Developing a National HIV/AIDS Surveillance System in Haiti Developing a National HIV/AIDS Surveillance System in Haiti NASTAD Haïti Juillet 2012

Reportable HIV/AIDS Events in Haiti HIV disease sentinel events HIV exposure (exposed infants or sexual transmission ) HIV infection 1 st positive HIV test 1 st CD4 count 1 st CD4 count <350 1 st viral load 1 st CD4 <200 AIDS-related Opportunistic Infection Death

Monitor HIV Disease HIV disease sentinel events HIV exposure (exposed infants or sexual transmission ) HIV infection 1 st positive HIV test 1 st CD4 count 1 st CD4 count <350 1 st viral load 1 st CD4 <200 AIDS-related Opportunistic Infection Death HIV Case Reporting

Monitor AIDS Disease HIV disease sentinel events HIV exposure (exposed infants or sexual transmission ) HIV infection 1 st positive HIV test 1 st CD4 count 1 st CD4 count <350 1 st viral load 1 st CD4 <200 AIDS-related Opportunistic Infection Death AIDS Case Reporting

(MESI, Haiti, Daily/Weekly)- “Surveillance”-Online (MESI, Haiti, Daily/Weekly)- “Surveillance”-Offline (I-TECH, WA, Biweekly/Monthly)-EMR (GHESKIO, Haiti, Biweekly/Monthly)-EMR (PIH, MA, Biweekly/Monthly)-EMR HAITI HIV SURV MOH MESI ITECH MESI 1 De-duplication Surveillance Loop System Design of Haiti’s HIV/AIDS Surveillance System (HASS)

MESI – flux hebdomadaire “Surveillance”-Online MESI-offline – Flux hebdomadaire “Surveillance”-Offline National EMR – Flux mensuel GHESKIO EMR – Flux mensuel HAITI Base de donnees Surveillance HIV/SIDA epuree MoH MESI ITECH MESI Deduplication automatisee et manuelle intra/inter systemes Surveillance Loop: - Rapports de tendance - Rapports de processus - Rapports de qualite PIH EMR – Flux mensuel Balises automatisees de saisie de donnees Feedback de duplication Intra-EMR Feedback aux sites sur la qualite des donnees

152 of 270 VCT sites reporting HIV cases to HASS (56%)

HIV reported cases by sex category (MESI, HASS )

Unique HIV cases reported to HASS ( )

Departmental Distribution of HIV Cases at Diagnosis, vs. Population Distribution (HASS ) Departement Population Estimée (1) % de Population Est. cas vivant avec HIV/SIDA (2010) % Total vivant avec HIV/SIDA Ouest 3,664, % 77, % Nord 970,4959.8% 14,900 10,48% Grande-Anse 425,8784.3% 5,195 3,65% Nord-Ouest 662,7776.7% 6,310 4,44% Nord-Est 358,2773.6% 3,106 2,18% Sud 704,7607.1% 9,126 6,42% Sud-Est 575,2935.8% 3,079 2,16% Nippes 311,4973.1% 1,413 0,99% Artibonite 1,571, % 12,718 8,95% Centre 678,6266.8% 8,785 6,18% Haiti* 9,923,243142,063

Departmental Distribution of HIV Cases at Diagnosis, vs. Population Distribution Outer: Estimated departmental HIV prevalence Center: % Haiti population per department

Commune of residency distribution of HIV cases at diagnosis (HASS ) Estimated HIV/AIDS leaving cases distributed by commune of Residence CommuneCasesClassification% de Total PORT-AU-PRINCE25, % CARREFOUR14, % DELMAS13, % CAP HAITIEN6, % PLAINE4, % CAYES4, % PETION-VILLE4, % PORT DE PAIX3, % GONAIVES3, % Jacmel % Jeremie %

HIV diagnoses rate in all age group population per department (HASS, ) *Unique individuals, (6 years), department of first report, 2009 population Haiti 182 per 100,000

Unique HIV cases reported to HASS ( ), by System and Total First HIV Diagnosis in Haiti (GHESKIO ) First HIV Diagnosis in Central Plateau (PIH) Foreign Assistance Programs increase in Haiti (PEPFAR, Global Fund) MESI launched (Solutions) Earthquake of 2010 Health facilities destroyed. Health staff perished. Millions displaced. Case Surveillance pilot begins (MSPP, NASTAD) iSanté GHESKIO PIH/ZL MESI

Patient Mobility Within and Between Networks (% of patients in network EMR diagnosed in same network)

Sex Distribution of HIV Cases at Diagnosis, vs. Population Distribution (HASS )

HIV prevalence among tested pregnant women (MESI )

Gender and age distribution of HIV at diagnosis (HASS )

Marital status reported at Diagnosis (HASS )

Most Reported risk factors HASS( )

Reported vs. Estimated VIH, SIDA Deaths in HASS, ( ) Of the 146,762 unique patients in HASS and according to information originally received from the report- 87% are diagnosed with HIV, 8% with AIDS, and 5% dead. Using estimated information (below), 68% are diagnosed with HIV, 19% with AIDS, and 13% are presumed dead. People are presumed dead if they were diagnosed prior to 2000 and do not have another report in HASS or they are 65 years or older and reported prior to People are presumed to have SIDA if they have a CD4 count <= 350 per ml blood. Note: These amounts may be subject to change as the methods for estimating death and out- migration are refined. Reported Estimated

Conclusion  Since 2009, an estimation of 95% of all HIV cases diagnosed in Haiti have been reported to the case surveillance system.  252 sites (56%) are periodically reported HIV diagnosis cases.  By early 2012, all four major electronic data sources were providing data feeds on a monthly basis.  Crucial reporting variables are present in more than 99% of all case reports.  Though the end of 2011, a total of 193,065 HIV cases were reported to HASS. Of those cases, 23.4% were reports related to a person reported more than once in the system.  With the existing and use of the de-duplication algorithm 147,880 unique HIV cases are identified in the national HIV/AIDS case surveillance system

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