presentation: health sector response: the national aids and sti prevention and control program...

8/13/2019 PRESENTATION: Health Sector Response: The National AIDS and STI Prevention and Control Program (NASPCP)

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PHILIPPINES

Health Sector Response:

The National AIDS and STIPrevention and Control Program(NASPCP)

Dr. Jonathan Neil Erasmo STI/HIV/AIDS Program Coordinator

Department of Health-Region VII

Disclaimer: The views expressed in this paper/presentation do not necessarily reflect the views or policies of the AsianDevelopment Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee theaccuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used

may not necessarily be consistent with ADB official terms.


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Outline of PresentationI. Epidemiologic Background

II. Policies and Guidelines

III. Elements of STI and HIV Program Essential Health Interventions for Key Affected Populations

IV. Program Goals and Objectives and Current Initiatives

V. Conclusion


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I. Epidemiologic Background

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1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2005 2007 2009 2011

MSTD

MSM

IDUFLSW

RFSW

1. Concentrated HIVEpidemic

2-6% HIVPrevalence amongMSM in selected

cities52% Prevalenceamong people whoinject drugs inCebu City

2. Estimated HIVPrevalence (2013):0.048%

3. Half of newinfections are inMetro Manila

National Center for Disease Prevention and Control

HIV prevalence among different riskgroups noted in the past 5 years

(Source: Integrated HIV Behavioral and Serologic Surveillance, NEC)


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Size of Key Affected Populations(National Epidemiology Center, 2011)

Cluster Key Population Numbers (Est.) Proportion toPopulation

Metro Manila MSM 95,909 0.211%RFSW 15,008 0.03%FFSW 7,504 0.17%

Cebu Province MSM 30,149 0.066%IDU 6,000 0.013%

RFSW 3,480 0.008%

FFSW 1,989 0.004%Rest of Country MSM 563,471 1.241%

IDU 9,355 0.021%RFSW 35,996 0.079%

FFSW 25,198 0.056%


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Estimated Number of PLHIV in Selected Countries 20 12(Source: UNAIDS Website)

Country Number ofPLHIV

PrevalenceRate (15-49 yo)

Thailand 490,000 1.20%

Indonesia 380,000 0.30% Vietnam 250,000 0.50%Malaysia 81,000 0.40%Cambodia 64,000 0.60%Philippines 26,907* 0.04%

* High estimate maybe lowest among the selected countriesbut increasing rate of cases per month


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*Due to lack of regional projections, the national projection of PLHIV from EPP/Spectrum was disaggregated based on the regional proportion in theHIV/AIDS registry.**Number of PLHIV on ART is based on the treatment hub in the region. No available data for regions with no treatment hubs.

HIV Cascade Model, 2012

23,918

11,125

49693,121

351-

5,000

10,000

15,000

20,000

25,000

30,000

*ProjectedNo. of PLHIV

No. of ReportedHIV Cases

PLHIV inneed of ART

**Enrolled inTx Hubs

Deaths


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Current Gaps in HIV Response for MSM1 Significant Portion of the Population are not being covered

(HIV Prevention Activities, HIV Counseling and Testing, Enrollment on ART and Reported Low Adherence to Treatment and Lost to Follow up of those on ART)

2 Very Basic Package of Intervention offered at SHCs, which are

primarily intended for FSWs3. Lack of a Comprehensive/Holistic Services among MSMs

4. Current Strategies are not age-specific and innovative to

respond to the needs of the MSMs5. Limited involvement of PLHIV CBOs in MSM Programs


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II. Key Policies and Guidelines for HIV ResponseSubject

(Year Issued)

Objectives of the Policy Internet Link

HIV Counselingand Testing(2010)

Guidance on HIV counseling and testing(HCT) at community and healthfacility settings

https://dl.dropbox.com/u/84112124/HCTao.pdf

PMTCT

(2009)

Guidance on prevention of mother to childtransmission of HIV that shall be used byhealth care providers nationwide

https://dl.dropbox.com/u/84112124/PMTCTao.pdf

Access of ARV(2009)

Standards for the use of ARVs among adultsand adolescent living with HIV in thePhilippines

https://dl.dropbox.com/u/84112124/ARTao.pdf

TB-HIV

(2008)

Provide guidelines for cross-referral of TB to

HIV, and HIV to TB and TB/HIV co-management

https://www.dropbox.com/sh/19ts3d5yq5nt9j2/mHQ_FOgti1/TB_HIVao.pdf

Philhealth Memoon HIV BenefitPackage(2010)

aimed to increase the proportion ofpopulation having access to effectiveHIV/AIDS treatment

http://db.tt/XgNkcjN1


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POST EXPOSUREMANAGEMENT Hepa B & C, HIV

Technical Guidelines


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MANUAL OFPROCEDURES

Social Hygiene Clinics

HACT GUIDELINES

PEDIATRIC HIVGUIDELINE


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Mobilization and coordination of key players including people living with

HIV/AIDS and Key Population Key players - health centers and clinical services (incl. TB, antenatal clinics, Social

Hygiene Clinics), PLHIV, Local AIDS Council, private sector, CBO, FBO and NGO Referral system to ensure access to and continuity of carePromotion of peer support mechanisms for Key Population, PLHIV

III. Elements of STI and HIV ProgramHIV Testing and Counseling

Pretest education/counseling HIV testing Post-test counseling

Clinical careManagement of OIs including TB, PCP

ART including adherence support Palliative care including symptoms and pain

HIV Prevention STI Diagnosis and Treatment Safer sex and condom promotionPost-Exposure Management for health workers Prevention of mother-to-child Transmission Harm reduction

Psychological and socioeconomic support HIV counseling and spiritual support End of life care

Social welfare Nutritional and daily living support Stigma and discrimination reduction

Prolonged quality of life through optimal ART adherence

Accelerated HIV prevention


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STI and HIV PreventionSTI Diagnosis and Treatment

Safer sex and condom promotion

Infection Control in the hospital setting Post-Exposure Management for health workers

Syphilis Management during Pregnancy

Harm reduction for People Who Inject Drugs


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Promotion of HIV Testing


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HIV Counseling and TestingSHC based HCT for walk in clients

Mobile VCT

Provider Initiated Counseling and Testing (PICT)all patients with STIpartners of high risk individualsTB and pregnant women in Category A sitespatients with AIDS-defining conditions in hospitals


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Clinical CareManagement of common opportunistic infections (OI)including TB, PCP

Antiretroviral therapy (ART)

Care for chronic conditions for those under long term ART

Palliative care including symptoms and pain


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Psychological and socioeconomicsupport for PLHIV

Counseling and spiritual support

Linkage to social support

Nutritional and daily living supportStigma and discrimination reduction

End of life care


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People Who Inject Drugs (PWID)

Community based Peer EducationMotivational Counseling and offer ofdrug counseling and rehabilitationEducation on use of clean needlesand syringeCondom promotion and distributionMobile VCTSTI Diagnosis and TreatmentHepatitis B and C testing


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People Living with HIVBaseline CD4 testing (requested by facilities doing thetesting) Adherence counselling prior to ARV initiation andduring ARV treatmentHIV Outpatient Benefit Package of PhilhealthManagement for common opportunistic infections (eg.,TB, co-trimoxazole for PCP, f luconazole) ARV for pregnant mothers and childrenEarly infant diagnosis thru PCR testing (as early as 6 weeks of life)


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Service Delivery Network for HIV

Support Groups,Networks,

TB-DOTS, Ante-natal andOFW Clinics

Hospitals

Blood ServiceFacilities

Community Based

Organizations

Social Hygiene Clinics And

HACT of Hospitals HIV

TreatmentHubs

SatelliteTreatment

Hubs


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IV. Program Goals, Objectivesand Current Initiatives

HEALTH SECTOR GOALS by 2016

GOAL#1: Reduce New HIV Infections Lower the cumulative new HIV infections by 50% (between 2013-2016)Lower the cumulative new pediatric HIV infections by 90% (between

2013-2016)60% of people living with HIV (PLHIV) know that they are infected

GOAL#2: Improve the quality of life of People Living with HIV (PLHIV) 90% of PLHIV in need of treatment are on Antiretroviral (ARV) drugs90% of 2-year cohort patients are still on the first-line ARV regimen90% of PLHIV with TB are provided TB treatment


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Key Accomplishments% of patients eligible for treatment are started on Antiretrovirals: 76% (2012),67% (as of June 2013)% of PLHIV on ARV enrolled to Philhealth HIV Benefit Package:47%18 HIV Treatment Hubs established nationwide4,500,000 male condoms distributed to MSM and Sex WorkersOrganised outreach activities linked to HIV testing in high riskcommunities

Mobilised individuals to volunteer as peer educators esp in highrisk citiesSupported CHD-NCR for establishment of 7 Satellite TreatmentHubs


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Reflections on the Results of the Gettingto Zero Assessment Tool for NCR

HIV/AIDS perceived as vertical health program can be goodopportunity or hindrance depending on the priority of healthauthorities (national/local)Danger of staff burn-outHealth services are available but not widely promoted, henceless popular;Stigma and discrimination felt/perceived (lack ofunderstanding on MSM/TG concerns)Ineffective IEC and communicationOpportunities - enthusiasm by CSO, individual volunteers,current projects, CHO supportSHC customers and stakeholders generally satisfied with theservices


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V. ConclusionLimited program coverage

only 15% of MSM underwent HCT and only 5% know theirstatusless than half of PLHIV know that they are infected

Services not friendly to MSM/Transgender; and Young PeopleHIV testing not accompanied by adequate quality counselingservicesReferral systems from diagnosis to HIV treatmentEffective IEC and health promotion campaignsPrisons, young people (males who like other males), partnersof KP (for PMTCT)No established system to notify partners of PLHIV

presentation: health sector response: the national aids and sti prevention and control program...

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