Haiti: The Feasibility, Demand, and Effect of Integrating Primary Care Services With HIV Voluntary Counseling and Testing

The researchers hypothesized that HIV voluntary counseling and testing (VCT) and primary care services have synergistic benefits, and that integrating the two could be an effective strategy against HIV transmission in developing countries.

"We hypothesize that primary care services and HIV VCT are synergistic; the on-site availability of primary care services attracts people to VCT, and VCT attracts people in need of primary care services for other transmissible diseases," the scientists wrote. "The goal of the current study is to demonstrate the feasibility, demand, and effect of integrating primary care services into VCT in a developing country."

From 1985-2000, services for HIV care, TB care, treatment of STDs, reproductive health, nutrition and prenatal care for HIV mothers were sequentially integrated into HIV VCT at Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) in Port au Prince, Haiti. This study examines the effects such integration had on the client population.

In 1985, GHESKIO counseled and tested 142 people, mostly male clients with AIDS, referred from Port au Prince medical clinics. By the end of 1999, the number of people tested annually for HIV increased to 8,175, with increasing percentages of women of reproductive age, adolescents, symptom-free clients and self-referred clients. Of the 2,013 adults who tested HIV positive at the GHESKIO VCT center in 1999, 55 percent received medical care at the center's adult HIV clinic. Twenty-one percent of those adults referred a sexual partner for HIV testing and counseling. Of the 121 children who tested positive, 72 percent received care at the pediatric HIV clinic.

Of 6,709 adults who were tested in 1999, 1,274 (19 percent) became new users of a contraceptive method. Seventy percent of clients who came in for family planning counseling chose to use condoms alone, while 372 women (30 percent of family planning users) chose a highly effective method of birth control. Of those women, 50 percent (186) also used condoms regularly.

Eighteen percent of clients (1,196) were given syndromic STD management (including counseling, condoms, and syndromic treatment with free medications), and 398 (6 percent) were diagnosed and treated for active TB. Nine percent (599) had a positive syphilis serology and received management for latent syphilis; 9 percent (597) received management for symptomatic STDs.

Follow-up data on the first 62 children born to women participating in the program to prevent mother-to-child HIV transmission show seven infected with HIV during an 18-month follow-up, for a rate of 11 infections/100 live births. Historical controls in Haiti estimate the infection rate at 22/100 live births.

"This report demonstrates the feasibility, demand, and effective synergy of integrated on-site primary care services and HIV VCT in Haiti," the authors concluded. "It is important to note that people diagnosed with HIV/AIDS in Haiti still risk tremendous social stigmatization; therefore, if thousands of people come for HIV testing, then they must believe that the benefits of VCT and integrated services outweigh the risk of stigmatization. We believe that the availability of on-site patient services is an important variable in this personal risk/benefit calculation."

"While some view HIV care and HIV prevention as opposing programs vying for limited resources," the researchers stated, "we believe that prevention and care are synergistic and forged together will be a powerful weapon in the fight against AIDS in Haiti and in many other developing countries."

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