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