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