Building Capacity for a Sustainable, Country-led Response to the HIV/AIDS Epidemic in Guyana: A Technical Assistance Support Model to the Guyana Ministry of Health (MOH) under the President's Emergency Plan for AIDS Relief (PEPFAR)
Approach: Activities Outcomes Short Term Outcomes (1-2 Years) Intermediate Outcomes (3-4 Years) Long Term Outcomes (5+ Years) Conduct operational assessment of current key populations (KP) HIV programs Detail the level of adherence/compliance of MOH program managers and senior staff to key population program implementation requirements Identify operational gaps in key populations’ program delivery (stock-outs of materials, difficulty recruiting and retaining providers, inability to reach targeting populations using recommended strategy, etc.) Develop new and revised key populations’ programming addressing operational and uptake challenges identified by administrators and end-users Inform provider training agenda based on self-reported needs of HIV-infected key populations Conduct end-user assessment of current key populations HIV programs Identify barriers to access and uptake of clinical services by HIV-infected members of key populations Describe preferred service delivery options as reported by HIV-infected key populations (e.g. hours of operation, location, attending clinical staff type, clinical service gaps) Increased access to HIV clinical services for key populations Improved uptake of HIV clinical services by key populations Reduced disparities between the general and key populations in HIV transmission and clinical outcomes (e.g. GP prevalence 0.8-1.3% vs KP prevalence 19-24%) Provide HIV best clinical practices trainings to clinicians at national and regional sites (offering should be open to clinical staff from NGOs) Increased adherence of clinicians to international HIV clinical and treatment guidelines Increased provider awareness of operational strategies for clinical management of HIV-infected members of key populations Increased collaborative care provision between national clinical treatment centers and civil society care and support organizations Increased access to and quality of HIV clinical care, especially for MSM and commercial sex workers (CSW) Improved linkage to and retention in care, especially for MSM and CSW Develop and pilot a single, consolidated HIV/AIDS care quality improvement strategy and assessment tool Implement and integrate consolidated HIV/AIDS care quality improvement strategy and assessment tool Increased efficiency in monitoring quality of care at the main MOH service delivery sites (efficiency as indicated by the number of administrative areas assessed in a visit and number of measures included in a single chart review) Improved quality of care at the main MOH service delivery sites Increased documentation of linkage to care Design and develop a pilot HIV/AIDS electronic database for patient monitoring Implement and integrate HIV/AIDS electronic database for patient monitoring Increased availability of strategic information (SI) for patient monitoring (adherence, CD4 count, viral load, HIV genotyping and phenotyping where applicable) Improved ability to use patient data for program monitoring at the national level Develop, pilot and implement a patient linking strategy with a single, robust patient unique identifier across all MOH programs Improved case tracking of HIV-infected clients across other MOH programs (e.g. TB, STI, PMTCT) Increased integration of HIV care with other comorbid conditions under the MOH management Improved quality of care Improved patient outcomes as documented in chart reviews and patient monitoring databases Develop and pilot an enhanced surveillance strategy for National AIDS Program Secretariat (NAPS) data linkage Decreased client duplication across multiple monitoring indicators used for reporting Increased cost savings by reducing excessive procurement spending (test kits, drugs, educational materials etc.) Develop and pilot a revised case surveillance form to include transmission risk Increased volume and quality of strategic information on key populations and other vulnerable group Increased data utilization for program targeting to reach MSM, CSW and transgender (TG) Increased data reporting on KP and vulnerable groups (risk and outcomes) Conduct data management and analysis trainings Increased capacity of HIV program officers for data analysis within the MOH Increased country ownership for HIV data management and utilization Improved program monitoring and evaluation Conduct HIV Drug Resistance (HIVDR) testing Report HIVDR trends among enrolled care patients Increased availability of strategic information to revise treatment guidelines with specific emphasis on the management of drug resistance for regimen selection and switching Reduced incidence of acquired HIV Drug Resistance Reduced HIV-related morbidity and mortality Conduct open case conferences with NGOs at the National Care and Treatment Center (NCTC) Reduced loss to care Increased rate of patient re-engagement after loss to care Increased proportion of patients retained in care Improved quality of HIV care Reduced HIV-related morbidity and mortality Conduct routine adherence assessments and transmission risk reassessment among retained care clients Improved detection of adherence challenges Reduced incidence of treatment failure Reduced incidence of acquired drug resistance Improved quality of HIV clinical care Reduced viral load Reduced incidence of opportunistic infections Develop and pilot an HIV/AIDS-specific quality improvement strategy and assessment tool for laboratory services Increased availability of strategic information around laboratory performance Reduced turnaround time for HIV confirmatory test results Increased quality checks for rapid testing using gold standards (ELISA and Western Blot) Improved quality of laboratory service delivery Maintenance of a safe blood supply Conduct an HIV drug resistance capacity assessment at national public health reference laboratory (NPHRL) Increased availability of strategic information around HIVDR testing at NPHRL Increased data for decision making ability around initiating HIVDR testing locally and the required inputs Monitor current infection control practices at HIV and TB care sites Decreased risk of TB/HIV nosocomial infections Decreased incidence of TB among HIV-infected patients in care Reduced TB/HIV-related morbidity and mortality for the coinfected Develop a clinical cascade at the national level for ongoing program monitoring and evaluation (M&E) Improved program management by highlighting areas of need across the continuum of care Improved program quality Reduced HIV-related morbidity and mortality Establish and build capacity for Caribbean regional support, including analysis Increased collaboration with peers and technical support resources within the Caribbean region Increased availability of sustainable HIV technical assistance outside of USG or international multilaterals
Office: CENTERS FOR DISEASE CONTROL
ygrant@cdc.gov
