HIV and Opportunistic Infections Care and Treatment Project

The President's Emergency Plan for AIDS Relief (PEPFAR), in coordination with the United States Agency for International Development (USAID) in Guatemala, funds the USAID HIV and Opportunistic Infections Care and Treatment project, implemented by Asociación de Salud Integral (ASI). The activity carries out interventions that support the implementation of the HIV care continuum to achieve the global 95-95-95 goals (that at least 95% of people with the virus know their diagnosis, 95% of people with HIV who know their diagnosis receive antiretroviral treatment (ART), and that 95% of people on ART achieve viral suppression) in Guatemala, El Salvador, Honduras, and Panama, with an emphasis on the diagnosis and treatment of opportunistic infections. 

GEOGRAPHICAL AND DEMOGRAPHIC FOCUS

In Guatemala, the interventions focus on strengthening the HIV clinic, Clínica Familiar Luis Ángel García (CFLAG), which manages the second-largest cohort of patients in the country and is affiliated with the General Hospital San Juan de Dios (HGSJD) under the Ministry of Health. Additionally, in Guatemala, the project supports strengthening FungiRed, a collaborative network of HIV comprehensive HIV services that aims to improve screening, diagnosis, and treatment of opportunistic infections. In Guatemala, El Salvador, Honduras, and Panama, ASI implements a continuous education program along with a technical assistance package to address opportunistic infections that includes HIV services from the Ministries and Secretariats of Health, Social Security, and private clinics such as APROFAM and its consortium.

CONTEXT AND CHALLENGES

Expanding the offer of HIV testing and services is one of the project’s challenges. It is necessary to reinforce provider-initiated testing strategies within other services of the General Hospital San Juan de Dios (HGSJD), as well as within other public and private healthcare services that refer individuals to CFLAG. Maintaining an adequate supply of ARV medications, diagnostic tests, and laboratory reagents to provide comprehensive patient care, conduct timely diagnosis, and administer appropriate treatment are  ongoing challenges in Guatemala.

At the regional level, recognized academic entities in the respective countries are being involved to endorse the training program, and provide the necessary support to enrolled individuals to ensure they complete the training  successfully. The project is planning to conduct an assessment to identify the technical assistance needed to improve the diagnosis and treatment of opportunistic infections.

APPROACH AND RESULTS

• Extend the hours of HIV testing availability at HGSJD for patient-initiated and provider-initiated testing, reinforce assisted contact notification, and train CFLAG personnel with the aim of increasing the proportion of individuals who know their diagnosis.
• Strengthen communication with healthcare providers, clinics, and civil society to expand patient referrals to CFLAG.
• Enhance the use of the 1540 Hotline in Guatemala (Línea 1540) to provide information about HIV testing, Undetectable=Untransmittable (U=U), and other relevant communication activities.
• Continue with rapid initiation of antiretroviral therapy (ART) and ART optimization, including multi-month dispensing of antiretrovirals.
• Expand interventions for the detection and treatment of human papillomavirus (HPV) at CFLAG.
• Implement intensified adherence counseling and the treatment re-engagement program to increase  the proportion of people living with HIV in viral suppression.
• Implement and maintain a quality management system at CFLAG along with an audit program to assess performance in quality matters.
• Improve the capacity of FungiRed, focusing on communication, expanding the diagnostic service portfolio, and upgrading CFLAG's information systems.
• Implement an educational and technical assistance program for healthcare personnel in the four countries, including online seminars, asynchronous courses, and internships focused on HIV and the clinical management and diagnosis of opportunistic infections.
• Disseminate findings in scientific journals to contribute to the global academic-scientific field.