By Dr Nadjy Joseph, PMTCT Surveillance Manager, NASTAD Haiti and Anna Carroll, Associate, Global Program, NASTAD
Over the past several years NASTAD has worked with the Haitian Ministry of Health (MoH) to establish one of the few functioning HIV/AIDS case based surveillance systems in the developing world. This system, in place since 2008, has significantly strengthened the MoH’s ability to understand and respond to the national epidemic. However, the reporting of infected pregnant women, HIV-exposed infants and confirmed mother-to-child transmission has not always been complete and timely, which has made it difficult for public health officials to respond to the epidemic in this population.
In September of 2012, NASTAD began working in collaboration with the MoH and the Centers for Disease Control and Prevention’s (CDC) office in Haiti to address this issue. Together they identified 137 sites throughout the country where prevention of mother-to-child transmission (PMTCT) services were being offered and where perinatal surveillance structures could be reinforced, and they worked together to pilot an enhanced perinatal surveillance system at 20 of these sites. In the subsequent year, the program was expanded to an additional 50 sites. The final 67 sites will be incorporated into the program beginning in January of 2014.
This enhanced perinatal surveillance process involves case management of infected pregnant women to support the prevention of mother-to-child transmission. NASTAD has supported the development and implementation of a low-barrier process that allows antenatal clinic staff to identify and report HIV diagnoses among pregnant women and record crucial clinical benchmarks to track their care and treatment throughout the perinatal period.
In addition to working extensively with the MoH and other partners at the national level to support the design of the enhanced perinatal surveillance process, NASTAD recognized the need to provide direct technical support on the ground. NASTAD developed and conducted trainings for case managers (PMTCT health workers who manage the care, treatment and support of all infected pregnant women) and additional staff involved in perinatal surveillance. Through these trainings, NASTAD provides case managers and PMTCT health workers with the tools they need to track HIV positive pregnant women, to support these women as they access delivery services and PMTCT interventions, to ensure that HIV-exposed infants are provided with prophylaxis to reduce HIV transmission, and with a definitive diagnosis, to link HIV positive infants to treatment and care services.
Since October of 2012, NASTAD PMTCT Surveillance Manager Dr. Nadjy Joseph and NASTAD Data Operators Weedner Moise and Kamaia Bastien have visited all 70 active sites to provide training, technical assistance and supportive supervision for case managers and PMTCT health workers on the ground. During the site visits, Dr. Joseph, Weedner and Kamaia deliver support materials to the health workers, including the algorithms for HIV case reporting and for HIV positive pregnant women, and the reportable sentinel events for perinatal and pediatric HIV case surveillance, and provide close guidance and instruction on how and when to use these materials effectively. The NASTAD team also works with the antenatal health clinic staff at these sites to enter backlogged data, to conduct validation checks with the perinatal registers and the active surveillance paper tools, and to investigate pregnant women who did not receive ART and were lost to follow up.
This extensive and comprehensive support has not gone unnoticed. Miss Marlene Orelus, a Case Manager at Hopital Secours in La Providence des Gonaives, a town in the Artibonite region, explained that “with NASTAD’s support, a large number of pregnant women who tested positive for HIV received ART in time [to reduce the risk of perinatal infection] and I was able to track the women until they gave birth at the Maternity service. NASTAD should continue to give us their support for better monitoring of these women.” Dr. Joseph agrees that the site visits have been instrumental in ensuring the success of the new enhanced perinatal surveillance process in Haiti: “From my experience, since enhanced perinatal surveillance started in September 2012, we have developed solutions to the issues that they are facing. With 3,651 HIV positive pregnant women currently being monitored via the perinatal surveillance system, NASTAD will continue to provide technical assistance and work closely with MoH, CDC and all the partners involved in case surveillance system to ensure that these women have access to all of the right services to reduce perinatal transmission of HIV.”
NASTAD believes that the strengthened perinatal surveillance process in Haiti will allow the MoH to better monitor the epidemic within this key population, which will ultimately support the elimination of mother-to-child transmission. NASTAD will continue to work closely with the MoH to support the development of this system at both the national, regional, and site levels, and provide technical support and supportive supervision to health workers involved in each stage of the case surveillance process.
If you are interested in learning more about what NASTAD is doing in Haiti to improve HIV and infectious disease surveillance, strengthen health systems and build capacity, please contact Mark Griswold.