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Washington, D.C., 25 September 2018 (PAHO/WHO). Between 2000 and 2015, deaths from tuberculosis (TB) fell by 37.5% in the Americas and new cases dropped by 24%. However, the rate of decline must be accelerated for the Region to be able to end the disease, according to a new report by the Pan American Health Organization (PAHO).

Tuberculosis in the Americas 2018, a report issued on the eve of the first United Nations High-level Meeting on Ending TB, provides a complete and updated assessment of the TB epidemic and progress made in treating and preventing the disease in the Region.

In 2017, the World Health Organization (WHO) estimated 282,000 new cases of TB in the Americas, 11% of which were in people living with HIV. In all, 87% of cases were concentrated in 10 countries, with Brazil, Peru, and Mexico reporting just over half the total. An estimated 24,000 people died last year from tuberculosis in the Region, and 6,000 of them were coinfected with HIV.

“Ending TB will only be possible if we step up the reduction in new cases and deaths,” said PAHO Director, Carissa F. Etienne. “We need to expand access to diagnosis and quality treatment for everyone who needs it and to address social determinants that affect health and favor transmission of the disease,” she noted.

Although preventable and curable, tuberculosis is currently the Region’s most lethal infectious disease and its persistence is largely due to the serious social and economic inequities in the Americas. Since 2015, deaths fell on average by 2.5% per year and new cases dropped by 1.6%, but they need to fall at a rate of 12% and 8% per year, respectively, to achieve the intermediate targets for 2020 and continue to decline until 2030.

Ending the worldwide tuberculosis epidemic is one of the targets of the Sustainable Development Goals (SDGs). WHO’s End TB Strategy, adopted by the World Health Assembly in 2014, aims to reduce deaths from TB by 90% and the incidence of the disease (number of new cases each year) by 80% by 2030, compared to 2015 levels.

Diagnosis, treatment, and multidrug-resistant tuberculosis

The report notes that more than 50,000 people in the Region––almost half of them under 15 years of age––do not know they have the disease and have not been treated. This diagnostic gap increased by 3,000 people, compared to 2016. Rapid diagnostic testing, a new tool that could help to close the gap, was used in just 13% of diagnosed cases, up slightly from 9% in 2016.

Treatment for TB has saved thousands of lives. However, in the last five years 75% of patients were cured, which is below the target set for 2030 (at least 90% cured). To step up progress, the report recommends that countries improve patient monitoring to ensure follow-through on treatment (8.6% abandon treatment) and address access barriers to health care, among other issues.

Multidrug-resistant tuberculosis is also a serious threat, with an estimated 11,000 people in the Region currently infected by this form of the disease. Among those who develop it, the cure rate is just 56%.

Caribbean countries with the lowest incidence of TB

The Americas is the region with the lowest percentage of new TB cases in the world (3% of the total) and is the first region with a real opportunity to eliminate the disease as a public health problem. According to the report, 15 countries,12 of them from the Caribbean, have low TB incidence (less than 10 cases per 100,000 people) and are on the road to elimination.

“Countries are adopting measures to tackle TB, but they cannot lower their guard and must redouble efforts, along with the collaboration of society at large, including the affected communities,” said Marcos Espinal, Director of PAHO’s Department of Communicable Diseases and Environmental Determinants of Health.

The report’s other recommendations for accelerating progress toward eliminating TB, especially in the countries with the greatest disease burden, include: promoting the study of contacts with people who have TB, especially children under 15; stepping up implementation of simpler treatment regimens and introducing drugs for children; reaching the most vulnerable populations and addressing social determinants, and ensuring that plans are financed with a country’s own resources rather than depending on external funds.

To download the full report on PANCAP.org CLICK HERE.

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Helpful links:

Report: Tuberculosis in the Americas 2018
http://iris.paho.org/xmlui/handle/123456789/49510?locale-attribute=es

Tuberculosis
www.paho.org/tuberculosis

UN General Assembly High-Level Meeting on Ending TB 2018
\www.paho.org/hq/index.php?option=com_content&view=article&id=14404:un-general-assembly-high-level-meeting-on-ending-tb&Itemid=72316&lang=en

Image: (L-R) PANCAP Director, Mr. Dereck Springer with H.E. Sandra Granger, First Lady of the Republic of Guyana and Vice Chair, SCLAN and Ms. Laura Tucker-Longsworth, OBE,  Speaker of the Belize House of Representatives and PANCAP Champion.

The Spouses of CARICOM Leaders Action Network (SCLAN) in collaboration with the Pan Caribbean Partnership against HIV and AIDS (PANCAP) hosted a special forum entitled “Pressing forward for the health and well-being of women, children and adolescents” as a side event during the United Nations General Assembly in New York on Monday 24 September 2018. The Forum was designed to increase awareness and to stimulate interest, especially among First Ladies to advocate for the development of programs that will support the safety, physical and psychological well-being of women, children and adolescents around the world.  The event was chaired by Hon. Kim Simplis Barrow, First Lady of Belize and Chair of SCLAN.

It was intended to bring together First Ladies, Spouses of Heads of Government and UN Representatives to facilitate knowledge exchange which can contribute positively to progress in key areas such as mental health, the reduction of gender-based violence, teenage pregnancy, and HIV and AIDS. This initiative also aimed to build upon the long-term efforts set forth by the global community including former UN Secretary-General Ban Ki-moon’s Every Woman, Every Child Global Movement and the Global Strategy for Women’s Children’s and Adolescents’ Health (2016-2030).

Present were Hon. Dr. Patricia Minnis, First Lady of The Bahamas, Hon. Kim Simplis Barrow, First Lady of Belize and Chair of SCLAN,  H.E. Sandra Granger, First Lady of the Republic of Guyana and Vice Chair, SCLAN, H.E. Martine Moise, First Lady of the Republic of Haiti, Hon. Eloise Gonsalves, First Lady of Saint Vincent and the Grenadines, Ms. Laura Tucker-Longsworth, OBE,  Speaker of the Belize House of Representatives, PANCAP Champion and Director of PANCAP, Mr. Dereck Springer.

The 15th Caribbean Cytometry and Analytical Society (CCAS) Expert Summit, which was convened on 26th – 30th August in Saint Lucia, provided a platform for PANCAP to share Test Treat Defeat – Caribbean Advocacy for Ending AIDS as a public health threat. The presentation focused on PANCAP’s high-level advocacy for the reduction of stigma and discrimination, the provision of affordable medicines and commodities, and adequate domestic financing for increasing the level of testing, treatment and viral suppression required to end AIDS as a public health threat in the Caribbean, and the successes to date.

Caribbean public health practitioners also presented on the process and challenges for achieving the elimination of mother-to-child transmission of HIV and Congenital Syphilis, shared country experience implementing Pre Exposure Prophylaxis (PrEP), the OECS Pharmaceutical Procurement System, a best practice for the region, and reported on the laboratory strengthening support, which is being provided by the Caribbean Med Lab Foundation in the OECS.  The CCAS also received presentations from Cuba in relation to EMTCT and GHESKIO in Haiti in relation to HIV Treatment.

However, while CCAS provided an opportunity for Caribbean public health practitioners to be updated on new technologies and to share best practices and experiences in HIV, the absence of National AIDS Programme Managers was glaring. In response, I would like to urge our member states to support the participation of these managers. NAP managers are ideally positioned to contribute by sharing best practices and experiences. NAP managers will also be exposed to the technological developments and strategies for ending AIDS. The PANCAP Coordinating Unit (PCU) will advocate for such support for our valued NAP managers to attend the annual CCAS.

I would like to congratulate the Caribbean Med lab Foundation on the occasion of its 10th Anniversary which was celebrated at a dinner hosted by the organization on 30th August at the end of CCAS 2018. CMLF promotes and supports the achievement of quality laboratory services in accordance with appropriate standards, through advocacy, resource mobilization, collaboration, research, and education. CMLF has provided invaluable services to the Caribbean region over the last 10 years and must be lauded for its stellar work. The work they do is even more important as we strive to achieve the UNAIDS 90-90-90 Targets given the crucial role of laboratory services for achieving each of these targets.

The PCU supported the PACC in preparing for the 34th Meeting of the PACC and 28th Meeting of the PANCAP Executive Board, which were held on 4-6 September in Georgetown, Guyana. The meetings provided an opportunity to discuss progress and challenges as well as programmatic and policy guidance. These meetings received and discussed the draft report on the evaluation of the CRSF and made policy recommendations for the Council for Human and Social Development (COHSOD) – Ministers of Health meeting scheduled for the third week in September in Washington D.C. USA.

A joint PANCAP – CVC – COIN Multi-country proposal was submitted to the Global Fund in August for funding in the amount of USD$6.5 million for the period 1 October 2019 to 30 September 2022. The conceptual framework for this proposal builds on the top-down and bottom-up strategies of the current Global Fund grants to more effectively work towards integrating these approaches into strengthened national programs that benefit from the inclusion of civil society and communities as equal partners in decision-making, planning, implementation, and oversight. This approach is indicative of a broader commitment of the regional response to stronger integration of community, civil society and government efforts as equal partners and stakeholders in the HIV response, and to more effectively link progress at the regional level to actions and tangible results at the national level. The proposal provides a unique opportunity to institutionalize partnerships between civil society and governments and to develop effective and sustainable programs to meet the needs of key populations and thereby diminish the HIV epidemic. The Partnership awaits the outcome of the Technical Review Panel, which is currently reviewing proposals submitted in August 2018.

By Sarah Goddard, Abt Associates

Guyana has achieved significant progress in funding the national response to HIV but faces challenges related to scaling up of Treat All in an environment of declining donor funding. The USAID-funded Health Finance and Governance (HFG) project, in collaboration with PAHO/WHO, has supported a National Health Accounts (NHA) estimation exercise in Guyana to improve understanding of national funding and spending on health. A National Health Accounts dissemination meeting was held in Georgetown on 3 August, at which it was revealed that the Government’s share of HIV spending increased from 25 percent in 2015 to 64 percent in 2016, indicating increasing domestic resource mobilization for HIV.

Guyana’s Health Accounts will play an important role in the country’s health policy and future decision making for health expenditures. Ms. Julia Henn, Director of Health and HIV/AIDS Office, USAID/Eastern and Southern Caribbean, described the National Health Accounts as a “goldmine of information for policymakers.” One key recommendation is for Guyana to better leverage the private sector in order to diversify domestic funding sources for health and HIV. According to Mr. Tesfaye Dereje, Senior Health Finance Specialist of the HFG project, “Guyana is off to a great start.”

Image: (L-R) Mr. Winfield Tannis-Abbott, CRN+ Chair presenting Dr Rhonda Moore, National AIDS Programme Manager, Guyana with a token of appreciation at the culmination of the dialogue. 

The Caribbean Regional Network of People Living with HIV and AIDS (CRN+) facilitated a dialogue with health care providers and People Living with HIV (PLHIV) in Georgetown, Guyana in August.  The dialogue encompassed discussions on the procedures of accessing services (testing, treatment, and care) in Guyana.

The event brought together representatives from the public treatment sites, Ministry of Health, National AIDS Programme Secretariat, National PLHIV Networks, Joint United Nations Programme on HIV/AIDS (UNAIDS), the Pan American Health Organization (PAHO) and CRN+.

The National AIDS Programme Secretariat opened the discussions with brief presentations on accessing services at treatment sites across Guyana and the importance of creating an Enabling Environment. Participants praised the initiative for focusing on the improvement of the system for accessing health services at public treatment sites.

The initiative forms part of a series of regional capacity building meetings by CRN+ which are intended to improve access to care and treatment by PLHIV. 

Image:  (L-R) CCAS Chairman Clive Landis, RTI International founder Dr. Wendee Wechsberg, CCAS President Vera Layne, Saint Lucia Health and Wellness Minister Mary Isaac, Caribbean Med Labs Foundation Director, Valerie Wilson, Director of PANCAP, Dereck Springer.

The 15th Annual Caribbean Cytometry & Analytical Society’s (CCAS) Expert Summit, “From Care to Cure – Towards the Elimination of HIV”, was held in Saint Lucia from 26 to 30 August. The summit brought together regional and international HIV experts to explore scientific innovations and social interventions that will accelerate progress toward ending the AIDS epidemic as a public health threat.

Present was Senator The Hon. Mary Isella Isaac, Minister for Health and Wellness, Saint Lucia.  View an interview with the Senator here.

PANCAP Director, Dereck Springer delivered a well-received presentation on Test, Treat, Defeat in Caribbean Advocacy and the Caribbean Regional Strategic Framework: beyond 2018.  He provided an illustration of the Barbados Treat All Programme, documented in a case study and animated video by PANCAP (View here). The Director advocated that the 2030 goal of ending AIDS can be realized with the region utilizing the Barbados Treat All experience as a best practice to improve the HIV response and to achieve better health outcomes for People Living with HIV and AIDS (PLHIV).
CCAS Chairperson, Professor Clive Landis pointed to successes of the Caribbean HIV response including the validation of seven countries for the elimination of Mother-to-child transmission of HIV and Syphilis.

He noted that while the region has embraced the power of antiretroviral treatment and viral suppression to prevent HIV infections in newborns, there is an inadequate understanding among the public about how successful treatment can also reduce sexual transmission.

View Professor Landis’ remarks here.

UNAIDS Director for Latin America and the Caribbean, Dr. César Núñez, noted that through the 2016 Political Declaration on ending AIDS, United Nations members states have agreed to adopt a Fast-Track strategy that involves increasing prevention, testing, and treatment services while working to eliminate stigma and discrimination. Dr. Núñez shared the latest HIV data, which indicates that the Caribbean must accelerate progress if it is to meet the targets to end the AIDS epidemic by year 2030.

The opening ceremony’s distinguished Speaker was Dr. Wendee Wechsberg of RTI International. She shared a gender-sensitive model for offering care to women living with HIV.  It extends beyond treatment to develop structural interventions that increase education and economic development and improve access to sexual and reproductive health.

What is CCAS? 

The Caribbean Cytometry & Analytical Society (CCAS) is a registered HIV Charity comprised of volunteers from the University of the West Indies, the Barbados Ministry of Health and the private sector. The mandate of the CCAS is to train and educate healthcare providers for improved diagnosis, monitoring and treatment of HIV and AIDS in the Caribbean region by removing technical and social barriers to care. CCAS’s annual HIV/AIDS regional workshop rotates through the region and has trained more than 1250 HIV/AIDS specialists from over 20 countries.

The Partnership extends a warm welcome to Mr. James M. Guwani, recently appointed Team Lead and Senior Advisor at the UNAIDS Caribbean Sub-Regional Office, based in Kingston, Jamaica. He will be responsible for leading the Sub-regional Team and overseeing support for the implementation of the Sub-Regional Programmes and working closely with UNAIDS Country Offices in the Region to strengthen national and partner capacities for fast-tracking the AIDS response.

Mr. Guwani recently joined the Caribbean Sub-regional Team, effective 1 August 2018, from the UNAIDS Regional Support Team for Eastern and Southern Africa (UNAIDS RST ESA) based in Johannesburg, where he served as Regional Strategic Information Advisor and later Regional Programme Advisor.

He has been with UNAIDS since 2004 and has served as the Global Monitoring and Evaluation (M&E) Capacity Building Coordinator in Geneva, M&E Advisor in Uganda, Zambia, Guyana and Suriname, and the M&E Technical Advisor to Barbados. Prior to joining UNAIDS, James worked as a Monitoring and Evaluation Specialist at the Centres for Disease Control and Prevention (CDC) in the US. Before joining the CDC, he worked with the American Red Cross in Washington DC, as the Senior Program Evaluator for the Red Cross HIV and AIDS Education and Prevention Programs. He has a Doctorate in Medical Epidemiology from The Pennsylvania State University. Prior to attending Penn State, he received a joint MPH and International Development Studies Degree from Ohio University.

The Partnership anticipates a fruitful collaboration with Mr. Guwani at this critical stage of the Region’s HIV response. 

The Spouses of CARICOM Leaders Action Network (SCLAN) received grant funding from Gilead Sciences Inc. for initiatives under the theme “Transforming Lives through Innovation: Implementation of high-impact prevention programs for adolescents, young men and women”.  The image depicts Mrs. Kim Simplis Barrow, First Lady of Belize and a representative of Gilead Sciences Inc during the presentation of the grant.

Image: Hon. Dr Karen Cummings, Minister within the Ministry of Public Health, Guyana  

Participants of the Guyana National Faith Leaders Consultation in August, including faith leaders and leaders of key populations, were privileged to hear from Hon. Dr Karen Cummings, MP, Minister within the Ministry of Public Health, Guyana.

While Minister Cummings reflected on the progress made in the region’s HIV response, including the seven Caribbean territories being validated for the elimination of mother-to-child transmission of HIV and syphilis, she spoke of some “hard truths” regarding the challenges related to the response.

Minister Cummings warned that stigma and discrimination threaten the laudable gains made and can be considered a primary barrier to vulnerable populations accessing HIV prevention and other health care services.

“From fears of contagion to negative social judgment, many persons in society often unwittingly engage in and encourage varying degrees of stigma and discrimination against persons living with HIV,” stated the Minister.

Tackling stigma is key to HIV prevention

Minister Cummings further reflected on the early history of the epidemic when the late Jonathan Mann, former Head of the World Health Organization’s Global Programme on AIDS, had identified AIDS-related stigma and discrimination as a third epidemic following the accelerated spread of HIV infection and the visible rise in AIDS cases.

Minister posited that Mann recognized that stigma, discrimination, blame, and denial are potentially the most difficult aspects of HIV to address. However, she affirmed that tackling the factors that were outlined by Mann continues to be the key to preventing HIV transmission and mitigating the impact of the disease on individuals, families, and communities.

Minister Cummings noted that since its detection in 1983, HIV has been associated with aspects of religion such as “moral failings” and “sinful behaviour”. She underscored that this was a misguided view, stating, “We need to recognize, acknowledge and embrace all people, regardless of their beliefs, political persuasion, and sexual orientation.”

The Public Health Minister said that an essential part of the Fast Track Initiative to end AIDS is the inclusion of key populations who are being left behind in the HIV response. This mainly occurs, the Minister noted, because of stigma and discrimination, which severely impact negatively on vulnerable groups who hesitate to be tested because of fear.  These persons are ultimately left untreated.

“As healthcare providers responsible for the health and wellbeing of our fellow human beings, we cannot be blinded by prejudice and insular judgment. If we are truly committed and determined to take the fight to end AIDS, then we must demonstrate that resolve by working with persons with HIV, including the key population component,” Minister Cummings emphasized.

Faith leaders are integral to the response

Addressing the participants of the consultation, Minister Cummings highlighted that religious leaders play a vital role in helping to further the achievements of the health sector.  “Through your perspective, you have expanded programmes in partnership with the Ministry of Public Health. Further, you have support from international funding to help track the epidemic in a multi-sectoral, multi-level, multi-dimensional effort that simultaneously reduces stigma, shame, denial, discrimination, inaction, and misinformation still attached to HIV.”

Minister recommended that faith leaders intensify their efforts to support public health initiatives by promoting the SAVE model – Safe practices, available medicines, voluntary testing and empowerment through education – at the individual, family, local, community and national level.

She challenged Guyana’s faith community to work closer with the public health sector on removing barriers of stigma and discrimination and underscored that partnership and collaboration are integral to achieving the 2030 goal of ending AIDS.