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Final Report for the AIDSCAP
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Table of Contents I. Country Program Description
III. Non-Subproject Highlights Sentinel Surveillance Technical Assistance to National Laboratory (FCO 26451)
Objectives The Ministry of Health and Social Affairs (SESPAS) operates a reference laboratory that is central to the Dominican Republic's blood bank screening and HIV diagnostics. A drive to establish a quality assurance system began under the AIDSTECH project and continued under AIDSCAP until September 1993. The purpose of this project was to improve the techniques, methodology, and facilities used for HIV testing in laboratories. This was to be achieved by training lab technicians in quality assurance and biosafety norms. Accomplishments A total of 121 laboratories participated in the project : 41 laboratories from the AIDSTECH initiative (Phase I labs) and 80 new laboratories (Phase II labs). These facilities represented private, public and semi-private institutions. A total of 747 people (567 women and 180 men) were educated through this process and 91 laboratory technicians (82 women and 9 men) received training in such areas as the proper recording of quality assurance data, equipment maintenance, updating of calibration data and standardization of internal controls. The project produced guidelines on quality assurance and biosafety in the Dominican Republic and distributed 4,050 training and educational materials. The Pan American Health Organization partially funded the training courses through SESPAS, and SESPAS provided twenty inspectors from its Department of Laboratory and Blood Banks to monitor the success of the project. The inspectors found that Phase I laboratories had all greatly improved their services and quality of work. There were diverse results among the Phase II laboratories. Some appeared to have improved HIV testing and implemented quality assurance measures while others had not. Project continuation was important and GODR commitment to continue was sought. Due to budgetary constraints, however, only supervisory activities and some training activities were continued. These were not conducted at the level anticipated or required to maintain quality assurance. Constraints There was a lack of unified criteria among the laboratory inspectors that contributed to inconsistent results in the Phase II laboratories. Also at the end of the project in September 1993, the guidelines had not been formally endorsed by SESPAS due to a lack of coordination between the project implementors and the government's director of laboratory network. After 1993, the National Laboratory has suffered budget limitations and has been unable to oversee the quality assurance efforts for the entire public health system. AIDSCAP/DR's mandate of controlling sexual transmission of HIV precluded continuation of funding to such a program.
Support to Sentinel Surveillance System of the STI and AIDS Control Program (FCO 55445-1,-3)
Objectives The STI and AIDS Control Program (PROCETS) began in 1987 as an extension of the Ministry of Health and Social Affairs (SESPAS). PROCETS is involved in the development of mass media events, peer education programs and educational materials. The PROCETS Sentinel Surveillance System was created in 1991 to track levels of HIV infection in eight health regions as well as determine patterns of transmission and trends of HIV prevalence. PROCETS supervises the collection and processing of blood samples. Under reporting of cases continues to be a constraint to PROCETS' surveillance activities. Public hospitals have been inconsistent in reporting positive HIV results, and the majority of private sector hospitals do not report cases at all. Accurate surveillance information is essential to efficiently and effectively directing HIV prevention interventions. To facilitate PROCETS' work, the AIDSTECH and AIDSCOM projects of Family Health International provided technical and financial assistance to PROCETS. With the inception of the AIDSCAP project, there was a shift in focus from the government sector to the NGO sector. However, AIDSCAP did continue to provide assistance to the national sentinel surveillance system when possible, and executed three formal agreements with PROCETS. Accomplishments During the course of these agreements, AIDSCAP assisted PROCETS with the transportation of blood samples and provided all of the reagents, such as the Elisa kits, necessary to test these samples. The data collected after processing these samples were compiled into periodic Epidemiological Bulletins and Sentinel Surveillance Bulletins. In addition to the epidemiologic data, the bulletins contained articles and editorials on topics such as AIDS legislation, updates on the national adolescent campaign, and the role of the church in HIV/AIDS prevention. In 1995, PROCETS also developed an updated policy document providing information of the current HIV/AIDS situation in the Dominican Republic as well as projections of the future course of the epidemic. During 1994-1995, PROCETS and AIDSCAP developed the program contents of two seminars. These seminars updated health personnel and public opinion leaders on the HIV/AIDS situation in the Dominican Republic. PROCETS held two more workshops in the spring of 1996, the objectives of which were to analyze the trends of the epidemic during the period of 1991-1995, evaluate the results obtained by the Sentinel Surveillance System, and provide recommendations to improve the system. These workshops were attended by eleven epidemiologists and public health specialists including the AIDSCAP/Dominican Republic Evaluation Officer and a representative from the Pan American Health Organization. AIDSCAP assisted PROCETS with the production of a final epidemiological report from these two meetings. During the August 1994-95 funding cycle, AIDSCAP provided technical assistance to PROCETS on the development of a database of STI/HIV/AIDS research in the Dominican Republic. Specifically, AIDSCAP worked with PROCETS on the design of indicators for 78 STI/HIV/AIDS research documents in the database, a system to update the database and a plan for disseminating information from data searches. In addition to the aforementioned assistance provided by AIDSCAP, on-going assistance was received by PROCETS in the development of modeling projections for the future course of the epidemic. Constraints The numerous changes of Directors in PROCETS affected coordination and continuity of activities. Staffing difficulties within PROCETS also delayed implementation of activities. Findings and Recommendations Many recommendations developed out of the evaluation workshops for improvements in the sentinel surveillance system. One suggestion was to extend the number of sentinel groups to include students, tuberculosis patients and military personnel. The importance of quality control in the collection of data was emphasized in order to reduce possible errors. For instance, a CSW who receives monthly test could be counted more than once since there existed a lapse of twelve weeks in the collection of data. A suggestion was also made to ensure that the same proportions of samples were collected from prenatal and postnatal women to allow for comparisons in data from year to year. PROCETS has incorporated these recommendations to provide the most accurate surveillance data possible.
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