Centers for Disease Control and Prevention

Description

In 2005, under PEPFAR, the Ministry of Health and Population (MSPP) in Haiti entered into a cooperative agreement with CDC to strengthen HIV prevention, diagnosis, care, treatment, monitoring, and surveillance in Haiti. That agreement established a funding mechanism to improve MSPP’s capacity to lead and manage a sustainable country-led response to the HIV epidemic. Initial resources focused on capacity for delivery of HIV/AIDS services among a network of publicly managed high volume sites. In 2012, a Partnership Framework was developed; the agreement addressed the need for national governments to increasingly assume primary strategic and financial responsibility over the long-term. In response, resources were progressively increased for MSPP to reinforce governance and regulatory capacity both at its central and departmental levels. Subsequently, an important health system strengthening component was added, enabling the Ministry to take on a more prominent role in terms of norms and standards definition, policy planning and implementation, coordination, and regulation of activities spread throughout the 10 geographic departments of Haiti. During the first two funding agreements with MSPP, HIV prevention, care and treatment activities have been broadly implemented throughout the country and Ministry capacity for surveillance and the use of strategic information (SI) has markedly improved. MSPP, together with partners, has achieved the following: in 2012, Haiti adopted the “B+ option” that provides all HIV-infected pregnant and breastfeeding women with lifelong antiretroviral therapy (ART) regardless of CD4 count, from 2010 to 2013, HIV-testing of pregnant women has increased from 128,540 to 223,626 and the proportion of identified HIV-infected pregnant women that received prophylaxis or ART increased from 61% to 92%. Haiti has continually updated guidelines for ART. According to UNAIDS estimates, ART coverage reached over 75% in 2013. The HIV epidemic in Haiti has stabilized; prevalence has fallen from ~ 6% in the 1990s and has been stable at 2% since 2007. Since ART availability has expanded, the stable prevalence reflects likely reductions in HIV transmission. Because health services in Haiti have been provided by a mix of government and non-government entities, there have not been clearly defined levels of care or well defined linkages between different health care facilities. Through a pilot program aimed at establishing referral networks, services have been mapped, services at referral facilities have been strengthened, and referral practices have been supported. Haiti has established sophisticated systems to conduct HIV surveillance, monitor patients with HIV, and track delivery of program services. After the January 2010 earthquake resulted in the destruction of key infrastructure and loss of key personnel, the objectives of the agreement with MSPP were expanded to address additional health threats such as tuberculosis (TB), cholera, malaria, lymphatic filariasis (LF), and malnutrition. Surveillance, laboratory, and epidemiologic capacity have all been expanded, capacity to diagnose and treat cholera expanded, two rounds of mass drug administration (MDA) for LF have been conducted, new guidelines for TB and malaria diagnosis have been implemented, and obstetric care capacity has been completed at 19 facilities. The National Public Health Laboratory (LNSP) has successfully expanded CD4 coverage to all 10 departments, established laboratory-based surveillance for several enteric diseases, significantly improved TB diagnostic capacity, and decentralized many activities through support of two regional facilities (one in the north, and one in the south). All activities focus on expanding capacity within MSPP; program planning; leadership and management; monitoring and evaluation (M&E); decentralization of health services, including laboratory capacity; integration of services; use of data for decision making; community planning; quality improvement, quality assurance and quality control; human resource planning and management; and surveillance. MSPP now supports more than 50 sub-grantees, including: MSPP central offices, departmental offices, health institutions, and 1 training school. This FOA supports PEPFAR goals, including reducing new HIV infections, ensuring high quality care and treatment for persons with and affected by HIV, and improving laboratory capacity. Activities are directly aligned with the HIV/AIDS strategy of the Government of Haiti (GOH), which focuses on the same program goals and on increasing the GOH’s capacity to lead and manage a sustainable response to the HIV epidemic. Non-HIV activities align with MSPP’s overall Strategic Plan. This FOA builds on past efforts to strengthen the capacity of the government of Haiti to respond to HIV/AIDS and other health threats with increasing success. These efforts reflect the very top priority of CDC program activities both past and present.

Who can apply

• Others

Contact

Kathy Middleton, Project Officer<br/>KOM4@CDC.GOV <br/>
KOM4@CDC.GOV