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National AIDS and STI Prevention and Control Program (NASPCP)

National AIDS and STI Prevention and Control Program (NASPCP). Jose Gerard Belimac, MD, MPH MS IV – National Center for Disease Prevention and Control. Estimated no. of PLHIV by region, 2011. Asia bears the 2 nd highest burden of HIV (4.9 million). Estimated no. of PLHIV.

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National AIDS and STI Prevention and Control Program (NASPCP)

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  1. National AIDS and STI Prevention and Control Program (NASPCP) Jose Gerard Belimac, MD, MPH MS IV – National Center for Disease Prevention and Control

  2. Estimated no. of PLHIV by region, 2011 Asia bears the 2nd highest burden of HIV (4.9 million) Estimated no. of PLHIV East South and South-East Asia Middle East and North Africa Sub-Saharan Africa Latin America & Caribean Europe and Central Asia Oceania Source: GARP 2012

  3. HIV prevalence among different risk groups noted in the past 5 years (Source: Integrated HIV Behavioral and Serologic Surveillance, NEC) National Center for Disease Prevention and Control

  4. HIV and AIDS Registry

  5. Projection of HIV Cases(Source: National Estimates of PLHIV and MARP, NEC-PNAC) YEAR 0.029 0.036 0.042 0.048 0.055 0.062 Est HIV Prevalence

  6. Relationship of Program Targets to AMTP Indicators

  7. Target #1 Reduce infections by 50% Target # 2 Reduce new pediatric HIV infections by 90% Target #3 60% of PLHIV know that they are infected Target #4 90% of PLHIV in need of treatment are on Anti-retroviral (ARV) drugs Target #5 90% of 2-year cohort patients are still on the first-line ARV regimen Target #6 90% of PLHIV with TB are provided TB treatment Program Targets x 2016

  8. Program Targets, Indicators x 2016 Target #1 Reduce the new HIV infections by 50% Reduce Sexual Transmission of HIV by 50% • Condom use among MSM (80%) • Condom use female sex workers (80%) • Condom use people who inject drugs (60%) • MSM, PWID with more than 1 sexual partner in the past year (<30%) • PWID use clean injecting equipments (80%) • MSM, FSW, PWID reached by prevention programs (80%) • MSM, FSW with Hepa B vaccination (80%) • STI cases provided treatment (90%) • Number of condoms and lubricants distributed*

  9. Program Targets, Indicators x 2016 • Target # 2 • Reduce new pediatric HIV infections by 90% Reduce mother to child transmission of HIV • High risk pregnant women screened for syphilis and provided treatment (80%) • High risk pregnant women offered HIV counseling and testing (80%) • PLHIV pregnant women provided ARV either prophylaxis or treatment (100%) • Infants borne to HIV (+) mothers received prophylaxis (ARV + co-trimoxazole); and underwent Early Infant Diagnosis (PCR) within 2-months at birth (100%) • PLHIV peripartum women counseled on family planning, and infant feeding options (same with national policy on breastfeeding) – 100%

  10. Program Targets, Indicators x 2016 • Target #3 • 60% of PLHIV know that they are infected Improve HIV Case Detection and Partner Disclosure • Men and Women 15-49 yo receive HIV counseling and testing (1%) • Male Sex Worker/PWID/MSM/Female Sex Worker underwent HIV testing and know their result (40%/40%/60%/80%) • Newly diagnosed PLHIV underwent baseline laboratory (CD4) at HCT facilities (95%) • Partners of PLHIV referred to HCT by Peer Educators (PLHIV) - xxx • 100% of PLHIV provided counseling on Partner Disclosure

  11. Program Targets, Indicators x 2016 • Target #4. #5 • 90% of PLHIV in need of treatment are on Anti-retroviral (ARV) drugs • 90% of 2-year cohort patients are still on the first-line ARV regimen Provide HIV Treatment, Care and Support Services • Percentage of adults and children with HIV known to be on treatment 12 months after initiation of anti-retroviral therapy • Percent PLHIV on treatment still alive 24, 36 and 60 months after initiation of ARV (90%) • Percent PLHIV on treatment undergo annual viral load monitoring (95%) • Percent PLHIV given key vaccines (flu, pneumonia, hepatitis) based on national guidelines (95%) • 100% of Care and Support Organizations conducting Peer Adherence Counseling • Percent PLHIV enrolled and availing PHIC HIV Benefit Package (90%)

  12. Program Targets, Indicators x 2016 • Target #6 • 90% of PLHIV with TB are provided TB treatment Reduce TB deaths among PLHIV • Percent of PLHIV (adult and children) started on Isoniazid Preventive Therapy (IPT) • Percentage of HIV positive TB incident cases who both received HIV and TB Treatment • Percentage of PLHIV enrolled in HIV Care who have their TB status assessed during their last visit

  13. Framework of Interventions – Health Sector

  14. Service Delivery Network for HIV Satellite Treatment Hubs Blood Service Facilities HIV Counseling and Testing (Social Hygiene Clinics, HIV AIDS Core Team of ALL Hospitals TB-DOTS, Ante-natal and OFW Clinics Hospitals HIV Treatment Hubs Community – Based Organizations Support Groups, Networks,

  15. Highlights of Accomplishments • 60,000 STI/OI cases provided treatment (2012) • 4,417,000 condoms distributed (2012) • 3,682 Western Blot Tests performed • 17 HIV Treatment Hubs established • 2 Satellite Treatment Hubs established (QC and Cebu City Health Department) • 3,492 PLHIV started on ARV (45% enrolled and availed of PHIC OPD HIV Benefit Package)

  16. Highlights of Accomplishments • Evaluated the HIV Counseling and Testing Models (TA – WPRO; UNICEF) • Evaluated and Revised the Peer Education Module and Strategy among Most at Risk Children and Young People conducted (TA - UNICEF) • Revised the Manual of Procedures of Social Hygiene Clinics (re-orientation of services to include MSM) • Developed Health Sector HIV Strategy 2013-2016

  17. Gaps • Coverage • program interventions limited coverage (only 15% target MSM underwent HCT, 5% know their status, condom use still very low DOH target of 60-80% • Quality • Insufficient standard operating guidelines, supervision mechanism • Effectiveness • structural barriers in SHC discourages access of Key Affected Population • Services not YP-MSM friendly • Peer Educators not maximised (logsitic concerns) • Limited staff in SHC, including medical technologists

  18. Challenges • Persistence of stigma in the community and health facility setting • Inadequate staffing of SHC and Hospitals, no designated HIV counselor • Minimal funding from the LGU • Fast turn-over of volunteer groups and individuals

  19. Priority Actions/Catch-up plans • Scale – up of services (esp in category A, B, C sites): • Community mobilization • Outreach activities • Address patient/client loss: • Faster release of HIV test results • Point of Care HIV Testing with on-site CD4 testing • Re-orientation of SHC services (YP-MSM friendly) • Comprehensive HIV Program for PWID in Central Visayas • Finalization of DOH HIV Health Promotion Plan (NCHP) • Establish HCT facilities (one-stop shop service) in ALL cat A/B cities • Establishment of HIV “Satellite Treatment Hubs” to Decentralize HIV Treatment • Revise HIV Treatment Guideline (Increase CD4 cut-off) • Private Sector engagement in HCT

  20. Priority Actions/Catch-up plans • Scale – up of services (esp in category A, B, C sites): • Community mobilization • Outreach activities • Address patient/client loss: • Faster release of HIV test results • Point of Care HIV Testing with on-site CD4 testing • Re-orientation of SHC services (YP-MSM friendly) • Comprehensive HIV Program for PWID in Central Visayas • Finalization of DOH HIV Health Promotion Plan (NCHP) • Establish HCT facilities (one-stop shop service) in ALL cat A/B cities • Establishment of HIV “Satellite Treatment Hubs” to Decentralize HIV Treatment • Revise HIV Treatment Guideline (Increase CD4 cut-off) • Private Sector engagement in HCT

  21. DOH Actions • Advocacy • Trainings • Surveillance • Study on Validation HIV testing algorithm • Tools, Guidelines and Policy development • Procurement of essential commodities (drugs, reagents, condoms)

  22. Areas in need of donor support/TA • Logistics during the conduct mobile clinics, outreach activities of peers and LGU (vehicles, transportation allowances, insurance of peer educators) • Augment staff of HCT sites (need more counselors and Medical Technologists) – at least two operational HCT sites in each high burden cities • Equipments: CD4 machines should be available in selected HCT sites • Fund NGO to advocate for setting up of Local AIDS Councils, 100% Condom Use Program, General Health Promotion Campaigns that aims to encourage people to take the HIV test, and mainstream HIV • Support of MARCY (most at risk children and Young People) interventions • Refurbishment of Social Hygiene Clinics • Private sector engagement in HIV Counseling and Testing Strategy • Further qualitative research on Transgender, Prisons, other HIV-risky situations • Innovative BCC Strategy approaches

  23. Summary • HIV epidemic is less than 1% in general population but with increasing prevalence annually • Major driver of epidemic are MSM and PWID, young people are at higher risk due to lower knowledge and poorer access to services • Future infections projected steeply increase with current scale of interventions – need to increase prevention and diagnosis coverage to 80% to stabilize epidemic • Health Sector Strategy developed anchored to the 5th AMTP • Commodities and Treatment are available, although still need more funding • Areas where partners can support are identified - mostly on scale – up of services (Peer Educators, Human Resource Complement in HCT sites, logistics especially in mobile clinics/outreach, BCC)

  24. Thank you

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