Order 187973: Public Health informatics informed approaches for monitoring or managing HIV in sex workers in Guyana (South America)

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MINISTRY OF HEALTH

Submitted to: Dr. Bheri Ramsaran, Minister of Health, Guyana.

Submitted by: Dr. Shanti Singh, Programme Manger, NAPS/MoH.

May 2012.

END OF TERM REVIEW

GUYANA NATIONAL HIV/AIDS STRATEGY 2007-2011

Government of Guyana , National AIDS Programme Secretariat

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TABLE OF CONTENTS

List of Acronyms P4-8

Technical Review and Writing Team P9

Foreword P10

Acknowledgments P11

Executive Summary P12

Introduction P13

Objectives of the End of Term Review P13

Methodology P14

Outline of the Report P15 Section One:

VI: Status of the Epidemic P16

VI:1 Sex distribution of HIV and AIDS Cases P18

VI:2 Age Distribution P19

VI:3 Spatial Distribution of HIV and AIDS P21

VI:4 AIDS Related Mortality P21 Section Two:

VII: Priority Area 1: Strengthen the National Capacity to Implement a Coordinated National Response P25 Section Three:

VIII: Priority Area 2: Reducing Risk and Vulnerability to HIV Infection P33 Section Four:

IX: Priority Area 3: Clinical and Diagnostic Management and Access to Care, Treatment and Support P56 Section Five:

X: Priority Area 4: Strategic Information P74 Section Six:

XI: Summary of Findings by Programmatic Area P81-82

XII: Summary of Findings by Targets P82-83 Section Seven:

XII: Considerations for HIVISION 2020 P90-91

XIV: Conclusion P91 Appendix A: List of Contributors P92-93

Appendix B: Key Informant Interview Questionnaire P94-101

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TABLES AND FIGURES

Table 1: HIV prevalence among Key Populations in Guyana P17 Table 2: Trends in Reported Cases of HIV and AIDS by Sex, 2002-2011 P19 Table 3: Distribution of HIV cases by Age-group 2006-2011 P20 Table 4: Proportion of HIV cases by Region 2006-2011 P21 Table 5: Annual Number and Proportion of AIDS-Related Deaths P21 Table 6: Summary of Overall Progress 2007-2011 -Targets and Indicators P22-24 Table 7: Summary of Programmatic Achievements-Priority Area 1 P26-30

Table 8: Strengthening the national capacity to implement a coordinated multi-sectoral response P31-32 Table 9: Summary of Programmatic Achievements - Priority Area 2 P34-44 Table 10: Summary of Priority 2 Targets and Indicators 2007-2010 (Prevention PV) P45-55 Table 11: Summary of Programmatic Achievements - Priority Area 3 P57-67 Table 12: Summary of Priority 3 Targets and Indicators 2007-2011 (Care, Treatment and Support CTS) P68-73 Table 13: Summary of Programmatic Achievements- Priority Area 4 P75-79 Table 14: Summary of Priority 4 Targets and Indicators 2007-2010 (Surveillance SR) P80 Table 15: Non Measurement of Cumulative Achievements P83-84

Table 16: measurements of Cumulative Achievements P85-89 Table 17: Summary of ratings of achievements by Priority Area P89 Figure 1: HIV Prevalence among various populations P16 Figure 2: Annual cases of HIV and AIDS, 2002-2011 P18

Figure 3: Proportion of HIV cases among Youth, 2006-2011 P20

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LIST OF ACRONMYS

ADT Anti-Retroviral Dispensing Tool

AIDS Acquired Human Immune Deficiency Syndrome

ANC Antenatal Clinic

ARV Anti-Retroviral

BBSS Biological and Behavioural Surveillance Survey

BCC Behavior Change Communication

BRHA Berbice Regional Health Authority

BSS Behavioural Surveillance Survey

CAREC Caribbean Epidemiology Center

CBO Community Based Organisation

CCM Country Coordinating Mechanism

CDC US Center for Disease Prevention and Control

CHW Community Health Worker

CME Continuing Medical Education

CML Central Medical Laboratory

CRIS Country Response Information System

CRS Catholic Relief Services

CSO Civil Society Organisation

CSS Client Satisfaction Survey

CSW Commercial Sex Worker

DNA De-oxyriboneucleic Acid

DPT Digital Proficiency Testing

EPP Estimation& Projection Package

ERC Electronic Resources Centre

ETR End of Term Review

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FBO Faith Based Organisation

FCSW Female Commercial Sex Worker

FSW Female Sex Worker

FXB Francois Xavier Bagnoud

GBCHA Guyana Business Coalition Association

GF Global Fund

GHARP Guyana HIV/ AIDS Reduction And Prevention Project

GOG Government of Guyana

GPHC Guyana Public Hospital Co-operation

GUYBOW Guyana Rainbow Foundation

GUYEXPO Guyana Exposition

GUYSUCO Guyana Sugar Cooperation

HAPSAT HIV/AIDS Programme Sustainability Analysis Tool

HBC Home Base Care

HCG HIV Clinician Group

HCW Health Care Worker

HFLE Health and Family Life Education

HIS Health Information System

HIV Human Immuno -Deficiency Virus

HMIS Health Management Information System

HPC Home and Palliative Care

HR Human Resource

HSDU Health Sector Development Unit

HTLV Human T-Lymphotropic Virus

ICT Information Communication and Technology

IEC Information, Education, Communication

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ILO International Labour Organisation

ITECH International Training and Education Center

JDG Joint Donor Group

L&D Leadership and Development

LHC Linden Hospital Complex

LSP Laboratory Strategic Plan

M&E Monitoring and Evaluation

MARP Most At-Risk Population

MCH Maternal and Child Health

MCYS Ministry of Culture, Youth and Sport

MERG Monitoring and Evaluation Reference Group

MMU Materials Management Unit

MoE Ministry of Education

MOH Ministry of Health

MOLH&SS Ministry of Labour, Human Services & Social Society

MSH Management Science For Health

MSM Men Who Have Sex With Men

MTR Mid Term Review

NAC National AIDS Committee

NAPS National AIDS Programme Secretariat

NASA National AIDS Spending Assessment

NCC Network for Community Commitment

NCTC National Care And Treatment Centre

NGO Non-Governmental Organisation

NHIVP National HIV Programme

NPHRL National Public Health Reference Laboratory

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NPOC National Procurement Oversight Committee

NSP National Strategic Plan

NTP National Tuberculosis Programme

NWT National Week of Testing

OI Opportunistic Infection

OVC Orphans and Vulnerable Children

PAHO Pan-American Health Organisation

PANCAP Pan Caribbean Partnership on HIV and AIDS

PCHA Presidential Commission on HIV and AIDS

PCR Polymerase Chain Reaction

PEPFAR US President's Emergency Plan for AIDS Relief

PLHIV Persons Living With HIV

PLWHAs People Living with HIV and AIDS

PMTCT Prevention of Mother to Child Transmission

PrEP Pre Exposure Prophylaxis

PSA Public Service Announcement

PUSH Positively United to Support Humanity

QA Quality Assurance

QC Quality Control

QI Quality Improvement

RAC Regional AIDS Committee

RDQA Routine Data Quality Assessment

RNCF Radio Needy Children Fund

SASOD The Society against Sexual Orientation and Discrimination

SCMS Supply Chain Management System

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SOP Standard Operating Procedure

STI Sexual Transmitted Infection

TB Tuberculosis

TOR Terms of References

TST Tuberculin Skin Test

TWG Technical Working Group

UNAIDS Joint United Nations Programme on HIV and AIDS

UNFPA United Nations Population Fund

UNGASS United Nations General Assembly Special Session

UNICEF United Nations Children's Fund

VCT Voluntary Counseling and Testing

WAD Women Across Differences

WB World Bank

WHO World Health Organisation

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TECHNICAL REVIEW AND WRITING TEAM

Dr. Shanti Singh- Programme Manager, MoH/NAPS- Principal Lead.

Miss Jennifer Ganesh- BCC Coordinator, MoH/NAPS

Mr. Nicholas Persaud- National Care and Treatment Programme, MoH/NAPS

Miss Shevonne Benn- National Home Base Care Coordinator, MoH/NAPS

Miss Nafeza Ally, Social Services Coordinator, MoH/NAPS

Miss Fiona Persaud, M&E Lead, MoH/NAPS

Miss Sophia Collier- Data Analyst, M&E, MoH/NAPS.

Dr. Bendita Lachmansingh – Epidemiologist, MoH/NAPS

Mr. Somdatt Ramessar- Food Bank Manager, MoH/NAPS

Miss Deborah Success- National VCT Coordinator, MoH/NAPS

Mr. Nazimul Hussain- Community Mobilisation Coordiantor, MoH/NAPS

Miss Elizabeth McAlmont – MARPS Coordinator, MoH/NAPS

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FOREWORD

The National HIV/AIDS response over the five years of 2007-2011 under the auspices of the National AIDS Programme Secretariat received tremendous support from key stakeholders including the broader Ministry of Health, other line ministries and government agencies, the private sector, the donor community and civil society organizations. These years noted expansion in the strategic areas of programme implementation as outlined in its NSP: Programme Coordination, Prevention, Care, Treatment and Support and Monitoring and Evaluation. Surveillance data showed a continued reduction in the number of notified HIV cases generally and with a stabilization and reduction in cases of pregnant women testing positive. Coverage of the Prevention programme was expanded through the increased number of VCT and PMTCT sites linking to an increase in access with over 95 % coverage of test for pregnant women. Whilst 100% of condoms distribution was not achieved, there has been an increase in the availability and access to condoms in all administrative regions of Guyana. BCC initiatives addressed a wide variety of issues and targeted the general as well as specific populations considered to be at a higher risk for HIV. Coverage for the prevention efforts and access to services for some of the MARPS populations increased through the significant inroads made by CSOs working with these groups. Key Coalitions such as the GBCHA and the GFCHA were established. Access to Care and Treatment increase covering all ten administrative regions of Guyana with significant improvements in treatment outcomes. Larger proportions of persons eligible for, receive ARVS and survival rates have increased. Legislation in support of OVCs was enacted and PLHIV benefitted from economic, nutritional, and psycho social and other forms of support. Of significant importance is the progress made in Monitoring and Evaluation. A fully staffed M&E Unit was in place at the NAPS. The Unit was able to contribute towards effectively completing internal reports and meeting external reporting requirements and participated in special surveys and research and in some case led these studies. Biological and Behavioral surveillance Surveys were conducted among special populations and Guyana‟s first Demographic Household Survey was done. Although progress was achieved and Guyana was able to under this NSP 2007-2011 reverse and stabilize the HIV epidemic, much still needs to be done. Focus as we move forward need to be placed on ensuring that the gains made are sustained and importantly that the issues financial sustainability is addressed. At a legislative and policy level, the issue of the HIV legislations needs to treated with priority. Programme areas are now required to refocus their efforts from responding to an emergency to consolidating the gains made and to ensure that value for money is guaranteed.

Dr. Shanti Singh

Programme Manager,

National AIDS Programme Secretariat

Ministry of Health

NAPS Mission Statement: To prevent the transmission and mitigate the impact of HIV/AIDS/STIs through a coordinated

national response that provides high quality services ensuring optimal health for all.

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ACKNOWLEDGEMENTS

The Ministry of Health, National AIDS Programme Secretariat expresses its profound gratitude to the following individuals and organisations: The Government of Guyana for its unwavering support and commitment to the HIV response. The Honourable Minister, Dr. Bheri Ramsaran for his leadership and clear guidance to our work. The Honourable Minister of Agriculture, Dr. Leslie Ramsammy ( former Minister of Health) for his leadership, commitment and dedication to the HIV response not only over the last five year but throughout his tenure as the Minister of Health. Mr. Hydar Ally, the former Permanent Secretary of the Ministry of Health. Mr. Leslie Codogan, Permanent Secretary, Ministry of Health, and all other staff of MoH All Clinical Staff and other field Staff. Thanks to the staff of the National AIDS Programme for dedication and commitment to this response not merely as a job, but as real cause worth fighting for. Very special thanks to all of our partners and donors who have contributed financially and technically and who have placed their trust in us in knowing that Guyana can make a difference. Thanks to the US Government and all of its partners (USAID, CDC, FXB, SCMS, ITECH and all others), The Global Fund, the World Bank, the UN Family (UNAIDS, UNICEF, PAHO, UNDP, UNFPA, ILO and all others), to PANCAP, the Clinton Foundation and all others who have made our successes possible.

Thanks to the Guyana Private Sector for working with us in ensuring that our workforce remains healthy.

Thanks to everyone who has contributed to the HIV response, our combined efforts have yielded results.

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1. EXECUTIVE SUMMARY

The End of Term Review of the 2007- 2011, National HIV/AIDS Strategic Plan confirms the significant progress made in achieving universal access to HIV/AIDS prevention, treatment, care and support programmes in Guyana.

The End of Term review process was commissioned by the Ministry of Health, National AIDS Programme Secretariat with the main objective of reviewing programme progress according to the agreed priority areas and activities, and indicators and targets.

It builds on the Mid Term Review recommendations to successfully reach agreed targets and serves part of an important monitoring and evaluation framework to keep the HIV/AIDS response on track.

This End of Term Review document is therefore an indicative landmark to how far Guyana has come in terms of the HIV response, where we are now and where we need to be going as it will serve to inform the New National HIV/AIDS Strategy 2011-2020.

The Guyana programme includes all components in the fight against HIV/AIDS and is coordinated by the National AIDS Programme Secretariat which is also responsible for rolling-out the various programmes.

The NHIVS review process was led by the NAPS and focused on the strategic activities for each indicator

under each of the broad strategic priority area as outlined in the NHIVS. The achievement for each of the

strategic activities was rated as one of the following: overachieved, fully achieved, partially achieved,

achieved or not achieved.

There are forty four (44) National M&E Indicators as per the National Monitoring and Evaluation Plan for the Multi-Sectoral Response to HIV and AIDS in Guyana 2007-2011. These indicators were developed to monitor and evaluate the HIV response in Guyana accordingly with each of the four (4) priority areas in the Guyana National HIV/AIDS Strategic Plan 2007-2011.

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I. INTRODUCTION

The Guyana‟s response to HIV commenced once the first AIDS case was diagnosed in 1987. Since then

the Ministry with its stakeholder embarked on a multi-sectoral response to this serious public threat. The

National Strategic plan of 2007-2011 was the third strategic plan under the response. It was the first plan

that truly described a more comprehensive understanding of the local HIV epidemic and projected for a

intensive, multi-sectoral response.

The NSP 2007-2011 was implemented with a wide stakeholder involvement, with significant financial

contributions from the international donors. Guyana‟s programme has annual reported improvements.

With the conclusion of the NSP 2007-2011, it is critical understand the five years achievements, to highlight

the successes and to identify areas of gaps. Even more importantly the findings of ETR are important in

providing guidance in the development of the new NSP, HIVision2020.

II. OBJECTIVES OF THE END OF TERM REVIEW

The review will serve the following:

1. To understand the impact made during the five years period through an examination of the epidemiological situation.

2. To provide an understanding of the level of achievement of the National Strategic Plan 2007-2011 through the examination of its priority areas.

3. To understand the degree of achievement and the impact of the interventions through the measurement of the indicators of the National Monitoring and Evaluation Plan.

4. To identify the areas of gaps in the implementation of the NSP.

5. To identify and document best practices under the NSP.

6. To identify challenges experienced in the implementation of the NSP.

7. To identify gaps under the priority areas that would inform the New NSP.

8. To solicit guidance and identify priorities areas for the development of the new National Strategic Plan HIVision 2020.

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III. METHODOLOGY

To comprehensively evaluate the progress made, the review employed the following steps:

1. Review of key documents inclusive of the NAPS annual reports, the Universal Access and

UNGASS reports, PMTCT, Blood Banking, National TB and other relevant department annual

reports, report of the midterm review of the NSP and others.

2. Review of progress and achievements by the Ministry of Health. This was conducted this review in

the second and third quarters of 2011. A first draft of the report prepared.

3. Key informant interviews. This was conducted through the administration of a structured

questionnaire to a cross section of partners and stakeholders. A total of 30 persons were

interviewed. The results of the interviews were incorporated into the report.

4. Consultation with stakeholders in smaller targeted sessions as follows:

 National Prevention Reference Group Meeting- 22nd February 2012.

 NSP Steering Committee Meeting- 27th February 2012.

 National Care and Treatment Technical Working Group Meeting- March 7th 2012

 Monitoring and Evaluation Reference Group Meeting- 12th March 2012.

 Focus Group sessions with PLHIVs (26th March 2012), FCSW (27th March 2012), MSM (27th

March 2012).

During these focus group sessions a total of 24 persons living with HIV, 26 men who have sex with men

and 19 female commercial sex workers participated. Feedback from these sessions was then incorporated

into the draft report. This generated a final draft.

5. Presentation of the findings at a National Stakeholders Consultation- April 12th 2012. Final draft

presented at the National Stakeholders Consultation and feedback incorporated to generate the

final report. A total of 44 persons attended the consultation and provided feedback.

6. Final report prepared and submitted to the Minister of Heath by April 30th 2012.

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IV. OUTLINE OF THE REPORT

The report would be structured in seven sections.

Section 1 of the report describes the Status of the Epidemic at the end of 2011. Epidemiological and

Surveillance data is presented for the five years period with trends described. Data presented are also

disaggregated by gender, agegroup and other variable to allow for a deeper understanding of the epidemic

and the results of the response.

Sections 2, 3, 4 and 5 of the report examine the status of progress made in the broad strategic programme

areas and specifically the strategic activities under the relevant priority areas. Linked to the narrative report

are the results for all indicators in the National Monitoring and Evaluation Plan under the appropriate priority

areas of the NSP. The results for the indicators captures the entire period of the NSP.

Section 6 of the report summaries the findings according to the specific programmatic area and targets

Section 7 of the report highlights the priorities advanced for consideration in the development of the

HIVision2020.

Outline of Report

Section 1: Status of the Epidemic; Results of Key Impact Indicators

Achievements against programme areas

Section 2: Priority Area 1: Strengthening the National Capacity to Implement a Coordinated Multi-Sectoral Response.

Section 3: Priority 2: Reducing Risk and Vulnerability to HIV Infection

Section 4: Priority 3: Clinical and Diagnostic Management and Access to Care, Treatment and Support

Section 5: Priority 4: Strategic Information

Section 6: Summary of Findings (Programme Area and Targets)

Section 7: Priorities for HIVision 2020

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SECTION ONE: VI: STATUS OF THE EPIDEMIC

Adult HIV Prevalence has been on a steady decline over the past eight years. The most recent estimation exercise conducted for 2011 revealed HIV prevalence among adults 15-49 of 1.1 percent (Spectrum/EPP 4.47). This represented a decrease from 2.4 percent in 2004 and 1.2 percent in 2009 (UNAIDS Estimates). According to PMTCT programme data, HIV prevalence among pregnant women was maintained around 1 percent between 2009 and 2011. In 2010, 5.8 percent of babies born to HIV-positive mothers were infected with HIV and 1.9 percent in 2011. HIV prevalence among blood donors was 0.2 percent in 2010 and 0.1 percent in 2011. The 2009 Biologic Behavioral Surveillance Survey (BBSS) showed a sharp decrease (38%) in the HIV prevalence among female sex workers (FSWs), from 26.6 percent (BBSS, 2005) to 16.6 percent (BBSS, 2009). In contrast only a slight decrease was observed among MSM, from 21.2 percent (BBSS, 2005) to 19.4 percent (BBSS, 2009). Figure 1 shows the most recent prevalence rates among key populations. Figure 1: HIV Prevalence among various populations

23.4%

19.4%

16.6%

5.2%

3.9%

2.7%

1.1%

1.1%

0.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

TB Patien ts

MSM

FSW

Priso ners

Miners

Security Guards

Adult Prevalence

Pregnant Wo men

Blood Donors

HIV Prevalence

Year of prevalence: Blood donors, Pregnant women, Adult Prevalence, TB patients- 2011; FSW and MSM- 2009; Security Guards and Prisoners- 2004; Miner- 2003

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A pattern of decreasing prevalence among key populations is illustrated in Table 1. The significant increase in the proportion of voluntary blood donors and improved screening of potential donors have contributed to the decreasing pattern observed among this group. The trend over the last eight years shows that the co- infection prevalence among TB-HIV patients is decreasing.

Table 1: HIV Prevalence among Key Populations in Guyana

POPULATION SEX YEAR PREVALENCE REMARKS

Pregnant Women

Female 2004 2.3 ANC Survey

2006 1.6 ANC Survey

2003 3.1 PMTCT Programme Report 2004 2.5

2005 2.2

2006 1.6

2007 1.4

2008 1.2

2009 1.1

2010 0.9

2011 1.1

Blood Donors All 2004 0.7 Blood Bank Programme Reports

2005 0.9

2006 0.4

2007 0.3

2008 0.5

2009 0.2

2010 0.2

2011 0.1

Sex Workers Female 1997 45.0 Special Survey

2005 26.6 BBSS

2009 16.6 BBSS

MSM Male 2005 21.3 BBSS

2009 19.4 BBSS

TB Patients All 1997 14.5 Chest Clinic Records

2003 30.2

2004 11.2

2005 30.2

2006 33.2

2007 35.3

2008 22.0

2009 28.0

2010 26.0

2011 23.4

Miners Male 2000 6.5 Special Survey One mine study

2003 3.9 Special Survey 22 mines study

Security Guards All 2008 2.7 BBSS

Prisoners All 2008 5.24 BBSS * 52%, 82% and 67% of TB patients were tested for HIV in 2004, 2005 and 2006 respectively

Source: National AIDS Programme Secretariat, 2011

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Since the first reported case of AIDS in 1987, there has been a progressive increase in the number of reported cases over the years. A cumulative total of 9,473 cases of HIV and 1,899 cases of AIDS were reported to the Ministry of Health for the period 2002-2011. The number of new AIDS cases has progressively decreased since 2004. There were 972 cases of HIV and 62 cases of AIDS reported in 2011. These are illustrated in Figure 2.

Figure 2: Annual Cases of HIV and AIDS, 2002-2011

VI.1 Sex Distribution of HIV and AIDS Cases

The male to female ratio for HIV cases has been fluctuating over the past four years. While HIV appears to have initially been most prevalent among males, the infection has been transmitted to increasing numbers of women. By 2003, the annual number of reported cases of HIV was higher among females and remained so until 2008 when the male female ratio was 0.91. The situation was again reversed in 2010 and 2011 when more females were diagnosed with HIV, with a male to female ratio of 0.8 in both years. This trend is illustrated in Table 2.

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Table 2: Trends in Reported Cases of HIV and AIDS by Sex, 2002 – 2011

CLASSIFICATION 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

HIV Male 301 339 368 325 591 422 446 600 449 432

Female 268 368 408 421 626 531 490 567 547 517

Unknown 39 55 61 36 41 40 23 9 43 23

Total 608 762 837 809 1,258 993 959 1176 1039 972

Sex Ratio 1.1 0.9 0.9 0.8 0.9 0.8 0.9 1.1 0.8 0.8

AIDS Male 243 232 117 58 99 80 14 21 86 41

Female 146 163 204 77 68 49 8 21 58 21

Unknown 26 22 27 7 5 1 2 1 2 0

Total 415 417 348 142 172 130 24 43 146 62

Sex Ratio 1.7 1.4 0.6 0.8 1.5 1.6 1.8 1.0 1.5 2.0

TOTAL

HIV

&AIDS

1,023 1,179 1,185 951 1,430 1,123 983 1,219 1,185 1,034

Source: Ministry of Health Statistics Unit and NAPS

VI.2. Age Distribution of HIV Cases

Whilst there are variations within the specific age groups, consistently more than three quarters of HIV cases are reported in the combined age group of 20-49, which is considered the productive workforce. Notable increases were observed among the age-groups 15-19 and 20-24 (in and out of school youth) in 2010 but there was a marked reduction in cases within these age groups in 2011. There was also an increase in cases in the 30-34 in 2010 and 2011. The highest proportion of reported cases of HIV has been occurring in the 30-34 age-group, as shown in Table 3.

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Table 3: Distribution of HIV Cases by Age-group 2006 – 2011

PROPORTION OF HIV CASES BY AGE GROUP 2006-2011

Age group in years 2006 2007 2008 2009 2010 2011

0-1 1.75 0.10 0.00 0.09 0.01 2.26

1-4 0.00 1.60 0.52 0.76 0.48 0.51

5 -14 1.66 2.50 1.56 1.19 0.87 0.93

15-19 3.60 3.80 2.91 6.04 6.83 4.01

20-24 12.00 10.70 11.47 11.56 17.52 13.68

25-29 17.00 16.30 17.30 13.69 12.80 13.27

30-34 19.60 19.60 18.03 17.35 18.58 18.10

35-39 15.34 15.70 16.37 16.83 13.67 15.23

40-44 11.00 11.40 11.05 12.15 11.93 11.52

45-49 7.00 6.00 7.30 8.93 6.54 8.54

50-54 4.50 3.70 5.01 4.08 4.04 5.66

55-59 2.25 2.70 2.19 2.55 2.60 4.12

60+ 1.03 2.60 3.44 2.12 2.02 2.16

Unknown 3.34 3.10 2.81 2.63 2.02 0.00

Figure 3: Proportion of HIV Cases among Youth, 2006 – 2011

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VI.3. Spatial Distribution of HIV and AIDS

Region 4 continues to account for the largest proportion of notified HIV cases; reaching over 70% by 2011. There have been fluctuations across the other regions over the past six years. However, the coastal regions (2, 3, 5, 6 and part of 10) have stood out in terms of the proportion of reported HIV cases which may be attributed mainly to the accessibility of the prevention programme in these regions as compared to the hinterland regions which face challenges because of the difficult terrain associated with these locations.The spatial distribution of HIV cases is illustrated in Table 4.

Table 4: Proportion of HIV Cases by Region 2006 – 2011

Region

Total

Population

% of

population

2006 2007 2008 2009 2010 2011

1 24,275 3.2 0.2 0.1 0.5 0.9 0.6 0.8

2 49,253 6.6 4.6 3.8 3.9 2.6 1.3 4.1

3 103,061 13.7 6.8 7.4 8.2 10.6 10.7 2.7

4 310,320 41.3 65.2 66.2 59.1 56.3 71.5 70.8

5 52,428 7.0 2.3 3.7 1.7 2.7 2.6 9.0

6 123,695 16.6 10.5 7.6 9.7 9.9 7.4 2.8

7 17,597 2.3 2.5 1.8 1.6 2.4 1.6 4.9

8 10,095 1.3 0.1 0.4 0.1 0.5 0.3 1.1

9 19,387 2.6 0.3 0.4 0.3 0.0 0.3 0.4

10 41,112 5.5 4.0 4.3 3.7 3.1 2.5 0.1

Unknown 0 0 3.7 4.2 11.1 10.8 1.3 3.3

Total 751,223 100.0 100.0 100.0 100.0 100.0 100.0 100

VI.4. AIDS-Related Mortality

The proportion of all deaths attributable to AIDS has declined from 9.5 percent in 2002 to 4.7 percent in 2008 and 4.2 percent in 2009. The actual number of AIDS-related deaths has also generally declined as illustrated in Table 5. According to the Ministry of Health‟s 2008 Statistical Bulletin, AIDS-related deaths have been among the top ten causes of deaths in Guyana, ranking at number 5 in 2006 and moving to number 6 at the end of 2008.

Table 5: Annual Number and Proportion of AIDS-Related Deaths

Year % of AIDS Related Deaths No. of AIDS Related

Deaths

Rate per 1,000 population

2002 9.5 475 0.6

2003 8.0 399 0.5

2004 7.1 356 0.5

2005 6.86 360 0.5

2006 5.9 298 0.4

2007 5.7 289 0.4

2008 4.7 237 0.3

2009 4.2 192 0.2

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Table 6: Summary of Overall Progress 2007-2011 – Targets and Indicators

Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)

No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achiev ement: 2007- 2011

Remarks

-2006 Target Results Target Results Target Results Target Results Target Results

IMP1 Proportion of all deaths attributable to AIDS

6.90% 6.40% 5.70% 6.20% 4.80% 6.00% 4.20% 5.80% N/A 5.60% NA 78.70%

Data for death is not available for

2010 or 2011 from the Ministry

of Health, Surveillance Department.

IMP2 Percentage of adults and children with HIV still alive 12 months after the initiation of ARV therapy

77.60% 78.50% 74.50% 79.50% NA 80.50% 72.20% 82.00% 80.70% 85% 80.40% 94.40%

IMP3 HIV Prevalence among women aged 15-24

1% <1% 1.3% (177/

13605)

<1% 1.20% (180/

15702)

<1%

1.10% (130/

11776)

<1% 0.90% (101/

11441)

<1% 0.9% (116/1 3490)

1.06%

(704/

66014)

This figure is based on

programme data for all pregnant

women and is for all women

accessing ANC services. Data

not disaggregated for

the 15-24 age group.

IMP4 HIV Prevalence among most at risk populations

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Table 6: Summary of Overall Progress 2007-2011 – Targets and Indicators

Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)

No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achiev ement: 2007- 2011

Remarks

-2006 Target Results Target Results Target Results Target Results Target Results

Prevalence Among MSM

21.25% - - - 19.40% 20% 19.40% 19% NA Rg4: 17.5%; Nationa l: 15%

NA 97%

Prevalence among CSW

26.60% - - 24% 15.00% 22.50% 16.60% 20% NA 18.70% NA 68.10%

Prevalence among mobile populations (miners)

3.90% - - - NA 3.20% NA - NA 3.00% NA Unable to

calculat e

Achieve ment

Prevalence among male STI patients

17.30% 17% NA 16.50% NA 16.00% 13.30% 15.00% 14.10% 15% 11.70% 85.00% All data obtained

primarily from NCTC

Prevalence among female STI patients

16.90% 16.50% NA 16.00% NA 15.50% 10.90% 15.00% 13.00% 15.00% 9.00% 72.30% All data obtained

primarily from NCTC

Prevalence among TB patients

24% 25% 35.20% 25% 22.00% 22.50% 28.00% 20.00% 26.00% 18.70% 23.40% 121.70 %

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Table 6: Summary of Overall Progress 2007-2011 – Targets and Indicators

Summary of Overall Progress against key impact indicators and targets 2007-2011 (Impact IMP)

No. Indicators Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achiev ement: 2007- 2011

Remarks

-2006 Target Results Target Results Target Results Target Results Target Results

IMP5 Percentage of infants born to HIV infected mothers who are infected

15% 14.00% 0% 13.00% 4.00% 3.50% 8.80% 3.00% 5.80% 2.70% 1.90% Unable to

calculat e

Achieve ment

IMP6 Ratio of current school attendance among orphans to that among non orphans age 10-14

- 1:01 NA 1:01 NA 1:01 - 1:01 - 1:01 NA Unable to

calcula te

Achiev ement

Source of Data: MICS. Type of Data: not cumulative

MICS sample size was too small for this indicator to

statistically cal.

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SECTION TWO:

VII.PRIORITY AREA 1: STRENGHTEN THE NATIONAL CAPACITY TO IMPLEMENT A COORINDATED

NATIONAL RESPONSE

Strategic Objectives:

1. Strengthen institutional capacity to effectively coordinate the multi-sectoral response through

implementation of the Three Ones Principles.

2. Strengthen human capacity to effectively coordinate and manage the multi-sectoral response.

3. Strengthen regional capacity to implement and manage HIV/AIDS interventions

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Table 7: Summary of programmatic achievements- Priority Area 1.

Broad Strategic Programme Areas

Strategic Areas Activities/Achievements Additional Comments

1.1 PCHA, HSDU & NAPS empowered to coordinate Guyana's national HIV/AIDS multi-sectoral response

1.1.1 Strengthen the leadership and programme management capacity of the PCHA, HSDU and NAPS

Training was conducted for MoH Staff on Project Management with the University of Guyana, Staff were trained in Public Health (Masters Degree with the London School of Tropical Medicine and Hygiene). Training was also conducted in leadership by GHARP using the MSH module adapted for the Guyana context. Staff were also trained with the Caribbean Health Leadership Institute on Leadership in Public Health. Linked to the capacity building, the programme generated regular prescribed reports such as the Presidential Commission Report on HIV and AIDS, the UNGASS, Universal Access, Report on the Elimination Initiative and other National and International Reports.

The strengthened leadership led to enhanced coordination with the efficient functioning of existing mechanisms and with the establishment of others. These include the Country Coordinating Mechanism, the NACC, the GFCHA, GBCHA. At a technical level several mechanisms established (National Care and Treatment Working group, VCT Steering Committee, OVC Steering Committee, HBC Steering Committee, The National Monitoring and Evaluation Reference Working Group, the National Prevention Reference group and others) also facilitated the coordination at the technical levels.

1.1.2 Define functions, roles, responsibilities and reporting relationships between HSDU, NAPS, PCHA as well as the Health Theme Group/Partnership Forum

The organization of the multisectoral response was defined with roles and responsibilities and reporting relationships clearly determined.

The NAPS is seen as the lead coordinating agency for the response.

1.1.3 Review/update TORs, and membership of the NAC and RACs in light of the scaled up response

The NAC continues to function with regular quarterly meetings of its executive body. The RAC established at regional levels throughout the country also functions and are involved in advocacy , particularly on human rights issues.

Many CSOs in country are working with HIV. Under the World Bank project of the Ministry of Health, more than 40 NGOS were sub-recipients and coordinating mechanism was established whereby these CSO organisations met once per month. With the conclusion of the World Bank project, this no longer takes place. Through the PEPFAR/GHARP a NCC (Network for Community Commitment) was established with a steering committee. The NCC met and continues to meet on a monthly basis. The NCC has worked with stakeholders in ensuring CSO participation at various for a such as the representation at one the Country Coordinating Mechanism

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1.2 Integrate HIV/AIDS into the programmes and services offered by other ministries

1.2.1 Provide technical assistance in programme management to the line ministries to develop their annual sectoral work plans

There are 16 line ministries with work plans and budgets supported by the World Bank. All Line Ministries operated with HIV Focal Points who were trained in programme management, proposal development, workplanning, monitoring and evaluation and in fiscal management. The focal Points were responsible for the implementation of the HIV workplans within each line Ministry. Coordination of the work of the Line Ministries was achieved through monthly meetings.

Major key Ministries were involved including the Ministry of Education, Local Government, Home Affairs, Housing and Water, Labour, Human Services and Social Security, Foreign Trade, Agriculture, Amerindian Affairs, Culture, Youth and Sport, Public Service Ministry. Other key parastatal agencies also implemented HIV work plans and included GUYSUCO, Land and Surveys, Mayor and City Council, Guyana National Newspapers Limited, Berbice Regional Health Authority and others.

1.2.2 Support the implementation of the HIV/AIDS Strategy for the Amerindian population

The Ministry of Amerindian Affairs has been a key Ministry in the implementation of a response to HIV among the indigenous population and particularly in regions 1, 7, 8 and 9. Support was provided to the Ministry of Amerindian Affairs in providing the evidence for programming, in the implementation of programmes , particularly in regards to prevention services ( outreaches, HIV testing) and through the primary health care system in the provision of clinical services for persons testing services.

The Ministry of Amerindian Affairs in ensuring a comprehensive approach of its response, collaborates with key agencies such as the National AIDS Programme Secretariat, the UN Agencies, CSO ( Youth Challenge Guyana, The Guyana Red Cross, Remote Area Medical) and other key Ministries ( Ministry of Local Government and Regional Development, Ministry of Education and others).

1.3 Harmonize and align resources to ensure efficient use of donor funding

1.3.1 Establish/strengthen mechanism to streamline the allocation of resources from the donor agencies

A milestone of the Guyana HIV response has been the implementation of the „three ones‟ principles by the government and its partners leading to overall coordination. Several high level mechanisms exist to ensure that alignment occurs including the CCM and the Policy Level Meeting between the Ministry of Health and the PEPFAR programme. Additionally other joint donor mechanisms such as the Health Thematic Group and the Joint Donors Group Meeting were also instrumental in coordination of financial resources.

Alignment was also facilitated through the costing of the National Strategic Plan and the Operational Plan to the Monitoring and Evaluation (M&E) Plan.

1.3.2 Monitor and evaluate the utilization of resources

The Ministry of Health produces financial reports on a regular basis to the Ministry of Finance. Regular financial reports are also prepared for the Global Fund projects and shared with the country coordinating mechanism and are posted the global fund website-www.theglobalfund.org. The Ministry conducted its second NASA, however that report is still being prepared. An assessment on HIV sustainability utilizing the HAPSAT tool was conducted and provided important information for sustainability and alignment.

Financial reports are not received from all agencies working in the HIV response. However some submission of financial data was done for the second NASA exercise ( report being prepared)

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1.3.3 Implement the recommendations for Three Ones implementation and of the Global task Team on Improving AIDS Coordination among Multilateral Institutions and International donors

The „three ones‟ principles are being implemented by the government and its partners. Several key international agencies coordinate with the Government of Guyana in ensuring that their agendas and priorities are aligned with the NSP and the National Monitoring and Evaluation Plan.

The partners and donors involved include the PEPFAR programme, the GF, the WB, the UN family and CSOs.

1.3.4 Effectively provide surveillance, GOG and donor programme planning, and key activities using Electronic Resource Centre (ERC)

The Ministry of Health utilizes a database used for capturing HIV surveillance data. This data is reported to and posted on the CAREC website on a quarterly basis. Additionally all programme areas utilize various methods in ensuring that data is captured, reported and used for planning. The HIV website was established in 2005 houses a wealth of information, toolkits and key documents.

In addition to Surveillance data, technical Areas under the National Programme also collect, analyze and use the data for programme planning. These include the treatment, voluntary counseling and testing and others.

1.4 Increase the involvement of civil society organizations and the private sector in the scaled up response

1.4.1 Provide technical assistance with the development of workplace policies with a focus on stigma and discrimination

HIV/AIDS Work Place Policy was developed patterned

after the ILO workplace Policy and being implemented.

There are 54 companies participating in HIV/AIDS

Workplace Education Programme which rejects stigma and

discrimination in the workplace. In addition the GBCHA

support the policy implementation in the private sector

workplace and 44 private companies have signed on to

workplace policies.

This work is done in close collaboration between the Ministry of Labour and the ILO.

1.4.2 Provide technical assistance with the development of workplace programme for prevention, care and support

Technical assistance to the roll out of the Workplace Programme has been provided through various partners such as GHAPR I and GHARP II and through various NGOS. The Guyana Business Coalition on HIV/AIDS provides technical support to 44 companies which are actively involved in prevention, care and support. There are 54 companies participating in the HIV/AIDS workplace policy developed jointly by Ministry of Labour and the International Labour Organisation (ILO)

A spin off effect of the engagement of the private sector is their involvement in contributing to the food bank initiative. A total of 26 private sector companies at the end of 2010 covered approximately one quarter of the needs of the food bank for 2010 in providing 4,715 hampers to 1,437 persons requiring support. For 2011, this trend continued with 4500 hampers distributed to 1087 patients with 30 private sector contributing 25.5% of the Food Bank needs.

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1.4.3 Provide training in programme management for these groups to strengthen the capacity of their organizations to respond

Repeated training was conducted in programme management, proposal writing, monitoring, evaluation and reporting and in fiscal management. Particular focus was placed on newly established grass roots community based organizations for capacity building, whilst ongoing continued assistance was given to all other NGOs. Capacity building in addition to the areas noted above also was provided in leadership. The number of CSOs working in HIV has increased over the years and the scope of work has expanded to capture almost all areas of HIV Prevention, Care and Support. These NGOs are in all Administrative Regions of the country covering HIV sensitization, education, interpersonal communication, HIV testing and counseling, care and support for PLHIVs and for OVCs .

A recent mapping exercise conducted by the NAPS, documented 73 NGOs, CBOs, FBOs working in the 10 administrative regions of Guyana.

1.4.4 Expand the number of civil society organizations involved in implementing HIV/AIDS activities in the regions

1.4.5 Build capacities of newly formed NGOs to develop proposals and access funding

1.5 Advocate for a legal and policy environment that protects the rights of people living with HIV/AIDS and vulnerable groups

1.5.1 Revise existing legal framework, National HIV/AIDS Policy and prepare new health legislation to combat all aspects of discrimination relative to HIV/AIDS

The National HIV policy was reviewed, revised and disseminated. A draft of HIV legislation is available for review and finalization.

1.5.2 Create mechanisms to stimulate advocacy by informing senior decision makers of the social and economic impact of HIV/AIDS on National Development

There continues to be high political commitment to the HIV response. This is demonstrated at events of the NWT and WAD, where senior officials and decision makers are integrally involved. Mechanisms for stimulating advocacy include the dissemination of information- PCHA, UNGASS process and others.

1.6 Review the National Response to the HIV/AIDS

1.6.1 Conduct mid-term review of the National Strategic Plan

Stakeholder review conducted and included the National and Regional Consultations of Health Care Workers, Representatives of CSO, PLHIV, Faith based communities and others. Report prepared and findings were used to revisit targets for the follow up three years.

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1.6.2 Conduct a Government-led participatory review of the National AIDS Response

Initial Review conducted by the MOH/ NAPS. Process also included consultations with relevant TWGs, with relevant communities (PLHIVs, MSM, CSW) and with the wider stakeholder. The findings of the End of Term Review would inform the development of Guyana‟s next Strategic Plan.

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Priority Area 1: Strengthening the national capacity to implement a coordinated multi-sectoral response

Table 8: Summary of Priority 1 targets and indicators 2007-2011 (National Capacity NC)

INDICATORS Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achievement:2007-

2011

Remarks

-2006 Target Results Target Results Target Results Target Results Target Results

NC1 Amount of National funds allocated by Government for HIV prevention and care

USD $503,805

NA

A second NASA was conducted. Report is being prepared.

NC2 Implementation of the three ones principles

Yes Yes Yes Guyana has fully implemented the three

ones. A CHAT was embarked on in

collaboration with UNAIDS and the

report is to be prepared.

NC3 National Composite Policy Index

Completed

This was prepared for the last two UNGASS

reports and for the country progress

report of 2010/11. See UNGASS report

available on www.hiv.gov.gy

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NC4 Percentage of schools with teachers who have been trained in life skills based HIV education and who taught it during the last academic year

- NA - 61.6% of teachers trained in life skills

- NA 70.00% 75.00% NA

In 2008, there was no target set. *results from the draft Ministry of Education Teachers survey report. In 2010 a total of 32 schools taught HFLE.

NC5 Number of Line Ministries with HIV work plans and budgets

7 11 11 14 16 16 17 18 16 20 NA 102.40% The decline in the number of Line

Ministries in the last year under review is

attributed to the conclusion of the

World Bank support to Line Ministries.

Arrangements are being made for this

support to be transitioned to under

the Global Fund Grant.

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SECTION THREE:

VIII: PRIORITY AREA 2- REDUCING RISK AND VULNERABILITY TO HIV INFECTION

Strategic Objectives:

1. Decrease misconceptions and discriminatory behaviors and increase knowledge and access to

prevention services

2. Reduce sexual transmission of HIV infection with a focus on most at-risk populations and their

partners through delayed sexual debut, reduced partner change and number, increase condom

use, and promotion of treatment adherence

3. Reduce mother-to-child transmission of HIV infection

4. Reduce the risk for transmission in medical settings

5. Reducing the socio-economic impact of HIV/AIDS and increase protection for OVCs

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Table 9: Summary of Programmatic achievements-Priority Area 2.

Broad Strategic Programme Areas

Strategic Areas Activities/Achievements Additional Comments

2.1 Design and implement Communication Programme on HIV/AIDS

2.1.1 Develop and implement National behaviour change strategy to reduce stigma and discrimination related to HIV/AIDS

BCC strategy was developed, printed, disseminated and used to guide implementation. One of the key components of the BCC Strategy is the Creation of an Enabling Environment for persons living with and affected by HIV. The effective implementation of this programme led to the involvement of NGO/FBO/CBO programs; reduction of stigma and discrimination; policy-related advocacy; workplace/private sector programs; links to economic/social programs. Another key element of the strategy was the identification of the MARPS groups and definition of key strategies to work with the MARPS. CSOs were funded to implement these among the MSM and FCSW and this has resulted in a reduction of the HIV prevalence among these groups as noted in the two rounds of the BBSS reports. Between the period 2007-2010 a total of 775,599 IEC materials were distributed in the form of brochures, posters, booklets etc. Messages of HIV prevention, stigma reduction, encouraging early HIV testing, Delaying onset of intercourse; decreasing number of partners; increasing condom use; recognition of early symptoms of sexually transmitted infections or HIV; How to access treatment for HIV; the importance of having a healthy lifestyle for HIV positive individuals; the importance of adherence to antiretroviral drugs; decreasing the risk and vulnerability of women to HIV; Increasing community involvement towards HIV prevention & reduction of stigma; decreasing opportunistic infections in persons living with HIV; prevention of TB/HIV Co-infection. The BCC awareness campaigns are part of an integrated, multilevel, interactive process with communities and involves community based reinforcement activities.

2.1.2 Use available data to develop mass media campaign to ensure that all members of society have information on prevention, care and treatment services

Several mass media campaigns were developed targeting various issues for various populations. Campaigns included Prevention of STIs, PMTCT, Prevention with Positives, Greater involvement of Men, Involvement of Religious groups, Youth adults and Children, TB/HIV co-infection, Women‟s empowerment and condom negotiation, Adherence to ARVS, HIV risk reduction among MARPS, Increase condom use, early HIV testing, Reduction on stigma and discrimination, Community involvement on HIV and AIDS, Early OI diagnosis and others. Each campaign comprised of several components- PSA, radio announcement, brochures, posters, billboards, lighted signs and documentary. These campaigns were widely disseminated via TV and other fora. The BBSS of 2004 and 2008/9 were both consulted in the development of mass media campaigns on prevention, care and treatment services targeted at the general population and specified MARPS populations.

2.1.3 Encourage the participation of NGOs, CBOs and other partners in the development and implementation of the behaviour change interventions

Several NGOs, CBOs, FBOs, Partners (GHARP) are consulted and participate in the development and production of BCC materials. All NGOs, CBOs, FBOs, Partners (GHARP) are fully involved in implementing BCC interventions. Full access to all BCC materials (audio/visual) is employed.

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2.1.4 Conduct assessment and test messages targeted towards general and high risk populations

This has been conducted for all messages done. Testing of the messages constitute a key element of the contractual arrangements with the agency.

2.1.5 Train staff to conduct health promotion activities

The Ministry of Health has established a health promotion Unit. This Unit oversees health promotion for the Ministry of Health and also provides technical support to the HIV promotional activities. Staff of the Unit have been trained and retrained in various aspects of Health promotion.

2.2 Develop and implement targeted behaviour change interventions to increase positive sexual practices and encourage early STI/HIV diagnosis and treatment among most vulnerable groups

2.2.1 Define and prioritize populations to be targeted

The MARPS and vulnerable populations were defined. The BCC National Strategy prioritized the populations by: Female commercial sex workers; Men who have sex with men; People living with HIV/AIDS and those affected by HIV/AIDS; Orphans and other vulnerable children; STI patients/clients; Health care workers; Policy makers; Out-of- school youth; Mobile populations; In-School youth. Additional populations include the General Population; Interior populations including Amerindians and Prisoners. Targeted Behaviours change interventions were designed and implemented for the MSM and CSW populations using the Evidence Based Intervention approach of CDC ( Centers for Disease Control) of Popular Opinion Leader. This programme has been implemented by CSO in seven regions at the end of 2010 ( Regions 2,3, 4, 6, 7,8 and 10)

The programme has shown significant results in the number of persons reached (1,192FCSW and 1,154 MSM), however there needs to be a greater understanding of the size of the population. In this regard ongoing efforts have been made with assistance from the partners to develop a size estimation.

2.2.2 Use available data to develop targeted behaviour change interventions for selected high risk groups

Utilized data from BBSS of 2004 and 2008/9 to tailor BCC campaigns for selected MARPS and general populations. Focus groups are done with the target populations. In most cases the target populations led the development of the interventions. In the keep the lights on project and the other interventions developed using the popular opinion leader model, members of the population were hired as full time staff and trained to provide an enabling environment for their peers (condoms availability etc) and for the transfer of knowledge.

2.2.3 Use messages designed to increase the use of VCT services and early treatment-seeking for STIs and HIV/AIDS

Several campaigns were developed on early testing and early treatment seeking behaviours. Campaigns included PSA for TV and Radio, posters, brochures, billboards, and documentaries. Indirectly linked to these specific campaigns were additional campaigns addressing stigma and discrimination, community involvement, and others. The results are demonstrated with the increasing number of HIV testing being done over the years. Audio/Visual and IEC materials utilized both at the general population level and interpersonal at community level.

Number of persons tested 2007- 67,681, 2008- 86,983, 2009- 105,030 2010-112,627.

2.2.4 Develop “friendly” services for youth and most at risk populations

There are a total of 19 Youth Friendly Services outlets located in 5 regions of Guyana (3, 4, 5, 6 and 10). These provide friendly services for all youth and particularly youth at a higher risk for HIV.

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2.2.5 Develop peer education programmes for high risk youth, CSWs and MSM

Peer education programmes were developed for these groups of persons. A total of 919 youths were trained as peer educator and have subsequently reached 26,229 persons through interpersonal communication through the National AIDS programme. More than 150 young persons were also trained as peer educator through the adolescent health unit. In regards to in-school youth- several programmes were instituted. The HFLE was strengthened with teachers trained and teaching the subject in school. The school health programme expanded over the years with a total of 75 school health clubs across all ten administrative regions. This has led to the development of a network of regional representatives and health club member with teachers. Manuals for the school health club initiative has been developed with a focus on sexual and reproductive health inclusive of HIV and targets both teachers and students. Additionally youth friendly health services were offered to the in school youth as noted above. As part of the popular opinion leader programme, CSWs and MSM were trained as peer educators. Manuals for both CSW and MSM developed for training as peer educators. Hence, several groups of Sex workers and MSM have been trained and are functioning as peer educators to discuss prevention and safer sex strategies with their peers. Direct intervention with Female sex workers and MSM are currently being targeted in regions 2, 3, 4, 6, 7, 8 and 10 and work is being done to improve their access to HIV and STI-related services at „friendly‟. However, several organizations have established networks through which they reach MSM and Sex Workers in all regions of Guyana. Yearly average shows close to a total of 1,400 MSM and 1,000 CSW being reached with HIV prevention activities. IEC materials were designed and developed to target the MARPS such as trigger tapes, documentaries, teaching aides such as cue cards. 20 MSMs in Region 4 were trained in VCT Testing and Counseling and now rotate on a no-pay shift with Artistes in Direct Support and to other CSO. In regards to prisoners, the Ministry of Home Affairs has taken the lead with a well define HIV work plan covering HIV prevention and ensuring HIV testing services for new entrants to the prison system and care treatment and support for PHIV in the system.

2.2.6 Develop mass and small media interventions to promote the use of risk-reduction sexual health practices

BCC campaigns have been developed and implemented. Mass media and small Media interventions on risk reduction was developed addressing stigma and discrimination, abstinence, condom use and early HIV testing. Posters, television and radio advertisements, television documentaries on HIV have been produced and a radio serial drama is ongoing with accompanying community-based reinforcement activities. Community based activities utilizing „Edutainment‟ has been employed with campaigns such as „PUT IT ON‟ for condoms. A total of 15 road shows were held across the country.

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2.3 Implement prevention education and behaviour change reinforcement activities

2.3.1 Implement HFLE at primary and secondary levels

Several stakeholders, including the Ministry of Education, GHARPII (in 130 schools), the MoH, and the Health and Family Life Education (HFLE) program conduct HIV prevention for in-school youth. HFLE, a Caribbean Community (CARICOM) multi-agency activity, trained 2,000 teachers from 180 schools nationwide between 2006 and 2009. A survey conducted on 73 schools found 62 percent delivered HFLE to all grades in the 2009 academic year. UNICEF and other organizations carry out smaller initiatives whereby youth are reached by teachers and frequently by peer educators. In addition to the formal HFLE programme, In school youths are also reached through the school health clubs, youth clubs, faith-based organizations, and sports clubs. Further edutainment such as music events, sports events, and story writing competitions are other types of HIV/AIDS outreach conducted targeting this population.

2.3.2 Develop peer education programmes for youth

Peer Education work continued under this NSP. For the period of 2007-2010, a total of 919 young persons were trained as peer educators by the naps and an additional of more than 150 trained by the AHU. Several initiatives engaged the persons trained including the “Me to You, Reach One, Save One” campaign where a total of 26,299 persons were reached through interpersonal communication. Persons trained as peer educators also provide support to major public initiatives such as the National Week of HIV testing, World AIDS Day, GUYEXPO, MASH and others.

A total of 919 youths were trained as peer educators ( 2007-250, 2008- 234, 2009- 145, 2010- 290)

2.3.3 Continue to implement the Abstinence and Faithful programs

Abstinence and Be Faithful messages and education form part of Peer Education Programme and is included in all campaign materials (targeted and general population). All school based programme include abstinence messages. Community leaders, including FBO leaders, have been engaged to promote abstinence and faithfulness. The Guyana Faith Coalition on HIV and AIDS is a lead agency in dealing with these.

2.3.4 Develop and implement serial communication programs reinforced with community-level education.

BCC campaigns have been developed and implemented at population and community level. Posters, television and radio advertisements, television documentaries on HIV have been produced and a radio serial drama is ongoing with accompanying community-based reinforcement activities. Community Opinion leaders were targeted and over the years a total of 382persons were trained. These leaders then use their position of advantage to continue communication of HIV. Merundoi, a radio serial has taken its reinforcement work to the communities using edutainment as the tool. The Merundoi radio serial estimates that its Abstinence and Be faithful messages has reached more than half of the population with almost 30% of those persons being weekly listeners with equal proportions of males and females. A Tour of Guyana Cycle Race (The BIG Ride & Ride for LIFE) conducted annually to raise awareness about HIV/AIDS and stigma and discrimination. During this time, cyclists were trained as peer educators and conduct community level education at each point of the race. Messages on abstinence, faithfulness, correct and consistent condom use, positive parent and child communication, alcohol reduction and prevention, access to quality HIV and STIs services, and reduction of stigma and discrimination information are reinforced at community level by the national programme, the regional health services, adolescent health unit and departments of the Ministry and CSOs.

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2.4 Expand condom social marketing programme

2.4.1 Review and implement strategy and expand program

Condom distribution has increased over the year with an average of 3M condoms distributed annually via public and private sector, NGO, female, Condom Vending Machines. Female Condoms were introduced during this period on a larger scale and recorded a high acceptance particularly among the FCSW. There has been an increase of Non -Traditional outlets (see below).

See condoms distributed in the indicator table below.

2.4.2 Increase the number of non-traditional outlets targeting high risk populations

The non -traditional outlets continued to function making condoms accessible to some of the hard to reach populations and persons at increased risk. The number of non-traditional condom outlets increased from 931 outlets in 2007 to 1079 at the end of 2010. The NAPS conducted several Stakeholder meetings with organizations working in the Hinterland Regions in efforts to scale up condom distribution. An enhanced condom distribution Strategy was determined and is currently being implemented.

Number of non traditional condom outlets: 2007-931 2008-1042 2009-1071 2010-1079

2.4.3 Develop monitoring and evaluation plan to assess impact of the interventions

The impact of the condom interventions are measured inherently in the BBSS for the target populations. Comparison between the two rounds of BBS shows that condom use at last sex improved among all groups as follows: CSW 46% (2004) vs 52.4% (2009), MSM 68.15% (2004) vs 79.9%(2009), military 19.8% (2004) vs 53.7% (2009), police 16.3% (2004) vs 28.5%(2009), in school youth 72.2% (2004) vs 73.2% (2009), Out of school youth 51.6% (2004) vs 71.2% (2009). Routine programme data is also used to monitor the programme and provided information that streamlined regional distribution. Mainly for community level interventions such as „PUT IT ON‟ campaign, an M&E component was developed and implemented to assess the effectiveness of the campaign.

2.5 Scale up the PMTCT Program

2.5.1 Strengthen service delivery capacity of PMTCT sites and expand geographic coverage at primary care facilities

The PMTCT Programme has been integrated within the Maternal and Child Health Unit expanded its coverage over the years, reaching a total of 165 sites at the end of 2010 in all ten administrative regions. Guyana has achieved universal access to PMTCT with more than 85% of the mother receiving ARV for the PMTCT. Guyana in 2008 DNA PCR testing for early infant diagnosis.

Number of PMTCT sites; 2007-110 2008- 134. 2009-157 2010-165 2011- 181 % mother receiving ARV : 2007-85.1% 2008-90.9% 2009-95.8% 2010-87.3% 2011-85.1%

2.5.2 Strengthen community mobilization and referral networks to include PMTCT

HIV testing uptake remained high over this period with more than 90% of pregnant women testing and receiving an HIV result. The PMTCT programme collaborated closely with the VCT programme and both VCT and PMCT counseling and testing curricula were revised. Significant public awareness was done through special campaigns on PMTCT that included PSA, radio announcements, Brochures, posters and others. In addition to women testing the PMTCT programme strongly advocated for both parents involvement and embarked on a male partner involvement programme. At the end o f 2010, 5.5% of partners were tested through a PMTCT setting.

Testing uptake 2007-97.6% 2008-95.5% 2009-89.8% 2010-93.7% 2011-94.8%

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2.5.3 Develop standardized system for monitoring and tracking

A curriculum was developed and used for training. SOP, Posters and other tools were developed to facilitate training of the health care workers and to ensure a high quality of care. A total of 748 health care workers were trained and retrained over the period from all ten administrative regions of Guyana. The PMTCT system comprises three reporting forms: the Maternity Ward (L&D) Monthly Monitoring Report, ANC/Postnatal Monthly Monitoring Report, and Laboratory forms. The M&E system is fully operational with reports coming in to the surveillance and the PMTCT departments. The data collection tools were revised and the HIV surveillance/notification form was also revised.

Health care workers trained: 2007-300, 2008-218 2009-132 2010-98 2011-306

2.5.4 Increasing the involvement of NGOs and CBOs in the PMTCT response

Guyana in 2008 introduced HIV DNA PCR testing for early infant diagnosis. The NPHRL developed the capacity for in house testing. The algorithm for DNAPCR testing was developed and revised in the second revision of the National guidelines for the management of adults and children infected with HIV. A total of 15 heath care workers were trained on HIV DNA PCR blood Collection The number of HIV exposed babies tested before the age of 18 months increased from 89 in 2009 to 159 in 2010 and to a further 213 at the end of 2011.

2.5.5 Strengthening PMTCT service delivery at labor and delivery wards

Services continue to be delivered throughout the healthcare setting with a significant proportion of ANC/PMTCT. Work continued and was intensified at all labour and delivery wards of the public hospitals and at several private hospitals in ensuring that all protocols were adhered. Health care workers were trained and retrained, SOPS were produced. Curriculum developed was revised to ensure that management is aligned to current evidence. .

Percentage of Babies tested HIV positive 2007-6% 2008-3.8% 2009-8.9% 2010-6.0% 2011-1.95 The Ministry has embarked on an elimination initiative for the mother to child transmission aligned to the outcomes of the HLM in June 2011 of Zero transmission by 2015.

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2.6 Reduce the vulnerability of OVC to HIV/AIDS

2.6.1 Mobilize additional CBO‟s NGO‟s to become involved in providing support to OVCs

OVC are being supported through the National Programme of the Ministry of Health, the Ministry of Human Services, partners such as UNICEF and CSO supported primarily through the PEPFAR and World Bank Programme. Support to OVC included support to package of minimum services for orphans and vulnerable children. The Ministry of Health in supporting OVCs has refurbished 25 orphanages, has trained a total of 44 children in various skill building exercises. In regards to CSOs funding was received to provide nutritional support through soup kitchens; uniform supplies; learning aids and other school supplies. CSOs also provided critical support to children HIV infected in monitoring Adherence on ARVs and in providing psychosocial support and home base care.

Persons trained in skills building: 2007- 10 children in hair dressing, dress making and cake decorating 2008- 12 children trained in hair dressing, dress making and cake decorating. 2009- 15 children trained in adolescent conflict resolution 2010- 7 children trained in quick meals preparations

2.6.2 Expedite and enact the legislation that protects the rights of the most vulnerable children and approve national policy

There are 14 + legislation dealing with the Rights of the Child/Child Care Protection. During the review period of 2007-2011 the following legislations were enacted or amended:

1. Juvenile Offenders (Amendment) 2007, 2009, 2010 2. Protection of Children Act 2009 3. The Sexual Offences Act 2010 4. Status of Children Act 2009 5. Childcare & Protection Agency Act 2009 6. Adoption of Children Act 2009 7. The Labour Act 2008

MoLHS&SS and MoH in collaboration with partners developed and instituted Minimum Operation Standards for institutional care and the formalization of foster care systems. The implementation of the minimum standards has been ongoing with ongoing support to the children‟s homes across Guyana for in creating a comfortable and enabling environment through infrastructure works, provision of amenities and supplies and others. Off the 29 registered children‟s home, a total of 25 benefitted from major infrastructure works. Further in supporting the minimum standards of engaging the children in quality recreational activities, many outreaches were organized for all children from the children homes in visiting the Guyana Museum, the National Zoological park. The children were also engaged in activities such as kite flying, sports etc.

2.6.3 Encourage the participation of key stakeholders from all sectors to ensure the provision of essential services, education, health care, birth registration etc.

Support to OVCs has been through the active involvement of all stakeholders. CSO organisations utilized their funding as noted above. Several other key initiatives were taken on board. A special initiative was dedicated to OVCs through the GT&T company in which the children of GPHC paediatric ward benefitted from the contribution of 5,000,000 G$. Over the last two years, the collaboration as achieved with the Guyana Medical Watch, an overseas medical team visiting Guyana during the summer holidays and providing medical services to several polulations. Over the last two years collaboration with this organisation resulted in 357 children from the orphanages ( 171 in 2010 and 186 on 2011) benefitting from medical services including dental services such as cleaning and filling. At end of 2010, registered in all 29 children‟s homes is a total of 1026 children of which 91.6% (940) attend school.

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The remaining 86 children not attending school falls into the categories of children who are too young to be in attendance or who have already completed school. The Radio Needy Children Fund (RNCF) has been a consistent partner in supporting the children of the treatment sites beginning from 2008 to current. The RNCF has sponsored the Christmas social for our infected children at the NCTC site and has provided Christmas gifts for all of the HIV infected children as follows- 2008- 152, 2009- 279 and 2010-256.

2.6.4 Involve children and youth as partners in designing and implementing HIV/AIDS interventions

Children and Youths are consulted at various stages in the development of messages for interventions targeting them. They are also involved in the implementation of some of these interventions such as the „PUT IT ON‟ campaign, „Me to You‟, Edutainment in the form of Drama in Schools among others

2.6.5 Strengthen the care and coping capacities of families and the community

25 orphanages were provided with furnishings and equipment 1,328 households with OVCs received free, external basic support 2,322 PLWHAs received economic support through the voucher programme 917 orphans/vulnerable children received support 517 people were trained in case assessment, child abuse issues, psychosocial support techniques, effective parenting skills and other areas of OVC care delivery NAPS has an Amenities Programme to complement the school uniform voucher programme provided by the MoLHS&SS.

2.7 Expand the VCT services

2.7.1 Design and implement operational strategy

The National VCT programme is well defined and operates under the key strategic guidance of the NSP. The work of the VCT programme is linked the strategies define in other related documents such as the BCC Strategy, the VCT guidelines, the Participant and trainer‟s manual and others. Guyana during the period under review scientifically tested the HIV testing algorithm and adapted it for Guyana‟s use. The algorithm utilizes parallel testing with a tie breaker in the event of discordant results.

2.7.2 Increase availability to a greater proportion of the population, with a special focus on service centers delivering care to high risk groups

With the introduction of VCT services in 1998, HIV testing became more accessible. The VCT programme is guided in its work by the National Steering Committee comprising of technical persons involved in the VCT programme. During the period of review the VCT programme expanded to ensure access to all administrative regions of Guyana. The number of sites increased from 5 pilot sites in 1998 to 75 fixed VCT sites at the end of 2010 and the number of testing accessed through the VCT programme doubled from 2007 to 2010. In regards to the high risk groups- targeted testing was done in the MARPS population of FCSW and MSM and the results are evident in the findings of the BBSS.

Number of sites: 2007-51 2008-62 2009-70 2010-75 Number of HIV tests done: 2007-48,573 2008-63,876 2009-85,554

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Access to testing measured by the % of persons ever having an HIV test in 2004 and 2008 shows an increase as follows CSW- 54.2% (2004) vs 85.2% (2009), MSM-43.85%(2004) vs 87.6% (2009), Police 40.6% (2004) vs 97.6% (2009), Military 55.8% 92004) vs 91.4% (2009) and out of school youth 17.6% vs 89.8%. All these persons having an HIV test the return rate for results improved with more persons in the target population knowing their HIV status as reported in the 2009 BBSS report: CSW- 93.6%, MSM-100%, Military-99.9%, Police-96.6%, In school youth- 93.5% and Out of school youth-96.9%. In specifically addressing the issue of testing among the MARPS, the National Steering committee in reviewing the recommendations for HIV testing focused on regular testing for this population. Further in targeting the population CSOs working with CSO has resulted in member of the population trained and certified as tester counselor and provided services to their population. In this regard a total of 20 MSM received training as VCT Tester/Counselors. Linked to the access to services for all populations, but moreso the most at risk populations is the existence of stigma and discrimination. This period has seen significant progress made in overcoming this as a barrier as health care workers were trained to provide services to these populations in an unbiased manner. A policy on stigma and discrimination was develop and facilities have signed on to the policy. Civil society organizations were funded to work with the population on issues of self confidence, internal sigmatisation and other related issues impacting on stigma and discrimination.

2010-93,532. 2011-106,491 In addition to VCT- HIV testing services were accessed through the PMTCT and Blood banking services with the cumulative annual testing as follows: 2007-67,681 2008-86,983 2009-105,030 2010-112,627 2011-127,910

2.7.3 Increase service uptake through community mobilization

HIV testing has increased over the years with testing become less stigmatized as evident in the increasing number of persons testing on annual basis and the openness in which persons seek the services. Over the years of this strategic plan community mobilization improved with more CSO bring on board testing programme and particularly for the MARPS populations. Further the National week of HIV testing (NWT) has seen the unparalled mobilization of all communities- the private sector, the media, the non health ministries, workplaces among others.

The results of testing during the NWT over the years are as follows: 2006-1,197, 2007-4,405, 2008-15,724, 2009-28,366 2010-35,771, 2011-45,198.

2.7.4 Improve QC and referral system

Quality assurance for counseling has formed part of the routine monitoring of the VCT programme with regular quarterly site visits and documentation of the findings. Quality assurance also included data verification and validation. In advancing the process a model developed by the AIDS Institute of New York State Department of Health called HIV QUAL international was adapted for the VCT programme ( VCTQUAL). This system is currently being finalized and would be piloted in 2012. Referral services from the VCT to care and treatment programme for persons tested has been strengthened during this period with the pilot of the case navigator system. The results of the pilot demonstrated the effectiveness of this approach and is under consideration for the expansion of a modified more cost effective version in the new planning period.

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2.7.5 Continually train and update skills for health care providers and laboratory staff according to National Guidelines

Curriculum for VCT – Counseling and Testing were developed. Facilitators‟ manuals and participants manuals developed. Monitoring and Evaluation System developed and fully functional. Infrastructural refurbishment of Sites and the establishment of new sites. All VCT sites adhere to National VCT Guidelines. Testor Counsellors were trained and certified by the National AIDS Programme using a standardized curriculum. Recertification of testor counselors occur on an annual basis. See indicator matrix below on the number of persons trained and retrained.

Continue training to ensure that there are skilled healthcare providers.

2.8 Reduce the vulnerability to HIV/AIDS through identification and treatment of STI/OIs

2.8.1 Increase the use of STI/OI services and early treatment-seeking for STIs and HIV/AIDS

The total number of sexually transmitted infections reported to the Ministry of Health Surveillance Unit increased annually over the last five years. This increase was attributed mainly to the strengthening of the surveillance system. In an effort to address the non HIV STIs in a more structured manner, a National Strategic Plan was developed for the period of 2011-2020 and in under implementation. Campaign to increase awareness and health seeking behavior for STI and OI developed and implemented. STI campaign aimed at raising awareness of STIs, risky behavior, signs & symptoms and general STI diagnosis, treatment and management was implemented at Mass Media, Community Level and Health care Service Provider Level. The development of relevant and appropriate messages targeting PLWHA that without treatment opportunistic infections mainly TB shortens the life of persons infected.

2.8.2 Train health care providers STI/OI management according to national guidelines

STI guidelines were developed, printed and disseminated. The development of the guidelines was guided by a sensitivity study and was an adapted version of the WHO guidelines using syndromic management. 429 persons trained in management of STIs according to national guidelines Refurbishment were done to clinical sites IEC materials were developed such as STI quick reference, brochures and others

2.9 Ensure safe blood supply

2.9.1 Maintenance of safe blood supply

All blood continues to be screened for infectious markers inclusive of HIV, syphilis, Hepatitis B and C, HTLV and others. The National Blood Transfusion Service (NBTS) adheres to the National External Quality Assessment Scheme for blood transfusion laboratory practice. The NBTS performs confirmatory tests for HIV and syphilis for all clinic facilities. There has been an annual increase in the number of units of blood collected and the proportion of those being voluntary donation. Over the reporting years an average of 7,500 units of blood is collected annually with close to 75% being through voluntary blood donations.

Total number of Units of blood collected: 2008-7500 2009-7700 2012-7595 2011-7930 Percentage voluntary donation- 2008-55% 2009-68% 2010-79% 2011-89%

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2.10 Implement plan to reduce health worker and community risk of HIV transmission through contaminated sharps

2.10.1 Provide a national policy to oversee injection safety in the public and private sector

A National policy for injection safety was developed and adhered to all health facilities. Additionally, protocols for the rational use of injectables were developed based on the findings of a comprehensive assessment. National coverage of medical facilities with safe injection practices has been achieved Safe injection training has been integrated into the training programmes of various Schools of Nursing, VCT, PMTCT and HPC. Key personnel, including waste handlers, Prescribers, pharmacists and physicians have been trained in the standards and correct practices for injection safety and waste management. Retractable syringes were introduced in several high risk settings to further minimize the risk of transmission of blood borne diseases.

2.10.2 Build competency of health workers to provide injections and dispose of sharps according to standards

Health care workers and workers involved in the disposal of medical waste were trained in the appropriate disposal of waste. Worker safety was enhanced by providing personal protective gear and pre-exposure vaccination. A new hydroclave system has been procured and set up at the GPHC to ensure the safe disposal of biomedical waste at the Georgetown Hospital and its environs.

2.10.3 Build competency of waste handlers to dispose of waste according to safe waste management standards

Training was conducted to increase knowledge of disposal of sharps according to the safe waste management standards. A needle remover and sharps barrel was introduced to minimize the amount of infectious waste. All clinical sites are furnished with biohazards containers and needle removers.

2.10.4 Advocate for rational use of injections

Training in injection safety covers administering injections according to standards, ensuring proper disposal, continuous supply, and proper care for sharps injuries as well as rational use of injections.

2.10.5 Reduce demand for injections among patients and community members

The training of Community Health Workers involves them educating/encouraging community members/patients to use oral medication and to have injections only when necessary. The use of injection safety posters was used to reinforce messages and demonstrations were done in front of patients in the form of cutting the needle and disposing same in the safety box. An example of community success of this programme and the understanding of injection safety by community members was the building of a „burn box‟ funded by community members to safely dispose of injections.

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 1

Percent of young men and women aged 15- 24 who have had sex before the age of 15

44.00% - NA 41.00% NA - 21.40% - - 191.60% Source of Data: BBSS 2008/2009. BBSS is conducted every 4-5 years: New target for 2013 is 20% for OSY

PV 2

Percent of youths aged 15- 24 reporting use of a

61.6 Females

- NA 67% NA - 81% - - 120.90% Source of Data: BBSS 2008/2009. Type of Indicator: not cumulative

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

condom during last sexual intercourse with a non- regular partner

67.6% Males

81% is for non- transaction al sex partner. The BBSS asked for paying and non-paying partners and not non- regular. New target for 2013 is 75% for OSY

PV 3

Percent of persons aged 15- 49 expressing accepting attitudes towards people with HIV/AIDS

19.4% Females1

9.5% Males

- - 40% NA - 20.1%: Females 23.9%:

Males

- - 55%

Source of Data; DHS Report. DHS is conducted every 5 years hence the New target for 2013 is 75% for OSY

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 4

Percent of young people aged 15- 24 who correctly identify ways of preventing the sexual transmissi on of HIV and who reject major misconcep tions about HIV transmissi on

35% - - 63% NA 51.10% - - 81.10%

Source of Data: DHS 2009 DHS is

conducted

every 5

years

New target

for 2013 is

70% for

OSY

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 5

Number of condoms distributed by the public and private sector in the past 12 months (,000s)

2,261 3,000 2,715 3,300 2,350 3,630 2,573 3,993 4,881 4,392.30 2701.02 83.1% Source of Data: NAPS Programm e records, MMU programm e records and private sector records.

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 6

Number of targeted prevention programs for most at risk population s (MARPS)

- 3 (CSW,

MSM,

Youth,

PE)

3 4 3 5 4 5 4 5 8 160%

Target programs exist for MSM, CSW, In- school youths, Out of school youth, Military, Police, Miners, and Prisoners Source of

Data:

MARPS

Programm

e Records.

Cumulative

PV 7

Percentage of most at risk populations (sex workers, men who have sex with men, mobile populations, and other vulnerable groups) who reported using a condom during their last sexual encounter with a regular or non-regular partner

% CSW reporting use of

89.3% client 46.0%

- - 83% 94.20% - - - - 113.50% BBSS is conducted every 4-5 years

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

condom at last intercourse

non- paying partner

Source of Data: BBSS 2008/2009 Report and Secondary Analysis on the dataset.

% MSM reporting use of a condom at last intercourse

68.1% regular partner 83.8%

commerci al partner

- NA - 72% 79.9% regular partner 84.2%

commer cial

partner

- - - - 87.70%

BBSS is conducted every 4-5 years Source of

Data:

BBSS

2008/2009

Report and

Secondary

Analysis

on the

dataset.

% Miners reporting use of a condom at last intercourse

NA - NA - NA - NA 89% NA 95% NA

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 8

Number of service outlets that offer PMTCT services

94 110 110 130 135 150 157 175 165 190 181 95.30% Source of Data: PMTCT Programm e Report/rec ords. Type of Indicator: cumulative

PV 9

Number of pregnant women who receive HIV counseling and testing for PMTCT and receive their results

11,731 12,035 12,004 12,325 14,337 12,615 10,046 12,905 10,794 94.80%

Source of Data: PMTCT Programm e Report/rec ords. Type of Indicator: not cumulative

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

% of pregnant women who were tested for HIV and received test results and were counseled

85% (12,900 /15,180

)

93.7% (11,635/ 12,415)

90% (13,000/ 14,444)

94.8% (13490/1 4234)

107.80%

Indicator was modified to read as a percentage at last target setting Exercise

PV 10

Percentag e of HIV infected pregnant women who receive a complete course of ARV prophylaxi s as part of PMTCT

63% 80% NA 82% 95.80 %

85% 91.00% 95% 82.70% 98% 64.80% 94.20% Source of Data: PMTCT Programm e Report/rec ords. Type of Indicator: not cumulative

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 11

Number of Health Care workers trained in the provision of PMTCT according to National guidelines

197 150 300 130 218 110 132 150 98 130 306 157.50% Source of Data: PMTCT Programm e Report/rec ords. Type of Indicator: not cumulative

PV 12

Percentag e of babies born to HIV positive women who are tested before the age of 18 months

74 tested at 18 mths

0% 116 Actual

Numbe

r

provide

d

90% 89 90% 234 Actual

Number

provide

d

95% 97.40% 98.00% 80.70% 86.20%

Actual Numbers used where Denominat or not available. Source of

Data:

PMTCT

Programm

e

Report/rec

ords. Type

of

Indicator:

not

cumulative

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 13

Percentag e of OVC whose household s received free basic external support in caring for the child

NA - NA 60% NA 70% NA 45% 1,328 45% 373

Denominat or not known, so percent cannot be calculated. Source of

Data: OVC

Programm

e

Report/Rec

ords. Type

of

Indicator:

not

cumulative

PV 14

Number of providers/c are takers trained in the provision of OVC

253 200 182 200 205 200 124 200 173 200 127 81.10% Source of Data: OVC Programm e Report/Rec ords. Type of Indicator: Not Cumulative

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Priority Area 2: Reducing Risk and vulnerability to HIV Infection

Table 10: Summary of Priority 2 targets and indicators 2007-2010 (Prevention PV)

INDICATO RS

Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achieveme

nt:2007- 2011

Remarks

2006 Target Results Target Result s

Target Results Target Results Target Results

PV 15

Percent of transfused blood units in the public and private sector in the last 12 months that have been adequately screened for HIV according to national guidelines

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Source of Data: Blood Bank Programm e

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SECTION FOUR:

IX: PRIORITY AREA 3: CLINICAL AND DIAGNOSITIC MANAGEMENT AND ACCESS TO CARE

TREATMENT AND SUPPORT.

Strategic Objectives

1. Increase access to diagnostic management and comprehensive treatment, care, and support in

an enabling environment

2. Strengthen the service delivery system to provide uninterrupted supply of medications and commodities

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Table 11: Summary of Programmatic Achievements- Priority Area 3

Broad Strategic Programme Areas

Strategic Areas Activities/Achievements Additional Comments

3.1 Expand access to ARV treatment to scale up the response

3.1.1 Strengthen existing treatment sites and expand the number of treatment

The number of ART treatment sites over the years has increase to ensure coverage in all ten administrative regions of Guyana with the hinterland regions served by a mobile unit. All treatment sites were strengthened to ensure a multidisciplinary approach to the management of persons living with HIV and AIDS. Physical infrastructure were enhanced, equipment were provided (BP apparatus, X-ray view boxes, stethoscope etc) , health care workers were trained and retrained. Details provided in the section below. The epidemiological profile of the national HIV care and treatment programme as at the end of December 2011, revealed that there are 4612 persons actively enrolled in the national HIV/AIDS care and treatment programme, of which 3432 persons are actively receiving antiretroviral therapy, 201 are children (females 97, males 104) which represents approximately 78 percent of the estimated number of PLHIV in Guyana. . Females accounted for 57% of all persons actively enrolled in the national programme, while the distribution on Pre ART and ART is 60% and 55.3% respectively .There are 1180 persons In Care (Non Art) of which 41 are children (females 23, males 18), while the distribution of adults In Care are 453 males and 686 females.

The national cohort report for the period January-December 2010-2011 reveal 534 persons were initiated on ART in 2010 with males accounting for 51.5% of the entire population. There twelve months survivability outcomes reveals that 80.4% are still alive and on treatment, females 0-14, 85.7% and 15 + females 83.8% while 15 + males 76.9% and 0-14, 80% .The overall mortality is 8.7% while lost to follow (LTF) account for 9.6%.

70% of adult‟s are receiving a standard first line regime of Truvada/ Efavirenz while 24.1% receives Truvada/ Nevirapine. 33.3% of pediatrics in the national programmme receives the combination of Dimune+Nivirapine while 19.8% are on Dimune + Evavirenz. 9.6% of the total adult‟s patient populations are on second line regime compared to 10% of all children. The National Care and Treatment Centre and Saint Joseph Mercy Hospital accounts for 56.7% of all patients enrolled in the national programmme. Region # 4 accounts for 78.4% of all persons on ART.

3.1.2 Standardize guidelines and protocols for care and treatment

National HIV guidelines for the management of HIV infected adults and children and for the management of Opportunistic Infections developed in 2004 were revised in 2006 and 2010.

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Many supporting tools were developed in aiding clinicians and the clinical team and included standard operating procedures, quick references etc. A patient monitoring system developed using the generic PAHO system is fully implemented and integrated within all sites. To monitor prescribing practices and adherence to guidelines, the ADT-Anti retroviral Dispensing Too was introdcuedl: This system is a Microsoft Access based computer software package that is used for the monitoring of pharmaceuticals. This programme is installed at thirteen of the sixteen treatment sites. It provides the utility for tracking and monitoring of drugs consumption, identifying defaulters, provides data for quantification and subsequent ordering of drugs.

3.1.3 Strengthen technical capacity of health care workers in delivering comprehensive care to PLWHAS

A multi-disciplinary team is in place with a holistic approach towards care. The team consists of HIV Clinicians, Nurse, Home Based Care (HBC) Nurse, Pharmacist, Data Entry Clerk, Social Workers and Out Reach Workers in addition to other supportive and administrative staff. Significant number of health care workers were trained and retrained on the HIV guidelines. Additionally specialized training modules were developed for targeting physicians. A more specialized Clinical mentoring programme for physicians was developed using a 11 module curriculum. With this programme 13 physicians were trained and certified. A specialized programme was also developed for medexes. Several medexes were from the hinterland regions of 1,7, 8 and 9 as the programme begins to transition its HIV mobile treatment services to the regional health services. There has been training done through various agencies e.g. FXB, I-Tech along with the CMP for physicians trained through FXB. This also includes training done through the HBC programme for which training targets have been surpassed.

Number of health care workers trained and retrained: Total 1237 2007- 200 2008-325 2009-207 2010-396 2011-109

3.1.4 Establish public-private partnership in treatment and care

The public-private partnership has been established. This is noted with the establishment of ST. Joseph Mercy Hospital and Davis Memorial Hospital services as treatment sites. In addition, the management of patient at the Bartica Hospital With a focus towards the sustainability the private sector engagement has been critical in the provision of nutritional support to persons living with HIV. The Private Sector support to the Food Bank accounted at the end of 2011 for 25.5% of the needs and is described in more details under priority area one dealing with public- private partnership.

The private hospitals involved in treatment is fully integrated with the overall Ministry‟s response particularly in regards to prescribing practices according to guidelines, the quality of care for patients and in the monitoring and reporting.

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3.1.5 Establish network of PLWHA Support groups

The PLWHA Support groups have been established for 11 care and treatment sites in 6 regions of Guyana. All coastal regions except regions 1, 7, 8 and 9. The network of support groups were established to enhance the well being and coping mechanisms of members of the various groups. Members are offered psychosocial and economic support. Skills based training programmes to support income generation as well as knowledge sharing and increased HIV awareness and education are provided.

National programme now promoting the self- sustainability of these support group programs.

3.1.6 Develop National Treatment and Care communications strategy

Although the formal document has not yet been developed, these areas have been covered in other documents such as the BCC strategy, the Home base care strategy, the stigma and discrimination policy and others. In the implementation of the BCC strategy, issues affecting , PLHIV who were identified as a priority group, were addressed through several mass media and other forms of communication. PSA announcements were designed, developed and disseminated to address adherence, early treatment, disclosure and others. Other communication channels used included posters, brochures, patient education sessions.

.

3.1.7 Strengthen human capacity to scale up the care and treatment response

The human capacity has been strengthened at various levels: In service training at the medical school, nursing school, medexes programme, pharmacy programme, CHW programme and others. Capacity has been strengthened through a number of training within the inservice arena. Highlights of these are captured in other sections of the report. A specialized Clinical mentorship programme was introduced with clinicians engaged in a comprehensive training at an inservice level. Medexes were trained to ensure the continuity and sustainability of the ART programme in the hinterland regions of 1,7,8 and 9. The Guyana-Cuba partnership has produce medical doctors for the health sector; they were exposed to extensive HIV/AIDS clinical didactic and practical session and has subsequently assume post at care and treatment centers, thus enhancing our local capacity to manage HIV/AIDS. Continuous training of members of the multi-disciplinary team has been ongoing with technical support from agencies such as FXB.

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3.1.8 Develop and implement national adherence strategy

Although there is no formal national adherence strategy, this aspect of the programme has been addressed in a number of ways. In the implementation of the BCC strategy, several specific campaigns were developed on adherence and included PSAs, posters, brochures . Additionally, general patient education sessions almost always dealt with this. Special sessions on adherence are part of the package that social workers are mandated to cover with all patients and group counseling on adherence has been introduced as a novel approach in some clinics. A manual in adherence that proposes individual case management was developed and would be introduced under the next strategic plan.

3.2 Create Centre of Excellence at the GUM clinic and GPHC

3.2.1 Upgrade the facility to provide specialized care and serve as a referral centre

The NCTC as the centre of excellence has the capacity to provide specialized care and treatment services, as well as providing training for HCWs. The NCTC has be strengthened to serve in that capacity through training of key clinical staff and supporting staff. The Multidisciplinary team of the Center is now well established and fully staffed to provide optimal care. The Center provides technical support to other clinical sites across the country in the review of cases, the mentoring of physicians and in the determination of movement of patients from first to second line therapy.

3.2.2 Design and implement Continuous Quality Improvement (CQI)Programme for the Centre

HEALTHQUAL Guyana Project was established in collaboration with the New York State. A system developed is now fully integrated and has completed the second wave of data collection; data would be analyzed to guide quality improvement activities. The first data extraction and audit was at 22 pilot sites regionally. The Project will facilitate the development of sustainable quality improvement activities through capacity building and capability for quality improvement. Quality Improvement Committees are established at clinical sites. These committees review and analyse their site specific data and design and develop quality improvement projects. The National Patient Monitoring System is implemented at all care and treatment sites regionally. It is seen as an important part of high quality patient care. The period under review saw the first Client Satisfaction Survey (CSS) being conducted at HIV and TB sites throughout the country. The CSS saw high levels of satisfaction reported for the health facility, health staff and health services.

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3.2.3 Upgrade technical capacity of the multidisciplinary team to provide specialized care in HIV/AIDS

Training was conducted for all category of health care workers. Persons were trained and retrained on the HIV guidelines and management of patients, on the management of opportunistic infections, paediatric management. Training was also done through continuing medical, nursing and pharmacy education. Specialised training was conducted for clinicians and medexes. A core group of persons were trained as trainer of trainers in conducting nutritional assessment. Training for supportive functions was also were conducted on counseling, adherence, and others.

3.3 Establish a quality home based and palliative care programme providing support to PLWHA and those affected by HIV/AIDS

3.3.1 Develop and implement a national HBC strategy for PWLHA and those affected by HIV/AIDS.

HBC Strategy has been developed and implemented with the major objectives of empowering individuals, families and communities. It addressed the reduction of stigma and discrimination, the streamlining of the client referral system, the facilitation of quality community care and mobilization of the resources necessary for the sustainability of the service. The strategy was fully implemented.

3.3.2 Strengthen and expand home-based care services for PLWHA and those affected by HIV/AIDS

HBC programs have been expanded and are presently available at the main care and treatment sites covering 7 administrative regions with 22 service outlets. A hospice for step down care was established and provides this service. Specialised home base care nurses serve the programme. These nurses were trained in home

base care and as facilitators/trainer of trainers in HBC. All Home Base Care Volunteers were

trained and retrained over the period.

Members of the general public who expressed an interest in home base care and families of

persons living with HIV were also trained.

All volunteers and HBC workers are optimally furnished with supplies and consumables

needed to effectively provide the services.

3.3.3 Establish network of Home Based Care Volunteers

A network of volunteers is established. This network remains robust through the facilitation of lessons sharing sessions and case presentations. A network of HBC nurses is also established comprising of the nurses at the clinical sites and at the NGOS. This network has facilitated easy and coordinated referral and management of cases. The robustness of the network is demonstrated at regular quarterly feedback meetings where referrals and cross referrals and other programmatic and clinical management issues are discussed.

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3.3.4 Establish public private partnership in Home Base Care

The establishment of the Hospice/Step down care has been a model private public partnership under home base care . This imitative was started by CRS with the MoH providing support to capacity building and other areas of support. Collaboration on HBC was significant with other agencies such as GHARP I and GHARPII and the 9 NGOs providing HBC services.

3.3.5 Strengthen the technical capacity of HBC workers in providing quality care

All HBC workers including HBC nurses and volunteers were trained and retrained using a standardized curriculum.

3.3.6 Establish National referral system for Home Base Care

A national referral system has been established clearly linking the services and referrals for patients between the clinical sites and the NGO providing HBC services. As part of the referral and monitoring system, standardized referral and additional related forms are utilized.

3.3.7 Strengthen the capacity of the volunteers in providing HBC services

Linked to previous notes in immediate section above, volunteers are trained and retrained using standardized curriculum. Additional training indirectly related to HIV home base care issues were also added to the training the volunteers received. These included mental health, substance use, chronic diseases and others. Other avenues for capacity building were also used such as case discussions.

3.4 Provide psychosocial care and support to PLWHA and those affected

3.4.1 Increase the number of social service programmes available to PLWHA and those affected

A wide range of services were provided to PLHIV. Programmes implemented during the period included the voucher programme where eligible persons were provided with economic support. As of December 2010, 49% of persons on treatment (1500/ 3037) were benefiting from this program.

PLHIVs received psychosocial support through the routine services of the treatment. More specialized support is provided through the network of support groups established at 11 care and treatment sites in 6 Geographic Regions.

Nutritional support programmes also were implemented mainly through the food bank initiative and through CSOs. The details of support from the food bank are noted in sections above. Several capacity building sessions were conducted in strengthening nutritional support to PLHIV. Health care workers with a focus on senior nurses, medexes and social workers were trained as trainer of trainers in conducting nutritional assessment and follow up for PLHIVs.

Prevention with Positive programme was initiated , with a manual and training curriculum develop.

Significant support was provided to the children‟s institutions for children infected and affected through the school amenities programmes. All children of school going ages and children infected attending treatment sites have received this support.

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The PLWHA Support groups have been established for 11 care and treatment sites in 6 regions of Guyana. A specialized support group was established to address issues affecting adolescent living with HIV. The members of the support groups benefitted from facilitated technical discussion and from a variety of skills building training. Training ranged from basic literacy to computer studies, from carpentry to masonry and others. A special initiative launched with the MoH, WB, Ministry of Housing , Food for the Poor and Habitat for Humanity resulted in a number of PLHIVs accessing house lots and home provided to PLHIVS. PLHIV‟s eligible for also received economic support in the forms of a monthly voucher value at the current public assistance value.

3.3.2 Establish referral network for psychosocial support

Referral network has been established and is an effective and efficient two-way process of linking a client from one health care service to another. It is not only functional for psychosocial support but is functional in other care aspects and is essential to ensure continuity of care.

3.4.3 Encourage public private partnership

Private public partnership has been developed and continues to be strengthened over the period. See details in related section above.

3.5 Design and implement institution training programmes for HIV/AIDS treatment, care and support

3.5.1 Develop and implement curriculum for pre-service HIV training programme and post- graduate training programmes at central and regional levels for the multi-disciplinary team

Work commenced through ITECH collaborating with University of Guyana and the Ministry of Health, Health Sciences Unit in reviewing the existing curricula. Further work was done in

updating the HIV materials in these curricula. Specialised training using these curricula were conducted for pharmacist, medexes, physicians and other categories of health care workers.

3.5.2 Review, revise and implement curriculum of graduate training programmes

3.6 Expand comprehensive care for opportunistic infections

3.6.1 Strengthen clinical care for opportunistic infections at present sites and expand to new sites

The management of opportunistic infections has been standardized and is in place at all HIV sites. Physicians and other members of the clinical team have been trained in the, management of IS based on standardized guidelines. Special emphasis was placed on the management of TB/HIV co-infection, see related section below. Tools were developed and disseminated at sites – brochures, documentary and other IEC materials. The laboratory diagnosis for opportunistic infections was enhanced and the NPHRL now has diagnostic capabilities for toxoplasmosis, Hepatitis B and C, tuberculosis and others.

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3.6.2 Revise/review protocols for opportunistic infections

The protocols for opportunistic infections were developed as part of the National Guidelines for the management of adults and children infected with HIV. These protocols developed in 2006 were revised in 2008 and 2010 and were distributed to all physicians and members of the clinical team. Additionally, aids were developed and distributed to facilitate easy use of the protocols.

3.6.3 Develop national communication campaign for treatment and care

Several national Communication campaigns were developed on the following issues linked to care and treatment:

1. Adherence 2. Home Base Care 3. Opportunistic Infections. 4. Disclosure. 5. Tuberculosis. 6. Sexually Transmitted Infections. 7. Others

3.7 Strengthen the link between the TB and HIV/AIDS/STI control programmes

3.7.1 Support increased screening for TB among HIV positive patients

Screening for TB among HIV positive patients was done using the WHO symptom screen and the TST at base line and annually. Health care workers at HIV sites were trained in the administration and read off of TST and are currently conducting the screening at HIV sites. The National TB Programme also continues to screen all persons for TB including HIV persons.

3.7.2. Improve training programme for staff

There has been significant training of staff during the period. In service training curriculum were developed for TB/HIV and for Sexually transmitted infections (Please see related sections above on STIIs). All levels of healthcare workers were trained including physicians, social workers, nurses, pharmacist, outreach workers, Dots Workers.

3.7.3 Improve facilities and logistical support

Facilities, particularly clinics have been improved to enhance infection control. Refurbishments and reconstruction were configured to facilitate optimal air flow and other needed dimensions for infection control. The reconfiguration of these facilities also ensure other functions were incorporated including enhanced privacy, patient flow, laboratory and pharmacy efficiency and others. A draft infection control policy was developed and is in the process of being finalized. Additionally, a National Infection Control Committee is being formed with hospital specific infection control boards.

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3.7.4 Support increased screening for HIV among patients with TB

All TB patients are required to be screened for HIV. The National TB programme has incorporated this guideline into its day to day functions with VCT sites established at Chest Clinics or at a minimum within close capacity. This has led 93% screened at the end of 2011 and represented an consistent increase over the five years period.

3.8 Implement activities to increase use of quality STI/HIV/AIDS diagnostic and treatment services

3.8.1 Strengthen STI services to provide comprehensive care and syndromic management for STI

STI services continued mainly as syndromic management. Over the years however several hundred of health care workers were trained and retrained using as standardized developed STI in service curriculum. Clinical sites provided syndromic management and some sites linked to HIV management provided etiologic diagnosis based on smear results from the site. The vast majority of patients were managed based on syndrome and parnter notification and contact tracing were done. Guidelines were developed and disseminated for use. A number of supporting tools such as a quick reference, posters, brochures, PSA (TV and Radio) and other IEC materials were developed and disseminated.

3.8.2 Expand the pool of health care workers trained in syndromic management

There has been technical capacity building of health care workers on syndromic management using a training curriculum. ( see notes above)

3.8.3 Review, update and disseminate guidelines, protocols and training, material for STI management in both the public and private sectors

Guidelines were developed, adapted from WHO guidelines for syndromic management and considered the findings of the STI study. The guidelines were used to train physicians and other members of the clinical team. Supporting materials were also developed and distributed including quick reference, posters, brochures, PSA (TV and Radio) and others. These were made available to both public and private sectors.

3.9 Upgrade laboratory capacity to diagnose and monitor HIV/AIDS and associated opportunistic infections

3.9.1 Upgrade GPHC‟s facility to undertake additional laboratory test for HIV, haematological, TB, STI, Biochemical, immunological markers and diagnosis of opportunistic infections

Georgetown Public Hospital (GPHC) , Central Medical Laboratory (CML) was strengthened through procurement of key laboratory equipment. Additionally in support of the functions reagents and consumables were acquired on a regular basis. Laboratory staff was received appropriate technical capacity building.

3.9.2 Strengthen regional labs to conduct quality diagnosis of HIV and opportunistic infections and for treatment and monitoring

There is some regional capacity to conduct quality HIV testing but this is not available in all regions. Quality assessment of testing primarily done through the NPRHL.

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3.9.3 Finalize and implement Lab Strategic Plan

A Laboratory Strategic Plan ( SPL) has been drafted and finalized for the period of 2011- 2014.

3.9.4 Enhance GPHC‟s capacity to serve as a QA/QC/QI site for tests

Capacity was strengthened at the GPHC CML. This function was however quickly transitioned over to the NPHRL established in 2008.

3.9.5 Train laboratory staff to use specialized methods for diagnosis and monitoring of HIV/AIDS and related issues at the post graduate level

Technical capacity was built with laboratory staff in very specialized fields including TB diagnosis (culture) , toxoplasmosis diagnosis and others.

3.10 Establish National Public Health Reference Laboratory

3.10.1 Construct national reference laboratory

The NPRHL was constructed and commenced functioning in the second quarter of 2008. Since its opening, the NPHRL has expanded its diagnostic and monitoring scope.

Strengthen the capacity of the quality assurance monitoring committee

Quality Assurance (QA) is led by a specialized department within the NPHRL. The dry tube specimen model recommended by CDC was adapted for the local context and is currently in use for QA of HIV testing. The NPHRL conducts internal QA through a quality management implementation system which entails regular audits and controls. External QA is also conducted with an International laboratory using the Digital Proficiency test (DPT)

3.10.2 Review/update systems for certification

The NPRHL has achieved local accreditation through the Bureau of Statistics Guyana and has maintained this. The NPHRL has commenced preparation for the International accreditation.

3.11 Procurement and distribution of care and treatment supplies improved (commodities management)

3.11.1 Establish inter-agency collaboration to expedite the process of procurement through the MMU

A National Procurement Oversight Committee (NPOC) was established and functions at the level of the Ministry of Health with the Minister of Health as the Chair of the Committee. The NPOC served as a coordinating mechanism for dealing with all technical procurement issues such as quantification and forecasting. The NPOC also addressed policy and other issues. A Joint Donors Group (JDG) comprising of all partners involved in the procurement for the HIV programme was established and met on a biannual basis. The JDG involved the Global Fund, The US Government (PEPFAR And USAID), the IDM, WB , EU and the MoH. The group addressed coordination of procurement among all donors.

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3.11.2 Strengthen the management and monitoring capacity of the MMU (Commodities Management)

Significant capacity building of the staff of the Materials management Unit (MMU) was achieved. Senior staff received specialized training on procurement and on warehouse management. Additionally there has been ongoing capacity building through mentoring by technical officers of the Supply Chain Management Systems ( SCMS) office. Capacity was also built in inventory systems, in forecasting and quantification. A logistic management system developed and introduced is being strengthened and would allow for accurate reporting and requisitioning of supplies from the primary health care setting to the Central MMU level. At HIV treatment and care sites, the ARV dispensing tool was introduced and strengthened allowing sites to closely monitor the stock levels and therefore make timely requisition avoiding situations of stock outs.

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Priority Area 3: Clinical and Diagnostic Management and Access to Care, Treatment and Support

Table 12. Summary of Priority 3 targets and indicators 2007-2011 (Care, Treatment and Support CTS)

INDICATO RS

Baseli ne

2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % Achievement:20

07-2011

Remarks

-2006 Target Result s

Targe t

Result s

Targe t

Result s

Target Result s

Target Result s

CTS1 Percentage of women, men and children with HIV infection receiving ART who are eligible according to National Guidelines

1,569 70.00 %

60.60 %

80.00 %

72.70 %

85.00 %

83.50 %

90.00% 71.80% 90.00% 77.20 %

88.30% Source of Data: Treatment & Care Programme reports. Denominator is based on UNAIDS estimates

CTS2 Number and Percentage of Regions with at least one outlet providing ART services following National Standards

10 (100%)

10 (100%)

10 (100% )

10 (100 %)

10 (100% )

10 (100 %)

10 (100% )

10 (100%) 10 (100%)

10 (100%) 10 (100% )

100% Achieved

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CTS3 Number of Health Care Workers trained on ART delivery according to National Guidelines

189 150 200 165 325 180 207 195 396 210 109 137%

CTS4 Percentage of general population aged 15-49 receiving HIV test results in the past 12 months

11.3% Female

s; 10.3% Males

12% 12.60 %

13.80 %

9.00% - 24.8% (DHS surve

y)

- - 85.1% DHS is conducted every 5 years

CTS5 Number of individual trained in the provision of VCT according to national Guidelines

71 95 96 111 125 117 137 420 330 440 333 96.30% This includes newly trained Counselor/Test ers (287) and those who underwent Refreshers’ training (43). Source of Data: VCT Programme Report/Record s. Type of Indicator: cumulative

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*Includes Refreshe

rs‟ Training

CTS6 Number of Regions with Service Outlets that provide HPC

6 7 6 8 6 9 7 10 7 10 7 75.70% Source: HBC Programme Reports

CTS7 Number of Service Outlets that provide HPC

18 19 19 20 20 21 21 22 22 23 21 98.30% Source: HBC Programme Reports

CTS8 Number of persons trained to provide HPC according to National Guidelines

66 50 310 100 210 100 140 120 182 145 112 239.80% Source: HBC Programme Reports

CTS9 Number of adults and children receiving HPC following National Standards

1,026 1,050 1,160 1,100 1,276 1,150 826 918 1,189 Source: HBC Programme Reports.

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CTS 9 (a)

Number of adults and children receiving HIV related care and support according to National Standards

4,055 5,600 4,213 7,200 4,612

<18yrs:2,1

00

<18yrs:2,7

00

Programme Data is

disaggregated

as <15 years

and 15+ years,

hence the

disaggregation

required is not

available

CTS1 0

Percentage of men and women with STI at health care facilities who are appropriatel y diagnosed, treated and counseled

- 853.00 %

NA 85.00 %

NA 55.00 %

100% 65.00% 100% 75.00% 100% 156% Source: STI Programme reports

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CTS1 1

Number of Persons trained in the manageme nt of STI according to National Guidelines

82 200 84 200 NA 200 145 160 210 200 217 88.60% Source of Data: STI Programme Report/records. Type of Indicators: not cumulative

CTS1 2

Percentage of eligible HIV positive registered TB patients given ART during TB treatment (modified)

- - 97.00 %

90.00 %

92.00 %

90.00 %

93.00 %

95.00% 91.00% 95.00% 88.00 %

98.5% Source of Data: TB Programme Records. Type of Indicator: not cumulative. For the period Jan- March2011:74 persons were trained; April- September 2011: 123 persons were trained.

CTS1 3

Percentage of registered TB patients tested for HIV

81.90% 83.00 %

80% 100% 83% 100% 89% 90% 90.00% 90.00% 92% 94.1% Source of Data: TB Programme Records. Type of Indicator: not cumulative

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CTS1 4

Percentage of patients on ARVs who receive regular Cd4 monitoring following ARV national treatment guidelines

NA 80% NA 90% 82.90 %

90.00 %

- 92.00% 78% 92.00% NA 88.40% Result from the HEALTH QUAL report for the period 1st July 2009 – Dec 31st 2009 for 15 care and treatment sites. Based on a sample size of 1,198 persons.

CTS1 5

Number of Regional Labs with capacity to perform CD4 tests following National Standards

3 3 3 4 2 4 - 5 3 5 3 67.50% Source of Data: NPHRL Programme Records. Type of Indicator: cumulative.

CTS1 6

Number of Persons trained to conduct CD4 testing according to National Guidelines

NA 5 2 7 1 9 NA 14 11 15 1 34.90% Source of Data: NPHRL Programme Records. Type of Indicator: not cumulative.

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SECTION FIVE:

X: PRIORITY AREA 4- STRATEGIC INFORMATION

Strategic Objectives

1. Increase local capacity to design and implement surveillance, monitoring and evaluation, special

studies, surveys and research on HIV/AIDS according to national and international guidelines.

2. Strengthen capacity at the national and regional levels for the collection and use of data for

decision making, planning, implementing, monitoring, and evaluating the local response to

HIV/AIDS

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Table 13: Summary of Programmatic Achievements-Priority Area 4.

Broad Strategic Programme Areas

Strategic Areas Activities/Achievements Additional Comments

4.1 Strengthen the HIV/AIDS surveillance systems

4.1.1 Review and update existing protocols and guidelines for HIV/AIDS surveillance

The existing HIV case-base surveillance form has been reviewed and updated to meet the new WHO clinical staging criteria. The reviewed system is being piloted and would be fully integrated under the new NSP. An electronic database has been developed to capture this information and would be implemented in collecting and analyzing the surveillance data. Health care workers were trained on the revised HIV surveillance forms as well as epidemiology nurses of the surveillance department.

4.1.2 Employ and train staff at national and regional levels to conduct HIV/AIDS surveillance

Health care workers were trained on the revised HIV surveillance forms as well as epidemiology nurses of the surveillance department. 75 MOH staff from various regions trained in basic M&E; including NAPS staff.

M&E head of unit trained in Routine Data Quality Assessment (RDQA) and conducted a mini training

with some coordinators.

Staff of the Ministry of Health and the NAPS were trained in the use of SPSS, basic Epi Info and

advanced Epi-Info and on basic and advance research skills.

12 social workers in the OVC programme were trained in data quality management.

4.1.3 Regionalize the HIV/AIDS surveillance system

There have been some advances made in regionalizing the HIV surveillance, however this was limited to only Regions 3 and 6. Working in ongoing to ensure that this continues.

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4.1.4 Conduct regular sessions for the review of surveillance and other data with key stakeholders

Regular sessions of HIV surveillance data to review findings are held with stakeholders. Within the MoH /NAPS sessions are held with technical staff as well as with all TWG. Of special importance are the meetings of the MERG. Other specials sessions are also held and includes the dissemination of the reports on universal access, UNGASS elimination initiative reports and others. These sessions usually involves a wider stakeholder. The NAPS Annual reports and the MoH surveillance report are widely disseminated and can be found on the MoH and HIV websites. All other HIV related data gathered and reported on is usually disseminated through the channels listed above, for example the Client Satisfaction Survey, the HIV Sustainability Assessment.

4.1.5 Prepare and disseminate regular reports of results of HIV/AIDS surveillance

Please see section above 4.1.4

4.2 Develop and implement a system for monitoring and evaluating the response to HIV/AIDS

4.2.1 Develop and disseminate a national M&E Plan

A National Monitoring and Evaluation Plan was developed to measure progress under this Strategic Plan of 2007-2011. The M&E plan was further strengthened with the development of an costed operational plan. These documents were disseminated through the mechanisms as listed in the two sections above and have been used consistently to ensure compliance to the 3X1s specifically to the one monitoring and evaluation framework.

4.2.2 Identify at the national level a unit which will be responsible for M&E related to HIV/AIDS

An M&E unit for the HIV response was defined in the operations manual. The M&E Unit was subsequently fully staffed with M&E Lead, Data Analyst, Researcher and Data Entry Clerk. This team has been instrumental in moving the M&E agenda forward with advancements made in almost every area- data verification, data quality, timeliness of reporting, accuracy of reporting, data analysis to list a few.

4.2.3 Develop and disseminate national guidelines on system and tools for monitoring the response to HIV/AIDS

The operations manual to the National M&E Plan was developed and disseminated. This manual included guidelines and tools for monitoring the HIV response. All sub programmes have defined their monitoring tools such as the PMS for care and treatment and VCT monitoring tools At a Central, the Country Reponses Information System (CRIS) is being adapted for use. Member of the M&E team and technical officers engaged in M&E were trained in CRIS.

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4.2.4 Identify priorities, develop and disseminate guidelines for measuring outcomes and impact of intervention related to HIV/AIDS

The measurement of impact and outcomes are built into the National M&E plan and the operational plan to the M&E plan. These measurements are taken periodically as defined within the M&E plan, with the vast majority being reported from special studies. The National programme has conducted the following special studies :

1. BBSS- CSW and MSM (2004) 2. BBSS-FCSW and MSM ( 2009) 3. BSS( military, police, GUYSUCO workers, in school youth (ISY) and Out school youth

(OSY))-2004 4. BSS( military, police, in school youth (ISY) and Out school youth (OSY))-2009 5. ANC survey (2004 and 2006) 6. BBSS- security Guards- 2008 7. BBSS prisoners- 2008 8. DHS- 2009/10 9. Client satisfaction survey -2010.

Impact was also measured particularly for the care and treatment programme utilizing the developed patient monitoring system.

4.2.5 Employ and train staff at the national and regional levels for monitoring and evaluation

Staff employed in the various sub programmes were trained in Monitoring and evaluation specific to there are of work. Regular refreshers training also include aspects of monitoring and evaluation.

4.2.6 Identify and establish a national system for the storage of data for monitoring and evaluating the national response to HIV/AIDS

The National Programme through the M&E Unit has adapted CRIS as the tool for data storage at the National Level. M&E staff and technical coordinators were trained in the use of CRIS and the system is currently being implemented. Additional sub programme also store data in specialized databases such as the Channel for condoms, Fox Pro for VCT.

4.3 Design, implement and disseminate results of special surveillance surveys and studies in selected groups

4.3.1 Conduct HIV/AIDS risk assessment surveys to collect information on attitudes, behaviours and sexual mixing patterns, health facilities utilization, and perceived intervention needs among defined target groups and the general population

See 4.2.4. Additionally several assessments were conducted- an assessment on the uptake of PMTCT services on the labour and deliver wards, TB/HIV services.

4.3.2 Conduct behavioural surveillance surveys in selected groups (in and out of school youth, sugar workers, sugar workers personnel)

See 4.2.4 and 4.3.1

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4.3.3 Conduct biological behavioural surveillance among MSM and CSW

See 4.2.4 and 4.3.1

4.3.4 Conduct and disseminate results of needs assessment- PLWHAs and orphans

The Client Satisfaction survey was done in 2010 and issues affecting PLHIVs were addressed.. The needs of PLWHAs including HIV infected children are routinely monitored through the care and treatment programme and through the support groups established at 11 treatment sites. The needs of orphans are also routinely monitored through the programmes established by the Ministry of Human Services and social security and through the monitoring of the minimum package of services for children‟s institutions. The DHS and the MICS conducted by the Ministry in collaboration with USAID /PEPFAR and UNICEF respectively provided additional information on OVC.

4.3.5 Assess capacity of health facilities in both the public and private sector to provide services related to HIV/AIDS

Capacity of healthcare facilities are assessed prior to the introduction of the HIV services and on ay yearly basis using standarised tools.

4.4 Strengthen local capacity to undertake research related to HIV/AIDS

4.4.1 Establish a multi-disciplinary HIV/AIDS Research Unit

The M&E unit within the NAPS, in collaboration with the MERG, the surveillance department and M&E department of the National Tuberculosis Programme (NTP) has built capacity to conduct research. A research agenda has been developed and several studies conducted over the period. The establishment of the M&E unit serves as the research unit since the full complement of staff has the requisite skills to conduct research. The BBSS, HIV Client Satisfaction Survey, Adherence, Drug Resistance Survey conducted.

4.4.2 Establish and support an HIV/AIDS Research Agenda

A HIV/AIDS research agenda was developed and supported. A number of special studies and as indicated above 4.2.1 and 4.3.1.

4.4.3 Develop a cadre of persons with appropriate skills to undertake research related to HIV/AIDS

A core group of persons from the Ministry of Health were trained on research methodologies through several mechanisms- through masters in public heath programme, thorough basic and advanced research skills training by the CHRC and other specialized short courses such as the sampling methodology course by the University of San Francisco. On site mentoring of the M&E Staff of the National AIDS Programme Secretariat, the National TB programme, the Surveillance department and clinical staff were mentored over a one year period by a resident advisor from MEASURE EVALUATION. . The IRB was established and meets once monthly to review and approve proposals. Members of the IRB were trained and retrained in order to best serve in their capacity. The University of Guyana through the School of Medicine, the Social Worker programme, the

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pharmacist programme has trained their students in the conduct of research. Many operations research were conducted on HIV by the students.

4.4.4 Conduct operations and cost- effectiveness research relevant to HIV/AIDS and disseminate findings

Operations research were conducted in a number of areas particularly in collaboration with the University of Guyana. Major of areas of focus included adherence among persons on ARVS and TB/HIV co-infection and access to services.

4.5 Strengthen the Health Information System

4.5.1 Develop and disseminate national guidelines on system and tools for a national HMIS

There is a national MIS Strategy and also an accompanying ICT Policies and Procedures document that has been developed to guide the implementation of ICT/HIS at the national and regional levels within the public health sector.

4.5.2 Hire and train staff at the national and regional levels for the operation and maintenance of the network

The National MIS Unit is fully functional with technical as well as support staff. This is currently ongoing and there are staff identified at the national level (MOH) and at some regional level to implement and support information networks established within these levels. With this HR support several advances were made in HIV including the modification and deployment of a CHANNEL database for condoms, a FoxPRO database for VCT, a SQL database for care and treatment, CRIS for the National M&E system. Support from the MIS unit was also critical in special assignments such as the HEALTHQUAL data collection and analysis, the HIVDR Survey and in all special studies. In addition to technical issues, the MIS Unit provided invaluable support to the maintenance of the technological infrastructure of the HIV programme.

4.5.3 Establish and interconnect networks at the national and regional levels

There are networks established at the national level (MoH) and at the regional levels being BRHA6, GPHC and LHC which are being interconnected back to the national level to facilitate data/information exchange across these sites.

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Priority Area 4: Strategic Information

Table 14: Summary of Priority 4 targets and indicators 2007-2010 (Surveillance SR)

INDICATORS Baseline 2007 2007 2008 2008 2009 2009 2010 2010 2011 2011 Avg. % of Achievement :2007-2011

Remarks

-2006 Target Results Target Results Target Results Target Results Target Results

SR 1

Percentage of service outlets with record keeping systems to monitor HIV and AIDS care and treatment

- 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

SR 1

Number of persons trained in strategic information monitoring and evaluation and/or surveillance and/or HMIS

162 75 - 75 114 75 0 75 86 75 66 70.90% 27 persons trained in

Surveillance, 39 in M& E where 20 were trained in SPSS and 19

in CRIS.

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SECTION SIX:

XI: SUMMARY OF FINDINDS BY PROGRAMME AREA

The National Strategic Plan has achieved the majority of what was intended. Full accomplishments were seen for

the majority of strategic areas under the broad programme areas. Some areas were fully achieved were identified as

priority in moving into the HIVision2020 and are highlighted in the related section below. The following summarises

the key achievements:

1. Priority Area A: The roles of the coordinating mechanisms were strengthened with the National Programme

building capacity in leadership and Public Health among key cadres. The multi-sectoral response was rolled

out to key line Ministries affecting specific constituents and to an increasing number of civil society and

community based organisations reaching the most at risk populations. The Programme fully adhered to the

three one principles and to all of its international, regional and national reporting commitments, including a

wide stakeholder consultative midterm and end of term review processes.

With the multi-sectoral response the Ministry of Amerindian Affairs was a key Ministry engaged. The findings

particularly from the focus groups sessions and key informant interviews suggest that the access to

prevention, care and treatment services was limited for the indigenous populations and the mobile

communities of Regions 1, 7, 8 and 9. On the legal front, the national HIV policy was revised and a draft HIV

legislation was prepare and being reviewed. Whilst coordination has been achieved, the programme has

been unable to conduct regular AIDS spending assessments.

2. Priority Area 2: Significant work was done in reducing risk among the general populations and with a focus

on the most at risk populations. In comprehensively capturing the IEC done among these population groups,

the BCC strategy developed was fully implemented with the exception of the population of the mini bus

drivers. The BCC prevention efforts were widely implemented among the in school youth and the out of

school youth and the results of the comparative BSS indicate the effectiveness of these intervention.

Several hundreds of young persons and community opinion leaders were trained as peer educators. The

HFLE has commenced and is being led by the Ministry of Education thus approaching HIV prevention from

a structured and wider base stand point of sexual and reproductive health. The PMTCT Programme

continued its strengthening over this five years period making the services accessible within all 10

administrative regions. The Voluntary Counselling and Testing programme expanded with a focus on more

outreaches and with special initiatives such as the National Week of HIV testing. The Blood Bank continued

its monitoring of donor supply to persons requiring same, though high quality screening of all blood and

blood products. The Health care facilities ensured that all infection control practices in place, including safe

injection practices and linked to this the rational use of injectables. A policy addressing stigma and

discrimination in the health care setting was developed and rolled out to treatment sites. OVC issues were

addressed through the enactment of several legislations dealing with the rights of the child and child

protection. Minimum standards defined for Children‟s Homes were supported. Several critical coalitions

were established targeting key populations. The Guyana Business Coalition on HIV and AIDS targeting the

private sector has engaged the private businesses across the country. The Guyana Faith Coalition on HIV

and AIDS also established during this period has been integral in HIV prevention among the Hindus,

Muslims, Christians, Baha‟is and Rastafarians. Civil Society Organisations were critical in ensuring that

services were delivered to the communities and particularly to the most at risk populations in preventing

HIV.

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3. Priority Area 3: HIV management including the provision of ARVS was significantly strengthened over the

period. Treatment sites were established in all ten administrative regions of the country (Mobile services to

the hinterland regions of 1, 7, 8 and 9). The multidisciplinary management of persons living with HIV was

well defined in the National Care and Treatment Guidelines which were revised and updated on two

occasions to incorporate new scientific evidence. Health care workers were trained and retrained on the use

of the guidelines and specialized Clinical Mentoring Programmes were rolled out. The IMAI was

implemented at the level of the Primary Health care setting. All persons accessing treatment and care are

provided appropriate laboratory, counseling and treatment services. New services were incorporated such

as the screening for cervical cancer using the VIA Methodology. The Laboratory services has been

strengthened with the establishment of National Public Health Reference Laboratory providing important

testing such as Viral Load, CD4 , DNA PCR , TB Culture and all other supporting and monitoring tests.

The NTP was significantly strengthened enhancing TB/HIV care and co-management

Several Communication Campaigns were developed, and disseminated in support of HIV positive persons

and in the reduction of stigma and discrimination.

The Quality of services was monitored through the introduction of HEALTH Guyana with quality

improvement projects implemented at clinical sites. The CSS was conducted with follow up improvement

projects.

Psycho social support was provided to all patients in addressing their issues and the support group network

also facilitated a support system for PLHIV. Prevention with Positives was introduced. Economic support

was provided through the voucher programme and nutritional support through the Food bank and other

related initiatives. Housing initiative provided house lots and houses for a number of persons and the safe

water programme ensure access to Pur and Chlorosol.

The HBC programme established provides formal services in 7 of the 10 administrative regions.

4. Priority Area 4: The availability and use of strategic information improved. The capacity of the MoH in

dealing with Strategic Information was enhanced through specialized training of key staff and through

mentorships arrangements. The research agenda developed by the MoH/NAPS was followed with the

completion of major special studies. The surveillance system for HIV has been revised. M&E capacity was

developed and a fully functional M&E Unit for HIV established.

XII. SUMMARY OF FINDINGS BY TARGETS

The National Monitoring and Evaluation describes a total of forty four (44) indicators with the vast majority

measuring progress under priority areas 2 and 3, risk reduction and care, treatment and support

respectively. The measurement of progress under this framework was possible, as at the inception national

targets were set against the proposed strategic areas of the NSP. These targets were based on a wide

stakeholder consultative process .The Mid Term Review (MTR) of the NSP demonstrated the

overachievements of the programme relative to the set targets. A key recommendation of the MTR was the

revision of the targets to ensure that they were more realistic considering the results at that point.

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The second target setting process was also conducted in a consultative manner and with wide stakeholder

participation. During this process, not only targets were revised, but also some indicators were split to

facilitate more detailed and meaningful disaggregated reporting. This resulted in an increase in the number

of indicators to fifty two (52).

The ETR therefore evaluated the 52 indicators from the second target setting process. Of the 52 indicators

10 were not measured for various reasons. See table 15 below.

Table 15: Non measurement of cumulative achievements

Name of Indicator Reasons for not Measuring Cumulative 5 years

achievement

IMP1. Proportion of all Deaths Attributable

to AIDS

This information is not available from for the years 2012 and

2011 at the time of the ETR

IMP 3: HIV Prevalence among Women

aged 15-24 years of age

The target set for this specific indicator was not absolute

numerical value but instead a less than value. Whilst this

noted the target set was less than 1%, the cumulative

achievement over the years is reported at 1.06%

IMP5. Percentage of Infants born to HIV

Infected mothers who are infected.

Although the indicator was reported on for every year, the

cumulative achievement was not calculated. The earlier

years of the 5 years plan- data on the numerator and

denominator was not available.

IMP 6. Ratio of current school attendance

among orphans to that among non orphans

age 10-14 years

Whilst this indicator was initially placed in the M&E plan,

newer and subsequent guidance provided by the UN

System, indicated that this indicator was not relevant for

Guyana. The reason noted for this, is that with HIV

prevalence as with Guyana, this is not required and would

not be statistically significant if calculated. The MICS

conducted between the MoH and UNICEF collected some

related information, however the sample size was too small

for statistical significance.

NC 1: Amount of National Funds allocated

to Government of Guyana for HIV

prevention and care

This was done through a NASA in the earlier years and a

follow up done in 2010/2011. Report on the second NASA

not available at the time of review.

NC4: Percentage of schools with teachers

who have been trained in life skills based

HIV education and who taught it during the

last academic year

This is an indicator linked to school health survey. The report

of the 2012 survey did not capture this information as per

definition.

PV 2: Percentage of Youths Aged 15-24

reporting the use of condoms during their

The BBSS reported on paying and non paying partners and

not on non regular partners. However 81% was reported for

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last sexual intercourse with a non regular

partner ( males)

non transactional sex partners.

PV 7: Percentage of Most at Risk

Populations (Miners) who reported

condom use during their last sexual

encounter with a regular or a non regular

partner.

No study was conducted among the miners during this

period.

PV 13: Percentage of OVCs whose

households received free basic external

support in caring for the child.

Whilst absolute numbers were reported for this indicator, the

denominator is unknown as a result of the issues highlighted

and linked to indicator IMP 6 above.

PV 9: Number of Adults and Children

Receiving HPC following National

Standards

This indicator was changed and redefined at the Mid Term

Review. The revised indicator was “Number of adults and

children receiving HIV related care and support according to

national Standards”. Whilst this is a related indicator, it is

much bigger than the first indicator. For these reasons, the

five years cumulative achievements were not possible to

measure.

This specific indicator was counted as two indicators in the

context of the overall 25 Indicators.

For the 42 indicators cumulative achievement was measured in the following way:

- For indicators with absolute numeric targets, the total 5 years achievements were measured against the

total five years targets.

- For percentages indicators, the 5 years cumulative results ( Numerator) was used against the cumulative 5

years targets ( denominator) to calculate the percentage 5 years cumulative achievement.

- To rate the degree of success a scale was used as follows- 80%-100%-Excellent , 70-79%- Good, 50-

69% -Fair and <50% -Poor.

Based on the findings of the findings the vast majority of the targets set for indicators were achieved with almost 81%

reporting excellent achievement and 90.4% reporting a combine excellent and good rating. The indicator relating to

the number of persons to be trained in CD4 testing was reported at below 50%, this was the only indicator rated as

poor. Please see table 16 below with the rating for each indicator and table 17 with rating per priority area.

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Table 16: Measurement of Cumulative Achievements

Indicator

Cummulative Five

Years Achievements

(%)

Rating

IMP1 : Proportion of all deaths attributable to AIDS Not measured See notes in table above

IMP 2: Percentage of all adults and Children with HIV still alive 12 months after the initiation of ARVS

therapy

94.40% Excellent

IMP 3: HIV Prevalence among women aged 15-24 Not measured See notes in table above.

IMP 4: HIV Prevalence among MARPS

Prevalence Among MSM 97% Excellent

Prevalence among CSW 68.10% Fair

Prevalence among mobile populations ( miners) Not measured See notes in table above.

Prevalence among male STI patients 85% Excellent

Prevalence among STI female patients 72.3% Good

Prevalence among TB patients 121.70% Excellent

IMP5: Percentage of infants born to HIV infected mothers who are HIV infected Not measured See notes in table above

IMP 6: Ratio of current school attendance among orphans to that among non orphans age 10-14 Not measured See notes in table above

NC 1. Amount of National Funds allocated by Government for HIV Prevention and Care Not measured See notes in table above.

NC 2: Implementation of the three ones principles 100% Excellent

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NC3: National Composite Policy Index 100% Excellent

NC4: Percentage of schools with teachers who have been trained in life skills based HIV education and

who taught it during the last academic year

Not measured See notes in table above

NC 5: Number of Line Ministries with HIV workplans and budgets 102.40% Excellent

PV1: Percentage of young men and women aged 15-24 who have had sex before the age of 15 191.6% Excellent

PV2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse with a non regular partner

PVC 2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse

with a non regular partner ( FEMALES)

120.90% Excellent

PVC 2: Percent of youth aged 15-24 reporting the use of condoms during the last sexual intercourse

with a non regular partner ( MALES)

Not measured See notes in table above

PV3: Percent of persons aged 15-49 expressing accepting attitudes towards people with HIV and AIDS 55% Fair

PV4: Percent of young people aged 15-24 who correctly identify ways of preventing the sexual

transmission of HIV and who reject major misconceptions about HIV transmission

81.1% Excellent

PV5: Number of condoms distributed by the public and private sector in the past 12 months 83.1% Excellent

PV6: Number of targeted prevention programmes for Most at Risk Populations 160% Excellent

PV7:Percentage of MARP ( sex workers, MSM, Mobile Populations and other vulnerable groups) who reported using a condoms during their last encounter with a

regular or a non regular partner

Percentage of MARP who reported using a condoms during their last encounter with a regular or a non

regular partner ( CSW)

113.5% Excellent

Percentage of MARP who reported using a condoms during their last encounter with a regular or a non

regular partner ( MSM)

87.7% Excellent

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Percentage of MARP who reported using a condoms during their last encounter with a regular or a non

regular partner ( Miners)

Not measured See notes in table above

PV8: Number of Service Outlets that offer PMTCT services 95.3% Excellent

PV9: Number of Pregnant Women who receive HIV counseling and testing for PMTCT ad receive their

results

94.8% Excellent

PV9 (a): Percentage of pregnant women who were tested for HIV and received their results and were

counselled

107.80% Excellent

PV10: Percent of HIV Infected pregnant women who receive a complete course of ARV prophylaxis as

part of PMTCT

94.2% Excellent

PV11: Number of Health care workers trained in the provision of PMTCT according to National

Guidelines

157.50% Excellent

PV12: Percentage of babies born to HIV positive women who are tested before the age of 18 months 86.2% Excellent

PV13: Percentage of OVC whose household received free basic external support in caring for the child Not measured See notes in table above

PV 14: Number of providers /care takers trained in the provision of OVC 81.1% Excellent

PV15:Percentage of Transfused Blood Units in the Public and Private Sector in the last 12 months that

have been adequately screened for HIV according to national guidelines

100% Excellent

CTS1: Percentage of women, men and children with HIV infection receiving ART who are eligible

according to National Guidelines

88.3% Excellent

CTS 2: Number and Percentage of regions with at least one outlet providing ART services following

National Standards

100% Excellent

CTS3: Number of Health care workers trained in ART Delivery according to National Guidelines 137% Excellent

CTS4: Percentage of the general population aged 15-49 receiving an HIV test result in the past 12 85.1% Excellent

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months

CTS5: Number of Individuals trained in the provision of VCT according to National Guidelines 96.3% Excellent

CTS 6: Number of Regions with Service Outlets that provide HPC 75.5% Good

CTS7: Number of Service Outlets that provide HPC 98.3% Excellent

CTS8:Numberof persons trained to provide HPC according to Natioanl Guidelines 239.8% Excellent

CTS 9:Number of adults and children receiving HPC following National Standards Not measured See notes in table above

CTS 9: Number of adults and children receiving HIV related care and support according to National

Guidelines

Not measured See notes in table above

CTS10: Percentage of men and women with STI at healthcare facilities who are appropriately

diagnosed, treated and counselled.

156% Excellent

CTS11: Number of persons trained in the management of STI according to national guidelines 88.6% Excellent

CTS12: Percentage of eligible HIV positive registered TB patients given ART during TB treatment 98.5% Excellent

CTS13: Percentage of registered TB patients tested for HIV 94.1% Excellent

CTS14: Percentage of patients on ARVS who receive CD4 monitoring following National treatment

guidelines

88.4% Excellent

CTS15: Number of Regional Laboratories with capacity to perform CD4 tests following National

Standards

67.5% Fair

CTS16:Number of persons trained to conduct CD4test according to national guidelines 34.9% Poor.

SR1: Number of persons trained in strategic information, monitoring and evaluation and/or surveillance

and /or HMIS

70.9% Good

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SR2:Percentage of service outlets with record keeping systems to monitor HIV and AIDS care and

treatment

100% Excellent

Table 17: Summary of ratings of achievements by priority areas.

Indicator Type Total #of Indicators

in M&E Plan

Total # indicators including

sub indicators ( after MTR)

Total

Indicators

measured

Excellent Good Fair Poor

Impact 6 11 7 4 2 1 0

NC 5 5 3 3 0 0 0

PV 15 18 16 15 0 1 0

CTS 16 16 14 11 1 1 1

SI 2 2 2 1 1 0 0

TOTAL 44 52 42

(80.7%)

34

(80.9%)

4

( 9.5%)

3

(7.1%)

1

( 2.3%)

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SECTION SEVEN:

XIII. CONSIDERATIONS FOR HIVISON2020

The discussions during the midterm review provided recommendations for consideration in the development of the

new National HIV strategic Plan (HIVision2020). The following are highlighted:

1. With the evolving nature of the global economic and political architecture, greater focus must be placed on

the understanding of the financial requirement s of the National Response, thus the need for better

coordination among all donors and for regular AIDS spending assessments. Linked to this is the need for

programmes to be results based and that value for money is demonstrated.

2. Nationally, with the changing dynamics and HIV now a Chronic Disease coupled with Treatment as

Prevention, mush of the response must continue within the Health Sector. A Review of the Current

Coordinating Mechanism is recommended to consider these and other changes.

3. Guyana‟s response has shown success in many areas. The relatively lower rates of reduction seen in the

FCSW and MSM populations and the continuing HIV infection rates requires a re-prioritising and refocusing

HIV prevention to address the MAPRS through evidence based interventions.

4. Addressing risk factors for unsafe behaviours- gender base violence, alcohol use, bully in school, socio

economic factors such as unemployment, poor education status and single parenting and single head

households.

5. Efforts on Stigma and Discrimination must be strengthened including finalization and the passing of the HIV

legislation.

6. The evidence that treatment prevents is now widely available and therefore prevention in the New NSP

should be through the lenses of a robust treatment programme.

7. With the environment of reduced external support to programmes, sustainability of all services must be

addressed with particular reference to sustainability of ARVS.

8. Addressing HIV as a chronic disease and all associated co morbidities.- mental health issues, Diabetes,

Hypertension, Cardio Vascular and other diseases.

9. With the development of resistance to second line therapy, considerations for third line therapy should be

made.

10. Continued monitoring for HIV drug Resistance

11. The treatment programme has made significant strides in the PMS and collection and analysis of data.

There is the urgent need for an Electronic Medical Records System.

12. Increase private public partnerships to enhance care and support services.

13. Integrate HIV services into the Primary Health care setting.

14. Continued capacity building for M&E, surveillance, research.

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15. Continue with the surveillance surveys; however focus must also be on operations research particularly in

the treatment programme and with TB/HIV co-infection.

XIV. CONCLUSION

The five years under review saw significant achievements in the areas of policy, prevention, treatment,

support, monitoring and evaluation, capacity building for human resources, private sector involvement,

multi stakeholder involvement and many others. The resulting programmatic achievements measured by

the targets for the indicator set for the five year period confirms that that the National Programme

accomplished what was set out to be done.

.

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APPENDIX A : LIST OF CONTRIBUTORS

1. Dr. Shanti Singh- Programme Manager, NAPS/MoH

2. Dr. Abdel Abdalla- Coordinator of the Roving Hinterland Medical Team, NAPS/MoH

3. Ms. Nafeeza Ally- Social Services Coordinator , NAPS/MoH.

4. Ms. Shevonne Benn- Home & Palliative Care Coordinator, NAPS/MoH.

5. Ms. Sophie Collier –Data Analyst, M&E Unit, NAPS/MoH

6. Ms. Lynette Fiedtkou-Baird- Researcher /Writer, NAPS/MoH

7. Ms. Jennifer Ganesh- Prevention Coordinator, NAPS/MoH

8. Mr. Nazimul Hussain- Community Mobilisation Coordinator, NAPS/MoH

9. Dr. Bendita Lachmansingh- Epidemiologist, M&E, NAPS/MoH

10. Mr. Trevor McIntosh- VCT Regional Supervisor and Quality Assurance Manager(frm), NAPS/MoH

11. Mr. Delon Braithwaite- VCT Regional Supervisor and Quality Assurance Officer, NAPS/MoH

12. Ms. Fiona Persaud – M&E Coordinator, M&E Unit, NAPS/MoH

13. Ms. Sophia Collier, Data Analyst, M&E Unit, NAPS/MoH.

14. Mr. Nicholas Persaud- Treatment and Care Coordinator, NAPS/MoH

15. Dr. Shauna Scotland- STI Coordinator, NAPS/MoH.

16. Ms. Deborah Success- VCT Coordinator, NAPS/MoH.

17. Mr. Somdatt Ramessar- Food Bank Manager, NAPS/MoH.

18. Ms Aneela Persaud, Support Group Coordinator, NAPS/MoH.

19. Mr. Joe Hamilton, Parliamentary Secretary, Ministry of Health.

20. Dr. Leslie Ramsammy- Minister of Health, Guyana (Former).

21. Ms. Cilandell Glen, Youth Friendly Health Services Coordinator, Adolescent Health Department,

MoH.

22. Ms, Jessica Small, VCT/SRH Coordinator, Adolescent Health Department, MOH.

23. Mr. Arjune Deally- Statistician, MoH

24. Ms. Preeta Saywack, Surveillance Officer, MoH

25. Mr. Ishwardatt Singh- MIS Director, MoH.

26. Dr. Ravindra Swammy, STI coordinator, NAPS/MoH

27. Ms. Elizabeth McAlmont- MARPS Focal Point, NAPS/MoH.

28. Dr. Ravi Homenauth, NAPS/MoH

29. Dr. Colin Roach, Director, NPHRL/ MoH.

30. Mr. Roland Birkett, MIS Director, HSDU/MoH

31. Ms. Sarah Insanally, Director, Planning Unit, MoH.

32. Dr. Vishwa Mahadeo, Chief Executive Office, Berbice Regional Health Authority.

33. Ms. Cristel Teixeria, NCTC/MoH

34. Ms. Diana Dhanraj, NTP/MoH

35. Ms. Angelina Karim, PMTCT/MoH

36. Mr. Collin Haynes, Strategic Information Advisor, Davis Memorial Hospital.

37. Mr. Donald Cole, Strategic information Advisor, PUSH project, CDC.

38. Ms. Rushell Perry, Social Services Officer, Red Cross , Guyana.

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39. Mr. Dereck Springer-PANCAP

40. Ms. Ann Greene- Ministry of Human Services

41. Mr. Trevor Thomas- Permanent Secretary, Ministry of Human services and Social Security

42. Ms. Janelle Sweatnam- HIV/AIDS coordinator, Ministry of Education.

43. Mr. Renato Gonzales- Advisor, Ministry of Amerindian Affairs.

44. Ms. Claudia Scott-Senior Personnel Officer, Ministry of Home Affairs.

45. Mr. Patrick Mentore, Line Ministries Coordinator, HSDU, Ministry of Health

46. Mr. Cleazel Gray, VCT Coordinator, Youth Challenge Guyana.

47. Ms. Desiree Edghill, Executive Director, Artiste in Direct support.

48. Ms. Merica George, Prevention Coordinator, Artiste in Direct Support.

49. Ms. Coleen McEwan, Executive Director, GUYBOW.

50. Ms. Namela Baynes –Rowe, Co-chairperson, SASOD.

51. Dr. Beverly Barnett, PWR, PAHO, Guyana.

52. Dr. Rosalinda Hernandez, HIV/STI Advisor, PAHO, Guyana.

53. Dr. Ruben del Prado, Country Representative, UNAIDS, Guyana.

54. Ms. Otilia St. Charles, M&E, Resident Advisor, UNAIDS, Guyana.

55. Dr. Barbara Allen, Chief of party, CDC, Guyana.

56. Ms. Licelot Mercer, Fellow, CDC, Guyana.

57. Nicolette Henry, Programme Officer, CDC, Guyana.

58. Mr. Oswald Alleyene, Strategic Information Officer, USAID, Guyana.

59. Ms. Beverley Gomes-Lovell- Programme manager, Guyana Defence Force.

60. Dr. Owoeye Olufemi, Chief of Party GHARP II.

61. Ms. Megan Kearns, Technical Director, GHARP II.

62. Dr. Karen Boyle, Prevention Director, GHARP II.

63. Ms. Vashti Hinds, Care and Support Officer, GHARPII.

64. Ms. Shaundell Shipley, MARPS, Coordinator, GHARP II.

65. Mr. Sean Wilson, Project Coordinator, ILO

66. Dr. San San Min, Lead Resident Advisor, SCMS.

67. Ms. Cheryl Morgan, Programme Manager, Catholic Relief Services.

68. Ms Patrice LaFleur, Country Representative, UNFPA, Guyana.

69. Mr. Jason Shepherd, HIV/AIDS Officer, UNFPA, Guyana.

70. Miss Jewel Crosse, Youth and Adolescent Development Officer, UNICEF, Guyana.

71. Mr. Michael Khan, Chief executive Officer, GPHC.

72. Ms. Paula Sampson, Senior Programme Officer, Guyana Responsible Parenthood Association.

73. Members of the PLHIV Community – 24 persons

74. Members of the MSM Community- 26 persons

75. Members of the FCSW Community-19 persons.

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APPENDIX B- KEY INFORMANT INTERVEIW QUESTIONNAIRE

Guyana National Strategic Plan 2012-2020 Questionnaire

Date:_____/____/______ Name:_______________________________

Organization: _________________________________ Designation: ___________________________

The Ministry of Health through the National AIDS Programme Secretariat, is conducting an assessment

on the implementation of it National HIV/AIDS Strategy 2007-2011. This plan would be cessated as of

December 2011. As part of the process of planning for the development of HIVision 20/20 you have

been identified as a key resource person within the multisectoral response to HIV. We therefore would

like to solicit your opinion of implementation of the 2007-2012 strategy and your view on direction of

the HIVISION 20/20. I wish to thank you for this interview and assure you that your contributions are

valuable to the process.

1. Have you heard of the National HIV/AIDS Strategy 2007-2011?

A. Yes B. No If so, are you familiar with the contents of the strategy? A. Yes B. No

……………………………………………………………………………………………………………………………………………………………….

2. As you know the Guyana National HIV/AIDS Strategy 2007-2011 address four (4) priority areas;

Strengthening the national capacity to implement a coordinated, multi-sectorial resource,

reducing risk vulnerability to HIV infection, clinical and diagnostic management and access to

care, treatment and support and strategic information.

Do you felt that the plan adequately achieve what it intended? ( if yes, ask what areas, if no ask

what areas )

A. Yes

B. No. If No, which area there should more attention be placed and Why?

Priority Area Discussion (if No) – Why do you believe

that this was not achieved? What were

the challenges

Discussion (if Yes) – What do you believe

were the successes? What would you

attribute this success to?

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1.0 Multi Sectoral Coordination YES NO REMARKS

1.1 PCHA, HSDU& NAPS empowered

to coordinate Guyana’s National

HIV/AHIDS multi sectoral response

1.2 Integrate HIV/AIDS into the

programmes and services offered by

other Ministries

1.3 Harmonize and align resources to

ensure efficient use of donor

funding.

1.4 Increase the involvement of civil

society organizations and the Private

Sector in the scaled up response

1.5 Advocate for a legal and policy

environment that protects the rights

of people living with HIV/AIDS and

vulnerable groups.

1.6 Review the National Response to

HIV/AIDS

2.0 RISK REDUCTION

2.1 Design and implement

Communication Programme on

HIV/AIDS

2.2 Develop and implement targeted

behavior change interventions to

increase positive sexual practices

and encourage early STI/HIV

diagnosis and treatment among

vulnerable groups.

2.3 Implement prevention education

and behavior change reinforcement

activities.

2.4 Expand condom social marketing

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programme

2.5 Scale up the PMTCT Programme.

2.6 Reduce the vulnerability of the

OVC to HIV/AIDS

2.7 Expand VCT services

2.8 Reduce the vulnerability to

HIV/AIDS through identification and

treatment and treatment of STI/OIs.

2.9 Ensure safe Blood supply

2.10 Implement plan to reduce

health worker and community risk to

HIV transmission through

contaminated sharps.

3.0 CARE, TREATMENT & SUPPORT

3.1 Expand access to ARV treatment

to scale up the response.

3.2 Create Centre of Excellence at

the GUM clinic and GPHC

3.3 Establish a quality home based

and palliative care programme

providing support to PLHIV and

those affected by HIV/AIDS

3.4 Provide psychosocial care and

support to PLHIV and those affected.

3.5 Design and implement institution

training programmes for HIV/AIDS

treatment, care and support.

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3.6 Expand comprehensive care for

opportunistic infections

3.7 Strengthen the link between the

TB and HIV/AIDS/STI control

programmes.

3.8 Implement activities to increase

use of quality STI/HIV/AIDS

diagnostic and treatment services.

3.9 Upgrade laboratory capacity to

diagnose and monitor HIV/AIDS and

associated opportunistic infections.

3.10 Establish National Public Health

Reference Laboratory

3.11 Procurement and distribution of

care and treatment supplies

improved (commodities

management)

4.0 Strategic Information

4.1 Strengthen the HIV/AIDS

surveillance systems

4.2 Develop and implement a system

for monitoring and evaluating the

response to HIV/AIDS

4.3 Design, implement and

disseminate results of special

surveillance surveys and studies in

selected groups.

4.4 Strengthen local capacity to

undertake research related to

HIV/AIDS.

4.5 Strengthen the Health

Information system

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3. Can you identify gaps or challenges of the NSP 2007-2011 as it relates to areas that are

mentioned? Do you think that there were missing elements to the last NSP under these priority

areas /

1.0 Multi Sectoral

Coordination

YES NO REMARKS

1.1 PCHA, HSDU& NAPS empowered

to coordinate Guyana’s National

HIV/AHIDS multi sectoral response

1.2 Integrate HIV/AIDS into the

programmes and services offered by

other Ministries

1.3 Harmonize and align resources to

ensure efficient use of donor

funding.

1.4 Increase the involvement of civil

society organizations and the Private

Sector in the scaled up response

1.5 Advocate for a legal and policy

environment that protects the rights

of people living with HIV/AIDS and

vulnerable groups.

1.6 Review the National Response to

HIV/AIDS

2.0 RISK REDUCTION

2.1 Design and implement

communication programme on

HIV/AIDS

2.2 Develop and implement targeted

behavior change interventions to

increase positive sexual practices

and encourage early STI/HIV

diagnosis and treatment among

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vulnerable groups.

2.3 Implement prevention education

and behavior change reinforcement

activities.

2.4 Expand condom social marketing

programme

2.5 Scale up the PMTCT Programme.

2.6 Reduce the vulnerability of the

OVC to HIV/AIDS

2.7 Expand VCT services

2.8 Reduce the vulnerability to

HIV/AIDS through identification and

treatment and treatment of STI/OIs.

2.9 Ensure safe Blood supply

2.10 Implement plan to reduce

health worker and community risk to

HIV transmission through

contaminated sharps.

3.0 CARE, TREATMENT & SUPPORT

3.1 Expand access to ARV treatment

to scale up the response.

3.2 Create Centre of Excellence at

the GUM clinic and GPHC

3.3 Establish a quality home based

and palliative care programme

providing support to PLHIV and

those affected by HIV/AIDS

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3.4 Provide psychosocial care and

support to PLHIV and those affected.

3.5 Design and implement institution

training programmes for HIV/AIDS

treatment, care and support.

3.6 Expand comprehensive care for

opportunistic infections

3.7 Strengthen the link between the

TB and HIV/AIDS/STI control

programmes.

3.8 Implement activities to increase

use of quality STI/HIV/AIDS

diagnostic and treatment services.

3.9 Upgrade laboratory capacity to

diagnose and monitor HIV/AIDS and

associated opportunistic infections.

3.10 Establish National Public Health

Reference Laboratory

3.11 Procurement and distribution of

care and treatment supplies

improved (commodities

management)

4.0 Strategic Information

4.1 Strengthen the HIV/AIDS

surveillance systems

4.2 Develop and implement a system

for monitoring and evaluating the

response to HIV/AIDS

4.3 Design, implement and

disseminate results of special

surveillance surveys and studies in

selected groups.

4.4 Strengthen local capacity to

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undertake research related to

HIV/AIDS.

4.5 Strengthen the Health

Information system

4. Having looked at the last NSP and now moving forward what would you suggest are key areas

for inclusion in the next National Strategic Plan bearing in mind that this plan is for the period

2012-2020. Is there any other area that you would like to identified that should be re included

in HIVision 20/20

5. Is there another new priority area that you would like to indentify for the new strategic plan?

Kindly provide details ?

6. Any additional comments or ideas that you would like to mentioned?

END OF QUESTIONNAIRE