Achieving Epidemic Control of HIV/AIDS
Achieving Epidemic Control of HIV/AIDS: Haiti has the greatest burden of HIV/AIDS in the Caribbean region with an estimated 150,000 people living with HIV/AIDS, according to UNAIDS 2016 data. While Haiti has a generalized epidemic with most transmission occurring from heterosexual sex, data indicate that drivers of new infections include unprotected transactional and commercial sexual activities as well as unsafe sexual practices among men who have sex with men.
The Division of Global HIV & TB (DGHT) opened the CDC office in Haiti in 2002 to support the GOH in addressing the HIV/AIDS epidemic. In 2003, with PEPFAR support, DGHT resources increased substantially to turn the tide against HIV/AIDS. Working in close collaboration with the Haitian Ministry of Health (MOH), CDC is supporting the national response to HIV/AIDS to achieve epidemic control by preventing the transmission of HIV; providing quality HIV clinical services and treatment; improving patient retention; and strengthening surveillance, laboratory, and health information systems. CDC supports 89 of the 140 health facilities in the PEPFAR Haiti network and manages cooperative agreements with eight implementing partners.
Strengthening Health Systems: To ensure a sustainable and robust health system, CDC supports critical staffing needs, training programs for medical and paramedical personnel, strengthening of MOH governance and financial management mechanisms, and improving strategic information systems and data use for informed decision-making.
- Strategic Information: CDC has worked closely with the MOH to develop and support various information systems for monitoring and tracking HIV patient data, including the national electronic medical record (EMR) system iSanté, which, along with two other EMR systems managed by partners, covers 96% of HIV care and treatment sites. The National Monitoring and Evaluation Platform, known by the French acronym MESI, allows health facilities to report aggregate HIV indicators. The MESI platform also hosts the web-based reporting system for new individual HIV cases and surveillance. These two systems link into a case-based longitudinal monitoring and surveillance system known by the French acronym SALVH. SALVH is further supported by innovative tools that enhance data quality and improve patient retention in care. To prevent the duplication of patient records in the system, CDC introduced Biometric coding (fingerprinting) as a unique patient identifier and has rolled-out the system to over 60% of patients on treatment. A mobile patient tracking tool, known as Patient Linkage and Retention (PLR), also feeds into SALVH and identifies patients who are lost to follow-up (LTFU). SALVH’s surveillance data is connected to the PLR tracking tool and linked to community health workers’ tablets to allow field investigations or the tracking and geo-location of patients missing from care. Close to half of the patients lost and tracked for the past two years were geo-located and brought back into care.
Strengthening Laboratory Systems and Networks: CDC has worked with the National Public Health Laboratory (LNSP) and partner organization GHESKIOExternal to develop multiple testing capacities including PCR for diagnosis of HIV in infants, scale-up of viral load testing, and testing for opportunistic infections in HIV-infected people. CDC has helped Haiti to establish an external quality assurance program and a training curriculum to build capacity for lab accreditation. Additionally, in 2017 CDC supported the Ministry of Health to develop and operationalize an enhanced integrated National Specimen Referral Network for collecting and transporting samples from all ten departments in Haiti to LNSP and the GHESKIO IMIS lab in Port-au-Prince for viral load testing, testing for early infant HIV diagnosis using PCR, surveillance, outbreak investigations, and surveys.
- Strengthening Laboratory Information Systems: CDC supports and works closely with LNSP and GHESKIO to establish and optimize laboratory information systems to improve public health service quality and efficiencies. The LNSP and GHESKIO laboratory information systems have the capabilities to interface with major testing instruments used for viral load and early infant diagnosis testing. The testing results are directly returned to the patient service sites after validation. These capabilities have improved the service quality by limiting transcription errors and real-time reporting of quality-assured testing results. The electronic reporting system has greatly improved CDC’s capacity to monitor implementing partner performance on key indicators of laboratory services and provide real-time feedback on a monthly basis on HIV viral load monitoring. Additionally, CDC is collaborating with implementing partners to ensure the connectivity of the electronic medical record (EMR) system with the laboratory information systems.
- Service Coverage: Our close collaboration with the MOH resulted in the adoption and implementation of WHO’s “Test and Start” strategy in 2016, ensuring that patients with an HIV-positive diagnosis are immediately eligible for antiretroviral therapy (ART). CDC, in collaboration with USAID Haiti, also supported HIV testing and counseling services for more than 1 million people in 2017 and promoted intensified case finding for TB. Through “Test and Start” and other innovative approaches designed to place and keep patients on treatment, like multi-month scripting of ART and community-based drug distribution, CDC has enrolled and provides services to 84% of the 100,000 PEPFAR-supported patients on treatment in Haiti. To monitor patient adherence to treatment and treatment effectiveness, CDC helped introduce dried blood spot specimen type-based viral load testing in 2016 and expanded testing capacity to all PEPFAR-supported sites in 2017. Viral load testing increased substantially from 26,000 tests in 2016 to over 62,000 tests in 2017. Working closely with implementing partners in FY18, the viral load testing coverage greatly improved. In the first half of FY18, over 41,000 patients had viral load tests performed, representing a 48% increase compared to the same period of FY17. CDC has also played a key role in increasing ART coverage for TB/HIV co-infected patients.