Group Discussion

1
Group Discussion

• Guyana, The Bahamas
• T T, Jamaica
• Barbados, Haiti
• Suriname, Curacao

2
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

3
Successess (2)

• Increased capacity to perform diagnostic testing
  in country
• Viral load now performed in Bahamas, TT, 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

4
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 TT 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

5
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

6
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

7
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

8
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)

9
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

10
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