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Group Discussion. Guyana, The Bahamas T & T, Jamaica Barbados, Haiti Suriname, Curacao. Successes (1). Reduction of deaths due to care and treatment Increased HIV testing E.g. increased VCT centers in Barbados Decrease incidence of mother to child transmission

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Group discussion l.jpg

Group Discussion

Guyana, The Bahamas

T & T, Jamaica

Barbados, Haiti

Suriname, Curacao


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Successes (1)

Reduction of deaths due to care and treatment

Increased HIV testing

E.g. increased VCT centers in Barbados

Decrease incidence of mother to child transmission

Decreased Incidence/Prevalence rates

Observed in both Jamaica and Trinidad

Guyana dropped 2.5% to 1.5%

Haiti dropped 6.4% to 2.2%

Medical patient management system in place


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Successess (2)

  • Increased capacity to perform diagnostic testing in country

    • Viral load now performed in Bahamas, T&T, Jamaica

    • CD4 performed in all countries

    • Barbados can also to resistance testing

  • Higher CD4 thresholds to initiate antiretroviral therapy (250-350 cells/mm3)

    • Means more patients on antiretroviral therapy

  • Development of National Reference Laboratory Capacity

    • Bahamas: Expansion of equipment & staff

    • Guyana: Infrastructure in place, hopeful operation soon

    • Trinidad and Jamaica implemented LIS

  • Increase in Prevention Programs

  • Free ARV therapy in all countries


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Successes (2)

  • Increased uptake of PMTCT program

  • Initiation of DNA-PCR testing for early infant diagnosis

    • In Bahamas/Guyana, samples sent to South Africa with support from Clinton Foundation

    • In T&T samples sent to CAREC

  • Countries have a National AIDS Coordinating Program

    • Includes increased capacity for monitoring & evaluation

  • Increase in access points for PLHIV

    • Bahamas: strengthening referral system to national treatment centers

    • Guyana: Increased care & treatment sites by incorporating HAART into regional hospitals and select health centers

    • Same with Trinidad & Tobago

    • Haiti: increase in youth participation in services


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OPPORTUNITIES

  • Cross-Country collaboration and technical support (sharing knowledge, etc.)

  • Standardization of Guidelines

  • Coordination of pharmaceuticals & lab reagents when supply stock-outs occur

  • Coordination of training

    • Examples:

      • Guyana ahead with rapid testing (could help Bahamas)

      • Bahamas already testing viral load (could help Guyana)

  • Use technology to improve access to hard-to-reach areas

    • Example: Haiti using manual CD4, Guyana – mobile clinic


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OPPORTUNITIES

To Provide & Share Research

To build on prevention based on the success of Care and treatment by integrating care treatment and prevention

Increase diagnostic capability for pediatric infection

Team approach to management

Government Support/Political Will

Using infrastructure created by HIV response to build overall health care infrastructure

Use existing care & treatment services as a model for decentralization of services


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COMMON BARRIERS

Procurement (medication and reagents) & Supply chain management (including cold chain)

The Absence of higher level testing in some countries (Resistance testing & viral load)

Different treatment regimes in countries

Lack of testing to date on HIV infection to know if infection is new or old

Lack dissemination of information


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COMMON BARRIERS

  • Human Resources

  • Stigma and Discrimination

  • Immigration and Emigration

    • Bahamas: immigration presents cultural and language barriers

    • Guyana: emigration of skilled staff

    • Haiti: contact tracing

  • Coordination of care for patients that move between Caribbean islands

  • Sustainability of HIV programmes

  • Integration of vertical programs

  • Changes in government & regulations

  • Power struggle and turf war (Information Hording)


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Needs (1)

  • Funding

  • Staff & Human Resources (particularly trained staff)

  • Training

    • Examples:

      • Bahamas: development of a national rapid testing algorithm

      • Lab certification/accreditation

      • Training in new technologies, retraining in existing ones

  • Increased involvement of private sector

  • Infrastructure: Easier transport for patients & specimens, consistent power supplies, etc.

  • Equipment Maintenance


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Recommendations

  • Fix all the needs and challenges!

  • Develop a method of coordination between Caribbean islands that could be used for:

    • Patient care

    • Training & technical assistance

    • Supply chain issues

    • Create a common regional policy?

  • Methods to reduce stigma & discrimination:

    • More education on HIV

    • Integration of HIV services to primary care

    • Opt-out testing

  • Implementation of a sustainability plan and planning for succession

  • Continue to integrate HIV care into primary care:

    • E.g. integrate HIV programs into existing clinics

    • E.g. integrate other STI screening at VCT sites


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