The Nursing Initiative & Critical Examination of HIV/AIDS in

Central African Republic

Shawn Z Stewart, RN, BSN, CCMThomas Edison State College

Nur-600 NG002Dr. Constance Morrison

December 12, 2009

Abstract

The sub-Saharan region of Central African Republic is one of the most poverty stricken areas in the world, and one of the worst affected by HIV/AIDS. Healthcare resources are scarce, with most being relied upon through international humanitarian organizations. This PowerPoint will identify current initiatives and suggest new initiatives in the hope of eradicating this epidemic.

Purpose and Objectives

Analyze the current HIV/Aids health initiatives in Central African RepublicExamine the heath issues in Central African RepublicExplore the nursing initiatives in Central African Republic

Major Topics

A look at the progress CAR is trying to make politically in order to create stabilityConsider the lack of aid that is received by CARAnalyze the lack of resources needed to stabilize, treat, and reduce the number of HIV/AIDS casesA look at the individual initiatives working to resolve the HIV/AIDS crises

Demographics of CARConsists of rolling plains 600-700 meters above sea levelThe climate is tropical with hot dry winters and hot wet summersSlightly smaller than the size of TexasAnnual government budget of $250 millionCAR has a population of just over 4.5 Million

Political Instability

Conflict and political instability surround CAR, as it is bordered by the countries of Sudan, Chad, Cameroon, Democratic Republic of Congo, and the Republic of CongoThe population of CAR faces many challenges in its attempt to establish some sort of order

CAR’s Economy

Car’s economy is one of the worst in the worldPer capita income of $700 in 2008Economic destitute is the primary factor that has resulted in CAR’s population living in such poor health

Healthcare Personnel

The healthcare personnel available in the central part of Africa are few and far between 10,000 patients per physician 1613 nurses in all of Central African Republic

Morbidity & Mortality

Average life expectancy at birth is 44.7 yearsInfant mortality rate at 112.9 per 1,000 birthsContributing factors to these disturbing rates are economic decline, civil conflict, the crushing burden of those infected with HIV/AIDS and a chronically underfunded health regime

Education

The educational system requires only 6 years of primary educationThe compliance rate is a mere 55%, often due to ethnic barriersThe education deficit has handicapped the population making it difficult to improve health awareness

Health Challenges Facing CAR

Population with sustainable access to improved drinking water 66%Population with sustainable access to improved sanitation 31%Number of physicians (per 10,000 population) <1Number of pharmaceutical personnel 17Prevalence of HIV among adults 15 and older (per 100,000) 9990

HIV/AIDSMost affected country in the region by the HIV/AIDS pandemicAntiretroviral therapy among people with advanced HIV 6%Ranked ninth in the worldMore than 240,000 persons estimated to be infectedRural areas have an infection rate as high as 20%

HIV/AIDS

Drastically affects the country’s productivity due to absenteeism and has stunted economic growthHealthcare benefits barely exist with only 4.2% covered by anti-retroviral therapyTeachers rank highest in mortality at 86% creating a positive feed back loop in quality of education

Global Humanitarian Assistance for HIV/AIDS

The goal is to work as one to conquer illness and disease throughout the worldHIV has shown how rapidly it spreads in its short 25 year history it has covered the globeGovernments fear if HIV/AIDS is not dealt with in all areas those in need will flee to other countries where healthcare is available

International Healthcare Organizations

Without significant assistance in supplies, treatment, and education this country will continue to become less productive and their economic future will become more dismalInternational healthcare organizations involved in the delivery of health care directed at the HIV/AIDS epidemic include the United Nations Development Program and National Coordination of the National AIDS Control Committee of the Government of the Central African Republic

Initiatives Working to Resolve the HIV/AIDS Crises

Strengthening Overall Care for People Living with HIV/AIDS

• Initiative started in 2003

• Aim is at scaling up voluntary counseling, testing, and prevention of mother to child transmission

• Providing greater access to antiretrovirals

Strengthening Overall Care for Orphans and Other Children Affected

by HIV/AIDS• Focus on minimizing the impact on orphans

and other young children• To assure that they are able to receive access

to basic services such as medical care, support, and education

Extension, strengthening and decentralization of comprehensive

care of persons living with HIV/AIDS

• The focus of improving quality interventions for HIV patients

• Directed through reduction of risk in vulnerable populations, reduction in morbidity and mortality, and the reinforcement of coordination and monitoring

HIV/AIDS Business Coalitions

• Development of national business coalitions against HIV/AIDS

• Intended to facilitate public-private partnerships with key stakeholders such as international donor agencies

Applied Information, Communication and Technology (ICT) Sector Focused

On HIV/AIDS• The CCA HIV/AIDS Initiative works with ICT sector companies, the

U.S. , international donor community, the African public- private sectors, and health associated industries

• Introduced to create partnerships that will effectively engage the skills, products and expertise represented in the diverse landscape of applied information technologies

The Global Fund HIV Education Prevention Campaign

• In the urban parts of CAR, such as Bangui, the capital city, there is an active campaign to educate the population

• Included is billboards, free medications, group education and free condoms

The Possibility of New Initiatives Specific to

Nursing

Development of New Initiatives

• Nursing could launch a new initiative in collaboration with The Corporate Council on Africa (CCA)

• A venture to provide telenursing to the underprivileged populations

• Focused on direct observation therapy (DOT) for managing adherence to antiretroviral drug therapy

• Nurse volunteers from all over the world could participate in the initiative

Barriers to The Telenursing DOT Initiative

• Compliance with participation in the telenursing DOT initiative

• This barrier could be overcome through education and promotion of the cause through the use of solicited media donations

Effectiveness of The Telenursing DOT Initiative

• Participation in the program would be utilized as a key indicator as to whether or not there was the possibility of making a significant impact

• A control group could be compared against those who were compliant in the intervention group to determine impact in blood counts and viral loads

Wrapping It Up

• HIV/AIDS epidemic is in desperate need of intervention• It is only through availability of anti-retroviral treatment

and a significant increase in education that this war can be fought

• Nursing could take a leadership role and initiate a new concept in direct observation therapy to increase compliance with anti-retroviral medications

ReferencesCentral Intelligence Agency. (2009, September 30). Central Intelligence Agency. Retrieved October 22, 2009, from https://

www.cia.gov/library/publications/the-world-factbook/geos/ct.html

Corporate Council on Africa. (2009). CCA: HIV/AIDS Initiative: Activities. The Corporate Council on Africa -- Home page. Retrieved

November 21, 2009, from http://www.africacncl.org/HIV_AIDS

Encyclopedia of the Nations. (2006). Ethnic groups - Central African Republic. Retrieved October 22, 2009, from

http://www.nationsencyclopedia.com/Africa/Central-African-Republic-ETHNIC-GROUPS.html

Imboden, N. "World humanitarian day celebrated in CAR." Humanitarian and Development Partnership Team Central African

Republic. N.p., 19 Aug. 2009. Web. 25 Nov. 2009. <hdptcar.net/>.

OECD. (2007). ODA by Recipient by Region. Retrieved October 24, 2009, from http://stats.oecd.org/Index.aspx?

DatasetCode=ODA_RECIPIENT_REG

Ramsay, S. (2002). African health researchers unite. Lancet, 360(9346), 1665.

U.S. Department of State. (2009, September 1). Central African Republic. Retrieved October 21, 2009, from

http://www.state.gov/r/pa/ei/bgn/

United Nations General Assembly Special Session. (2005, December 1). Central African Republic 2003-2005 UNGASS

Report . Retrieved October 22, 2009, from data.unaids.org/pub/Report/2006/2006

The Global Fund, (2009). Portfolio of grants - Central African Republic & the Global Fund to Fight AIDS, Tuberculosis and

Malaria. (2009, January 1). Retrieved November 21, 2009, from

http://www.theglobalfund.org/programs/portfolio/? CountryId=CAF&Component=HIV/AIDS&lang=

The World Bank. (2009, March 9). Program document for a proposed economic management and governance reform

grant II in the amount of SDR $3.4 million (US $5million equivalent) to the Central African Republic. The

World Bank. Retrieved November 21, 2009, from www-wds.worldbank.org/external/default

The World Bank. (2009, January 1). Central African Republic - Country brief. Retrieved October 22, 2009, from

http://web.worldbank.org/WBSITE/

Townsend, D. (2009). HIV programs not reaching the Central African Republic’s periphery. UNICEF - The Convention on

the Rights of the Child. Retrieved November 21, 2009, from http://www.unicef.org/wcaro/2009_

World Health Organization. (2008). Core health indicators. World Heatlh Organization. Retrieved October 19, 2009.

apps.who.int/whosis/database/core/core_select.cfm?.