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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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slide2

DOMINICAN REPUBLIC

Geographic location: Caribbean Sea, West Antilles.

Shares Hispaniola Island with Haiti

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

slide3

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

slide4

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

slide5

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

slide7

Health Service Network

PHC services:

UNAPS/Rural clinics (1,100)

Municipal Hospital (+100)

Regional Hospital (8)

Provincial Hospital (40)

slide9
Strategies:
  • Pre and Post HIV Test Counseling
  • ARV supply to mother and child
  • C. Section at 38th week of pregnancy
  • Formula feeding during six months
slide11

Pre Test Counseling

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.

hiv aids national strategic plan care and management
HIV/AIDS National Strategic PlanCare and Management

Objective:

Increase access of PLHA to adequate services including ARV treatment

basic elements for arv provision
Basic Elements for ARV Provision
  • 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

components
COMPONENTS
  • 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
ethical aspects
ETHICAL ASPECTS
  • Autonomy /Voluntarity
  • Confidentiality
  • Right to recieve quality health care
  • Non - Stigmatizing
program development conecta support
Program DevelopmentCONECTA 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
pnai program development timeline
PNAI - Program Development Timeline

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

scenarios
Scenarios

Primary Health Care Level

(UNAPS)

Ambulatory Care Center (CD)

Intake Care Unit (UAB)

Tertiary Care Level

slide21

mailbox of suggestions

j

k

l

m

n

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

Involves the whole

organization

slide22

FBO

Local

Government

NGO

School

Municipal

Govt.

Integral HIV/AIDS Care integrates health facilities to community

COMMUNITY

Stakeholders

Health Facilities

CBO

slide23

Basic Care Units and Day Care Centers

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

slide24

AMBULATORY

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

care and services included
CARE AND SERVICES INCLUDED

“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
b package of care intake patients
“B” Package of Care Intake Patients
  • Specialized Consultation
  • Emergency Care
  • Emergency Procedures
  • Admission
  • Laboratory Tests
  • Surgical Procedures
  • Follow-up Consultation