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ARV National Care and Treatment Program Dominican Republic. DOMINICAN REPUBLIC Geographic location: Caribbean Sea, West Antilles. Shares Hispaniola Island with Haiti.

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DOMINICAN REPUBLIC

Geographic location: Caribbean Sea, West Antilles.

Shares Hispaniola Island with Haiti

Territory: 48,670.82 km2Government: DemocraticReligion: CatholicLanguage: Spanish


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Investment on Health Indicators

  • Population: 8.2 million (2002).

  • Female: 50.2% , Male: 49.8%

  • Population <18 years old: 40.22%

  • Fertility rate: 3

  • Infant mortality rate: 31/1000 b.a.

  • Maternal mortality rate: 122/100,000 b.a.

  • Cronic malnutrition (H/A)

    (Children< 5 years old): 8.9%

  • Health investment (HI): 5% of GDP

  • Media HI in Latin America: 7.2%

  • AIDS investment: RD$142.2 Million

    *Year 2001: GODR: 87.8 M Donors: 40 M NGO: 14.4 M


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Intermediate Results

IR1:Increased use of services and practices to prevent and mitigate HIV/AIDS in at risk population.

IR3: Increased use of selected, effective child survival services.

IR2: Sustainable, effective Reproductive Health / Family Planning services provided by public and private sectors

Sub-Proyectos

Support to Comprehensive

HIV/AIDS care

Haiti- DR

Frontier Strategy

Mejoramiento en la calidad de atención obstétrica en 8 hospitales seleccionados

Fortalecimiento del PAI – Región V

Programa de Sub-Acuerdos de Donaciones a ONGs

Mejoramiento de los sistemas de logística de insumos - Areas Proyecto CONECTA

Fortalecimiento Institucional de la SESPAS

Other Activities


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Intermediate Results

IR1:Increased use of services and practices to prevent and mitigate HIV/AIDS in at risk population.

IR3: Increased use of selected, effective child survival services.

IR2: Sustainable, effective Reproductive Health / Family Planning services provided by public and private sectors

Cross cutting program areas

Comunicación para Cambio de Comportamiento (CCC)

Estrategia de Información, Educación y Comunicación (IEC)

Estrategia de Movilización Comunitaria

Fortalecimiento Institucional

Desarrollo/Mentoria de Alianzas


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Current HIV/AIDS Epidemic DHS -2002 Dominican RepublicHIV Seroprevalence Study


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Health Service Network

PHC services:

UNAPS/Rural clinics (1,100)

Municipal Hospital (+100)

Regional Hospital (8)

Provincial Hospital (40)



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Strategies: TRANSMISSION OF HIV

  • Pre and Post HIV Test Counseling

  • ARV supply to mother and child

  • C. Section at 38th week of pregnancy

  • Formula feeding during six months


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RED PAV TRANSMISSION OF HIV VCT Network


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Pre Test Counseling TRANSMISSION OF HIV

Post Test Counseling

Both Counseling

Fundación Génesis – REDPAV Clients receiving counseling: Pre, post or both (81) VCT sites September 2002 – October 2003

*IMPACT / Fundación Génesis - Proyecto RedPAV. Data collected from 81 VCT sites. October 2003.


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HIV/AIDS National Strategic Plan TRANSMISSION OF HIV Care and Management

Objective:

Increase access of PLHA to adequate services including ARV treatment


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Basic Elements for ARV Provision TRANSMISSION OF HIV

  • Integral VCT services

  • Health care providers trained in ARV

  • Patient registration systems

  • Access to laboratory testings

  • Continuous stock of ARV and supplies for palliative care and opportunistic infections.

  • Logistics system for essential commodities

Fuente: FHI


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Unidad Coordinadora de Atención Integral en VIH/SIDA. TRANSMISSION OF HIV

Response to the HIV/AIDS Epidemic

Ministry of Health


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COMPONENTS TRANSMISSION OF HIV

  • Integral Health Care including ARV

  • National PMTCT Program

  • VCT

  • Home Base Care and Palliative Care

  • OVC

  • New Program areas (Vaccines, Terciary Prevention, adults, PMTCT +)

  • BCC, Research, Surveillance, M&E


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ETHICAL ASPECTS TRANSMISSION OF HIV

  • Autonomy /Voluntarity

  • Confidentiality

  • Right to recieve quality health care

  • Non - Stigmatizing


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Program Development TRANSMISSION OF HIV CONECTA Support

  • UCAI set up (seconded personnel)

  • NGO/GODR Health Facilities: infrastructure & equipping

  • On going supervision and accreditation process

  • Logistics Mgt. ARV/medical supplies

  • TA and Training : F&A systems development PWCoopers; ARV, VCT, Biosecurity, service management and financing schemes, information systems, M&E, lab quality control

  • Mentoring (Service teams)

  • IEC materials; patient control forms, clinical history

  • Community mobilization and PLHA involvement for HBC and follow up of DOTS- TB and HAART (Enlace Project)

  • Lab services screening for ARV/ package of care financing


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PNAI - Program Development Timeline TRANSMISSION OF HIV

2000 tested/

438 adults

40 children

32 PLHA UAI/IDCP

48

90

200

ARV CARE

March/03

April/03

Jun/03

Sept/03

Nov/03

Jan/04

Feb/04

Jul/04

Program evolution

Contingency Plan

FHI/HQ

TG meeting

(Mentoring)

WJCF

1 st ARV

Training

GWU-Tebas

1st Line

ARV/ WJCF

UCAI

NGO sites

Trained CU

Peds/Adult

Initiate ARV


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Scenarios TRANSMISSION OF HIV

Primary Health Care Level

(UNAPS)

Ambulatory Care Center (CD)

Intake Care Unit (UAB)

Tertiary Care Level


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mailbox of suggestions TRANSMISSION OF HIV

j

k

l

m

n

Integral HIV/AIDS Care is based on teamwork...

Involves the whole

organization


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FBO TRANSMISSION OF HIV

Local

Government

NGO

School

Municipal

Govt.

Integral HIV/AIDS Care integrates health facilities to community

COMMUNITY

Stakeholders

Health Facilities

CBO


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Basic Care Units and Day Care Centers TRANSMISSION OF HIV

Public Private Partnerships - CONECTA Project

Support to HIV/AIDS Integral Care Program

CEPROSH

Puerto Plata

IDCP

Puerto Plata

Dajabón

Santiago

Santiago

CEPROSH

Hosp. Ramón Matías Mella

Santo Domingo

La Romana

IDEV

IDCP

L y S

HSS

Activo 20-30

Centro

Micaeliano

Hosp. F.

Gonzalvo


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AMBULATORY TRANSMISSION OF HIV

PSS

PLWHA

PSS

PSS

PSS

PSS

PSS

Evaluation

Initial & CD4 (UOI)

NO TTO ARV(UOI)

TREATMENT

WITH ARV (UOI)

Follow-up Consultation /3m

Re-evaluation Consultation

6 months later

Nutritional care

Emergency

DIRECT OR REFERRED

Start of TTO

Monthly control

Counseling

Self-care and Support

Emergency

Nutritional care

ODONTOLOGIC EMERGENCY

EMERGENCY AND/OR ADMISSION

REFERRAL

UNIT

Admission Hospital


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CARE AND SERVICES INCLUDED TRANSMISSION OF HIV

“A” Package of Care (Ambulatory)

  • Initial Evaluation Consultation

  • Follow-up Consultation

  • Specialist Consultation, Emergency

  • Counseling and Emotional Support, Group/Family

  • Laboratory Tests

  • Nutritional Care

  • Psycological Evaluation

  • Basic information and orientation

  • Day Care / Procedures

  • Supplementary feeding


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“B” Package of Care TRANSMISSION OF HIV Intake Patients

  • Specialized Consultation

  • Emergency Care

  • Emergency Procedures

  • Admission

  • Laboratory Tests

  • Surgical Procedures

  • Follow-up Consultation


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ARV Regimens TRANSMISSION OF HIV National Norms/WHO


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Estimated Human Resources TRANSMISSION OF HIV


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Accreditation Status TRANSMISSION OF HIV


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Thank you…. TRANSMISSION OF HIV


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