COUNTRY PRESENTATION

GUYANA

5th CCAS August 2008

Guyana

• Area: 214,970 sq km

• Land: 196,850 sq km

• Water: 18,120 sq km

• Population: 751,223 (2001 census)

Mechanism to reorganized the National Response

NAP

PCHA

PEPFAR

GF

WBUNAIDS

PAHO

CDC Co AgPANCAP

GHARP CDC

FXB

CAIHDI MARCH

UNV/UNDP

SCMS

Technicalagencies

CSO

CSOs

CRN+CCNAPC

Ministry of

HealthLM

Other GoG entities

GSIP

MSH

JSI

Estimates 2006 - 2010

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

HI V incidence 1220 1160 1110 1060 1000

AI DS incidence 1010 990 980 980 999

ART needs 3120 3240 3330 3390 4330

2006 2007 2008 2009 2010

Health System

• Public and Private

• Public- Health care is free including all services for HIV and AIDS

• Public accounts for more than 80% of the health care provided to the people of Guyana

Programs

• Care and Treatment• Home-based care• Food Bank• Food Voucher system (private hospital)• VCT• PMTCT• TB/HIV• Line Ministries• Prevention• M&E• PMS,CQI,HIVQAL

Epidemiology

• Adult prevalence 2.4% (UNAIDS report)

• Females 28%; males 72%

• Females under 24yrs are the majority

• Majority of the cases are among persons 20-44 yrs.

• Leading cause of death among 20-49 yrs

• Primary transmission via heterosexual exposure.

Care and Treatment

• 16 fixed C&T sites (3 private facilities)

• 1 mobile team for the hinterland.

• ARV available free of cost at all sites.

• Revision of Treatment guideline in 2007

• Initiation of ARV with CD4 count of 350.

• Introduction of a mentoring program for physicians.

Care and Treatment Jan – June 2008

• 2,185 persons on ART (2,038 adults;147 children)

- 55% females - 45% males• 1,238 persons in Care - 60% females - 40% males

• 1,513 persons received Cotrimaxazole for OI prophylaxis

VCT Models

• Integrated within existing health services, i.e., general clinical care settings and specialized clinics, such as ANC,TB, STI, Malaria and Dental

• Free-standing VCT sites• Mobile (outreach) VCT services• Private VCT services• Youth-friendly VCT services• Work places

VCT Jan – June 2008

• 61 fixed VCT sites (Public, NGO)

• 23,600 received VCT services;

- 14,094 females

- 9,506 males

PMTCT

• 117 PMTCT facilities ( public, private)• ANC seroprevalence 1.5%;

- 15-19 yrs <1%

- 20-24 yrs >1.34%

- 30-34 yrs 2.46%• >90% uptake with the PMTCT program.• >80% of the women received Nevirapine • 85% of the babies born to HIV+ pregnant women receive

Nevirapine treatment after birth.• 4% of babies born are infected

Early Infant Diagnosis

• Funding from Clinton Foundation

• Training of Health Care Providers

• DBS collection at central and regional PMTCT sites

• Storage at central facility

• Samples shipped weekly to laboratory in South Africa ( PCR DNA assay)

• Results received within two weeks.

Mother’s status unknown; infant with

clinical symptoms

Rapid Test

Confirmatory DNA PCR within 2 weeks of

receiving results

DNA PCR

Report as positive

RT 3 months after cessation of breast

feeding or age ≥ 12 mo, whichever is later

Report as positive

Ongoing Clinical Assessment

HIV-exposed baby between 6 wks

and 12 mo

Note: If a child who tested negative at any point develops clinical symptoms, perform DNA PCR immediately if less than 12 months or rapid antibody test if older

HIV-exposed baby between 12 and 18 mo

POS

NEG

POS NEG

POS

RT 3 months after cessation of breast

feeding or age ≥ 12 mo, whichever is later

POSNEGDNA PCR

NEG

ASYMPTOMATICSYMPTOMATIC

POS

NEG

POS

NEG

NEGPOS

Report as positive

Rapid test at 18 mo

Rapid test at 18 mo

POSNEG

DNA PCRDNA PCR

HIV DIAGNOSTIC ALGORITHM FOR CHILDREN LESS THAN EIGHTEEN MONTHS (18MTHS) OF AGE

Laboratory Statistics Jan - July 2008Jan Feb March April May June July Total

CD4+ 330 670 638 606 415 453 515 3,627

Hematology 200 216 205 247 180 219 220 1,487

Chemistry 243 229 225 303 224 214 269 1,707

New patients 61 213 211 199 69 91 98 942

New patients with CD4+ < 350

42 129 112 93 51 61 74 562

Paeds

5 10 5 5 8 4 6 37

Activities

• Annual National Day of testing

• Valentines Day Promotion

• Completion of National Public Health Institute Facility

• Training of Health Care Providers in HIVQAL

• Peer exchange visit

• Roll-out of PMS

Peer Exchange Visit

• Collaboration with PANCAP

• A total of twenty-eight (28) Persons visited Guyana with a variety of experience and interest. Programme managers (6), Treatment coordinators, prevention etc

• Representatives from 9 countries

Countries

The following countries were represented;

1. Antigua & Barbuda2. Belize3. Grenada4. Jamaica5. Montserrat6. St Kitts & Nevis7. Dominica8. St Vincent & the Grenadines9. OECS

Peer Exchange Visit

Objectives• To understand the coordination NAPS in

Guyana

• To gain an insight into the various components of NAPS

• To establish partnership between Guyana & the National AIDS Programme of the Caribbean Countries.

HIV Patient Monitoring Systemin Guyana

• To develop a minimum set of indicators for monitoring the national care and treatment programme

• To develop a unified set of tools which can be used at all levels of the health care system in both public and private sector

• To develop a single system which will facilitate national and international reporting by all stakeholders

• To increase local capacity for the development and management of the care and treatment programme

Strategy

• Formed technical working group (MOH/NAPS, CDC, USAID, PAHO, GHARP, FXB)

• Modified generic WHO patient monitoring guidelines and tools, while also systematically reviewing & discussing previous forms

• Defined important reporting indicators• Addressed issues of stigma and

confidentiality

Components of the PMS

• Hand-held patient appointment card• Patient Record - Patient chart, baseline info and

- HIV care/ART summary sheet

- Follow- up sheet

• Pre-ART Register and ART Register• Reports - Monthly report (cross-sectional data)

- Cohort analysis report (for patients on ART)

• Referral Form (transfer to/from care and treatment sites)

Aggregated June 2007 Cohort*  At start of ART

June 2007

Month 6

Dec 2007

Month 12

June 2008

A. Number of people initiated on ART in original cohort 50 50 50

B. Number of transfers in (TI & TI TB) X 2 4

C. Number of transfers out (TO & TO TB) X 2 6

D. Net Current Cohort (A+B-C) 50 50 48

E. Number of persons who died X 2 4

F. Number stopped X 0 0

G. Number dropped (lost to follow-up) X 3 6

H. Number of persons on original first-line regimen 50 45 36

I. Number of persons on alternate first-line regimen (substituted)

X 0 2

J. Number of persons on second-line regimen (switched) 0 0 0

K. Percent of cohort alive and on ART (H+I+J)/D*100 100% 90% 79%

P. Functional status      

Number Working 33 34 32

Number Ambulatory 6 3 5

Number Bedridden 1 1 0

TOTAL W+A+B 40 38 37*All cohorts except SJMH

January to October 2006 Cohorts:Survivability Data after 12 months on ART

GENDER Jan. 06 - Jan. 07

Feb. 06-Feb 07

Mar 06 - Mar 07

Apr 06 - Apr 07

May 06 - May 07

Jun 06 - Jun 07

Jul 06 - Jul 07

Aug 06 - Aug 07

Sept. 06 - Sept 07

Oct 06 - Oct 07

Average

Males: 0-14 100.00 100.00 100.00 100.00 100.00 100.00 66.67 0.00 100.00 100.00 86.67

Males: 15+ 78.57 75.00 66.67 68.18 57.89 69.23 55.00 66.67 47.06 84.00 66.83

All Males 82.35 77.27 70.37 72.00 65.22 72.41 56.52 66.67 52.63 84.62 70.01

Females: 0-14 100.00 100.00 100.00 0.00 100.00 100.00 0.00 100.00 100.00 0.00 70.00

Females: 15+ 91.67 82.14 69.57 80.77 82.35 59.09 67.74 81.25 78.57 76.00 76.92

All Females 92.31 82.76 73.08 80.77 83.33 62.50 67.74 83.33 80.00 76.00 78.18

All 0-14 100.00 100.00 100.00 100.00 100.00 100.00 66.67 100.00 100.00 100.00 99.67

All 15+ 86.84 79.17 68.09 75.00 69.44 64.58 62.75 72.97 66.67 80.00 72.55

All Males & Females 88.37

80.39

71.70

76.47 73.17 67.92

62.96

74.36 69.39

80.39 74.51

Survival Rate after 12 Months on Treatment

National Care & Treatment Centre (GUM Clinic): April 2002 Cohort

At start

of ART

April 2002

Month

6 Oct 2002

Month

12 April 2003

Month

24 April 2004

Month

36 April 2005

Month

48 April 2006

Month

60 April 2007

Month

72 April 2008

a. Number of people initiated on ART in original cohort

25 25 25 25 25 25 25 25

e. Number of person who died X 1 1 1 4 4 4 4

f. Number stopped X 1 1 1 2 1 1 2

g. Number dropped (lost to follow up) X 2 2 2 3 3 4 4

h. Number of person on original first line

25 19 18 18 13 11 7 0

I. Number of person on alternate first line

X 3 3 3 3 5 8 12

j. Number of person on second line (switched)

0 0 0 0 0 1 1 2

k. Percent of cohort alive and on ART (H+I+J)/A*100

100% 88% 84% 84% 64% 68% 64% 58%

Challenges

• Inclusion of private physicians

• Poor compliance and adherence by patients in the public system due to economic and social reasons.

• Stigma and discrimination

• Use of the service by MARP (CSW, MSM)

• Work, Work, and more work

• Sustainability

Future Plans

• Completion of HIVDR country plan and protocol

• Implementation of DNAPCR assay in-country

• On-going monitoring of the PMS

• New WHO Annual Patient Monitoring Review will be piloted in Guyana

http://www.hiv.gov.gy