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

Fir

st A

IDS

Ca

se

1987

Elisa Testing

1989

GU

M C

LIN

IC

1998

VC

T

PMTCT A

RV

S

Gu

ide

lin

es,

CD

4 t

esti

ng

Ge

ne

ric im

po

rte

d A

RV

s,

Pe

dia

tric

A

RV

s

Vir

al

loa

d t

esti

ng

,

He

alt

hq

ua

l

2005200420022001 20092008

Rapid testing SDN, Locally Manufactured,

LSN

Gu

ide

lin

es

revis

ed

PM

S2007 2010

HIV

DR

S

urv

eil

lan

ce,

Pa

tie

nt

Sa

tisf

acti

on

Su

rve

y &

HQ

2

Ro

un

d

Th

ird

Wa

ve

Da

ta C

oll

ecti

on

, 2

ndR

ev

isio

n

Gu

ide

lin

es.

2n

dC

lie

nt

Sa

tisf

acti

on

Su

rve

y,

Fo

urt

h W

av

e o

f D

ata

Co

lle

cti

on

an

d

De

ve

lop

me

nt

of

Co

nsu

me

r A

dv

iso

ry B

oa

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. NCTC

2. SJHM

3. Davis Memorial Hospital

4. Dorothy Bailey Health Centre

5. Campbelville Health Centre

6. West Demerara Hospital

7. Suddie Hospital

8. Wismar Upper Demerara Hopsital

9. Rosignol Health Centre

10. New Amsterdam Family Health Clinic

11. Skeldon Hospital

12. Bartica Hospital

13. Mobile Clinic Region #1,7,8,9

14. Enmore Poly Clinic

15. Beterverwagting Health Centre.

16. Georgetown Chest Clinic

17. East La Penitance Health Centre

NCTC CHC DBHC DMH SJMH B'TCA WDRH

WUDH

SUD'H

NAFHC

S'KDH R'NOL BVHC EPC Chest Mo-bile

ELHC Na-tional

Male 702 31 47 142 295 20 67 75 30 101 30 17 4 8 29 8 1 1607

Female 644 130 116 222 413 17 94 82 35 119 23 20 33 6 21 14 8 1997

100

300

500

700

900

1100

1300

1500

1700

1900

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 Mo-bile

ELHC Na-tional

Male 26 4 4 4 31 3 7 6 2 8 0 0 5 0 0 0 0 100

Female 24 6 3 3 36 2 1 4 2 12 2 1 2 0 0 0 0 98

5

15

25

35

45

55

65

75

85

95

Graph Showing Total Number of Children on Treatment-March 2013

Treatment Sites

# on

Tre

atm

ent

100

300

500

700

900

1100

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 Mo-bile

ELHC Na-tional

Male 2 0 1 1 2 0 2 1 0 1 1 1 0 0 0 0 0 12

Female 1 0 1 0 3 1 2 1 1 2 2 1 0 0 0 0 0 15

1

3

5

7

9

11

13

15

Graphg Showing Number of Children In Care-March 2013#

In C

are

NCTC CHC DBHC

DMH SJMH

B'TCA

WDRH

WUDH

SUD'H

NAFHC

S'KDH

R'NOL

BVHC

EPC ELHC Mo-bile

GCC Total

2010 131 17 3 12 47 3 12 10 3 14 4 0 2 1 1 1 0 261

2011 133 18 3 16 63 4 10 8 5 17 2 0 2 1 1 4 0 287

2012 165 24 1 32 94 3 8 7 4 15 4 1 0 1 1 5 1 366

25

75

125

175

225

275

325

375

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 2011-2012

Start-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%

NCTC

CHC

DBHC

DMH

SJMH

B'TCA

WDRH

WUDH

SUD'H

NAFHC

S'KDH

R'NOL

BVHC

EPC

Mobile

National

2009-10

83.7

70.6

90.3

82 86.4

75 81.8

88.2

75 65.2

66.7

50 83.3

83.3

58.3

80.7

2010-11

79.9

100

92.5

87 88.4

50 80 85.7

53.4

66.7

91 40 75 83.3

100

80.4

2011-12

85.3

87.5

81.6

73.1

88.4

50 83.3

73.7

75 77 91 75 92.9

80 77.8

81.5

525456585

Graph Showing Comparison of Twelve Months Surviability Measure

2009-102010-112011-12

Pe

rce

nta

ge

%

2009-10 2010-11 2011-12

7.69.6

7.7

9.1 8.7

6.9

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