In recent years, great advances in HIV care and treatment have permitted many people living with HIV and AIDS(PLWHA) to reclaim their health: benefit from increased life expectancy; and generally, resume productive lifestyles which will allow them to contribute to society. As simpler and less expensive antiretroviral (ARV) treatment regimens have become more readily available,  programmes within the region have expanded to assist thousands of PLWHA to access the care and treatment they need.

In 2002, important progress was made when PANCAP signed an agreement with six pharmaceutical companies that reduced the price of ARVs for all Caribbean countries. Significant gains have been made in many countries since the signing of  this agreement, and an estimated 51% of people needing antiretroviral treatment in the region are receiving it. There were an estimated 30,000 adults and children on ARV therapy within the region in 2007,  compared with only 4,000 persons in 2003( UNAIDS, 2008).

 

With the success of ARV treatment, the management of PLWHA has evolved so that patients now need access to an array of services not limited  to only ARV treatment. These services vary along the natural evolution of the infection and include -

  • Counselling and psychosocial support.
  • Prevention of further transmission.
  • Nutritional support.
  • Treatment and prophylaxis of Opportunistic infections(OIs).
  • Palliative care, Home-based care, end of life support.
  • Laboratory support for monitoring and diagnosis.

 The Caribbean Regional Strategic Framework (CRSF) 2008-2012 seeks to deliver on this mandate, as well as create an environment which enables and promotes universal access.

Key Achievements

The success of the Pan Caribbean Partnership Against HIV and AIDS (PANCAP) is reflected in the decrease in mortality of persons from AIDS-related complications. This is attributable, but not limited, to the following -

  1. Improved access to less expensive ARVs across the region through cooperative agreements, for example, the respective Brazil/ OECS and Brazil/ CARICOM cooperative agreements, as well as through the principal donor agencies, the Global Fund, World Bank, Clinton Foundation and US President's Emergency Plan for AIDS Relief (PEPFAR), to mention a few.
  2. Development of Caribbean Guidelines for the Care and Treatment of Persons with HIV Infection, to improve standards of treatment.
  3. Development of Caribbean Guidelines for the Prevention, Treatment, Care and Control of Tuberculosis and TB/HIV.
  4. Establishment of the Caribbean HIV Regional Training (CHART) network in Jamaica in 2003, and its expansion to five other countries in the region, improving access to  healthcare workers trained in the field of HIV. CHART has trained and mentored approximately 16,542 healthcare workers during the period 2005-2009.
  5. Improved access to laboratory monitoring of PLWHAs, especially in the fields of CD4, viral load and resistance monitoring which, if not accessible in-country, are accessible through the strengthened laborsatory network within the region.

Treatment, Care and Support - Update as of 2010

  1. The Caribbean has made commendable progress in the area of access to treatment. Here are some quick facts
    •    Between 2004 and 2009 the region has had an almost seven-fold increase in the number of persons who have been placed on antiretroviral therapy (ART), increasing from just over 9000 to almost 63000 persons
    •    By the end of 2009, close to two-thirds of individuals who required ART were actually receiving it, based on the initial World Health Organization (WHO) criterion of initiating ART at CD4 counts of 200 and below.
    •     48% of the population of PLHIV who require ART in the Caribbean are  actually on therapy, based on the revised WHO criterion of initiating therapy at CD4 counts at or below 350
    •     Regardless of the value used for initiating therapy, the Caribbean is among those regions where the largest percentages of persons who need ART actually receive it.
    •     However, with the recently provided evidence that early treatment of the infected partner in discordant couples can prevent transmission in 95% of cases, it is quite likely that there will be calls for initiating ART at significantly higher CD4 counts. This will severely challenge Caribbean health systems to provide such treatment.
    •    There are also major achievements in retaining those individuals on therapy. In 2007, 78% of persons who initiated therapy were still on ART 12 months later.
    In addition, PANCAP’s regional support partners, in particular the Pan American Health Organization (PAHO/PHCO), the Caribbean Epidemiology Centre (CAREC) and Caribbean Medical laboratory Foundation (CMLF) have developed a variety of tools and guidelines to support ARV treatment and monitoring programmes.
    The Future Agenda

The focus for treatment and care, as guided by the CRSF 2008-2012, will be to increase access to services and to build the capacity of support services for treatment and care, both nationally and regionally.

This will be achieved mainly through the following initiatives -

  • Increasing access  and sustainability initiatives for ARV and OI drugs.
  • Improving the management of sexually transmitted infections (STIs) and OIs.
  • Integration of HIV treatment into primary health care and the decentralisation of services.
  • Improving access to nutritional and psychosocial services.

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