Les Centres GHESKIO: Partnership and its impact in increasing access to HIV services

Transcription

1 Les Centres GHESKIO: Partnership and its impact in increasing access to HIV services Marie Marcelle Deschamps MD Deputy Director,GHESKIO 3eme Forum de l Amerique Latine et Caraibes : 6-8 Novembre, 2017

2 Partnership and its impact in increasing access to HIV services Our partnership and increasing services developed as a result of : l Our tripartite mission: Services, Training, Research. l The natural history of HIV/AIDS which involved other diseases: other STIs, TB, diarrheal diseases l As a result of the 2010 earthquake and cholera epidemic that broadens further our mission

3 Les Centres GHESKIO : l 1 st worldwide Comprehensive Center for operational research, services, training on AIDS, later extended to other STIs, TB, dengue, HPV, Chikungunya, ZIKA l Partnership: Ministry of Health and 116 local institutions l National recognition Private Fondation FHAME (1994) Granted of Utilité Publique by Haitian government (2000) l Continuous support from NIH (1983), Fogarty (1988) l Post-earthquake: Global health: care for IDP, primary, vocational, education and microcredit programs l Cholera l Strong international collaboration: Cornell, F. Mérieux, others l 26 sites in Haiti: 2 large Centers in PAP and 24 other collaborative sites

4 GHESKIO Centers VCT Unit l 1 st Voluntary Counseling and Testing (VCT) center in Haiti (1985). l All tested for HIV receive pre and post-test counseling. l All patients are encouraged to visit the family planning clinic, where condoms and other family planning options are offered. l This is the main VCT unit in the Americas: In 2016, we received 40,000 new patients: q 7 % test + for HIV q 90 % come by themselves q Those with cough for 2 weeks are immediately referred to the TB unit for rapid evaluation for TB q Rapid test for HIV and syphilis is done for pregnant women q For other patients HIV test results are given within one week

5 HIV prevalence among new individuals tested at the GHESKIO VCT Center: % 95% 9% 9% 7% 8% 7% 13% 12% 13% 12% Percentage 90% 85% 16% 15% 16% 91% 93% 92% 83% 93% 80% 84% 85% 87% 88% 87% 84% 88% 75% Negative Positive Years

6 Overview of ART Unit Care at GHESKIO l Background Largest network of patients on ART in Haiti: > 26,000 patients, 1/3 of all patients on ART are in the GHESKIO-MOH network Largest clinic in the Americas for patients on ART: 12,314 patients at GHESKIO-INLR and GHESKIO-IMIS l Objectives Identify HIV patients early to place them on ART to improve their quality of life and decrease HIV transmission in the population Improve adherence l At enrolment, many strategies are used to improve adherence: Cells phone with Prepaid phone cards; contact card (staff phone#); home visits; Updating patients address and phone number; Transportation fees; School support; economic opportunity, nutritional support, Multi-month scripting. l Rapid pathway: a new intervention to reduce the waiting time Improved retention of well patients More time for physicians to care for sick patients Significantly reduced wait time for visits

7 GHESKIO HIV/Tuberculosis Unit l One of the largest centers for diagnosis and treatment of TB in Americas. l In 2016: 2,803 new TB cases diagnosed. l All persons presenting with cough for > 2 weeks are screened the same day and if diagnosed with TB are treated the same day. l Contact tracing is done for all TB cases. l About 20% are HIV+

8 Ten largest TB ins-tu-ons in Hai Ins-tu-ons TB cases Ins-tu-ons TB cases Ins-tu-ons TB cases GHESKIO 2719 GHESKIO 2771 GHESKIO INLR 2803 Sanatorium de Port-au- Prince 737 Sanatorium de Port-au- Prince 643 Mennonites Croix-des- Bouquets 509 Mennonites Cx-d-B 529 K-Soleil 489 Sanatorium de PAP 485 Missionaires de la Charite 460 Mennonites Cx-d-B 426 K-Soleil 447 CDS de Ka Soleil 420 GHESKIO/IMIS 377 Grace Children Hospital 394 IMIS GHESKIO 362 Grace Children Hospital 364 Missionnaires de la Charité 378 GCH 344 Hopital IC Cayes 315 GHESKIO IMIS 313 Sanatorium de Siguenau 288 Sanatorium Sigueneau 290 Sanatorium de Sigueneau 271 Hopital IC Cayes 287 PeRts Frères & Sœurs 273 Hopital Immaculee des Cayes 261 CDS de verexes 198 Hopital Ste Therese 267 Nos PeRts Freres et Soeurs 261

9 Development of public health models l As part of our mission we conduct operational research to develop public health models to important public health problems l Through training these models are scaled-up nationwide l As a result we constantly develop new partnerships ( public and private ) and increased access to services

10 Examples of Public heath models in collaboration with the Ministry of Health (MOH) l STIs national algorithms l TB Isoniazid prophylaxis for dually HIV and TB infected Active case finding based on chronic cough MDRTB treatment model l HIV OIs: l prevention and treatment of isosporiasis and cyclosporiasis PMTCT: HIV and Syphilis ART care Test and treat

11 Role of Sexually Transmitted Infections (STIs) in HIV transmission 475 discordant couples Incidence of HIV InfecRon (#/100p.yrs) Condoms STI in HIV- partner Deschamps MM et al. Ann Intern Med;125: , 1996.

12 Diarrhea, Wasting and AIDS GHESKIO developed the definirve treatment and prophylaxis of isosporiasis and cyclosporiasis CLINICAL MANIFESTATIONS AND THERAPY OF ISOSPORA BELLI INFECTION IN PATIENTS WITH THE ACQUIRED IMMUNODEFICIENCY SYNDROME Jack A. DeHovitz, M.D., M.P.H., Jean W. Pape, M.D., Madeleine Boncy, Warren D. Johnson, Jr., M.D. A description of the disease and effective therapy N Engl J Med 315:87-90, THERAPY AND PROPHYLAXIS OF ISOSPORA BELLI INFECTION IN PATIENTS WITH THE ACQUIRED IMMUNODEFICIENCY SYNDROME. Jean William Pape, Rose-Irene Verdier and Warren D. Johnson. N Engl J Med ;320:1044-7, CYCLOSPORA INFECTION IN ADULTS INFECTED WITH HIV: CLINICAL MANIFESTATIONS, TREATMENT, AND PROPHYLAXIS Jean William Pape, Rose-Irene Verdier, Madeleine Boncy, and Warren D. Johnson The treatment and prophylaxis of cyclosporiasis is described Ann Int Med 121:654-7, 1994 TREATMENT AND PROPHYLAXIS OF ISOSPORIASIS AND CYCLOSPORIASIS WITH TRIMETHOPRIM- SULAFAMETHOXAZOLE VERSUS CIPROFLOXACIN: A COMPARATIVE STUDY. Rose Irene Verdier, Warren D. Johnson Jr, Jean William Pape. Ann Int Med;132:885-8, 2000.

13 Test and Treat for TB, HIV The risk of having active tuberculosis among patients with cough at an HIV testing center is 30%. Patients with TB and cough are rapidly identified and treatment initiated the same day to prevent ongoing transmission. Patients infected with both TB and HIV are placed on isoniazid prophylaxis the same day to prevent active TB. Burgess AL et al AIDS 2011:15: Burgess AL, Fitzgerald DW, Severe P, Joseph P, Noel E, Rastogi N, Johnson, WD Jr., Pape JW. IntegraRon of tuberculosis screening at an HIV voluntary counseling and tesrng center in HaiR. AIDS 2001; 15:

14 MDRTB: Diagnosis and Treatment l One of 2 MDRTB treatment hospitals in Haiti l GHESKIO BSL-3 TB lab is the national reference lab for MDRTB diagnosis l In 2016, GHESKIO treated 64 of the 132 MDRTB patients in Haiti; 68 were treated at PIH/ZL

15 10-Year Survival of Patients with AIDS Receiving Antiretroviral Therapy in Haiti l Survival at 10 years : 70% of the AIDS patients on ART at GHESKIO in 2004 are still alive today although 80%: Had advanced AIDS and Severely underweight at ART start l Results indicate long-term sustainability of international efforts to provide ART in resourcepoor settings Pierre S, et al. Ten year survival of parents with AIDS receiving anrretroviral therapy in HaiR. New Engl J Med 2016; 374: January 28, 2016 DOI: /NEJMc

16 Training HIV counseling, prevention/care : OIs, TB/MDRTB, ART, PMTCT, Malaria, FP, Cholera, global health Healthcare providers January TOTAL Technicians 1, ,979 Psychologist Social workers Nurses / Nurses assistant 1, ,465 3, ,016 Physicians 2, ,218 Others ,248 TOTAL 9, ,132 1, ,926 Community IEC 127,216 19,628 65,996 89,747 69,538 20,500 15,262 17, ,599

17 Lab Workload Tests HIV Testing (Rapid+elisa+Arch) 75,896 73,518 58,976 64,967 HIV Western Blot Syphilis (RPR Bioline+ Archit) 62,104 71,883 55,803 62,256 Chemistry 44,391 45,847 45,982 43,175 CBC 27,103 30,501 27,936 31,780 CD4 21,627 21,507 27,426 13,476 Malaria ,272 Pregnancy Tests 5,712 4,288 3,861 4,383 Quantiferon (IGRA- latenttb) CHIK Ig(G)/Ig(M) (serologie) ,603 Hepatitis B, HBAg (BS) 1,903 2, Hepatitis C (BS) 1,581 2, HTLV (BS) 1,543 2, HIV Viral Load RNA PCR 1,823 2,002 2,381 16,158 HIV DBS-DNA PCR (EID) 1,200 1,861 1,850 1,938 ZIKA PCR ZIKA/DENG/CHIK PCR

18 National extension of GHESKIO Model and Services : l Largest network of patients on ART in Haiti l Over 26,000 patients, 1/3 of all patients on ART in Haiti are from the GHESKIO-MOH network. l Currently, the GHESKIO-MOH network consists of 26 sites: l 8 GF and 18 PEPFAR l Of the 18 PEPFAR sites: 8 Public, 7 Private and 3 Mixed

19 National expansion of the GHESKIO/MOH model % of all patients receiving ART in Haiti were from the GHESKIO/MOH network ART in Haiti National HIV prevalence Haiti GHESKIO Network

20 Public Private Partnership GHESKIO MOH (26 Sites) 2 GHESKIO Sites (INLR and IMIS) 15 Private Sites 9 Public Sites Nippes

21 Active Patients on ART in Haiti/ and GHESKIO network Ac-ve pa-ents on ART Sept (Sept) HaiR GHESKIO Network

22 GHESKIO unit for GBV First and largest unit in the country: > 5000 since 2000 Age: 6 mo-86 years old; most between yrs.; 42 % adolescents Services offered: all available prevention/care offered 24/24. Medical care: Emergency contraception; PEP for HIV; STIs prevention. Psychological care: counseling, therapy and support. Rape victims : June 2000 December ,345 victims : 5,289 women - 56 men Victims Years

23 Model of Preven-on and Treatment of cholera GHESKIO / MOH / CDC CTC GHESKIO developed a model of training, prevenron and management of cholera with CDC/PEPFAR support: 15,727 parents. GHESKIO produces chlorine and distributes clean water to the community GHESKIO conducted a cholera vaccine campaign in April 2012; Over 50,000 received OCV; only 1 parent since September 2013 had documented cholera 2. WASH (Chlorine factory) Canal du Bois de Chêne 3. Oral Cholera Vaccine Severe et.al, Effectiveness of Oral Cholera Vaccine in Haiti: 37- Month Follow-Up, American Journal of Tropical Medicine and Hygiene, 2016 May 4;94(5): doi: /ajtmh Epub 2016 Feb 29

24 GHESKIO programs for improving population economic condition WASH: Chlorine factory, distribution of Jerry canes hand washing, street cleaning GHESKIO Vocational School GHESKIO Primary school recognized by MOE 2010 N = 326 students Micro Credit Program : 10,612 loans to 4,106 beneficiaries

25 Partnership Impact: Comprehensive Research, Training and Services Through public- private collaboration/networking : a common vision focusing on the country health priorities Research: > 300 publications: AIDS, TB, syphilis, HPV, cholera, cervical cancer, Zika Training: > 15,000 health workers in Haiti including ASCP. Care: Characterized AIDS, 2/3 decreased HIV seroprevalence, introduced and validated HIV guidelines, STI, OIs Public models developed for HIV, STI, TB, Cholera, Global health ( education, economic development) Now addressing other challenges with national and international partners for ending HIV, addressing HPV,MDRTB, cholera, Chikungunya,ZIKA.