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HIV Surveillance in Barbados

HIV Surveillance in Barbados. 2 nd Global HIV/AIDS Surveillance Meeting Bangkok, Thailand March 2-5, 2009. Anton Best, MBBS, MPH&TM Senior Medical Officer of Health (CD) HIV/AIDS Program Ministry of Health Barbados. Outline. Background of Barbados HIV Surveillance system

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HIV Surveillance in Barbados

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  1. HIV Surveillance in Barbados 2nd Global HIV/AIDS Surveillance Meeting Bangkok, Thailand March 2-5, 2009 Anton Best, MBBS, MPH&TM Senior Medical Officer of Health (CD) HIV/AIDS Program Ministry of Health Barbados

  2. Outline • Background of Barbados • HIV Surveillance system • HIV/AIDS Epidemiology in Barbados • The Barbados HIV/AIDS Surveillance Report 2007 • Program response • Conclusion HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  3. Barbados • Barbados is the easternmost island in the Caribbean • Size: 430 sq. km (166 sq. miles) • Population (2007 est.): 274, 700 • GDP: $14, 500 USD per capita HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  4. HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  5. HIV Surveillance in Barbados • HIV surveillance is laboratory-driven. • All blood samples for HIV testing are sent to a central laboratory at the main hospital. • Each HIV+ case is documented and submitted to the HIV Surveillance Unit • Previously we got very basic information on patients- no CD4- no risk data HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  6. HIV Surveillance in Barbados (2) • Now, a Surveillance Nurse completes the newly designed case report form before submission to the Surveillance unit. • Information on the HIV+ cases are then entered into the NHS data base. HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  7. Minimum Variables • Name • Sex • Date of Birth • Address • Date of diagnosis • Risk behaviour • Related laboratory results • Data on Care/treatment HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  8. Reporting criteria • Anyone who is newly diagnosed with HIV at any clinical stage • Anyone who was previously diagnosed and reported with HIV who has progressed to AIDS is reported again as having AIDS • When an HIV-infected person dies HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  9. Epidemiology of HIV/AIDS in Barbados • The first case was in 1984 • Stable HIV incidence since 1994 • Dramatic decline in HIV deaths after 2001 • 1.9% HIV prevalence amongst adults1 • The HIV epidemic is mixed • Vulnerable populations – some identified but little HIV sero-prevalence data 1 The UNGASS Report for Barbados 2008

  10. Cumulative HIV Statistics; 1984 – 20072 2The Barbados HIV/AIDS Surveillance Report 2007

  11. Cumulative HIV and AIDS cases, Persons living with HIV and HIV-related deaths from 1984 to 2007 HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  12. HIV/AIDS surveillance 1984 – 2007 HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  13. HIV/AIDS Surveillance in 20072 • 163 cases newly diagnosed with HIV; 99 men (60.7%) and 64 women (39.3%) • 53 new AIDS cases; 32 men (60.4%) and 21 women (39.6%) • 50 PLHIV died; 34 men (68%) and 16 women (32%) • Male preponderance of all facets of surveillance 2The Barbados HIV/AIDS Surveillance Report 2007

  14. Risk factors for HIV transmission • 143 PLHIV registered for care in 2007 • Detailed information is captured in their medical records • These data were analyzed to determine some possible risk factors for HIV transmission in Barbados HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  15. Self-identified sexual preferences of HIV+ men in 2007 HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  16. Immunological classification of new patients HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  17. Program response • Efforts to diagnose HIV earlier; particularly for men • Targeted HIV testing and outreach programs, more routine testing (PITC) • Plan to improve contact tracing to increase number of PLHIV diagnosed and accessing care • Efforts to collect information on risk behaviours routinely • Future behavioural surveillance on our most-at-risk populations (including MSM, sex workers and drug addicts) • Male focussed prevention interventions • Future studies on mortality HIV Surveillance in Barbados - March 2009 - Dr. Anton Best

  18. Data Management • NHS database and database at the clinic (SHIP) are being improved with support from the CDC • AIM: To use IT databases to obtain more routine, accurate and detailed epidemiologic analyses HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  19. Resources Human Resources Technical Assistance Caribbean Epidemiology Centre (CAREC) CDC • Head of HIV diagnostics • Surveillance Nurse • Data Analyst (Statistician) • HIV program manager (Senior Medical Officer of Health) HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  20. Conclusion • HIV case surveillance is laboratory-initiated • A new HIV case report form and systems are being explored and expected to provide more detailed understanding of the HIV epidemic in Barbados HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  21. Conclusion (2) • More appropriate and targeted interventions for most-at-risk groups • Evaluate the HAART program HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  22. Acknowledgements • The CDC (Caribbean Regional Office and the CDC, Atlanta)- Dr. Shirley Lecher- Dr. Irum Zaidi- Ms. Wanjiru Waruiru • PAHO/WHO (Caribbean Office) HIV Surveillance in Barbados - March 2009 Dr. Anton Best

  23. Thank you! 2nd Global HIV/AIDS Surveillance Meeting Bangkok, Thailand March 2-5, 2009 Anton Best, MBBS, MPH&TM Senior Medical Officer of Health (CD) HIV/ AIDS Program Ministry of Health Barbados anton.best@barbados.gov.bb

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