1. Epidemiology of HIV in Dominica November 25, 2015 Ministry of Health Conference Room Dr. Paul Ricketts, National Epidemiologist Guadeloupe-Dominica HIV & AIDS Programme Exchange Visit

2. Outline Background HIV statistics Strengthening of the HIV information system Challenges and the Way Forward

3. Background Demographics, Healthcare Policy, Organization of the Healthcare System

4. Population structure Total population = 71,293 (2011 census) Males = 51.1% Mix of races, Kalinago 2001 census Population <5 = 8.9% Population <25 years = 45.4% Population >60 years = 13.4% Data source: Dominica 2001 Census

5. Trend in Life Expectancy, 1995-2012

6. National Health Policy 11 priority areas Family Health Chronic Non-communicable Diseases HIV/AIDS Mental Health including Substance Abuse Food and Nutrition Environmental Health Prevention and control of Communicable Diseases Strengthening of Health Systems Human Resource Development Health Disaster Management Health Care Financing

7. National HIV Strategic Plan NSP 2015-2019

8. 7 health districts 7 district health teams 52 health centre/clinics 2 district hospitals Main hospital in Roseau (secondary care) Health Care Delivery

9. Natural Disasters Dominica was visited by Tropical Storm Erika on the morning of Aug 27, 2015 17 inches of rain between 1 am and 5 pm 14.1 inches between 4 am and 9 am No warning to the population Extensive damage to national infrastructure Roads, bridges US$443,805,184.00 (€407,933,480.00) Erika Satellite Image, Aug. 27, 2015

10. HIV Statistics Trends in HIV Incidence and Mortality

11. Cumulative HIV Positive Cases, 1987-2014 N = 428

12. HIV Positive in Dominica by Year and Sex, 1987-2014 N = 428

13. Male:Female Ratio, 1987-2014

14. Number of HIV Cases by Age Group, 2010-2014 N = 76

15. Seroprevalence StudyPartnerYearSample SizeResult Prison SurveyCAREC/PAHO20051912.6% EstimateUNAIDS20080.75% Pilot MSM SurveyUNAIDS, PHAC20107226.7% Prison SurveyCDC, PAHO20122103.1%

16. HIV-related Deaths by Sex Dominica, 1987-2014 N = 151

17. Continuum of Care Cascade - Dominica,2012

18. Continuum of Care Cascade - Dominica, 2013

19. HIV Information System

21. Integrated Case- based HIV Information System Efforts currently underway to strengthen CBS Harmonized manual (OECS) Electronic application due to be developed

22. HIV Drug Resistance Surveillance OECS survey being planned Pre-ART and acquired HIVDR – first in the OECS PHAC, Centre Hospitalier Universitaire (Martinique), PAHO, OECS HAPU Protocol under development Meeting being planned for Barbados, January 2016 Indicators generated by PM 1.3 Indicators generated

23. Challenges and Opportunities The Way Forward

24. Challenges and Way Forward (Epidemiology) Limited seroprevalence/behaviour data ?collaboration on behavioural, seroprevalence survey Sustaining nation-wide HIV rapid testing No formal HIV information/surveillance data exchange between Martinique Guadeloupe and Dominica Automate report generation in information systems with translation Develop electronic linkages between Dominica and Guadeloupe Telemedicine consultation Participate in regional meetings

25. Challenges and Way Forward (Epidemiology) Change management Improving data quality

26. END