Accelerating and achieving HIV epidemic control in haiti: the challenges facing haiti's health system are enormous and include civil unrest, chronic underfunding, and high turnover, often due to…

Accelerating and achieving HIV epidemic control in haiti: the challenges facing haiti's health system are enormous and include civil unrest, chronic underfunding, and high turnover, often due to immigration of providers to other countries. This poses a huge challenge to the health system in general and for facilities providing care for persons living with HIV (plhiv). Despite progress made in haiti during the last 15 years in combating the HIV epidemic; HIV infection remains the 5TH leading cause of disability-adjusted life years (dalys) lost. In the setting of a deteriorating economic and safety situation haiti's ministry of health (mspp), in partnership with charess, implementing partners, CDC and others donors has worked hard to maintain and improve outcomes for patients living with HIV. Recent studies show that between 41% and 81% of plhiv know their status, 93% of those are on treatment and 87% are achieving viral load suppression. Unfortunately, treatment is often interrupted with up to 25% of plhiv lost to follow-up in the first year of treatment. Given these mixed results charess, with consortium partners of faculty of medicine (FMP) at haiti's state university, university of washington and university of california, SAN francisco present a robust plan to strengthen the capacity of haiti's health system with a keen focus on: 1) building the capacity of the clinical workforce; 2) setting high standards of clinical practice through the review, updating and creating of standards and guidelines; and 3) strengthening and expanding the continuous quality improvement programs developed by healthqual. To achieve these goals, charess, seeks, in partnership with CDC, to provide technical assistance to mspp and implementing partners (IPS) providing direct services for prevention, care and treatment for HIV to achieve epidemic control by 2025 and for HIV to cease being a public health threat by 2030. Charess's technical assistance will:1) ensure that haiti continues to have strong pre-service and in-service programs, training, and skills in care of patients with HIV, as well as related coinfections (e.g. TB) and ncds. 2) build on a strong track record of partnership, and 3) seamlessly transition from the prior award to a new award, with tenacious and deliberate implementation of several innovations. These innovations include: 1) leveraging the EMR, isantéplus, as demonstrated by the "patient profiling" initiative to proactively identify risk factors and reduce the risk of losing patients in follow-up. 2) adapting workforce development in the setting of civil / political and economic insecurity through the provision of a suite of in-person and remote training programs (e.g. synchronous and asynchronous training). 3) using the project echo model to expand clinical mentoring effectiveness through distance learning. 4) providing all clinicians real time access to expert clinical consultation through a "warm line" via whatsapp. 5) continued focus on the basics- making sure testing is optimized (e.g. focusing on index patients), listening to front line clinicians on what they need to be effective and meticulous tracking of patients who miss follow-up to rapidly find and return them to care. 6) improving the effectiveness of the frontline clinicians and avoiding turnover by working closely with implementing partners on issues affecting provider retention. To set high standards for clinical care, charess will provide TA to mspp to update on a regular basis the national policies, guidelines, standard operating procedures (sops), and job aids and ensure that these AR e continuously used by healthcare providers to improve care and services. Finally, charess will work with healthqual to implement international standards for continuous quality improvement (CQI) and thus optimize the care of plhiv in haiti.