Ministry of Public Health & Population Haiti Toward Universal Care HIV/AIDS October 2010

I- HIV burden in Caribbean & Haiti Steps in Haiti's response to HIV infection IMAA strategy Decentralization Approach Main aspect of the approach Situational analysis Challenges Opportunities Perspectives Conclusion

III- HIV burden in Caribbean & Haiti HIV/AIDS is one of the main causes of death in Caribbean Estimated population : 32 millions PLHIV almost HIV prevalence different from one country to one other Haitian rate : 2.2% Feminization of the epidemics in Haiti

IV- Steps (national) In Haiti's to HIV epidemic 1986 – 87 : political commitment 1996 : Strategic plan 2000 :mid-term plan :new strategic plan : Multisectorial plan/operational plan by sector need for universal care and ARV therapy : IMAAD strategy (PCIMAA)

V- IMAAD Multisectorial project (OMS) guidelines & training materials for primary health care personal in low income countries. Simplified guidelines for nurses, nurses aids, community health workers working with MD & under supervision.

VI- Decentralization Vision Better coverage and access to therapy of ARV for the majority of PLHIV Basically, strengthening services at peripheral and referral site

VIII- Approach Background CDC/PEPFAR initiate decentralization process long time ago Decentralization of care trough IMAAD HCR SSPE HCR becomes ARV sites as referral center according to UCS strategy SSPE, first contact within the health system, leaving means to detect HIV & providing follow up for PLHIV Sites of excellence…………………………………………….

IX- Main Aspects of the approach (strategy) Select evidence based interventions and according to the prevalence Maximize human resources (Existing Staff) Implement Standardized clinical protocols and alleviated follow up Work with community, PLHIV in program designing management and provision of care (in decision making) Select cost effective interventions, notably, essential medicines.

XI- Institutional Coverage Year VCTPMTCTSupport service

- Distribution of ARV sites based on estimated PLHIV 3,0 % ,2 % ,6 % ,0 % ,1 % ,9 % ,7 % ,6 % ,4 % ,4 % 4324

XV- Challenges Setting a National Commission for Aids program toward a multisectorial approach and a better coordination Donors Coordination mechanism Rational allocation of resources Better Communication channel

XVI- Opportunities Political will, external interest in Haiti growing after the earthquake Multisectorial strategic plan Pool of donors : GF, PEPFAR (CDC, USAID) IDCA, UN, Agencies ( UNICEF, OPS/OMS, UNFPA, ONUSIDA) Efficient public private partnership Expertise development, technical cooperation increased, civil society involvement PLHIV involvement

XVII- Perspectives Staff training on IMAAD strategy Care expansion (treatment site expansion) norms dissemination Drugs resistance surveillance QI/ QA reinforcement Standardized information system Mid-term evaluation of the National Strategic Plan

XVIII- Areas for technical support MCT Management OI Management STI Management Monitoring and Evaluation VCT Care in community

XIX-Areas for PANCAP intervention Viral burden OI IMAA training Resistance surveillance M & E

XX- Conclusion Multisectoral approach is a key element for decentralization Partnership is essential to MSPP to reach universal care for PLHIV