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Group Discussion
Guyana, The Bahamas
T & T, Jamaica
Barbados, Haiti
Suriname, Curacao
Successes (1)
Reduction of deaths due to care and treatment
 Increased HIV testing
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E.g. increased VCT centers in Barbados
Decrease incidence of mother to child
transmission
 Decreased Incidence/Prevalence rates
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Observed in both Jamaica and Trinidad
 Guyana dropped 2.5% to 1.5%
 Haiti dropped 6.4% to 2.2%
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Medical patient management system in place
Successess (2)
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Increased capacity to perform diagnostic testing in
country
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Higher CD4 thresholds to initiate antiretroviral therapy
(250-350 cells/mm3)
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Means more patients on antiretroviral therapy
Development of National Reference Laboratory Capacity
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Viral load now performed in Bahamas, T&T, Jamaica
CD4 performed in all countries
Barbados can also to resistance testing
Bahamas: Expansion of equipment & staff
Guyana: Infrastructure in place, hopeful operation soon
Trinidad and Jamaica implemented LIS
Increase in Prevention Programs
Free ARV therapy in all countries
Successes (2)
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Increased uptake of PMTCT program
Initiation of DNA-PCR testing for early infant diagnosis
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Countries have a National AIDS Coordinating Program
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In Bahamas/Guyana, samples sent to South Africa with support
from Clinton Foundation
In T&T samples sent to CAREC
Includes increased capacity for monitoring & evaluation
Increase in access points for PLHIV
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Bahamas: strengthening referral system to national treatment
centers
Guyana: Increased care & treatment sites by incorporating
HAART into regional hospitals and select health centers
Same with Trinidad & Tobago
Haiti: increase in youth participation in services
OPPORTUNITIES
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Cross-Country collaboration and technical support
(sharing knowledge, etc.)
Standardization of Guidelines
Coordination of pharmaceuticals & lab reagents when
supply stock-outs occur
Coordination of training
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Examples:
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Guyana ahead with rapid testing (could help Bahamas)
Bahamas already testing viral load (could help Guyana)
Use technology to improve access to hard-to-reach
areas
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Example: Haiti using manual CD4, Guyana – mobile clinic
OPPORTUNITIES
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To Provide & Share Research
To build on prevention based on the success of Care and
treatment by integrating care treatment and prevention
Increase diagnostic capability for pediatric infection
Team approach to management
Government Support/Political Will
Using infrastructure created by HIV response to build
overall health care infrastructure
Use existing care & treatment services as a model for
decentralization of services
COMMON BARRIERS
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Procurement (medication and reagents) &
Supply chain management (including cold chain)
The Absence of higher level testing in some
countries (Resistance testing & viral load)
Different treatment regimes in countries
Lack of testing to date on HIV infection to know if
infection is new or old
Lack dissemination of information
COMMON BARRIERS
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Human Resources
Stigma and Discrimination
Immigration and Emigration
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Bahamas: immigration presents cultural and language barriers
Guyana: emigration of skilled staff
Haiti: contact tracing
Coordination of care for patients that move between
Caribbean islands
Sustainability of HIV programmes
Integration of vertical programs
Changes in government & regulations
Power struggle and turf war (Information Hording)
Needs (1)
Funding
Staff & Human Resources (particularly trained
staff)
 Training
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Examples:
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Bahamas: development of a national rapid testing algorithm
Lab certification/accreditation
Training in new technologies, retraining in existing ones
Increased involvement of private sector
Infrastructure: Easier transport for patients &
specimens, consistent power supplies, etc.
 Equipment Maintenance
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Recommendations
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Fix all the needs and challenges!
Develop a method of coordination between Caribbean islands that
could be used for:
Patient care
 Training & technical assistance
 Supply chain issues
 Create a common regional policy?
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Methods to reduce stigma & discrimination:
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More education on HIV
Integration of HIV services to primary care
Opt-out testing
Implementation of a sustainability plan and planning for succession
Continue to integrate HIV care into primary care:
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E.g. integrate HIV programs into existing clinics
E.g. integrate other STI screening at VCT sites