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ARV National Care and Treatment Program Dominican Republic

ARV National Care and Treatment Program Dominican Republic. DOMINICAN REPUBLIC Geographic location: Caribbean Sea, West Antilles. Shares Hispaniola Island with Haiti.

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ARV National Care and Treatment Program Dominican Republic

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  1. ARV National Care and Treatment Program Dominican Republic

  2. DOMINICAN REPUBLIC Geographic location: Caribbean Sea, West Antilles. Shares Hispaniola Island with Haiti Territory: 48,670.82 km2Government: DemocraticReligion: CatholicLanguage: Spanish

  3. Investment on Health Indicators • Population: 8.2 million (2002). • Female: 50.2% , Male: 49.8% • Population <18 years old: 40.22% • Fertility rate: 3 • Infant mortality rate: 31/1000 b.a. • Maternal mortality rate: 122/100,000 b.a. • Cronic malnutrition (H/A) (Children< 5 years old): 8.9% • Health investment (HI): 5% of GDP • Media HI in Latin America: 7.2% • AIDS investment: RD$142.2 Million *Year 2001: GODR: 87.8 M Donors: 40 M NGO: 14.4 M

  4. Intermediate Results IR1:Increased use of services and practices to prevent and mitigate HIV/AIDS in at risk population. IR3: Increased use of selected, effective child survival services. IR2: Sustainable, effective Reproductive Health / Family Planning services provided by public and private sectors Sub-Proyectos Support to Comprehensive HIV/AIDS care Haiti- DR Frontier Strategy Mejoramiento en la calidad de atención obstétrica en 8 hospitales seleccionados Fortalecimiento del PAI – Región V Programa de Sub-Acuerdos de Donaciones a ONGs Mejoramiento de los sistemas de logística de insumos - Areas Proyecto CONECTA Fortalecimiento Institucional de la SESPAS Other Activities

  5. Intermediate Results IR1:Increased use of services and practices to prevent and mitigate HIV/AIDS in at risk population. IR3: Increased use of selected, effective child survival services. IR2: Sustainable, effective Reproductive Health / Family Planning services provided by public and private sectors Cross cutting program areas Comunicación para Cambio de Comportamiento (CCC) Estrategia de Información, Educación y Comunicación (IEC) Estrategia de Movilización Comunitaria Fortalecimiento Institucional Desarrollo/Mentoria de Alianzas

  6. Current HIV/AIDS Epidemic DHS -2002 Dominican RepublicHIV Seroprevalence Study

  7. Health Service Network PHC services: UNAPS/Rural clinics (1,100) Municipal Hospital (+100) Regional Hospital (8) Provincial Hospital (40)

  8. NATIONAL PROGRAM FOR THE REDUCTION OF MOTHER TO CHILD TRANSMISSION OF HIV (MTCT)

  9. Strategies: • Pre and Post HIV Test Counseling • ARV supply to mother and child • C. Section at 38th week of pregnancy • Formula feeding during six months

  10. RED PAVVCT Network

  11. Pre Test Counseling Post Test Counseling Both Counseling Fundación Génesis – REDPAV Clients receiving counseling: Pre, post or both (81) VCT sites September 2002 – October 2003 *IMPACT / Fundación Génesis - Proyecto RedPAV. Data collected from 81 VCT sites. October 2003.

  12. HIV/AIDS National Strategic PlanCare and Management Objective: Increase access of PLHA to adequate services including ARV treatment

  13. Basic Elements for ARV Provision • Integral VCT services • Health care providers trained in ARV • Patient registration systems • Access to laboratory testings • Continuous stock of ARV and supplies for palliative care and opportunistic infections. • Logistics system for essential commodities Fuente: FHI

  14. Unidad Coordinadora de Atención Integral en VIH/SIDA. Response to the HIV/AIDS Epidemic Ministry of Health

  15. COMPONENTS • Integral Health Care including ARV • National PMTCT Program • VCT • Home Base Care and Palliative Care • OVC • New Program areas (Vaccines, Terciary Prevention, adults, PMTCT +) • BCC, Research, Surveillance, M&E

  16. ETHICAL ASPECTS • Autonomy /Voluntarity • Confidentiality • Right to recieve quality health care • Non - Stigmatizing

  17. Program DevelopmentCONECTA Support • UCAI set up (seconded personnel) • NGO/GODR Health Facilities: infrastructure & equipping • On going supervision and accreditation process • Logistics Mgt. ARV/medical supplies • TA and Training : F&A systems development PWCoopers; ARV, VCT, Biosecurity, service management and financing schemes, information systems, M&E, lab quality control • Mentoring (Service teams) • IEC materials; patient control forms, clinical history • Community mobilization and PLHA involvement for HBC and follow up of DOTS- TB and HAART (Enlace Project) • Lab services screening for ARV/ package of care financing

  18. PNAI - Program Development Timeline 2000 tested/ 438 adults 40 children 32 PLHA UAI/IDCP 48 90 200 ARV CARE March/03 April/03 Jun/03 Sept/03 Nov/03 Jan/04 Feb/04 Jul/04 Program evolution Contingency Plan FHI/HQ TG meeting (Mentoring) WJCF 1 st ARV Training GWU-Tebas 1st Line ARV/ WJCF UCAI NGO sites Trained CU Peds/Adult Initiate ARV

  19. Scenarios Primary Health Care Level (UNAPS) Ambulatory Care Center (CD) Intake Care Unit (UAB) Tertiary Care Level

  20. mailbox of suggestions j k l m n Integral HIV/AIDS Care is based on teamwork... Involves the whole organization

  21. FBO Local Government NGO School Municipal Govt. Integral HIV/AIDS Care integrates health facilities to community COMMUNITY Stakeholders Health Facilities CBO

  22. Basic Care Units and Day Care Centers Public Private Partnerships - CONECTA Project Support to HIV/AIDS Integral Care Program CEPROSH Puerto Plata IDCP Puerto Plata Dajabón Santiago Santiago CEPROSH Hosp. Ramón Matías Mella Santo Domingo La Romana IDEV IDCP L y S HSS Activo 20-30 Centro Micaeliano Hosp. F. Gonzalvo

  23. AMBULATORY PSS PLWHA PSS PSS PSS PSS PSS Evaluation Initial & CD4 (UOI) NO TTO ARV(UOI) TREATMENT WITH ARV (UOI) Follow-up Consultation /3m Re-evaluation Consultation 6 months later Nutritional care Emergency DIRECT OR REFERRED Start of TTO Monthly control Counseling Self-care and Support Emergency Nutritional care ODONTOLOGIC EMERGENCY EMERGENCY AND/OR ADMISSION REFERRAL UNIT Admission Hospital

  24. CARE AND SERVICES INCLUDED “A” Package of Care (Ambulatory) • Initial Evaluation Consultation • Follow-up Consultation • Specialist Consultation, Emergency • Counseling and Emotional Support, Group/Family • Laboratory Tests • Nutritional Care • Psycological Evaluation • Basic information and orientation • Day Care / Procedures • Supplementary feeding

  25. “B” Package of Care Intake Patients • Specialized Consultation • Emergency Care • Emergency Procedures • Admission • Laboratory Tests • Surgical Procedures • Follow-up Consultation

  26. ARV RegimensNational Norms/WHO

  27. Estimated Human Resources

  28. Accreditation Status

  29. Thank you….

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