Primary Health Care for Perinatal and Childhood HIV Infection in

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Primary Health Care for Perinatal and Childhood HIV Infection in
Primary Health Care for Perinatal and
Childhood HIV Infection in Haiti
The Global HIV/AIDS Epidemic in
Haiti

Estimated number of adults and children
living with HIV/AIDS, end of 2001- 250,000
– Adults (15-49) 240,000
 Adult
rate (%)- 6.1
– Women (15-49) 120,000
– Children (0-15) 12,000
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AIDS deaths in 2001- 30,000
Current living orphans (< 15 yrs) – 200,000
Surveillance in Pregnant Women
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Sentinel Surveillance in Pregnant Women
1996-1998 revealed a seroprevalence rate of
<1%- >20% in various regions of the country
Among urban & rural antenatal clinic
attendees, median HIV prevalence ws 3-4%
(range 0-13%)
AIDS* by Gender/age
(*Not HIV Infection…data From 1997)
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
All Ages
0-14
15-24
25-49
>49
Unspecified
Male
Female
Unspecified
Total
Demographic Constraints
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Total Population- 8,270,000
Population 15-49 yrs 4,053,000
GNI Per Capita ($US)- 460
Adult literacy- 47% (49/45
M/F)
Male Primary School49.2%
Female Primary School46.4%
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Male Secondary School21.4%
Female Secondary School20.4%
Government Budget Spent
on Health Care- 9.7%
Per Capita Expenditure on
Health Care- $21
36 % Urban Population and
Growing
Economic Constraints
Urbanization & Limited Infrastructure
Limited Access to Health Care
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Access to some kind of health care- 60%
Contraceptive prevalence rate- 28%
Births attended by skilled health personnel24.2% (even in P-au-P)
Fully immunized children at 1 yr of age- 59%
1 yr olds immunized against measles- 80%
Limited VCT and ART
Limited Access to Health Care
Problems of Knowledge & Behavior
in 15-49 Year Olds
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Knowledge of HIV Prevention Methods– Females- 58%; Males- 77%

Understand HIV Transmission
– Females- 80%; Males- 83%
Problems of Knowledge & Behavior
in 15-49 Year Olds
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Higher risk sex in the last year
– Females- 32%; males- 55%
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Condom use in last higher risk sex
– Females- 14%; males 25%
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Condom use during premarital sex (youth 15-19 yr
olds)
– Females- 6.6%; males 32.6%

Commercial sex in last year (both sexes aged 1559)- 9%
Prevention Indications

Total number of condoms available for
distribution during preceding 12 months
divided by total population aged 15-49 yrs– Sold by private sector- > 12,000,000
– Distributed by PROMESS- >13,000,000
– Sold by PSI- 3,000,000
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Prevention of MTCT nationwide- no data
Screening of blood supply- 100%
Primary HIV Prevention

Make the connection between- knowledge
and practice
– Education
– Education
– Education
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Support (groups, role of churches)
Other factors (next slide)
Educate Health Workers
Educate Midwives
Primary HIV Prevention in Women
and MTCT
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Reduce social & economic vulnerability of
women and girls
Ensure access to condoms
Provide information about MTCT
Timely diagnosis/treatment of STD’s
Safe transfusions & med/surg procedures
Elements of MTCT Programs
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Develop & promote VCT & HIV testing
Strengthen antenatal care services &
attendance
Strengthen family planning services
Breastfeeding choice for uninfected/unknown
HIV status- prevent commercial pressures for
artificial feeding
Prevention of MTCT Must Be Home-based
Integrated Management of HIV
Infection in Women and Children

Pyramidal structure of health care system
– village-level/household activities
 prevention,
education, sick visits, follow-up
– intra-community/regional activities
 rally
posts, education, EPI activities, nutrition
surveillance, family planning, prenatal services
– regional health care facilities (fixed/mobile)
– central facilities for case referral, training,
supervision,coordination, administration
Health Care Pyramid
HSC
Regional
Clinics &
Dispensaries
Rally Posts
Village/home activities
Take the Service to the Patient
Regional/satellite Dispensaries….
Are Less Expensive Than a Hospital
Integration of HIV Services Into Existing
Community-based Health Program
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Implementation of an IMCI strategy
– improvement in case management skills
– improvement in health system required for
effective case management
– improvements in family and community practices
Evaluation & Preparation for MTCT
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Estimation of HIV prevalence
Assessment of
– stigmatization
– social and cultural barriers to counseling, testing
and replacement feeding
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Assessment of attendance for antenatal care,
family planning and related services
CHW’s & TBA’s…the Keys to Success
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Live in their
communities
Know their
communities
Are leaders in their
communities
Have the confidence of
their communities
E & P Tasks for CHW’s & TBA’s
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Review main causes of infant illness and
death
Assess prevalence of malnutrition
Assess family capacity and resources for
replacement feeding
– morbidity and mortality associated with artificial
feeding
– average family’s access to safe water, sanitation
and fuel- feasibility of replacement feeding
Priority Tasks for Implementation
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HIV VCT integrated into the maternal child health
services
Develop treatment & management guidelines for
 HIV
 infant feeding
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Guidelines must be personnel-specific: physicians
of mother and child, nurses (maternity, pediatric,
public health), nutritionists, CHW’s,
TBA’s,counselors, pastors, clergy
Early Implementation Tasks 20012002
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Development of training plan or strategy
Adaptation of clinical guidelines
Selection of initial implementation areas
– Cabaret
– Delmas
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Training of central-level facilitators
Early Implementation Tasks 20012001
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Preparation and planning at central level
– Global Child Health
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Initial training of CHW’s & TBA’s
Initial training of school children and church
congregations
Follow-up of trainees and review
Early Implementation Tasks 20012001
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Dedication of permanent AIDS Information
Center
– Open daily for information
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Initiation of VCT activities
– Testing by “POS”
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Follow-up of individuals undergoing VCT
Collaboration with the “reseau SIDA”
Implementation of MTCT 2003-2004
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Identify or create support groups, community-based
programs for HIV+ women
Strengthen antenatal care services and their use by
pregnant women
Provide information to pregnant women and their
partners about MTCT
Provide information about the risks of unprotected
sex and counseling about safer sex and of
preventing infection
Evaluation and Management of HIVinfected Children- The Future
 Identification of specific outcome indicators such
as exclusive breast feeding rate, timely
complimentary feeding rate, continued breast
feeding rate, bottle feeding rate, weight-for-age at
key ages, fertility, appropriate use of breast-milk
substitutes
 Key clinical, immunological, and morbidity
parameters
The Future Continued
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Jubilee Center
Holy Cross Hospital and other Episcopal
medical institutions and programs

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