hiv in suriname ministry of health suriname m.sigrid mac donald – ottevanger, md focal point hiv...
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HIV in Suriname
Ministry of Health Suriname
M.Sigrid Mac Donald – Ottevanger, MD
Focal point HIV Treatment and Care, NAP
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HIV in Suriname• Inhabitants 531.000¹, Multi-ethnic population• Estimated HIV prevalence 1.1²• Universal access to HAART/medicines for OI • CD 4 and VL testing free of charge• Prevalence for HIV & pregnant women: 1%
• 42 repeat pregnancies in 2012!• baby-formula
• Access to HAART 66% of advanced HIV²• Only 62% still on HAART after one year²
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Number of people on Treatment
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• >50% decrease in incidence of HIV (UNAIDS)
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Healthcare System & Suriname
• Health care expenditure of US$ 324.26 per capita per year
• Primary health care is provided by – RGD (Regional Health Services),– MZ (Medical Mission) 300 clinics– Private sector.
• The RGD provides health care in the coastal area & capital
• Medical Mission provides health care in the interior (over 50 clinics!)
• Secondary health care is provided in 5 hospitals, of which 4 are in the capital Paramaribo
• ARVs available at all Hospital pharmacies (RGD/MZ)**
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HIV & SurinamePolicies
• The Government of Suriname adopted the UNGASS Declaration of Commitment in June 2001,
• National Commitment to the response against HIV and AIDS.
• In 2002 Surinamese Government initiated a process for the systematic and strategic control of HIV.
• In 2007, the second National Strategic Plan for HIV (NSP) 2009-2013 was developed.
• A multi sectoral approach of HIV/AIDS prevention, treatment and care
• ARV purchasing fully funded by government!
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HIV & Suriname Ministry of Health
• Focal point system– Focal point HIV treatment & care– Focal point PMTCT (case manager)– Focal point Prevention
• Technical unit• Monitoring & Evaluation manager• Center of Excellence • NGO’s • One Stop Shop for chronic disease
management
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Center of Excellence
Primary Health Care
NGOs, Religious groups
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Fundaments of HIV Treatment in Suriname
• Public Health approach• Multiple VCT sites• Primary care physicians treat HIV• Complicated HIV is referred to secondary care• Patient support
• Family• Peer counselors and buddy’s • NGO’s / Religious groups• Social workers
• National treatment guidelines since 2000• Current guidelines are third revision (2010)
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“TO HALT THE SPREAD OF HIV AND TO INCREASE THE QUANTITY AND QUALITY OF LIFE OF PEOPLE LIVING WITH HIV”.
Main objective:
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Treatment guidelines (I)• Newly diagnosed HIV not seriously ill
preferably work-up by primary care physician• Patient history
• Medical history• Psychological status
• Social status : work, family, relationships, children• Intoxications: alcohol/ drugs
• Emphasis on • Acceptance of HIV• Building patient support
• Physical exam• Clinical condition/ symptoms of opportunistic infections
• Laboratory tests• CD4 counts, CBC, liver and kidney function tests,
screen for TB, cervical cancer
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Treatment guidelines (II)
• CD4 count above 200• CD4 count > 350 no HAART (exception PMTCT,
HIV dementia, hepatitis B, HIVAN )• CD4 count 200-350: HAART depending on patient
motivation, adherence and age
• CD4 count ≤ 200 or WHO stage III/ IV prepare to start HAART
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Treatment guidelines (III)• Inform patient (and buddy)
• Need for treatment• Importance of adherence• Foreseeable visits to clinic, laboratory exams• Potential adverse effects
• First-line regimen• Duovir-N ( AZT/ 3TC/ NVP)
• Second – line regimen: PI • Register patient with HIV program• Referral to second line care when needed
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Concerns
• Denial and stigma
• Patients enter late into care
• Estimated > 50 % in secondary care
• High percentage LTFU• In pharmacy data after start HAART• Patients get LTFU after diagnosis (VCT’s)• Patients get LTFU after PMTCT
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Concerns & Challenges
• Challenge has now evolved from acute to chronic care (One stop shop)
• PMTCT – repeat pregnancies – importance of Eliminiation Initiative prongs 1-4
• HIV-infected infants and children now survive to adolescence and adulthood – Obstacle: scaling up paediatric care
• An increasing number of HIV-infected children highlights the primary importance of PMTCT
• HIV/TB Comorbidity• Hard to reach populations
– (Interior, covert SW)
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