Control of Sexually Transmitted Infections (STI) in Guyana: Plan to Integrate into Existing Programmes Scotland, S 1 ; Singh, S 1 ; Hernandez, R 2 ; Springer, D 3 ; LaFleur, C 4 ; Boyle, K 5 ; Singh, AE. 6 1 Guyana Ministry of Health, Georgetown, Guyana; 2 PAHO/WHO, Georgetown, Guyana; 3 Consultant, Georgetown, Guyana; 4 Guyana HIV/AIDS Reduction and Prevention Project, Georgetown, Guyana; 5 U.S. Centers for Disease Control & Prevention, Georgetown, Guyana; 6 University of Alberta, Edmonton, Canada BACKGROUND After the diagnosis of the first AIDS case in 1987, the Government of Guyana, together with global agencies and local partners, established state of the art voluntary counselling and testing (VCT) and care and treatment sites for HIV (1). This was facilitated by a government and Ministry of Health with the political commitment to address the many challenges posed by HIV and AIDS. Other contributing factors to this multisectoral HIV/AIDS response were the collaboration between the Guyana Ministry of Health National AIDS Programme Secretariat (MOH/NAPS), local and global partners and the development of the first National HIV/AIDS Strategic Plan in These interventions have resulted in a decline in HIV prevalence in antenatal as well as most at risk populations (MARPs defined as female sex workers, men who have sex with men, in and out of school youth, military and police). The majority of HIV transmission in Guyana is acquired through heterosexual exposure and from , the reported cases of other STI increased significantly (2). For MARPs, Behavioural Surveillance Surveys have also shown that although many report high awareness of STIs and perceive themselves to be at little or no risk for these infections, self-reported rates of STI symptoms were high (3). For non-HIV STI, a structured programme did not exist prior to Since then some enhancements have included improved surveillance for STI and development of multiple Visual Inspection with Acetic Acid (VIA) sites across the country to provide screening for cervical cancer. In recognition of the serious health, social, emotional and economic consequences, the Guyana MOH/NAPS, supported by the Pan American Health Organization/World Health Organization (PAHO/WHO), committed to providing leadership in collaboration with local and global partners to develop a comprehensive strategy to effectively manage and prevent STI in Guyana. METHODS CONCLUSIONS A comprehensive ten year plan for the prevention and control of non HIV sexually transmitted infections has been developed in Guyana. Programmes and strategies will build on existing services for testing, care and treatment for HIV; antenatal programs; Behavioural Surveillance studies in most at risk populations; immunisation programmes. In the longer term, the capacity to screen and test for non-HIV STIs in primary care settings will be developed. A Monitoring and Evaluation Plan will inform the progress of the strategy over the 10 year period. REFERENCES 1.HIV/AIDS in Guyana accessed on 2.Sexually Transmitted Infections Annual Report Guyana Behavioural Surveillance Survey 2008/2009 Report Poster for International Society for STD Research, Quebec City, Canada July 10-13, 2011 ABSTRACT # ABS0235 The Guyana STI Strategic Plan was developed through a collaborative/consultative process which involved key stake-holders and governmental organisations and sectors. The process was facilitated through a local and external consultant, and began with interviews of key stake-holders involved in STIs/HIV programmes. A technical working group was established to provide technical guidance to the process. A gap analysis workshop was held to identify the strengths and weaknesses of the STI response and to determine the strategic priority areas that will be targeted during the ten year period. Focus Group sessions were also held to review and assess the drafts of the documents produced. Further revisions of the draft document were made by the Guyana MOH/NAPS, in conjunction with local and global partners. RESULTS The Goal of the Guyana STI Strategic Plan is to reduce the transmission of and morbidity and mortality caused by STI and to minimise the personal and social impact of the infections. The Purpose of the Guyana STI Strategic Plan is to: Provide the structural framework to guide the coordination, implementation and evaluation of the national response to sexually transmitted infections in Guyana. Serve as a mechanism for the engagement of partners and stakeholders involved in the STI programme. Serve as an advocacy tool for the support of the National STI programme. The Primary Objectives of the Guyana STI Strategic Plan are: To increase the national capacity to manage and coordinate the STI programme. To intensify strategies aimed at primary and secondary prevention for STI. To strengthen the health system to provide quality and efficient STI services by enhancing national laboratory quality and procurement and supplies management systems. To increase the capacity to provide integrated, confidential and quality care and treatment services aligned with the national standards and guidelines. To increase the availability and utilization of strategic information to guide programme planning. Goal, Purpose and Primary Objectives of the Strategy Some Examples of Areas where Services could be integrated Adding screening for other STI (e.g. gonorrhoea, Chlamydia, syphilis, hepatitis B) to existing programmes/clinics/surveys, e.g. antenatal, HIV care and treatment sites, blood donors (syphilis, hepatitis B only), Behavioural Surveillance studies in most at risk populations Using cryotherapy to treat external genital warts at VIA sites Using existing staff within HIV and TB programmes to assist with contact tracing for non-HIV STIs Integrating Syphilis and Genital Ulcer Disease control strategies to assist with the target goal of eliminating congenital syphilis Integrating screening and testing for non HIV STIs into primary care activities Adding HPV immunisation programs to other school based immunisation programmes Broadening participation and involvement of existing community, non governmental and faith based as well as global agencies involved in HIV related activities. RESULTS cont’ Duration of Strategy, Priority Areas and Monitoring and Evaluation In recognition of the fact that long-term measures would be required to impact on STI and HIV, a Ten Year Plan for the prevention and control of sexually transmitted infections has been developed in Guyana. The strategy highlights activities under five Priority Areas: 1) Strengthening STI Programme Management and Coordination 2) Promoting Healthy Sexual Behaviours to Reduce the Transmission of STI 3) Expanding access to STI Prevention, Care and Treatment in the Health Sector 4) Increasing Access to Medicines, Vaccines, Diagnostics and Laboratory Support 5) Improving the Availability of Strategic Information Under each priority area, broad goals, rationale, specific objectives, expected outcomes and targets have been developed. A Monitoring and Evaluation plan has been developed as an integral part of the Strategy to monitor progress over the 10 year period. Government of Guyana Ministry of Health