History

History: HIV

The first case of Paediatric AIDS was identified in Jamaica in 1986.In the years following this diagnosis, there was a sharp increase in morbidity and mortality due to HIV/AIDS in Jamaica’s children. HIV AIDS was in the top 4 causes of mortality in children less than 5 yrs of age. The Mortality rate in HIV/AIDS was ~ 50%. In the midst of this grim reality, efforts to Prevent Mother to Child Transmission of HIV in Jamaica began in 2000 as a pilot programme implemented by the Ministry of Health in selected sites in four parishes. Mothers were offered HIV testing and counselling in pregnancy. HIV positive mothers received Nevirapine during labour and HIV-exposed infants also received Nevirapine prophylaxis after birth. These interventions did result in a reduction in HIV related mortality among these infants despite limitations in the uptake of these interventions and infant testing.

In September 2002, the Kingston Paediatric and Perinatal HIV/ AIDS Programme(KPAIDS) was commenced in response to the paediatric HIV epidemic. KPAIDS, in collaboration with the University of the West Indies, the Ministry of Health and international partners established pMTCT initiatives and organized followup care for HIV exposed and infected children. These initiatives were implemented in the field by Research Nurses. KPAIDS focused on early identification of HIV positive pregnant women, reduction of mother to child transmission through provision of antenatal care and antiretroviral therapy and close followup of HIV exposed infants in Greater Kingston and St. Catherine. The programme began with a Zidovudine based regime for mothers and infants. pMTCT interventions were also ongoing in other parts of the island with Nevirapine based regime. The KPAIDS team also established outreach clinics in rural parishes. Several training exercises were conducted to improve the knowledge base of the health care team islandwide. There was a demonstrable fall in pMTCT rates from 25-30% prior to the start of the Programme to <2% in the KPAIDS cohort.

 

In 2005, additional funding was obtained to facilitate Highly active antiretroviral therapy to pregnant women. The National HIV/STI Programme was also making efforts to integrate Treatment, Care and Support with pMTCT Services in an initiative called pMTCT +.These interventions led to an islandwide fall in PMTCT rates to approximately 10% by 2008.  The period of 2005-10 also saw improved access to laboratory testing with more widely available rapid testing, availability of CD4 panel and viral load testing, availability of HIV RNA PCR and more recently availability of HIV DNA PCR. With the success of the KPAIDS team, they were invited by the Ministry of Health to lead pMTCT interventions islandwide in 2009. The name at that time was changed to Jamaica Perinatal Paediatric and Adolescent AIDS Programme (JaPPAAIDS). This collaborative initiative between the dedicated members of the health care team islandwide and JaPPAAIDS has seen the further fall in PMTCT rates to <5% islandwide. Elimination of Vertical transmission of HIV (with rates of <2%) has always been the goal but finally the light became visible at the end of the tunnel.

References

  1. Pediatric and Perinatal HIV/AIDS in Jamaica. West Indian Medical Journal 2004;53(5);217-365.
  2. Pediatric, Perinatal and Adolescent HIV/AIDS in Jamaica. West Indian Medical Journal 2008;57(3);187-320. 
  3. Christie CDC, Pierre RB.  Eliminating Vertically-transmitted HIV/AIDS while Improving Access to Treatment and Care for Women, Children and Adolescents in Jamaica. West Indian Med J 2012; 6l;4:395–403.

 

History: Syphilis: A Success Story

In the 1980s, Syphilis was a highly prevalent Sexually Transmitted Infection. The advent of treatment with penicillin gave new hope that this infection could be conquered. Several challenges remained in the way of that goal. Programmatic challenges such as inadequate testing, limited follow up and lack of clearly defined protocols, as well as client related challenges of inconsistent condom use and insufficient education about the disease. With dedicated leadership and collaboration with overseas partners and funding agencies, there was a marked and sustained reduction in the incidence of syphilis from greater than 90 cases per 100000 population to less than 10 cases per 100000 population between 1987 and 2001. How was this achieved?

  1. Accurate reporting of the incidence of primary and secondary syphilis cases at public STI clinics and antenatal clinics and Congenital syphilis cases occurring at hospitals
  2. Programmatic changes that improved the Control of Syphilis as well as other STIs including HIV:
  1. Increased number of STI care centres
  2. Introduction of TRUST test for syphilis
  3. Decentralized syphilis screening with same day treatment for STI and ANC clinic attenders

With the assistance of funding partners, aspects of the existing programme were scaled up including Surveillance for Congenital Syphilis, STI syndromic management, Condom use promotion, Contact investigation service, STI training for various categories of health staff, Behaviour change communication (BCC) activities involving Non Governmental Organisations, Operational research and Monitoring and evaluation.

On a functional level, this resulted in an emphasis on Syndromic case management and with funding support, written protocols and guidelines. There was also significant training of health care workers. The number of clinics were increased. Decentralisation of laboratory testing for Syphilis facilitated same day screening and treatment of STI and ANC clients, reducing loss to follow up and ultimately, transmission of the disease. Passive Surveillance of records, as well as active surveillance of Known Syphilis exposed infants; computerization of reported data and an increase in the staff complement and training of contact investigators led to improved monitoring and evaluation of programmatic aspects as well as case finding. These interventions led to a reduction in Syphilis rates as seen in the diagrams and set the stage for the achievement of Elimination of mother to child Transmission of Syphilis.

 

References

Syphilis Control and Prevention in Jamaica, 1987 – 2001:A Success Story

Abstract # 0637 at the ISSTDR Congress, Ottawa Canada, July 27-30, 2003

Brathwaite AR1, Figueroa JP1, Hylton-Kong TM1, Dallabetta G2, Behets FM-T3

1.Ministry of Health, Kingston, Jamaica,2. Family Health International, VA, USA,

3. University of North Carolina, NC, USA.

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