIV status to the children, psychotherapy). F) 3 new children and adolescents learn their HIV status. G) 85% people attended support meeting. H) 1,549 home visit done during. QI #1: status: 64% QI #2: status: 29.5 %. I) 14 PMTCT patients started HAART.J) 16 HIV (+) pregnant women delivered in hospital. K) 20 newborns exposed to HIV/AIDS received HAART prophylaxis for this Quarter. L) 37 PCR DNA done during this period.

Programmatic Activities:

1. Distribution of food supplement to eligible patients meeting the criteria for this nutrition program started since January 2015.

2. Ending the sessions of epidemiology training (CDC/MSPP) 3. Participation of Psychologist to support more our adolescent and pregnant

patients. 4. Seminary for caregivers and data administrators about the information

system of toolsof HIV. Success:

All Newborns from our PMTCT cohort, benefiting from management during first trimester of pregnancy, have a negative PCRDNA HIV: meaning no HIV transmission from their mothers. PCR+ children at HSD are recruited from sick children admitted at the hospital or mothers presenting in labor with no previous PMTCT care.

Our patient retention in ART care is 99.3% and patient retention in clinical care is 100%.

All HIV infected pregnant women enrolled in the program received ART option B+ (PMTCT: 83.3%)

Pediatric Early Detection (86.3% children exposed to HIV aged 4 to 6 weeks have benefited from screening by PCR DNA HIV)

Summer camp for the children of the program with the partnership of NGO WWO (worldwide orphanage).

Nutritional Support for 300 patients with assistance ABF.

Challenges: CDC/I-TECH budget reduction makes things really difficult. We were fortunately able to send and budget all these people on the ABF

funds. How to better organize the clinic for teenagers, as we have a great number

who are no longer in the age range for our paediatric cohort we should think about an adolescents clinic.

Our Goal Continue to improve the quality and efficiency of care offered with sustainability of the program of food distribution.

2015 - FINANCIAL EXPENDURE Initial budget for the HIV Program covered by ABF with Amfar 230.000,00 $ Extra budget for the Food Pack action (from July to December) 36.000,00 $ Total budget 266.000,00 $ 2015 - FUNDS TRANSFER First tranche (March 25th, 2015) 140.000,00 $ Food Pack action (July 15th, 2015) 36.000,00 $ Second tranche (November 3rd, 2015) 90.000,00 $ Total funds transferred 266.000,00 $

EMPOWERING PEOPLE AND COMMUNITIES THANK YOU FOR SUPPORTING US