SPECIAL PROGRAMME ON SEXUALLY TRANSMITTED INFECTIONS

Mission

To reduce the spread and to minimise the impact of HIV/AIDS and other sexually transmissible infections by behaviour modification and improved surveillance, diagnosis and treatment capabilities.

INTRODUCTION

The CAREC Special Programme on Sexually Transmitted Diseases has been renamed the Special Programme on Sexually Transmitted Infections (SPSTI).

In 1999, the WHO working group on sexually transmitted diseases recommended a change in the terminology sexually transmitted diseases (STDs) to a more comprehensive one — sexually transmitted infections (STIs). The rationale for this change is that asymptomatic infections which are not expressed as disease must be taken into consideration for public health action. This therefore prompted the name change of CAREC’s Special Programme from STDs to STIs. As a consequence, in implementing its activities, the SPSTI will put more and more emphasis on the early detection, syndromic management and the asymptomatic status of STIs among women in general as well as the epidemiological treatment of partners of STI index cases.

With regards to the regional response to the HIV epidemic, the SPSTI multi-disciplinary team implemented CAREC’s programmes as planned in the PTS1 and PTS2 (six-month plans). The programme of work was carried out in collaboration and co-ordination with other CAREC and PAHO/WHO divisions, member countries, international and regional organisations/agencies such as CARICOM, UWI, UNDP, CRN+, and UNAIDS; and non-governmental and community-based organisations. 

Regular planning and co-ordination meetings took place between CAREC-SPSTI and its resident donors (FTC and GTZ) as well as the Regional HIV/AIDS Task Force under the leadership of CARICOM and the UN theme groups on AIDS.

Financial and reporting systems functioned very well during this period. The SPSTI team (Technical officers and Managerial/Support staff) worked together to meet the various deadlines of different donors in terms of financial reporting and reporting progress on the implementation of projects in CAREC Member Countries. However, this responsibility is becoming more and more complex every year, thus increasing the workload of staff. 

KEY ACHIEVEMENTS/IMPACTS 

SPSTI achieved these results through activities supported by CAREC’s international partners in HIV/AIDS prevention and control in the Caribbean: the Pan American Health Organization (PAHO), the Canadian International Development Agency (CIDA), the German Technical Co-operation (GTZ), the French Technical Co-operation (FTC), and the United Kingdom Department for International Development (DFID).

ADVOCACY, POLICY, PLANNING AND CAPACITY BUILDING

Reaching Labour Leaders and Decision Makers 

Regional labour leaders and senior staff in different Ministries from Guyana and Barbados were sensitised about the trends and impacts of the HIV epidemic in the Caribbean and the necessity for an expanded national response to the situation. This was done at two workshops organised in collaboration with CARICOM and UNDP-New York.

During the workshops, participants were confronted with the complex negative impacts (developmental, economic and social) which the epidemic is having on the region as well as methods which are available for them to participate as individuals and as decision makers in the national efforts to control the epidemic.

In Tobago, an analysis of the AIDS situation and the local response was presented to representatives of the Tobago House of Assembly (THA) and community leaders. Understanding the urgent need for broader mobilisation, the THA chairman decided to establish and lead a Tobago AIDS Commission to stimulate activities in all sectors and to ensure effective co-ordination.

At the end of the workshop, participants committed themselves to promote, implement and participate in the reinforcement of best practices in the right against AIDS at the national and regional level.

Regional Strategic Planning 

The development of National Plans using a Strategic Planning Process for an expanded response continued in a number of CMCs, with SPSTI providing either technical and/or financial support. Guyana and Barbados finalised their plans, which now have to be promoted to key stakeholders in the respective countries. Barbados started in December with a sensitisation workshop held with its National Advisory Committee on AIDS. 

The committee is now charged with the responsibility for completing an integrated work plan for 2000 including technical input and resources from other Ministries, non-governmental organisations and the private sector.

In Trinidad, two seminars were held with an Inter-sectorial Technical Advisory Committee to develop an integrated work plan for 2000. The plan was presented to the Minister of Health, who chairs a cabinet-appointed Inter-Ministerial Committee on HIV/AIDS. Trinidad plans to begin its Situational and Response Analysis including political, economic, social and cultural factors affecting the spread of HIV/AIDS, early in 2000. 

On World AIDS Day, December 1, 1999, the National AIDS programme of St. Kitts and Nevis launched its Strategic Initiative and Planning process for the development of its National Plan. The initiative outlines the national philosophy on HIV/AIDS, the vision of the Federation, the proposed national priorities and the key guiding principles on how they will be implemented. The Ministry of Health has circulated the document to encourage public debate, and inter-sectorial and community discussions. In January 2000, the Ministry of Health will initiate a study on the present situation and the past responses to preventing the spread of HIV/AIDS in St. Kitts and Nevis. 

Cost Intensity Study 

Discussions were held with the Department of Health Economics at the University of the West Indies, St. Augustine, on the development of a proposal for the implementation of a Cost Intensity Study in Jamaica and Trinidad and Tobago. The study aims at assessing the average cost of treating a person living with HIV/AIDS, looking at both direct and indirect costs.

Targeting the Tourism Industry

The SPSTI provided technical and financial (through CAREC-GTZ) support for the HIV/AIDS component of the Caribbean Tourism, Health, Safety and Resource Conservation Project which is implemented by CAREC. This project collaborates with the tourism industry and health sector in the development of policies, standards and procedures that protect the health of visitors and host populations. Its initial focus is on Barbados, Bahamas, Jamaica, and Trinidad and Tobago. The objective of the HIV/AIDS component is to enhance the capability of the tourism sector to proactively respond to HIV/AIDS.

PROMOTION OF BEHAVIOURAL CHANGE

Promoting safer sexual behaviour 

During the 1980s and beyond there has been increasing recognition that changing knowledge alone rarely changes behaviour. There has been a shift towards a health promotion approach in which health education is included in broad programmes taking into account the socio-economic environments in which individual behavioural decisions are made. Within the region, this has been reflected in policy developments such as the 1993 Caribbean Charter for Health Promotion, with its emphasis on issues such as creating supportive environments and healthy public policy, and the Caribbean Cooperation in Health Initiative (CCH-II, 1998).

Health promotion, as “the process of enabling people to increase control over, and to improve their health” (WHO), is concerned with environmental factors influencing behaviours affecting health. The concern is to create an enabling environment for behaviour change. Figure 1 shows a simple conceptual framework for the links among factors affecting the HIV epidemic. SPSTI team members provided technical assistance for research on these links and assisting in the design of interventions based on the existing evidence from within and outside the Caribbean region. Interventions are therefore research and theory driven. They focus on vulnerable groups and the environments in which vulnerability is created. The approach is participatory, involving members of target groups as much as possible in all stages of an intervention.

Figure 1 Factors Influencing the HIV Epidemic

Projects with Young People 

The Toco Youth Sexuality Project is a community-based intervention in a remote rural area of Trinidad. In this area, literacy is relatively low and access to the media, health services and condoms is poor. It is in this setting that CAREC-SPSTI continued to provide financial and technical assistance for a community-based project. Young people were trained as peer workers and now run a variety of educational activities (e.g. popular theatre, talks in churches and at special events such as Carnival time) as well as being available for individual consultation. The Programme also facilitated discussions with condom suppliers to improve the local supply. 

Tobago Needs Assessment

The Tobago Youth Sexual Health Needs Assessment is a joint project of the Family Planning Association of Trinidad and Tobago (FPATT) and the Tobago AIDS Society (TAS). It is funded by the Royal Netherlands Embassy as one of its Small Embassy Projects. The SPSTI team members provided technical assistance to the project including research design, training of field staff and report writing. The research seeks to assess:

1. What are the social, economic political and environmental factors that need to be taken into account in designing a sexual health promotion project for youth in Tobago?

2. What do adults who are influential in the lives of youth think are the most important issues affecting youth sexual health? 

3. What do young people think are the most important issues influencing their sexual and care-seeking behaviour and thus their sexual health?

4. What are the features of Tobago youth knowledge, attitudes and behaviour in relation to sex and HIV/AIDS that could be the focus of behaviour change interventions?

At time of writing, data from only the first three of these had been fully analysed.

The evidence suggests a need for sensitively designed community participation strategies, involving parents and churches as well as youth, to tackle the debilitating silence and stereotypes around issues of sexuality. It also suggests a need to improve vocational training, recreational and employment opportunities for youth.

Life After School

In Antigua and Tobago, the Life After School Fairs provided a day of exposure to HIV/AIDS/STI education, career guidance information and edutainment to school leavers in 1999. The Fairs were held in Antigua on June 30th and July 1st, and Tobago July 2nd and 3rd. Hundreds of students in their last weeks of school attended a day at a Fair consisting of booths providing information, entertainment and advice on issues such as sexuality, careers, further education, sports and parenting, games and popular theatre. The SPSTI provided in-house technical assistance and the services of a Short Term Consultant to help Antigua and Tobago with planning and implementation of the Fairs. CAREC also produced a package of educational materials which is also available for subsequent Fairs. In both countries, the planning teams included representatives from the the health and wider public sector, as well as the private sector. The general response from participants, and facilitators, was that such an intervention provides significant exposure for young people who are about to leave the structured school environment. 

Secondary school students at the Life After School Fair in St John’s Antigua.

Sexual Health Convocation

A Convocation on Youth Sexual Health was held in Port of Spain, organised by Trinidad and Tobago Ministry of Sport and Youth Affairs in collaboration with CAREC-SPSTI and the National AIDS Programme in November 1999. The Convocation brought together participants from the statutory and voluntary sectors to help build an expanded response and strengthen networking and collective activities. Prof. Robert Blum, Director of the WHO Collaborating Centre on Adolescent Health, attended the workshop with CAREC support and provided the keynote address on Successful Youth Health Strategies: Research Findings. Assistance is being provided for the establishment of a co-ordinating council for youth sexual health promotion programmes. 

Rap Port 

In Trinidad, hundreds of young people in and out of school are reached by Rap Port, a youth drop-in centre and outreach programme for which financial and technical assistance is provided by CAREC-SPSTI. 

Evaluating HIV/AIDS education 

In Barbados, technical assistance was provided for the evaluation of a pilot project on HIV/AIDS education in primary schools. Six experimental and six control schools are involved in the pilot study that runs for the school year 1999–2000.

People Living with HIV/AIDS (PLWHA)

MSM are a particularly vulnerable group in the Caribbean context of high levels of homophobia and discrimination. While the proportion of men in the population of people with AIDS has fallen, men continue to represent about two thirds of AIDS cases in the Caribbean, and it is likely that a substantial proportion of these men have sex with men, and some with both men and women. 

Research in five Eastern Caribbean countries in 19981 led to the involvement of MSM in the design and production and of regional information, education and communication (IEC) materials and one workshop, in Antigua, using interactive and mass media approaches. Distribution of the materials — television and print — has begun in Trinidad and Antigua and will form part of interactive educational sessions in selected member countries in 2000.

Results of the research, which was conducted by AIDS Activist and Playwright, Mr Godfrey Sealy, also influenced the updating of the play originally called “One of Our Sons is Missing” into a new version “One of Our Sons” which deals with the issue of bisexuality and HIV transmission and the value of a supportive environment. CAREC supported the video-taping of the play for distribution in the Caribbean for World AIDS Day 1999. 

Female Sex Workers

Sex work takes many different forms in the Caribbean, according to dominant economic activities (e.g. tourism, mining) and levels of poverty.

Guyana is one of the poorest of CAREC member countries, and sex work generally involves young women and girls in situations of squalor and deprivation. CAREC-SPSTI has supported the development of a peer support, education and condom distribution programme among female sex workers in the capital, Georgetown. A baseline survey was conducted in 1997, and a follow-up survey has been planned for 2000. A women’s NGO, Red Thread, has been invited to submit a proposal for funding of a project to extend the sex workers’ project to a mining area (Mahdia) where the sex trade is related to the residential employment of men many miles away from their regular partners. Migration has been identified as one of the determinants of HIV transmission.

Barbados is one of the more prosperous Caribbean countries, relying to a large extent on tourism. A study supported by CAREC-SPSTI examined the feasibility of a peer education programme among “beach boys”, young men who work on the beaches, many of whom exchange sex with tourists for money or favours. Following presentation of the results, the project will be launched in 2000.

Voluntary Counselling and Testing

The SPSTI mounted an in-country workshop in Grenada for Health Educators, nurses, other public sector workers and NGO representatives, including Planned Parenthood, aimed at exposing participants to the concepts and application of Social Marketing Communication.

The SPSTI organised workshops for media professionals in St. Kitts and Nevis and Trinidad and Tobago, and collaborated with UNESCO to mount a regional exercise in St. Vincent, aimed at Mobilising Youth for HIV/AIDS/STI Prevention, using the Mass Media. 

Following presentations by SPSTI at the annual general assembly of the Caribbean Broadcasting Union (CBU) in Guyana, the unit once again joined the CBU in the production of a major television programme which was transmitted to all CAREC member countries for World AIDS Day, 1999. 

The Caribbean News Agency (CANA) carried a simulcast of the broadcast for transmission to radio audiences across the region, thereby expanding the reach of the programme that evening.

The programme carried features and participants from Antigua and Barbuda, Barbados, the Bahamas, St. Lucia and St. Vincent and the Grenadines. There was also live interaction with the audience from various countries via the telephone. 

Staff of the SPSTI and Media Personnel prepare for the live broadcast of the CAREC/CBU-produced, Pan-Caribbean World AIDS Day.

Caribbean AIDS Telecommunication and Information Network (CATIN)

The commencement of two DFID grants, one for the United Kingdom Overseas Territories (UKOTS) and the other for the larger independent Caribbean territories, facilitated activities towards expanding CATIN, whose foundation was laid through efforts funded by CIDA and other partners. 

SPSTI served as a resource in advising on the development and promotion of a project aimed at enhancing the delivery and receipt of information to CMCs using satellite, to more effectively instruct decision making in public health in the region. SPSTI’s direct interest is for the integration of CATIN into such a project to take advantage of the latest technology to incorporate such elements as teleconferencing, distance education and other interactive projects involving the exchange of information on HIV/AIDS between CAREC and its stakeholders.

Gearing Ministry Personnel to Relate with the Media 

The Unit responded to requests from the Trinidad and Tobago Ministry of Health for technical assistance in its efforts to better equip its senior personnel to interact with the mass media as part of its health sector reform communication activities. An SPSTI team member served as one of the lead resource persons for two separate training exercises. These exercises brought together more than 30 senior national divisional managers, and the Chairman, General Manager and department heads of the South-West Regional Health authority for presentations, discussions and practical demonstrations on how to relate to the various arms of the mass media. 

HIV/AIDS Satellite Conference

CAREC-SPSTI provided advice to a Committee mounted by the Ministry of Health to organise the Trinidad and Tobago end of a conference to heighten awareness of HIV/AIDS in the Caribbean region, on the information and promotional component of the exercise. The meeting, scheduled for 2000 intends to link Port of Spain with centres in the US Virgin Islands, the Bahamas, Jamaica, and Barbados via satellite for discussions in the conference.

CLINICAL MANAGEMENT — DIAGNOSIS, CARE AND SUPPORT

The quality of care available to people living with HIV/AIDS (PLWHA) has become a growing concern to CAREC. Despite the generalised state of the epidemic in the region and the important role of other STIs, the management of these conditions is still largely seen as a speciality rather than as part of basic health care. Training curricula of medical and nursing schools need to be updated as they leave young health workers ill-prepared to deal with these patients adequately. Uncertainty and fear among health workers — as described in earlier studies — explain the numerous personal testimonies of PLWHA that speak of inadequate practices and discriminatory attitudes experienced in health facilities. Moreover, the growing number of effective but expensive antiretroviral drugs available in industrialised countries and a few CAREC member countries is creating an ethical and economical dilemma for countries with limited resources. Thus CAREC, although not a clinical centre, feels compelled to contribute towards an acceptable standard of care for PLWHA. In all countries this is represented by a minimum package of prophylaxis and treatment of opportunistic conditions as well as easy access to qualified psychosocial support services. Antiretroviral treatment should be the norm wherever indicated by the analysis of cost-benefit ratios and resources. Efforts to prevent further HIV transmission will remain futile if all those who are infected and who may infect others do not have access to the best possible care that is feasible and affordable in a given country. 

The CAREC Guidelines for Clinical Management of HIV Disease (first edition 1994) were revised and published in consultation with a group of Caribbean physicians. This effort had become necessary in view of recent advances in diagnosis and treatment, of the experiences made in the application of the original guidelines, and in view of the fact that HIV/AIDS was still underrepresented in the training of health workers in the region. Consideration was given not only to management of opportunistic infections on an etiologic or syndromic/empiric basis but also to antiretroviral treatments (HAART) and the necessary laboratory support. The concept of a management plan has also been emphasised to make sure that persons living with HIV/AIDS receive adequate care at regular intervals throughout the duration of their infection.

To facilitate the guidelines’ use in CAREC member countries with varying diagnostic and treatment capacities, and to help ensure that persons living with HIV/AIDS receive appropriate care, minimum standards of care were defined, depending on the level of health institution. Regardless of the economic development of any given Caribbean country, this minimum package of services should be provided to all persons living with HIV/AIDS in all CAREC Member Countries. 

To ensure that future training programmes for medical students, clinicians and other health workers will put emphasis on that minimum package of services, the guidelines will be promoted among medical associations, universities and individual clinicians. 

Home and Community-Based Care

New Guidelines for Home and Community Care for Persons Living with HIV/AIDS were developed and are being tested among PLWHA and care givers. The aim of these guidelines is to promote the concept of a continuum of care that ensures integration of institutional, community and home-based care. This approach has been successfully applied in other countries where it helped families to deal with HIV-related disease in a humane way while reducing the financial burden on the health care sector.

Simplified training modules will be developed for caregivers to be updated on essential basic elements necessary to provide a good quality care to persons living with HIV/AIDS at home and community levels.

MTCT Guidelines

Guidelines for the reduction of Mother-to-child-transmission (MTCT) of HIV have been distributed to all CMCs. In at least eight CMCs (Belize, Jamaica, Antigua and Barbuda, Guyana, St. Kitts and Nevis, Trinidad and Tobago, Dominica and St. Lucia) the guidelines are being used to develop national policies on this important public health intervention. Training sessions were conducted in Trinidad and Tobago, Dominica and St. Lucia on drug regimens to be used in an MTCT programme, Education and Voluntary Counselling and Testing, and Clinical management of mothers and babies. Technical support was provided to Jamaica to finalise its MTCT programme. In addition to the already adopted regimen using the short course AZT, Nevirapine has been added as a second drug which if administered during the early stage of labour can significantly reduce mother-to-child-transmission of HIV (HIVNET-Uganda- Regimen).

The MTCT prevention programme is stimulating a spirit of technical cooperation among CMCs for sharing experiences between the first two countries to introduce the intervention — Barbados and Bahamas — and the other CMCs. Advocacy for MTCT programmes will be sustained in the year 2000, targeting national policy decision makers. 

Training programmes on Syndromic Management of Sexually Transmitted Infections (STI) conducted during 1997 and 1998 were evaluated in Grenada and Guyana. There were very encouraging results from the evaluations which were presented at the PAHO-UNAIDS regional EPI-Surveillance meeting in Mexico: The Positive Impact of Syndromic Management on the STI Surveillance Systems. The evaluations showed that the care providers exposed to the training have been using their skills to assist clients with STIs and that STI syndromic reporting has contributed to improving the sensitivity of the surveillance systems. 

Taking into consideration the desire of member countries to benefit from this public health approach, new training sessions were conducted in Barbados, Tobago, Grenada and Guyana. For the latter, a training of trainers’ workshop was conducted. This equipped five (5) health professionals with knowledge and skills to conduct future training sessions in Guyana for Medical Officers, Community Health Nurses, Medexes and new graduates from the University of Guyana. 

Clear recommendations were formulated for the Ministries of Health in the four countries regarding the necessary policy changes to rationalise STI diagnosis and treatment and to expand it to the peripheral level, thus bringing health services closer to the community

Laboratory Services

In an ongoing effort to assist CMCs to make reliable clinical HIV/STD diagnoses and to provide safe blood for transfusions, the SPSTI continued to work closely with the Laboratory Division to assist countries to implement and/or maintain high quality laboratory operational systems. A joint SPSTI-Laboratory Team conducted preliminary evaluations of laboratory quality assurance (QA) systems in Aruba, Antigua, Grenada, St. Vincent and the British Virgin Islands as a first step towards introducing a QA programme. A QA training workshop was conducted for laboratory staff in Tobago. QA monitoring and retraining visits were made to Belize, Dominica and the Turks and Caicos Islands where achievements and limitations were addressed with multidisciplinary country teams, solutions agreed and work-plans modified. CAREC and laboratory staff in CMCs continued to seek the support of key decision-makers in obtaining critically needed resources. Other key stakeholders such as the Caribbean Life Underwriters and Health Care Providers in CMCs were sensitised to laboratory QA issues through presentations made at seminars, annual meetings and symposiums. 

The draft financing proposal for the “Medical Laboratory Strengthening” project to be submitted for European Union funding was prepared in collaboration with consultants and is currently being finalised. 

By the end of 1999, CAREC had assisted nineteen of its twenty-one member countries to evaluate their laboratory QA programmes, train laboratory staff or monitor QA programme implementation. A report on the outcomes of CAREC’s QA initiative has been prepared and excerpts are currently being extracted for publication and dissemination. 

QA Guidelines

In 1999, work continued on the development of QA programme implementation guidelines in collaboration with the Laboratory Proficiency Testing Programme in Ontario, Canada. The first and second drafts of these guidelines have been prepared. A multimedia approach was agreed and the final version will be published by the third quarter of 2000. These guidelines present a novel approach to quality strengthening in laboratories and are expected to benefit not only CMCs but also laboratories in other developing countries.

Distance Education

Following the successful piloting of the distance education approach in 1998 and 1999, a presentation on the outcomes of this initiative was made at an international distance education conference, which generated much interest from participants. A new project proposal for the continued piloting of the distance learning modus for Quality Assurance training was approved. CAREC, in collaboration with the U.S Centers for Disease Control and Prevention will pilot a QA training programme delivered via the internet, by the third quarter of 2000, in an effort to further expand the reach of the QA training initiative. 

Other Assistance

Discussions on the revision of curriculum for training medical laboratory technologists continued with CARICOM and the St. George’s University, Grenada. In 1999, staff of the SPSTI and Laboratory Division agreed to assist CARICOM to evaluate a 1996 initiative that addressed the strengthening of regional medical laboratory training programmes. This will be completed in 2000.

Blood Banking Guidelines

The final draft of the Caribbean Blood Banking Standards was developed in collaboration with a regional committee of blood bankers and personnel from the American Association of Blood Banks. A draft implementation tool for blood bank managers to be used in conjunction with these standards was also prepared. These documents will be finalised and circulated to all CMCs by the second quarter of 2000. All CMCs have had an input in the development of these guidelines. Personnel in blood banks in all countries, CAREC and PAHO will be expected to aggressively advocate for the early implementation of these standards in regional blood banks. 

HIV Confirmatory Tests

In 1999 the Laboratory Division provided HIV confirmatory testing services for thirteen (13) CMCs, testing a total of one thousand, nine hundred and twenty-four samples (1,924). A breakdown of samples submitted for testing is reflected in Table 2. Discussions held with Abbott, Bioquest Corporation and the Ministry of Health, Trinidad and Tobago on the evaluation of new HIV test kits will continue in 2000. An evaluation of kits for the MTCT programme in Trinidad will be initiated in the first quarter of 2000. A collated report on the evaluation of four HIV assays — Chemindex Akudex HIV 1&2, Akuchek HIV 1&2 rapid assay, Health tech International HIV 1&2 Q Spot and the HIV 1&2 EIA — was disseminated to all CMC laboratory directors in 1999.

SURVEILLANCE, RESEARCH AND EVALUATION

CAREC Initiative to Strengthen HIV/AIDS/STI Surveillance

Following a series of evaluations of HIV/AIDS/STI surveillance in the Caribbean and the CIDA/GTZ progress reviews in 1999, CAREC created a multidisciplinary team — “the surveillance cluster” — to improve regional and national HIV/AIDS/STI surveillance systems. Its focus is to work towards a more timely and accurate HIV/AIDS/STI surveillance system in order to capture shorter term trends and other data needed for public health planning and decision making. 

During 1999, in Grenada and St Vincent and the Grenadines, evaluation of HIV/AIDS/STI surveillance systems was conducted. The findings showed that the sensitivity of surveillance systems is very poor for STI in both countries. The STI surveillance is confined to the public sector in Grenada. In St Vincent and the Grenadines, the surveillance of STIs is limited. Only two conditions (Gonorrhoea and serological syphilis) are reported by the Epidemiology Division.

Based on sensitivity estimates the evaluation team concluded that AIDS reporting is high in both countries (70% in Grenada and more than 80% in St. Vincent and the Grenadines). The HIV reporting is low in Grenada with a sensitivity around 40% and high in St. Vincent and the Grenadines (80%). 

The use of data for planning is evident in St. Vincent and the Grenadines in terms of decision making related to community care for persons living with HIV/AIDS and minimising their hospitalisation. For the prevention component it was clear to some extent that plans were based on the results of data analysis (e.g. MTCT programmes). However, the skills to monitor behavioural change is very limited. In Grenada, the use of data for public health actions and plans is very limited and there is a lack of skills for behavioural surveillance.

Recommendations for improvement of epidemiological and behavioural surveillance were formulated for both countries. CAREC will support the two in implementing the recommendations. 

Sentinel Sero-survey in Tobago

CAREC supported an anonymous HIV survey using cord blood samples from seven hundred and six (706) women delivering at the only hospital in Tobago over the period of 12 months. This proved to be a cost-effective alternative to collecting samples from ANC clinics. Preliminary results indicate an overall sero-prevalence of 2.4%, and 3.2% among women younger than 25 years. In 1995/96, a national survey among ANC had found a nationwide rate of 1.0% but the sample size for Tobago had been too small to allow comparisons. 

PROJECT REVIEW AND EVALUATION

In early 1999, a joint progress review was conducted of the programme components supported by CIDA and GTZ. The joint approach was based on the understanding that CAREC’s HIV/STI activities represent one integrated programme supported by different partners whose contributions need to be well co-ordinated. In conducting the review exercise, multidisciplinary teams visited some CMCs, interviewed key personnel, and reviewed project documents. The review also measured the progress accomplished so far on each grant compared to the planned activities. Overall there was a satisfactory outcome on both sides. Clear and constructive recommendations were formulated which guided a planning workshop for the extension of the GTZ contribution for a second four-year (4) phase (December 2000 – November 2004) and a new version of CIDA’s Inception Report for the remaining duration of the project.

In May, the FTC project steering committee held a meeting in Grenada to measure progress towards planned activities. The representatives of the six OECS countries have expressed satisfaction with the FTC project and its tangible support for their national HIV/AIDS/STI programmes. At the end of that meeting, a draft plan was developed to be finalised with the input of the OECS and submitted to the French Government as an extension for the next three years (2001–2004).

SUMMARY OF HIV TESTING FOR 1999

Routine Confirmatory Testing

^aSeven (7) samples were not tested for Barbados because of insufficient quantity.
^bJamaica submitted one (1) sample for PCR testing. This test is not offered at CAREC currently.
^cTwo (2) samples were reported as inconclusive for Trinidad and Tobago

Primary Screen

^cTrinidad and Tobago submitted two (2) samples

Other Laboratory Testing — Special Studies

Antigua Antenatal Surveillance: HBsAg - 184

Guyana Study:      HIV-201
                            HBsAg - 193
                            RPR - 185

Tobago Cord Blood Study: 479 Samples were submitted.

                            HIV - 107 tested (1:5 negative and all reactive samples

Proficiency Testing

CDC 12 samples
LCDC 10 samples
WHO/Germany 4 samples

Kit Evaluation

Dominica 194 samples
Guyana 150 samples
St Kitts 52 samples

Western Blot testing to date (this includes special studies and kit evaluation).

Total Samples Submitted for Routine Confirmatory Testing

Caribbean Epidemiology Centre
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain
Republic of Trinidad and Tobago
Tel: (868) 622-4261, Fax: (868) 622-2792
E-mail: postmaster@carec.paho.org

Page last modified 04 July, 2001