HIV/STD Prevention and Intervention Program June 2009 CNMI Department of Public Health

1. HIV/STD Prevention and Intervention Program June 2009 CNMI Department of Public Health

4. HIV/STD Resource & Treatment CenterBuilding N-29 Navy Hill, Saipan

5. STDs • STDs remain a significant public health concern in the CNMI • CNMI notifiable disease reports • STDs remain the highest • Chlamydia remains the most commonly reported infectious disease in the CNMI • STDs are under reported

6. Reported STD Cases by Sex and Year

7. Total cases of Chlamydia by age, gender & sentinel site for 2008

8. Total cases of Chlamydia by ethnicity & gender in 2008

9. 2009 HIV Epidemiology for the CNMI • Cumulative number - since 1997: • 29 cases diagnosed in CNMI since 1997 • 1 new male case in late 2008; 1 female partner tested positive early 2009 • 8 clients with HIV known to the HIV Program: • 5 are adult males and 3 adult females • 4 on ART • Gender: • 13 Females • 16 Males • Reported Mode of Transmission: • 18 Heterosexual (5 men, 13 women) • 5 MSM • 2 Mother to Infant • 4 Unknown mode • 0 Intravenous drug use

10. 2009 HIV Epidemiology for the CNMI Ethnicity:

11. Cumulative HIV Cases in the CNMI

12. Vertical Transmission – Mother to Infant • 2 cases – late 1990’s (Chuckese). • Since 2000, 4 deliveries; no positive infants; 5th case to delivery 2009. • ART during pregnancy; CDC guidelines for prevention of perinatal transmission - peripartum (AZT) • Collaborative effort – physicians (OB,Ped,IM), nurses, pharmacist, prevention staff, clients

13. 2009 HIV Screening – CNMI Who do we screen ? • Positive STD clients (referrals from government & private clinics) • Prenatal clients – routine testing, unless opts-out • Non-resident Workers Health Program (HIV, RPR, CXR for Tb) – 30,000/yr (private sector) • All blood products – procured through American Red Cross • Correctional clients • Self-referred clients • Active Tuberculosis clients (DPH Chest Clinic) • Family Planning Program clients - Oraquick™ HIV Rapid Test • Adolescent Clinic (high school) & NMC (community college)

14. 2008 HIV Screening • 942 HIV total tests conducted through Public Health in 2008 • Mostly prenatal cases • 1,384 live births at CHC in 2007 • Not including private clinic testing • 306 HIV tests conducted at the HIV/STD Resource and Treatment Center in 2008. • 2008, Oraquick™ HIV Rapid Test introduced in November, testing about 30/month • Family Planning clients; contraception control

15. Client Services • Ryan White CARE Act Part B • Discretionary funds that is payer of “last resort” for Core Services • Core Services • Medications & AIDS Drug Assistance Program (ADAP) • Out-patient care • Laboratory services • Inter-island transportation • Dental & eye care • Health Insurance Continuum of Coverage Programs (HICCPs) • Private insurance co-payments

16. HIV/STD Prevention Staff • MD • shared IM with CHC during clinic days • RN • shared RN with DPH during clinic days • Program Manager • Manages CDC’s HIV and STD Prevention Grant, HIV Surveillance Grant, and HRSA’s RWCA Part B • Counseling, Testing & Referral Services (CTR) certified • STD Case Worker • Case managers positive STD referrals • Contact tracing • CTR certified • HIV Case Worker • Same as STD Case Worker but for HIV (+) clients & partners • Vacant at the moment • HIV Community Worker • Outreach & education • Alien Health Screening Program client management • HIV Clinical Attendant • Clerical duties (appointments, follow-ups, procurement, etc.)

17. Some Training Outcomes since 2000 • HIV demystified - less stigma/fear about HIV (clinical staff more informed – nurses, lab, support)- positive, caring attitude • Improved awareness –barriers to care, universal precautions, guidelines PEP, ART, and prevention of vertical transmission • Importance - STD risk assessment, HIV testing, POS rapid testing, client support and services • Much better understanding – HAART & complicatons, monitoring CD4 & VL, adherence, secondary prevention • Appreciation of challenges faced by PIC’s • Access to consultants

18. Needs Strengthening • MONITORING & EVALUATION: • Improvement of data collection, analysis & reporting • Improve reporting, data-sharing and case management with private providers • DIAGNOSIS, TREATMENT & CARE: • Increase in certified Counselors, training of new staff – constant turnover • Improved contact tracing & partner services • More HIV testing in primary care clinics (private) • ? Dedicated medical provider for HIV/STD Clinic • ? On site STD laboratory testing/processing • EDUCATION & OUTREACH: • Enhance screening activities & outreach (at-risk population e.g. MSMs, sex workers, etc.)

19. CNMI HIV/STD Contacts James U. Hofschneider, MD, HIV/STD Physician (MAP) Laura Shevy, MD, HIV/STD Physician (CHC) John Dax Moreno, DPH Communicable Disease Manager Carol Paez, RN, STD/HIV Nurse (Part-time) Alingmar Uludong-Ogumoro, HIV Community Worker Delma Dela Cruz, HIV Administrative Assistant Tenta Tenorio, STD Caseworker Telephone #: 664-4050 Fax #: 664-4051 E-mail: juhofschneider@gmail.com johndax.moreno@gmail.com

20. Si Yuus Maa’se. Olomwaay.

21. Outreach Activities Street Market outreach in Garapan with Guahan Project’s Barbara Bernardo and JoBeth Aquino

22. Outreach Activities World AIDS Day & Street Market outreach with Napu Life Foundation