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COUNTRY PRESENTATION

COUNTRY PRESENTATION. GUYANA. 5 th 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. PCHA. HDI. MARCH. CAI. GHARP. CDC. Ministry of Health. LM

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COUNTRY PRESENTATION

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  1. COUNTRY PRESENTATION GUYANA 5th CCAS August 2008

  2. Guyana • Area: 214,970 sq km • Land: 196,850 sq km • Water: 18,120 sq km • Population: 751,223 (2001 census)

  3. Mechanism to reorganized the National Response

  4. PCHA HDI MARCH CAI GHARP CDC Ministry of Health LM Other GoG entities CSOs FXB PEPFAR UNV/ UNDP NAP Technical agencies PAHO GSIP GF UNAIDS WB SCMS JSI CSO MSH PANCAP CDC Co Ag CRN+ CCNAPC

  5. Estimates 2006 - 2010

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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 Cotrimaxazolefor OI prophylaxis

  11. 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

  12. VCT Jan – June 2008 • 61 fixed VCT sites (Public, NGO) • 23,600 received VCT services; - 14,094 females - 9,506 males

  13. 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

  14. 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.

  15. 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

  16. 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

  17. Countries The following countries were represented; • Antigua & Barbuda • Belize • Grenada • Jamaica • Montserrat • St Kitts & Nevis • Dominica • St Vincent & the Grenadines • OECS

  18. 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.

  19. 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

  20. 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

  21. Components of the PMS • Hand-held patient appointment card • Patient Record - Patient chart, baseline info and - HIV care/ART summarysheet - 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)

  22. Aggregated June 2007 Cohort* *All cohorts except SJMH

  23. January to October 2006 Cohorts:Survivability Data after 12 months on ART Survival Rate after 12 Months on Treatment

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

  25. 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

  26. 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

  27. http://www.hiv.gov.gy

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