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HIV in Suriname

HIV in Suriname. Ministry of Health Suriname M.Sigrid Mac Donald – Ottevanger, MD Focal point HIV Treatment and Care, NAP. HIV in Suriname. Inhabitants 531.000¹, Multi-ethnic population Estimated HIV prevalence 1.1² Universal access to HAART/medicines for OI

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HIV in Suriname

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  1. HIV in Suriname Ministry of Health Suriname M.Sigrid Mac Donald – Ottevanger, MD Focal point HIV Treatment and Care, NAP

  2. HIV in Suriname • Inhabitants 531.000¹, Multi-ethnic population • Estimated HIV prevalence 1.1² • Universal access to HAART/medicines for OI • CD 4 and VL testing free of charge • Prevalence for HIV & pregnant women: 1% • 42 repeat pregnancies in 2012! • baby-formula • Access to HAART 66% of advanced HIV² • Only 62% still on HAART after one year²

  3. Number of people on Treatment

  4. >50% decrease in incidence of HIV (UNAIDS)

  5. Healthcare System & Suriname • Health care expenditure of US$ 324.26 per capita per year • Primary health care is provided by • RGD (Regional Health Services), • MZ (Medical Mission) 300 clinics • Private sector. • The RGD provides health care in the coastal area & capital • Medical Mission provides health care in the interior (over 50 clinics!) • Secondary health care is provided in 5 hospitals, of which 4 are in the capital Paramaribo • ARVs available at all Hospital pharmacies (RGD/MZ)**

  6. HIV & SurinamePolicies The Government of Suriname adopted the UNGASS Declaration of Commitment in June 2001, National Commitment to the response against HIV and AIDS. In 2002 Surinamese Government initiated a process for the systematic and strategic control of HIV. In 2007, the second National Strategic Plan for HIV (NSP) 2009-2013 was developed. A multi sectoral approach of HIV/AIDS prevention, treatment and care ARV purchasing fully funded by government!

  7. HIV & Suriname Ministry of Health • Focal point system • Focal point HIV treatment & care • Focal point PMTCT (case manager) • Focal point Prevention • Technical unit • Monitoring & Evaluation manager • Center of Excellence • NGO’s • One Stop Shop for chronic disease management

  8. Center of Excellence Primary Health Care NGOs, Religious groups

  9. Fundaments of HIV Treatment in Suriname • Public Health approach • Multiple VCT sites • Primary care physicians treat HIV • Complicated HIV is referred to secondary care • Patient support • Family • Peer counselors and buddy’s • NGO’s / Religious groups • Social workers • National treatment guidelines since 2000 • Current guidelines are third revision (2010)

  10. Main objective: “TO HALT THE SPREAD OF HIV AND TO INCREASE THE QUANTITY AND QUALITY OF LIFE OF PEOPLE LIVING WITH HIV”.

  11. Treatment guidelines (I) • Newly diagnosed HIV not seriously ill preferably work-up by primary care physician • Patient history • Medical history • Psychological status • Social status : work, family, relationships, children • Intoxications: alcohol/ drugs • Emphasis on • Acceptance of HIV • Building patient support • Physical exam • Clinical condition/ symptoms of opportunistic infections • Laboratory tests • CD4 counts, CBC, liver and kidney function tests, screen for TB, cervical cancer

  12. Treatment guidelines (II) • CD4 count above 200 • CD4 count > 350 no HAART (exception PMTCT, HIV dementia, hepatitis B, HIVAN ) • CD4 count 200-350: HAART depending on patient motivation, adherence and age • CD4 count ≤ 200 or WHO stage III/ IV prepare to start HAART

  13. Treatment guidelines (III) • Inform patient (and buddy) • Need for treatment • Importance of adherence • Foreseeable visits to clinic, laboratory exams • Potential adverse effects • First-line regimen • Duovir-N ( AZT/ 3TC/ NVP) • Second – line regimen: PI • Register patient with HIV program • Referral to second line care when needed

  14. Concerns • Denial and stigma • Patients enter late into care • Estimated > 50 % in secondary care • High percentage LTFU • In pharmacy data after start HAART • Patients get LTFU after diagnosis (VCT’s) • Patients get LTFU after PMTCT

  15. Concerns & Challenges • Challenge has now evolved from acute to chronic care (One stop shop) • PMTCT – repeat pregnancies – importance of Eliminiation Initiative prongs 1-4 • HIV-infected infants and children now survive to adolescence and adulthood • Obstacle: scaling up paediatric care • An increasing number of HIV-infected children highlights the primary importance of PMTCT • HIV/TB Comorbidity • Hard to reach populations • (Interior, covert SW)

  16. Thank You!

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