NAPS Newsletter Issue 8

Ministry of Public Health

News

Programme Manager: Dr. Shanti Singh-Anthony A quarterly newsletter by the National AIDS Programme Secretariat

Volume 1 Issue 8 October to December, 2015

Minister Of Public Health Deems Suicide A National Crisis; Spearheads Emergency Meeting Honourable Minister said that suicide takes precedence in his long list of public health concerns and as such suicide happens to be one of those issues that he will take on personally.

H

onourable Dr. George Norton has deemed suicide a very complex issue that is far beyond a public health problem.

Speaking to NAPS News on his priorities for the year 2016 the

IN THIS ISSUE Pg 2 Guyana adapts HIV serial testing algorithm Pg 2 Farewell and Best of Luck to Gina Arjoon Pg 3 Supportive Supervision remains a key tool for quality improvement Pg 3 Training on the Serial testing algorithm in Region 9 Pg 4 World AIDS Day Activities 2015

The Minister alluded to the fact that Guyana recently saw “11 suicides in 11 days” and those he said are successful attempts. In all of these cases the Minister said the victims have not had exposure to any medical intervention, counseling or any form of social advice. We have to do a lot more and this is the reason we are convening an emergency meeting where a committee will be formed with ‘key players’ in efforts to bring on board all major stakeholders to have a national discourse on the way forward, the Minister indicated.

Minister Norton said that his government has received much concern and offers for professional, expert assistance from Guyanese in the Diaspora as well as non Guyanese. While, the government will take these into consideration, the Minister noted that tackling suicide will be done in a holistic approach.

“We have tried many interventions in the past and Guyana still remains one of the country’s leading in rates of suicide globally”, Minister Norton posited.

The psychiatrists believe according to the Minister that 90% of the

mental disorders come from the society, in the community and therefore 90% of the solution resides in the society. He added that many persons are also saying that suicide is not a mental illness but this is to be debated on.

Minister Norton said that a little community like Baramita located in Region 1 was having 1 suicide every 6 weeks and we are yet to figure out the reason. Suicide according to the Minister is not prone to one community in Guyana anymore, it cuts across the racial and economic barriers, he said. “We as a country have suffered from negligence” Minister Norton noted and “if we continue along that line I as Minister would be guilty of that as well, hence, I am taking the lead in finding a solution to this scourge”.

According to the World Health Organization (WHO) in 2012 Guyana was recorded as the country with the highest suicide rate globally of 44.2 per 100,000 people whereas the global average is 12 per 100,000.

The most common form of suicide in Guyana is poisoning by ingestion of pesticide.

On HIV, Minister Norton reiterated his fully support in ensuring that the HIV response continues to operate at an optimal level despite the challenges of reduced donor funds.

He encouraged every Guyanese to

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Minister of Public Health deems suicide a national crisis... take their responsibility seriously; to practice behaviours that will protect them from HIV, to know their HIV status and persons positive to access treatment. He expressed his satisfaction with the high quality of the treatment

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programme and with the professionalism in which the health care workers deliver on their mandate. He urges all partners and stakeholders to stay the course, as the vision of ending AIDS by 2030 must be realized.

Guyana adapts HIV serial testing algorithm

rom the inception, persons testing through the Voluntray Counseling and Testing Programme received their results within 15 minutes through a parallel testing algorithm. This algorithm entailed the testing of a person with 2 tests being done simultaneously in a parallel fashion.

With consideration for the emerging evidence and the new global guidance, the Ministry of Public Health through its National AIDS Programme has approved a serial testing algorithm and the process has began to ensure its full implementation within the first quarter of 2016.

The process of the approval of the new algorithm was spearheaded by a National VCT technical working group led by the Programme Manager of NAPS, Dr. Shanti Singh and in close collaboration with technical persons from the National Public Health Reference Laboratory. Significant technical assistance was given from the PEPFAR programme through the Laboratory Advisor of CDC Guyana Office, Dr. Colin Roach.

great prudence in the use the serial test algorithm.

In preparation for the transitioning, the National Public Health Reference Laboratory will be training all testers and counselors from VCT and PMTCT sites.

The National AIDS Programme Secretariat underscores that the results will continue to be issued within 15 minutes and encourages everyone to know their status.

The almost one year deliberation, reviewing of the evidence and laboratory validation resulted in the approval of the serial testing algorithm by the technical working Group in the last quarter of 2015. This means that persons can now get tested with one test (Determine). If negative result is received, the person will be reported as HIV negative. If tested positive a follow up test will be done using a second test (Unigold). The role out of the implementation of this new algorithm will be closely monitored with supportive supervision given at a regional level from trainer of trainers and nationally from the NAPS and NPHRL. This will ensure that the National HIV testing programme continues to deliver the highest standard of care with reliable and accurate results. See more details of the algorithm in schematic below.

The shift to serial testing is based on the fact that its performance equals that of parallel testing and therefore from economic and implementation standpoints there is

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Training on the Serial testing algorithm in Region 9

Seated in the center- National VCT Coordinator, Ms Deborah Success.

First test - Determine Positive

Negative Report out as Negative Second Test - Unigold

Negative Test

Positive Test Report Out as Positive Third Test - Stat PAK Negative Test

Positive Test

Report out as Negative

Report Out as Positive

Serial Testing Algorithm

Supportive Supervision remains a key tool for quality improvement

T

he National care and treatment meeting of December 2015 reviewed the findings of the supportive supervision held during 2015. The supportive supervision conducted by 5 experienced HIV clinicians saw the review of 588 charts from 14 treatment sites, including 48 children.

Among these 62 charts were reviewed from the hinterland regions of 1, 8 and 9. In addition to chart reviews, difficult cases are discussed.

Comments from Reviewing Physician- West Demerara Treatment Site.

• • • • •

Dr. Quacy GrantClinician Region 8

Supportive supervision started in 2014, and therefore the review of 2015 was the second round. Several key parameters are scrutinized as part of the process. These include documentation in chart, adequacy of follow up visits, ART initiation and maintenance, adherence to the monitoring schedule for patients including these with TB and other opportunistic infections, appropriate, timely request and availability of laboratory test among others.

Comparatively to the first, the review highlighted the improvements across the sites in areas of documentation, follow up, adherence to guidelines in initiation and maintenance on ARVS. Laboratory support improved somewhat but continued to be a challenge.

The review commended two sites for their improvement. Dr. Quacy Grant was singled out for his leadership in Region 8. His site report showed that chart documentation was excellent, that patients at all timese were initiated on ARVs on a timely basis and placed on an appropriate regimen, patients were at all times monitored for TB through WHO screening questions, most of the times had appropriate ordering of laboratory test and in all charts reviewed there were current results for CD4 and Viral Load available . Dr. Quacy Grant in the last quarter of 2015 has been reassigned to the National Vector Control Services. The National AIDS Programme Secretariat wishes him all success in his new role.

The West Demerara Regional Hospital Treatment site has also been highlighted as a site where performance has improved significantly. See box with comments from the reviewing physicians.

The meeting was also reminded physicians that the threshold for initiating patients has increased from 350 to 500 cells/ mm3. Dr. Singh noted that sound scientific evidence was used to guide decisions especially recognizing the importance of treatment as prevention. This shift in the guidelines is also according to the WHO 2013 recommendation to increase the threshold to 500 cell/mm3.

Increasing the threshold will see patients starting Antiretroviral Treatments (ARVs) earlier in the stages of disease progression

Great improvement since last visit, Charts are properly completed Excellent rate of initiation, when not done clearly documentation on attributed social and other reasons Guidelines are followed correctly Excellent work, great improvement. Doctors are knowledgeable, show great interest in their patient management and are willing to learn Congratulations !

and therefore remaining on Highly Active Antiretroviral Therapy (HAART) for the duration of their lifetime.

According to Dr. Singh, the guiding principle of the Guyana’s ART programme is to ensure that every person eligible for receives antiretroviral therapy. And, Guyana recognizes the benefit of starting antiretroviral early and therefore the discussion on Test and Treat as recommended in the most recent WHO guidelines has engaged the attention of the Ministry of Public Health.

Farewell and Best of Luck in Your Future Endeavors

G

ina Arjoon served as Key Populations Coordinator at the National AIDS Programme Secretariat from April 2014-December 2015. But Gina’s work with the NAPS started way before then.

She was involved in the Global Fund HIV/AIDS RCC application, particularly in the preparation of its Counterpart Financing and Willingness to Pay requirements. In addition, she has assisted in the coordination of the budget for the Phase II RCC proposal in 2013.

Gina served as the focal point for the National AIDS Spending Assessment (2011-2012) which was funded by the UNAIDS. As Key Populations Coordinator, Gina organized the first Prevention Forums for MSM and Sex Workers which were held in June 2014 and June 2015 respectively. Under her tenure, a review of the Keep The Lights on Manual was initiated, the first Directory of places where the KAPs can be found was completed and flipcharts to assist in the delivery of key prevention messages for KAP peer educators were created.

In addition to supporting the NAPS, because of her training in Health Economics, Gina has provided technical assistance to the Ministry of Public Health being the principal investigator for a Costing Analysis of Diabetes and Hypertension in Guyana and a Comparative Costing Analysis of the Treatment of Dialysis in Guyana.

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World AIDS Day Activities 2015 A number of activities were held as is customary to mark World AIDS Day observed on 1st December every year.

The annual Appreciation Ceremony held at the Regency Suites Hotel on 3rd December, 2015 recognized health care workers in the Hinterland Regions for outstanding commitment to enhance the delivery of services to patients. Awards were presented to medexes and nurses from region 1, 7, 8 and 9. These were Lolitta Rebeiro, Julett Willie, Sharon Rudie, Winston Williams, Dawn Dunn, Natasha Torres, Henry Lenski, Leola Barnes, Lorraine Gilkes and a post-humus award to Human Rights Activitist Zenita Nicholson.

The book titled “My HIV Story: True Stories of People Living with HIV” written by award winning Guyanese journalist Rawle Nelson was officially launched on World AIDS Day 1st December, 2015 at 14:00hrs at the National Care and Treatment Centre (NCTC).

Rawle Nelson in center is flanked by HIV Programme Managers and Activists

Minister of Public Health Dr. George Norton in center with awardees and other dignitaries On 28th November, 2015 the NAPS spearheaded an awareness and observance walk that marked 28 years of AIDS in Guyana. The walk attracted close to 300 persons from government, faith organizations, community organizations, partners, the private sector and individuals.

Guyana adopted the global theme as selected by the United Nations which was “ending the AIDS Epidemic as part of the sustainable development goals”.

Rawle Nelson managed to gain rare access into the lives of HIVPositive Caribbean people and their families who tell stories about what it’s like living in ‘their world’ with HIV. The book captures thirty (30) stories from individuals who told their stories in the hope that they will eliminate the stigma and discrimination persons living with the virus often face.

Members of various organizations at the Awareness and Observance Walk Designed and Layout by

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