2. COUNTRY PRESENTATION GUYANA 5 th CCAS August 2008

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

5. Mechanism to reorganized the National Response

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

7. Estimates 2006 - 2010

8. 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

9. 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

10. 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.

11. 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.

12. 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 Cotrimaxazole for OI prophylaxis

13. 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

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

15. 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

16. 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.

18. Laboratory Statistics Jan - July 2008 Jan Feb MarchAprilMayJuneJuly Total CD4 + 3306706386064154535153,627 Hematology2002162052471802192201,487 Chemistry2432292253032242142691,707 New patients61213211199699198942 New patients with CD4+ < 350 4212911293516174562 Paeds5105584637

19. 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

20. 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

21. Countries The following countries were represented; 1.Antigua & Barbuda 2.Belize 3.Grenada 4.Jamaica 5.Montserrat 6.St Kitts & Nevis 7.Dominica 8.St Vincent & the Grenadines 9.OECS

22. 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.

23. HIV Patient Monitoring System in 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

24. 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

25. Components of the PMS Hand-held patient appointment card Patient Record - Patient chart, baseline info and - HIV care/ART summary sheet - 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)

26. Aggregated June 2007 Cohort* At start of ART June 2007 Month 6 Dec 2007 Month 12 June 2008 A. Number of people initiated on ART in original cohort50 B. Number of transfers in (TI & TI TB)X24 C. Number of transfers out (TO & TO TB)X26 D. Net Current Cohort (A+B-C)50 48 E. Number of persons who diedX24 F. Number stoppedX00 G. Number dropped (lost to follow-up)X36 H. Number of persons on original first-line regimen504536 I. Number of persons on alternate first-line regimen (substituted) X02 J. Number of persons on second-line regimen (switched)000 K. Percent of cohort alive and on ART (H+I+J)/D*100100%90%79% P. Functional status Number Working 333432 Number Ambulatory 635 Number Bedridden 110 TOTAL W+A+B 403837 *All cohorts except SJMH

27. January to October 2006 Cohorts: Survivability Data after 12 months on ART GENDER Jan. 06 - Jan. 07 Feb. 06- Feb 07 Mar 06 - Mar 07 Apr 06 - Apr 07 May 06 - May 07 Jun 06 - Jun 07 Jul 06 - Jul 07 Aug 06 - Aug 07 Sept. 06 - Sept 07 Oct 06 - Oct 07 Averag e Males: 0-14100.00 66.670.00100.00 86.67 Males: 15+78.5775.0066.6768.1857.8969.2355.0066.6747.0684.00 66.83 All Males82.3577.2770.3772.0065.2272.4156.5266.6752.6384.62 70.01 Females: 0-14100.00 0.00100.00 0.00100.00 0.00 70.00 Females: 15+91.6782.1469.5780.7782.3559.0967.7481.2578.5776.00 76.92 All Females92.3182.7673.0880.7783.3362.5067.7483.3380.0076.00 78.18 All 0-14100.00 66.67100.00 99.67 All 15+86.8479.1768.0975.0069.4464.5862.7572.9766.6780.00 72.55 All Males & Females88.37 80.3 9 71.7 0 76.4 773.1767.92 62.9 6 74.3 669.39 80.3 974.51 Survival Rate after 12 Months on Treatment

28. National Care & Treatment Centre (GUM Clinic): April 2002 Cohort At start of ART April 2002 Month 6 Oct 2002 Month 12 April 2003 Month 24 April 2004 Month 36 April 2005 Month 48 April 2006 Month 60 April 2007 Month 72 April 2008 a. Number of people initiated on ART in original cohort 25 e. Number of person who died X1114444 f. Number stopped X1112112 g. Number dropped (lost to follow up) X2223344 h. Number of person on original first line 251918 131170 I. Number of person on alternate first line X33335812 j. Number of person on second line (switched) 00000112 k. Percent of cohort alive and on ART (H+I+J)/A*100 100%88%84% 64%68%64%58%

29. 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

30. 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

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