Ten Year Retrospective on HIV capacity building in the Caribbean Valerie Wilson Caribbean Med Labs Foundation CCAS EXPERT SUMMIT: From Care to Cure – Shifting the HIV Paradigm 27-31 August 2017 Barbados
Presentation Outline CCAS Country Presentations 2008-2016 Rationale Highlights Some Examples of Country Successes CCAS Declarations Ongoing Laboratory Strengthening Initiatives 2008 - 2016 2
The Caribbean Experience
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CCAS Country Presentations CARICOM countries Dutch Caribbean islands, specifically St. Maarten, Aruba and St. Eustatius; Spanish Caribbean - Dominican Republic British Overseas Territories of Bermuda and Cayman Islands. 21 countries Each year – 2008 – 2016: Barbados and St. Kitts & Nevis Each year except one - Bahamas and J amaica Six or seven years – 8 countries 6
CCAS Country Report Objectives (2008) To celebrate progress made To identify gaps and barriers To define needs and agree recommendations for moving forward To agree targets for the future To collect, collate and utilise data to advocate for resources and continued support for meeting the needs of national HIV Lab programmes & achieving targets
Country Presentations CCAS 2008-2016 2008 2009 2010 2011 2012 2013 2014 2015 2016 Demographics HIV Prevalence CD4 testing <350 <500 TREAT ALL Access to VL LOCAL testing or refer (LRU for OECS) VCT/PITC PMTCT/ Elimina EMTCT EMTCT tion Validation Targets
Country Presentations CCAS 2008-2016 2008 2009 2010 2011 2012 2013 2014 2015 2016 ARV Access Treatment Cascade Laboratory TAT Indicator PT Reporting Surveilla nce National Laboratory Policy Accreditation Lady Bahamas of HIV Ref Meade HIV Ref Labs Ref Lab Lab CCAS Declarations
HIV Prevalence reported in country reports 10 10
HIV Prevalence – key populations 2016 Haiti: MSM – 14% CSW – 8% Dominican Republic MSM – 3.9 – 6.9% Trans – 14% 11 11
PMTCT Testing Rates reported 12 12
PMTCT The PMTCT Program is hosted by the public Antenatal Clinic PMTCT program 95% of pregnant women are tested 2006 – 982 total mothers, 860 tested ,87% 2007- 1004 total mothers, 923 tested, 92% 2008- 564 total mothers, 513 tested, 91% 98-100% ARV coverage in those mothers known to be HIV pos by the antenatal clinic. Provision by the CCC In those mothers who adhered to ARVS there has been 100% success
Key Population Treatment Cascade COIN – Dom Rep
Examples of Programme Successes 2008 Bahamas testing and treatment programme – fully government funded Guyana – Patient Monitoring S ystem for public and private patients Monthly reports generated Challenges Inclusion of private physicians Poor public patient compliance (use by CSW and MSM, stigma and discrimination) 16 16
Examples of programme successes Haiti 2008 National EQA programme for HIV testing using dried tube specimen (DTS) 2016 Patient Linkage data from 52 Sites: 16,100 Patients reached in ~ 9 Months, with 3,000 reached the last month More than 45% LTFU patients returned to care after tracing intervention 17 17
Tobago Health Promotion Clinic 18 18
Mortality THPC ‘04-’07 70 60 50 40 30 20 10 0 03 04 05 06 07
120 100 80 60 Adherence 2004 -2007. 40 20 0 03 04 05 06 07
PT performance and impact St. Vincent – 2014
PT performance and impact – St. Vincent PT performance - reported during the monthly QMS meeting by department supervisor. A review of unacceptable reports , and corrective action are presented at the same time. A follow up on previous corrective action is also addressed.
Declaration - 2011 Participants resolved: To support the establishment of a Caribbean Laboratory Network for HIV- related laboratory services at various levels within and among participating countries. That this network will serve as the first step in regional efforts to establish laboratory networks to support the Caribbean Public Health Agency (CARPHA). Benefits to be gained and sustained from such a network: Early diagnosis - persons with HIV infection, other STIs and OIs Access to critical tests for monitoring at national level and regional reference nodes. Cost effective delivery of laboratory services coupled with improvement of quality care to support the wider health services including non-communicable and chronic disease management.
CCAS Declaration 2011 Requested Ministers of Health to collaborate with Ministers of Trade and Finance to: Establish national regulations to ensure quality of laboratory services including point of care Prioritize laboratory service improvement - overall national strategic plans Allocate resources to ensure continuous lab support Support development of the laboratory network through facilitating arrangements for reference node referrals (MOUs, timely payment, logistical arrangements – transport, Customs) Initiate discussions with appropriate Ministries and Customs Agencies aimed at preserving the integrity of temperature-sensitive reagents Ensure development and implementation of plans to transition from resources provided by regional partners to services fully supported by national resources to ensure sustainability
CCAS Declaration - 2014 Request to Ministers of Health: Ensure quantum of human and financial resources allocated to secure consistent, uninterrupted, reliable testing and information generation by labs Approximately 5% of national health budget in most countries is expended on lab services, lab data influences 70% of clinical decisions. Ensure that priority continues to be placed on the strengthening of regional and national laboratory networks to effectively support HIV/ AIDS and NCD programmes Ensure key critical services e.g. support for prevention and social services, are provided in order to retain PLHIV in care and on treatment, and ensure treatment adherence – viral load suppression Support and encourage attendance of public sector staff at the annual CCAS meeting – (clinicians, programme managers, laboratorians and other HCWs, procurement specialists, commercial vendors)
Country Report Presentations Share successes o Provide support and guidance for targets o Monitor and track progress (consistency of data o points) Generate greater understanding between different o disciplines Determine gaps and challenges o Advocacy strategies o 26 26
Other Capacity Building Initiatives in the Caribbean CDC PEPFAR Laboratory Strengthening – 2009 Support for staff and infrastructure including equip. Strengthening Laboratory Management Towards Accreditation (SLMTA) training Support for accreditation – HIV Reference Laboratories, major public labs – Bahamas, Barbados, J amaica, Suriname, Guyana, Trinidad & Tobago. Collaboration – PAHO/ WHO-CDC with CROSQ, CARPHA, CMLF, Accreditation Bodies – Caribbean Laboratory Quality Management – Stepwise Improvement Process (LQMS-SIP) 27 27
CARIBBEAN LABORATORY QUALITY MANAGEMENT SYSTEMS STEPWISE IMPROVEMENT PROCESS 28 28
Other Capacity Building Initiatives in the Caribbean CMLF – GF R9 PANCAP Grant (2011-2015) and OECS GF Grant (2016-2018) Network monitoring indicators at CCAS 2011- TAT, PT and Surveillance Reporting National laboratory network plans Provision of PT for key analytes Regional framework for national laboratory policy and development of draft national policies Study to determine barriers to laboratory access for key pops in OECS countries Validation of algorithm – HIV and syphilis for OECS Training for testers - key populations in OECS 29 29
Regional Policy Framework Endorsed by meeting of CMOs in April 2014 and by COHSOD (Ministers of Health) September 2014: Model Regional/Sub-Regional Policies and Legislation: National Laboratory Policy Framework presented by CMLF The COHSOD: Endorsed the Regional Laboratory Policy Framework; and Requested Member States to provide leadership at the national level to support adaptation and implementation of the National Laboratory Policy Framework. 30 30
National Policy Consultation and Drafts 2014-2015: CARICOM-PANCAP GF CMLF Project Belize Suriname 6 OECS countries (Antigua & Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, St. Vincent & The Grenadines) Montserrat Barbados J amaica Bahamas Collaboration with PAHO HIV Office (2014): OCTs – Anguilla, Cayman Is., St. Maarten, TCI
Laboratory Policy Components • Essential elements of the national laboratory policy include : – Laboratory Governance and Network Structure – Quality M anagement Systems – Laboratory Support Systems – Information and Data M anagement 32 32
COHSOD 2015 – Ministers of Health Noted and congratulated countries for the progress • made in developing national laboratory policies with facilitation by CMLF; • Committed to provide leadership at the national level to support adoption and implementation of the National Laboratory Policy – critical to ensuring reliable and sustainable national laboratory services and to meeting IHR requirements. 33 33
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