ARV Treatment and monitoring

The UNAIDS 2009 scorecard for the Caribbean shows a mixed picture of the ART Coverage in the Region.  Many countries record a significant deficit in ARV coverage; Cuba, Guyana and Barbados are the only exceptions.  The available data shows that in half of the 10 larger countries (Belize, Trinidad and Tobago, Haiti, Jamaica and the Dominican Republic), where 88% of all Caribbean people living with HIV reside, the national ART coverage is below 50%.  Bahamas and Suriname have coverage between 50% and 60%.
A drastic improvement is required if the number of premature deaths among people living with HIV is to be reduced.  In 2009, only six of the 16 Caribbean states reported a survival rate above 90% 12 months after starting treatment.  On the other hand in 6 countries less than 10% have been lost to follow up within 12 months of starting ART for the period 2006-2009
Much of the challenges with ART coverage are due to late presentation for treatment and adherence issues, the former possibly due to the stigma and discrimination attached to HIV.    According to 2010 UNGASS reports, an emergent issue is a rapid increasing trend of patients moving quickly from first to second line treatment, and the somewhat frequent use of protease inhibitors in the first line.  To address these issues, UNAIDS recommends that the Caribbean adopt the principles of Treatment 2.0 as summarized below.
Treatment 2.0 is designated to maximize the efficiency and effectiveness of HIV treatment through focus on five priorities
•    Optimising drug regimens
•    Advancing point-of-care and other simplified platforms and monitoring
•    Reducing cost
•    Adapting delivery systems and
•    Mobilising community
In addition to the efforts of UNAIDS, other PANCAP regional support partners such as PAHO/PHCO, CAREC and the Caribbean Medical Laboratory Foundation (CMLF)  have also developed a variety of tools and guidelines to support ARV treatment and monitoring programmes in countries.
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