National Hiv Sti Programme Annual Report 2017 Nhp-Annual-report-2017

This document presents the National HIV/STI Programme report covering the period
January to December 2017. It reflects the implementation of the National Integrated

Strategic Plan 2014 – 2019 through the outstanding coordination of the HIV/STI/Tb Unit in
collaboration with the National Family Planning Board, other government agencies, civil
society organizations and the private sector.
The Annual Report was compiled and edited by Michell Scott and designed by Fabian
Henry. To request additional information or assistance in interpreting the information
herein, please contact:
HIV/STI/Tb Unit
Ministry of Health
10-16 Grenada Way
Kingston 5
Tel: 876-633-7433
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CONTENTS
ACKNOWLEDGEMENTx
LIST OF ACRONYMS xi
MESSAGExv
MESSAGExvii
MESSAGExix
MESSAGExxi
FOREWORDxxiii
EXECUTIVE SUMMARY 1
OVERVIEW1
STRATEGIC INVESTMENTS IN THE FIGHT AGAINST HIV/AIDS 1
STRENGTHENING THE APPROACH TO FIGHTING HIV/AIDS 2
KEY ACHIEVEMENTS IN THE FIGHT AGAINST HIV/AIDS 3
CONCLUSION4
CHAPTER 1: EPIDEMIOLOGY OF HIV IN JAMAICA 7
AIDS MORTALITY 9
NEWLY DIAGNOSED CASES 10
RISK BEHAVIOURS AND OTHER FACTORS FUELLING THE EPIDEMIC IN JAMAICA 12
CHAPTER 2: HEALTH PROMOTION AND PREVENTION 13
OVERVIEW13
OUTREACH TESTING 14
HIV Testing 15
Syphilis Testing 16
HIV PREVENTION AMONG KEY POPULATIONS 16
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Men who have Sex with Men 17
Persons of Trans-experience 18
Female Sex Workers 20
Correctional Institutions 22
GENERAL POPULATION INTERVENTIONS 24
Peer Navigation 24
Condom Demonstration and Distribution 24
Themed Events 25
CAPACITY BUILDING OF OUTREACH WORKERS 31
CHAPTER 3: TREATMENT, CARE AND SUPPORT 33
OVERVIEW33
TEST AND START MEDIA CAMPAIGN 34
CONTINUUM OF CARE 36
Linkage to Care 36
HIV TESTING 44
Provider Initiated Testing and Counselling 45
Treatment with ARVs 46
Laboratory Monitoring Tests 47
Early Diagnosis of HIV Exposed Infants - DNA PCR Testing 48
CD4 Testing 48
Viral Load Testing 49
Site Mentoring Team 49
SUPPORT50
Psychosocial Support 50
Quality Improvement Programme 51
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ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF HIV & SYPHILIS 52
The Way Forward 54
SEXUALLY TRANSMITTED INFECTIONS 54
The Way Forward 56
TUBERCULOSIS57
CHAPTER 4: ADOLESCENT HEALTH 59
OVERVIEW59
TEEN HUB- HALF WAY TREE TRANSPORT CENTRE 59
YOUTH AND ADOLESCENT TECHNICAL WORKING GROUP 61
ADOLESCENT STANDARDS AND CRITERIA 61
CHAPTER 5: ENABLING ENVIRONMENT & HUMAN RIGHTS 63
OVERVIEW63
ADDRESSING GAPS IN POLICY AND LEGISLATIVE FRAMEWORK 65
HUMAN RIGHTS AND POLICY MONITORING 67
NON-DISCRIMINATION IN HEALTH SETTINGS 69
REDRESS FRAMEWORK IN ALL SETTINGS 71
CHALLENGES72
THE WAY FORWARD 73
CHAPTER 6: STRATEGIC INFORMATION 75
OVERVIEW75
SURVEILLANCE76
Hepatitis & Tuberculosis 77
Sexually Transmitted Infections 77
HEALTH INFORMATION SYSTEM 77
RESEARCH78
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MONITORING AND EVALUATION 79
THE WAY FORWARD 79
CHAPTER 7: GRANTS MANAGEMENT 81
OVERVIEW81
FUNDERS82
Global Fund 82
PEPFAR/USAID84
CONTRACTS AND AGREEMENTS 85
Overview of the Structure 85
Overview of the Partners 85
IMPLEMENTING STAKEHOLDERS 88
GRANT MANAGEMENT UPDATES 89
SUMMARY OF CHALLENGES – TECHNICAL AREAS 90
Prevention90
EEHR91
TCS91
MER92
SUCCESS STORIES & THE WAY FORWARD 92
CHAPTER 8: PROCUREMENT 95
OVERVIEW95
PROCUREMENT THROUGH THE GOJ & DONOR MECHANISM 96
Government of Jamaica 96
Donor96
Zero-Rating of Suppliers Invoices 96
IMPROVING PROCUREMENT EFFICIENCY 96
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E-Procurement System 96
Goods Specialist Sector Committees 97
CAPACITY BUILDING 97
CHAPTER 9: FINANCE & ADMINISTRATION 99
FINANCE99
Overview99
Expenditure101
Funding Sources 104
Challenges 106
Appraisals107
ADMINISTRATION107
Overview107
Staffing 107
Team Meetings 108
Monitoring and Oversight 108
HIV Annual Review 109
Capacity Building 109
Office Space 109
New Initiatives 110
HIV & AIDS FACTS AND FIGURES 2017 111
DATA TABLES 112
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ACKNOWLEDGEMENT
The Ministry of Health (MOH) acknowledges the following government agencies for their
support of the national HIV response in 2017: National Family Planning Board (NFPB),
National Council on Drug Abuse and the Ministries of: Finance, Education, Tourism,
Labour and Social Security and Justice.
Special thanks to the civil society organizations that work tirelessly on the ground to ensure
that services reach those who are most in need. Organizations such as: Jamaica Network
for Seropositives (JN+); Jamaica AIDS Support for Life; Jamaica Red Cross; ASHE; Children
First; Children of Faith; Hope Worldwide; JFLAG; RISE Life Management; EVE for Life and
the Jamaica Community of Positive Women, provided continuous support to people
living with HIV and other key population (KP) groups.
Thanks to: The Global Fund to fight AIDS, Tuberculosis and Malaria; the United States
Agency for International Development (USAID); the President Emergency Plan for AIDS
Relief (PEPFAR); the Joint United Nations Programme on HIV and AIDS (UNAIDS) and
the Pan American Health Organization (PAHO) for their continuous technical and funding
support throughout 2017.
Special recognition to the Government of Jamaica, who among its Caribbean neighbours
is an exemplar of dedication and commitment to ending AIDS.
We would also like to acknowledge the support and contribution of our private sector,
media partners and volunteers for their contribution and dedication to the HIV and AIDS
response in Jamaica.
Special thank you to the tireless health care practitioners, HIV project managers, HIV
advocates and people living with HIV for their dedication and concerted efforts in the
continuous prevention, treatment, care and support for those infected and affected by
HIV and AIDS.
This report was compiled through the combined efforts of many individuals in the Ministry
of Health. The Ministry of Health acknowledges the leadership of the National HIV/STI/Tb
Unit and the National Family Planning Board – Sexual Health Agency (NFPB-SHA) in the
completion of this report.
Disclaimer
Unless otherwise stated, the appearance of individuals or groups in this publication gives
no indication of HIV status, sexual orientation or gender identity.
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LIST OF ACRONYMS
AC Adherence Counsellors
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Clinic
ART Antiretroviral Therapy
ARV Antiretroviral
BCC Behaviour Change Communication
CD4 Cluster of Differentiation
CBO Community-based Organization
CCM Country Coordinating Mechanism
CF Community Facilitators
CM Case Manager
CRH Cornwall Regional Hospital
CSO Civil Society Organization
CVCC Caribbean Vulnerable Communities Coalition
DHIS2 District Health Information System 2
EEHR Enabling Environment and Human Rights
EMTCT Elimination of Mother-To-Child Transmission
FAACC Fort Augusta Adult Correctional Centre
FACS Fluorescence-activated Cell Sorting
FHU Family Health Unit
FSW Female Sex Worker
GIPA Greater Involvement of Persons with HIV/AIDS
GIS Geographic Information System
Global Fund Global Fund to Fight AIDS, Tuberculosis and Malaria
GOJ Government of Jamaica
GPS Global Positioning System
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HARC Horizon Adult Remand Centre
HATS HIV/AIDS Tracking System
HCW Health Care Worker
HP+ Health Policy Plus
HSTU HIV/STI/Tb Unit
JADS Jamaica Anti-Discrimination System
JaPPAIDS Jamaica Paediatric, Perinatal and Adolescent HIV/AIDS

Programme
JASL Jamaica AIDS Support for Life
JCCM Jamaica Country Coordinating Mechanism
JN+ Jamaica Network for Seropositives
JYAN Jamaica Youth Advocacy Network
KAPB Knowledge, Attitude, Practices and Behaviour
KP Key population
LFA Local Funding Agent
MLSS Ministry of Labour and Social Security
MoFPS Ministry of Finance and Public Service
MOH Ministry of Health
MSM Men who have Sex with Men
NBACC New Broughton Adult Correctional Centre
NERHA North East Regional Health Authority
NFPB National Family Planning Board
NFM New Funding Model
NGO Non-Government Organization
NHF National Health Fund
NHP National HIV/STI Programme
NISP National Integrated Strategic Plan
NPHL National Public Health Laboratory
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OIG Office of the Inspector General
OGAC Office of the Global AIDS Coordinator
OSH Occupational Safety and Health
PAHO Pan American Health Organization
PEPFAR President’s Emergency Plan for AIDS Relief
PCR Polymer Chain Reaction
PCU Project Coordinating Unit
PDSA Plan Do Study Act
PHDP Positive Health Dignity and Prevention
PITC Provider Initiated Testing and Counselling
PLHIV People Living with HIV/AIDS
PMTCT Prevention of Mother-To-Child Transmission
PR Principal Recipient
PSIS Prevention Services Information System
RFACC Richmond Farm Adult Correctional Centre
RHA Regional Health Authority
S&D Stigma & Discrimination
SDC Social Development Commission
SERHA South East Regional Health Authority
SI Strategic Information
STI Sexually Transmitted Infection
SR Sub-Recipient
SRH Sexual and Reproductive Health
SRQ Self Reporting Questionnaires
ST. CACC St. Catherine Adult Correctional Centre
Tb Tuberculosis
TCS Treatment, Care and Support
TFACC Tamarind Farm Adult Correctional Centre
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TG Transgender/Persons of Trans-experience
TOT Training of Trainers
TRAT Treatment Readiness Assessment Tool
TRP Technical Review Panel
TSACC Tower Street Adult Correctional Centre
TSIS Treatment Site Information System
TWG Technical Working Group
UBRAF UNAIDS United Budget, Results and Accountability

Framework
UIC Unique Identifier Code
UNAIDS Joint United Nations Programme on HIV/AIDS
UNICEF United Nations Children’s Fund
USAID United States Agency for International

Development
VBI Venue-based Intervention
VCT Voluntary Counselling and Testing
WHO World Health Organization
WRHA Western Regional Health Authority
YATWG Youth and Adolescent Technical Working Group
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MESSAGE
Jamaica is steadily pursuing actions to address
key sexual and reproductive health and HIV
concerns. These actions play an important
role in the country’s National Development
Plan – Vision 2030 Jamaica, into which HIV
and population and development goals and
strategies have been integrated.
The Government of Jamaica (GOJ) stands

behind the work of the National HIV/STI
Programme (NHP) and continues to increase
its budgetary contribution to match this
commitment. The government hopes to
reduce AIDS-related morbidity and mortality
with effective biomedical and supporting
interventions and reduce new HIV infections
Dr. Christopher Tufton
Minister of Health
among key populations through behavioural
and structural interventions. Over the year
the Ministry of Health engaged available resources to advance the national response and
accelerate the way for all Jamaicans to access optimum health care in respect of their
sexual and reproductive rights.
Currently, of the 34,000 persons estimated to be living with HIV in Jamaica, 78% have
been diagnosed and are aware of their status. The country has the highest proportion of
people living who know their status in the English-speaking Caribbean—an achievement
attributed to community-led prevention and testing programmes and the wide spread of
provider initiated testing. Programme data indicate that 75% of persons diagnosed have
been linked to care, and of those linked, 62% have been retained in care.
In 2017, Jamaica adopted the WHO 2015 “Treat All” guidelines, which contain key
recommendations to treat all people living with HIV, including children, adolescents,
adults, pregnant and breastfeeding women and people with coinfections. The guidelines
are based on findings noted in several studies which showed a reduction in morbidity
and mortality if treatment was started at diagnosis. Towards this end, a social-marketing
campaign was launched by the Ministry of Health to encourage persons living with HIV to
take their medication and to continue to do so for life. The campaign, which is dubbed,
‘Test and Start: Get on yu meds and get on wid life’, goes further to encourage persons to
get tested for HIV to know their status, and if confirmed positive, to commence antiretroviral
treatment. Radio, television and poster advertisements form part of the social-marketing
campaign of ‘Test and Start’.
Testing is a critical tool in the management and treatment of HIV/AIDS. The national
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programme made more progress with the initiation of HIV prevention among key
populations through the outreach strategy. During 2017, 10,693 men who have sex with
men (MSM) were reached and 5,759 were tested while 6,694 out of the 10,230 female sex
workers (FSW) reached were tested. The challenges to reach persons of trans-experience
(TG) persists, however 654 were reached and 361 tested. A total of 1,858 inmates across
seven adult correctional institutions were reached and tested for HIV and Syphilis.
Investments in the national AIDS response continue to generate concrete results. Key
achievements in 2017 include the launch of the rebranded Jamaica Anti-Discrimination
System for HIV (JADS), which is a robust and confidential mechanism through which
people living with HIV, and other persons who experience stigma and discrimination at
health institutions, can make reports and seek redress.
The target for the rate of mother-to-child transmission of HIV was not met for the year. This
is a national priority issue. Several strategies are being pursued by the Ministry of Health
to get the country back on track to secure and sustain elimination status. The Programme
also faces other serious challenges. Gaps in the continuum of care continue to pose a
problem especially in the areas of linkage and retention in care, ARV coverage and viral
suppression. This is especially so for youths and other key populations.
Nevertheless, our commitment as a country to end the AIDS epidemic by 2030 as a legacy
to present and future generations, to accelerate and scale up the fight against HIV and
end AIDS to reach this target, and to seize the new opportunities provided by the 2030
Agenda for Sustainable Development, remains strong. We will do more to ensure that
no one is left behind. Improvements in the health information system will be undertaken
to better guide the national response. New ways must be found to reach and link MSM
and other key populations, as well as to combat internal and external stigma. Stopping
new HIV infections and untimely HIV-related deaths through both primary and secondary
prevention and better management approaches must be prioritized.
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MESSAGE
The prevention and management of
HIV, Sexually Transmitted Infections and
Tuberculosis remains one of the Ministry
of Health’s top priorities. The Ministry
plays a critical role in the management and
distribution of resources to support the
National HIV Programme. The response is
financed primarily through the Government
of Jamaica and contributions from the
Global Fund to Fight AIDS, Tuberculosis and
Malaria and the United States Agency for
International Development. Together these
funds support activities and interventions that
target key populations and people living with
HIV (PHLIV), as directed through the various
Sancia Templer components of the response including
Permanent Secretary Prevention, Treatment, Care and Support
services, Enabling Environment and Human
Rights, Monitoring and Evaluation and Governance and Programme Management. The
MOH has contracted a total of twenty-one (21) implementing partners under the Global
Fund and PEPFAR/USAID grants, ten (10) of which receive funds from both grants to
implement activities in the response to HIV.
Jamaica has made some strides in its commitment to “treat all” people living with HIV as
a treatment and prevention strategy. The “Treat All” strategy by the WHO in 2015 aims
to improve the quality of HIV treatment and to bring us closer to the universal health
coverage ideals of integrated services, community-centred and community-led health
care approaches, and shared responsibility for effective programme delivery. All geared
to end AIDS by 2030. With this move, however, there was a clear recognition of the need
to invest in strategic information to guide programme planning and sustain national and
international commitment and accountability. Strategic information is essential if the
National HIV/STI Programme is to respond proactively to the epidemic. Toward this end,
the monitoring and evaluation component of the programme was restructured during the
year to form the strategic information (SI) component. The SI component is responsible
for undertaking surveillance of HIV and sexual transmitted infections (STIs), monitoring
and evaluation and research to guide policy, planning, resource allocation, programme
management, service delivery and accountability.
The focus on youth continued during 2017. One significant development was the
continued operation of a ‘Teen Hub’ at the Half Way Tree Transport Centre, in St. Andrew,
for adolescents and youths to access a mix of services. The services include counselling,
HIV and Syphilis testing and mental health screening. A total of 2,665 young people
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visited the Teen Hub in 2017 and 657 HIV tests were conducted. This has strengthened
our commitment to providing increased access to sexual and reproductive health services
for young people, including valuable information about preventing HIV and STIs.
Bolstered by partnerships with Government Ministries, Departments and Agencies,

private financial institutions, non-governmental organization and community-based
organizations, the Prevention component of the programme continued with some key
intervention strategies during the year, including risk assessment and risk reduction
conversations, psycho-educational sessions, evidence-based interventions and voluntary
counselling and testing (VCT). We continue to see marked declines in HIV prevalence
among female sex workers of 2% coming from as high as 12% in the early 1990s.
Work continued in 2017 to advance care, treatment and support for the estimated 34,000
individuals living with HIV in Jamaica. The data indicates that significant achievements
have been made in core areas of the treatment priority area such as diagnosing 78% of
persons estimated to be living with HIV. Despite the lingering gaps in linkage to care,
retention in care and viral load suppression there are incremental improvements in the
number of persons returned to care.
For Jamaica, the way forward to achieving the global HIV goals requires continued
sustained effort. All stakeholders in the response must do more strategically. The Ministry
of Health is committed to its role to provide national leadership for HIV prevention,
treatment, care and support. More focus will be given to HIV primary prevention and the
promotion and provision of effective tools to prevent HIV infections while addressing the
gaps in human resources, health information and the enabling environment and human
rights.
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MESSAGE
The advances made, and the lessons learnt,
in the treatment and prevention of HIV/
AIDS during the year would not have been
possible without the strong participation
of all the partners and stakeholders in
the national HIV response. The focus
given to increasing the scale and quality
of implementation of HIV prevention
programmes has resulted in an estimated
78% of PLHIV being aware of their status
and 95% of the persons living with HIV in
care, retained on antiretroviral therapy.
There were no ARV stock outs in 2017. An

ARV tracking tool was developed to record
quantities of ARVs and Test kits in stock at the
Dr. Nicola Skyers
Senior Medical Officer, HIV/STI/Tb Unit National Health Fund (NHF) warehouse. This
tool has allowed the easy visualization and
early identification of ARV levels allowing timely ordering and delivery lead times. Notably,
during the year, ARVs were procured through the Global Fund pooled procurement
mechanism (WAMBO) process, and although there were some minor challenges using
the platform and delays with delivery, the overall procurement time frame remains shorter
than the standard GOJ process. Of significance too is the fact that the NHF assumed the
management of government pharmacies in 2017. This change will lead to a standardized
management structure, which is expected to result in improved tracking of the dispensing
of ARVs.
In 2017 a lot of emphasis was placed on building the capacity of the psychosocial
team and standardizing practice and documentation systems across the four Regional
Health Authorities (RHAs). A training curriculum for case managers was developed and
successfully piloted. Also completed was the Adherence Counsellors’ protocol, which will
guide the standardization of adherence counselling practice across RHAs.
HIV testing is normalised with high demand from both key and general populations.
However, persons who are at high risk of contracting HIV continue to be reluctant to
access the service. During the year, the Prevention team was challenged to develop
differentiated prevention packages that meet the need of key populations and the general
population. The Peer Navigation system, which involves linking PHLIV to health care
systems, identifying and reducing barriers to care, and tailoring health education to the
client to influence his or her health-related attitudes and behaviours, was officially rolled
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out in 2017. Prior to the rollout 120 Peer Navigators were trained, certified and deployed.
In 2018, the Programme will incorporate the following:
QQ A quality assurance plan will be implemented to aid in ensuring the quality of ARV
drugs obtained through the WAMBO process.
QQ Health care workers will be trained to identify and handle cases of gender based
violence.
QQ The HIV/AIDS Tracking System (HATS), which has been a repository for all diagnosed
cases in the Jamaica since the start of the epidemic, will be merged with the Treatment
Site Information System (TSIS). This will allow for a seamless monitoring of the epidemic.
QQ Formulation of an overarching roadmap for STIs in Jamaica that considers the current
state of affairs, implements recommendations from the 2017 SITAN and determines
the most feasible approach for the continued holistic management of STIs.
The mandate of the HIV/STI/Tb Unit to support the provision of quality services to those
at risk of, infected with, and affected by HIV, remains unchanged. We will go forward into
2018 with an even greater commitment to accelerating prevention, treatment, care and
support for those most at risk.
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MESSAGE
Jamaica welcomes the opportunity to be at the
forefront of that forward-thinking movement
to transform our world and our country to
ensure sustainable development by 2030.
Our people deserve to attain good health
and well-being, no poverty, zero hunger,
gender equality, reduced inequalities and
opportunities for quality education, a clean
environment, decent work and economic
growth. These are some of the seventeen (17)
sustainable development goals articulated by
the United Nations. The accelerated success
of our national sexual and reproductive health
(SRH) and HIV programmes will contribute
significantly to the achievement of those
Lovette Byfield goals and will ensure that indeed, no one is
Executive Director, National Family left behind. The realisation that population
Planning Board explosion places pressure on the availability
of resources of a natural, national and familial
kind, and influences prospects for work and earning potential, highlights the need to
institute control measures.
Health care providers are conduits for the messages and services provided by the National
Family Planning Board and the Ministry of Health. The focus on the SRH and HIV work
of public sector health care workers and civil society partner organisations was borne
out in the Mid-term Evaluation of the National Integrated Strategic Plan for Sexual and
Reproductive Health and HIV, 2014-2019, in November 2017. Admittedly there are still
challenges to be overcome by the National HIV/STI Programme for the real benefits to be
realised by persons of reproductive age including adolescents, PLHIV, key and vulnerable
populations and by extension their loved ones and the wider society. There is a clear
need for improvement in the attitudes of some health care workers and their treatment
of clients. Additionally, the stigma and discrimination portrayed by ancillary workers to
adolescents and key populations must be erased from the landscape.
Kudos for the expansion of testing, treatment and care services, which were underpinned
by strong partnerships, effective coordination and utilization of resources and a high
quality training programme.
Getting to sustainability revolves around behaviour change. Behaviour change where safe
sexual practices becomes normative, HIV/STI testing is accessible to all and individuals
started on antiretroviral/HIV treatment adhere to the regimen and can lead productive
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lives that contribute to the nation’s growth.
By way of this Annual Report the HIV programme is giving account of our duty bearers.
From the point of the strategic priorities, the NFPB’s core areas of contribution to the
national programme and this report are in:
QQ Prevention and Sexual and Reproductive Health Outreach
QQ Enabling Environment and Human Rights
QQ Monitoring and Evaluation
QQ Sustainability, Governance and Leadership
The workers of the NFPB recommit their energies to the people of Jamaica and thank the
Government of Jamaica and our international development partners for their investments
in the National HIV/STI Programme.
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FOREWORD
Jamaica continues to make progress in scaling up prevention programmes as part of a
comprehensive national response to meet global targets and commitments to end AIDS
as a public health threat by 2030. Critical to this effort has been the commitment and
support of the Government of Jamaica, donors and international partners and civil society.
The national HIV/STI response is funded primarily by the Government of Jamaica, the
Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Agency for
International Development; the budgetary contribution for 2017 was J$1.95B. The GOJ
was the leading contributor by a slight margin; contributing J$765.38M (39%) through
the recurrent budget and through its contribution towards the USAID and Global Fund
grant funded projects. The Global Fund contributed J$762.31M while USAID contributed
US$3.1M. The Programme also received J$0.11M in small grants from UNICEF.
The National HIV/STI Programme is executed through the combined efforts of the HIV/STI/
Tb Unit (HSTU) and the National Family Planning Board – Sexual Health Authority along
with key partners and stakeholders in the national response. The National HIV response is
led by four technical components: Prevention and Health Promotion; Treatment, Care and
Support (TCS); Enabling Environment and Human Rights (EEHR) and Strategic Information.
During the year, several new initiatives were undertaken to accelerate the HIV response. A
few of these are highlighted below and are further elucidated in this annual report.
Surveillance data estimates that there are 34,000 persons living with HIV in Jamaica in
2017 up from 30,000 in 2016. The number of newly reported HIV cases declined from
2,015 cases in 2016 to 1,197 cases in 2017; some 7% were reported notified for the first
time as deaths. HIV prevalence among the general population is estimated at 1.8% up
from 1.7% in 2016.
Several studies were undertaken during the year and will form the basis for the work
ensuing in 2018 and beyond. These include:
QQ Bio-Behavioural Surveillance Survey of Female Sex Workers
QQ Bio-Behavioural Surveillance Survey of Men who have Sex with Men
QQ Annual HIV Sentinel Surveillance Sero-survey
QQ Knowledge, Attitude, Behaviour and Practice (KABP) Survey
SEX WORKER SURVEY

The FSW Survey was conducted among Female Sex Workers, Female Patrons and Workers
of Sites where Persons Meet Sex Partners or Participate in Sexual Activity in Jamaica. The
prevalence of HIV among female sex workers seems to be continuing its steady decline
down from 4.1% in 2011 and 2.9% in 2014 to 2% in 2017. Workers and patrons at sites
where female sex workers operate also exchange sex for money and need to receive similar
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interventions as sex workers. The study also showed that partner/ relationship intimacy is
the biggest threat to consistent condom use.
MSM SURVEY
Data collection for the Integrated Biological and Behavioural Surveillance Survey with
Population Size Estimation among Men who have Sex with Men and Transgender Persons
in Jamaica began in December 2017. The study will be used to estimate the size of
the MSM and Transgender (TG) populations and to determine HIV prevalence and risk
behaviours for these groups.
SENTINEL SURVEY AMONG ANC ATTENDEES AND STI CLINIC

ATTENDEES
The Annual HIV Sentinel Surveillance Sero-survey was conducted in sentinel sites from
three urban parishes and three rural parishes from all four health regions. Certain trends
were observed in the HIV seroprevalence of various sub-groups of study participants of
the 2017 HIV Sentinel Surveillance Serosurvey; many of these are consistent with what has
been noted over the years that the survey has been in existence.
Higher prevalence of HIV was observed in STI clinic clients (4.6%) compared to antenatal
clinic (ANC) clients (0.9%); in both groups the 2017 HIV seroprevalence rate was an
increase over the previous year. Generally, the male cohort of participants had a higher
prevalence than the female cohort. A higher HIV prevalence was observed in the urban
cohort compared to their rural counterparts for both ANC clients and STI clinic clients. The
trends in ANC client HIV seroprevalences over the years would indicate that there has been
a downward trend in the epidemic since the mid-1990s and that the rate has stabilized
since 2010 (up until 2017). These findings are similar to what has been reported from
surveillance data. The HIV seroprevalence in STI clinic clients has also trended downwards
since the mid-1990s. However, the rate in the last three years (2014 to 2017) has shown an
upward trend. The 2017 prevalence is similar to the 2004 rate.
Syphilis seroprevalence was higher than HIV seroprevalence for both ANC (0.96%) and STI
(6.1%) clinic clients. Males overall had a higher Syphilis sero-prevalence than females, and
rural dwellers had a higher rate than urban dwellers (for both ANC and STI clinic cohorts).
Syphilis positive clients had a higher HIV seroprevalence (15.4%) than both the general
ANC (0.9%) and STI clinic client (4.6%) survey populations.
KNOWLEDGE, ATTITUDES, PRACTICES AND BEHAVIOUR SURVEY

The KAPB is a cross-sectional, household-based survey that was conducted among a
randomly selected a sample of 2,000 persons island-wide. The results of the 2017 KAPB
indicate mixed programme results in several areas.
Fewer persons are initiating sex early; the median age for first sex is maintained at age 15
years for males and age 17 years for females as obtained in the 2012 survey. There is notable
improvement among the males, aged 15-24, who have had sexual intercourse before the
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age of 15 (from 49% in 2012 to 41.6% in 2017); no change is recorded among the females.
This improvement in early sexual debut is also reflected in more persons 15-19 who report
having never had sex. Multiple partner relationships, which ranks among the leading risk
factors in Jamaica, increased marginally in 2017 versus 2012; most notable within the age
subgroups was an increase among the 15-24 years male cohort. Overall, condom use at
last sex act among persons reporting multiple partners declined from 61.1% in 2012 to
58.7% in 2017. The percentage of adults aged 15–49 reporting transactional sex declined
significantly in 2017 (31%) versus 2012 (39%). This decline was evidenced in both genders
as well as in age and relationship status. The proportion of persons expressing accepting
attitudes towards people with HIV/AIDS declined significantly in 2017 (11.6%) versus 2012
(14.3%). Intimate partner violence against married or partnered women was considerably
more prevalent in 2017 with 14.8% of women reporting same versus 9.3% in 2012; this
was notably so for women younger than 25 years. Overall there was a decline in correct
knowledge of HIV transmission from 38.5% in 2012 to 32.9% in 2017 among both males
and females but more so among females.
This 2017 report presents information on the HIV response between January 1 and
December 31, 2017. It describes the trends in the epidemic in Jamaica, the programmatic
activities geared at prevention, care and treatment and actions at policy and legislative
reform.
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EXECUTIVE SUMMARY
OVERVIEW
At the end of 2017, 34,000 Jamaicans were estimated to be living with HIV. Since 1982,
36,553 Jamaicans were diagnosed with HIV, the majority (72%) of whom are still alive.
Jamaica continues to exhibit features of both a generalized and concentrated HIV epidemic.
The prevalence in the general population is estimated at 1.8%, however surveys show a
higher HIV prevalence in at-risk groups. Key populations that constitute the concentrated
epidemic include female sex workers, men who have sex with men, transgender persons,
homeless persons and inmates. Estimates among KPs show that the prevalence rate is
approximately 32%, 2% and 52% among MSM, FSW and people of trans-experience,
respectively.
In 2017, 1,197 newly diagnosed cases were reported to the MOH. Of this, 7% (82) were
reported to the National Epidemiology Unit for the first time as deaths. This indicates that
there is still need for wider testing.
Persons aged 20-29 years accounted for the largest proportion (26%) of newly diagnosed
cases in 2017 followed by persons aged 30-39 years old who accounted for 24% of the
total reported cases.
Just under a third (32%) of Jamaicans living with HIV are aged 20-29 years old. More than
half (61%) of Jamaicans living with HIV currently reside in the most urbanized parishes,
namely Kingston and St. Andrew, St. Catherine and St. James.
STRATEGIC INVESTMENTS IN THE FIGHT AGAINST HIV/

AIDS
The objectives of the National HIV/STI/Tb Programme are primarily guided by the National
Integrated Strategic Plan for SRH and HIV and specific objectives of Vision 2030 Jamaica,
the National Development Plan. A substantial portion of the funding for the HIV/AIDS
response has been supported through agreements with donor agencies such as the
Global Fund New Funding Mechanism and the United States Agency for International
Development. However, contributions from the Government of Jamaica have increased
significantly since 2013. This signals a strong commitment to a more sustainable national
response.
The budgetary contribution for the HIV/AIDS response in 2017 was J$1.95B; this
represents an approximately 16% (J$269M) increase over the previous year. The total
GOJ contributions through the recurrent budget and through its contribution towards the
USAID & Global Fund grant funded projects, was J$765.38M. The GOJ’s contributions
increased by 19% (J$118.84M) in 2017 making the GOJ the largest overall contributor by
a slight margin over the Global Fund. Resources were also received from the GOJ through
in-kind contributions.
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The Global Fund New Funding Mechanism (NFM), signed in 2016, was in the second year
of implementation and contributed 39% of the budget (J$762.31M), which is an increase
of approximately 21% over the previous year. Under USAID, the Year 7 agreement was
signed in the amount of US$3.1M; this grant is expected to end in September 2018.
Operating concurrently during 2017 was Year 6 Implementation Letter (IL) 4; this grant
had an originally end date of September 2017, however, it was extended to March 2018.
The Programme also received J$0.11M in small grants from UNICEF.
STRENGTHENING THE APPROACH TO FIGHTING HIV/

AIDS
The NHP expanded its outreach to all PHLIV.
Jamaica adopted the WHO 2015 “Treat All” guidelines, which contain key
recommendations to treat all people living with HIV, including children, adolescents,
adults, pregnant and breastfeeding women and people with coinfections. The guidelines
are based on findings noted in several studies which showed a reduction in morbidity and
mortality if treatment was started at diagnosis.
The NHP made a significant step to strengthen the data system.
The Monitoring and Evaluation Component was given a bigger mandate and reformed
into the Strategic Information (SI) Component. As the overarching goal to end the
HIV epidemic emerged and the work of the HIV/STI/Tb Unit expanded, the need for a
more comprehensive approach to data capture, analysis and use became increasingly
critical. There was a clear need for strategic information that exceeded the boundaries
of monitoring and evaluation to include surveillance, research and health information
systems.
The SI Unit collects, analyses and disseminates data that is used to evaluate and expand
the efficiency and appropriateness of programmes, which are aimed at prevention of
HIV transmission, early detection of new HIV infections and treatment of HIV infected
individuals. The National HIV/STI Programme relies on the SI component to shape its
objectives, inform and improve strategy and programming and monitor progress through
research, analysis and forecasting. Programme Managers, policy-makers and stakeholders
rely on quality information to make informed decisions that are in the best interest of the
people and groups they serve. The SI component enables the HIV/STI Programme to
respond proactively to the epidemic.
The NHP expanded its work in the Enabling Environment and Human Rights arena.
A legal and policy review committee was established to coordinate the development of
policy positions, use of findings from previous legal reviews, compilation of best practices
and production of other communications to inform and guide SRH Advocacy Strategy.
The Enabling Environment & Human Rights Unit convened six (6) legal and policy review
committee meetings and two (2) dissemination meetings to coordinate the development,
printing and dissemination of policy positions and legal briefs. The Committee comprises
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representatives from key Government Ministries, Departments and Agencies, civil society
organisations (CSOs) and international development partners. The committee will function
to build consensus among sexual and reproductive health stakeholders and partners on
recommended actions to address gaps in programming and the policy and legislative
frameworks for HIV and SRH in Jamaica. Two policy briefs were drafted and endorsed by
the Committee on the topics of HIV Sensitive Social Protection and Recommendations to
address discrimination based on health status with focus on HIV and SRH needs.
KEY ACHIEVEMENTS IN THE FIGHT AGAINST HIV/AIDS

Improvement in the management and distribution of ARVs
There were no ARV stock outs in 2017. A constant supply of ARVs is essential to support
the new initiative to “Treat All”. In response to the challenges experienced with ARV stock
levels in 2016, changes were made in the forecasting and planning mechanisms to prevent
national stock outs of ARVs. Training was carried out with members of the TCS and SI Unit
on the Quantimed and Pipeline software, which assists with the forecasting of ARV needs
and allows planned ordering of ARVs. Additionally, an ARV tracking tool was developed
by the Treatment, Care and Support unit to record quantities of ARVs and test kits in stock
at the National Health Fund warehouse. The tool details the average monthly usage of the
ARVs, expected deliveries of ARVs, expiry dates, expected duration of ARVs in stock and
the expected duration of ARVs with upcoming deliveries. The tool has allowed the easy
visualization and early identification of ARV levels allowing timely ordering and delivery
lead times. Increased collaboration with the NHF warehouse team has also been initiated.
Additionally, although delays in receiving some of the shipments of ARV orders procured
through WAMBO resulted in a stock out of ARVs at some treatment sites, recirculation
of ARVs between ARV dispensing pharmacies minimized the interruption of patient
treatment and prevented patients from being switched to alternate regimens.
Notably, the National Health Fund assumed the management of all government
pharmacies in 2017. This change will lead to a standardized management structure, which
is expected to result in an improvement in the number of ARV dispensing pharmacies that
submit Pharmacy reports.
Improvement in Procurement Efficiency
The introduction of the E-Procurement System, the Government of Jamaica’s first electronic
procurement platform, and its establishment of the new Specialist Sector Committees to
facilitate the timely processing of submissions for awarding contracts has significantly
improved the HSTU’s ability to carry out its procurement functions. Some 2,000 persons,
including procurement practitioners and suppliers, were trained to use the E-Procurement
System in 2017. The HSTU utilized the Goods Specialist Sector Committee in 2017 to
receive approval for the procurement of Viral Load Tests, Reagents and Supplies valuing
over JMD 60M, with notable success. The HSTU had access to specific persons on the
Committee, which made for easier communication and faster processing time.
Closing the Gaps in the Continuum of Care
During 2017, the deployment of PHLIV as lay providers was piloted as an approach to
involve PLHIV in the delivery of HIV and SRH services. The engagement of PHLIV Facilitators
initiated the formal inclusion of PLHIV participation as lay providers in health systems. The
engagement of PLHIV Facilitators to provide one-on-one support to their peers at the
treatment sites and work as members of the treatment team is one innovation that has the
potential to increase the number of clients who adhere to their treatment and eventually
become virally suppressed.
The use of the case management approach has helped the workers at the treatment
sites to work better as a team. During the year, treatment teams engaged a collaborative
approach to reviewing, assessing, facilitating and coordinating care for each client
resulting in the best suited treatment team member(s) being assigned to guide and assist
individual PLHIV cases. The scale-up of the case management approach, to ensure that
clients receive quality services and care from entrance to exit of the health facilities, will
accelerate the national response.
In 2017, the implementation of the Treatment Site Mentoring Team to conduct audits,
provide recommendations on corrective measures and provide technical support to the
treatment team was helpful in addressing some critical gaps at the site level. The work of
the Treatment Site Mentoring Team will be scaled up to ensure that corrective measures
are implemented in a timely manner and that improvements are properly documented.
The Peer Navigation System was officially rolled out in January 2017 following the
training, certification and deployment of 120 Navigators in 2016. Navigation includes
linking persons to health care systems, identifying and reducing barriers to care and
tailoring health education to the client to influence his or her health-related attitudes and
behaviours. The Peer Navigation System has facilitated the link between HIV prevention
and treatment. Efforts to scale-up the Peer Navigation System will involve the participation
of Navigators in treatment team meetings and training in the case management approach.
CONCLUSION
During the reporting period, the NHP made strides in addressing the HIV/AIDS epidemic
in Jamaica and was able to build on the foundation that it had established in previous
years. During the year, the NHP expanded its programming by using information gathered
through surveillance and research; strengthened its ability to use data to drive its response
to the epidemic and continued its efforts to engage and empower stakeholders to ensure
that the national response remains relevant.
The work of the NHP continues in the face of challenges in reaching key populations. It has
become more difficult to engage FSWs in site-based interventions as more of them work
from home and use their phones to contact their clients. For the MSM and TG population,
the lack of safe spaces and stigma within the community continue to hinder the progress
of intervention. The refusal of some inmates to do blood work, the transfer of inmates
between correctional institutions without their medical charts, the “no-condoms in prison”
policy and delays in results from the National Public Health Laboratory have all created
challenges for follow-up and care in the correctional system.
Nevertheless, the NHP through the GOJ and its partners in the response will continue the
work towards control of the HIV and AIDS epidemic in Jamaica, buoyed by the momentum
of the progress made over the last six years.
CHAPTER 1: EPIDEMIOLOGY OF
HIV IN JAMAICA
The Ministry of Health’s 2017 HIV Epidemiology Profile indicates that an estimated 34,000
persons are currently living with HIV, but approximately 22% are unaware of their status.
In 2017, there were 1,197 newly diagnosed cases, a significant decline from the 2,015
cases reported in 2016.
Fig. 1 Persons Living with HIV (non-AIDS), Advanced HIV and AIDS and Deaths in
Jamaica, 1982-2017
AIDS MORTALITY
Jamaica continues to produce good results in terms of the number deaths averted because
of AIDS-related illnesses. The AIDS mortality rate declined from 25 deaths/100,000
population in 2004, to just over 10 deaths/100,000 population in 2017; this represents a
significant decline since the inception of universal access to ARVs in 2004. The reduction
in deaths can be traced to the introduction of public access to antiretroviral treatment in
2004, the scaling up of the National Voluntary Counselling and Testing (VCT) Programme
and use of rapid test kits allowing for earlier diagnosis, the availability of prophylaxis against
opportunistic infections and improved laboratory capacity to conduct investigations such
as CD4 counts, viral load and PCR tests.
Fig. 2 Number of people living with HIV/AIDS by Sex & Age (Current)
Fig. 3 New HIV, Advanced HIV and AIDS in Jamaica by Sex & Current Age (2017)
NEWLY DIAGNOSED CASES

In 2017, 1,197 newly diagnosed cases were reported to the MOH. Approximately 62%
of the newly diagnosed cases were for persons diagnosed with CD4 ≥350; this is likely a
reflection of scaled-up HIV testing and counselling efforts. However, there is still the need
for wider testing as 82 (7%) of these cases were still notified to the National Epidemiology
Unit for the first time as deaths. Persons aged 20-29 years accounted for the largest
proportion (26%) of newly diagnosed cases followed by those aged 30-39 years old
accounting for 24% of the total reported cases.
Fig. 4 First Reported & Classified 2017
Fig. 5 First Reported by Age Group 2017
RISK BEHAVIOURS AND OTHER FACTORS FUELLING THE

EPIDEMIC IN JAMAICA
Jamaica continues to exhibit features of both a generalized and concentrated HIV
epidemic. The prevalence in the general population is estimated at 1.8%, however survey
show higher HIV prevalence in at-risk groups.
The main risk factors fuelling the epidemic in Jamaica include history of STIs, men having
sex wth men, multiple sex partners, and sex with sex workers.
CHAPTER 2: HEALTH PROMOTION
AND PREVENTION
OVERVIEW
The prevention of HIV and AIDS is a key component of the National HIV/STI Programme.
This component focuses on developing, promoting and supporting health promotion
and behaviour change strategies that impact sexual risk behaviours and cultural norms to
reduce the transmission of HIV and other sexually transmitted infections (STIs). Behaviour
Change Communication (BCC) is used to guide the development of strategies to reduce
the transmission of new HIV infections through universal access t o prevention and support
services, among general as well as key populations. This work is led by the National Family
Planning Board in collaboration with the Prevention teams from the four Regional Health
Authorities as well as several civil society organizations (Jamaica AIDS Support for Life,
ASHE, Children First, Children of Faith and National Council on Drug Abuse).
In 2017, the Prevention Unit pursued five (5) broad objectives including: identifying,
building relationships and increasing interactions with MSM and TG populations;
maintaining reach and coverage of all known sex work sites; providing opportunities
for HIV testing during community outreach activities using the mobile testing unit, with
increased focus on the key populations; reducing new HIV infections especially among
15-49 age group and improving the treatment cascades through Peer Navigation.
During the year, specific effort was made to target KPs that are considered most at risk,
including men who have sex with men, female sex workers, persons of trans-experience
and vulnerable populations like inmates of correctional facilities (both males and females).
The current HIV prevalence rate for the general population is 1.8% while estimates
among KPs show that the prevalence rate is approximately 32%, 2% and 52% among
MSMs, FSWs and TGs, respectively (MOH EPI data 2017). Key populations were targeted
at three levels: individual, group and community. The intervention strategies included:
risk assessment and risk reduction conversations; capacity building; psycho-educational
sessions; evidence-based interventions and voluntary counselling and testing.
Some of the key messages that were delivered through the work of the Prevention Unit
include:
QQ Abstinence
QQ Delay debut of sexual activity
QQ Reduce multiple partnerships
QQ Mutual monogamy
QQ Access rapid HIV and Syphilis testing
QQ Practice treatment seeking behaviour
QQ Consistent and correct condom use and condom negotiation
QQ Utilize referrals for treatment, care and support
The efforts of the Prevention Unit were bolstered by partnerships with other entities
such as Government Ministries, Departments and Agencies, private financial Institutions,
non-government organizations (NGO) and community-based organizations (CBOs).
The partnerships were valuable in addressing some of the social, economic, political
and cultural challenges that would have impacted implementation, and ultimately the
achievement of Programme targets.
OUTREACH TESTING
HIV testing is normalised with high demand from both key and general population. However,
persons who are at high risk of contracting HIV, especially within the communities, continue
to be reluctant to access the service. During the year, the Prevention team was challenged
to devise creative and innovative strategies for promoting testing and increasing uptake.
It became necessary to increase conversations and testing opportunities among the
general population to unearth the key populations who would not be reached through
the targeted testing.
In addition to conducting routine HIV and Syphilis testing, site based prevention
interventions are a key element of the Prevention package of services. These interventions
take place in low income, high prevalence and volatile communities, town centres,
transportation hubs, places where people go to meet new sex partners (PLACE sites),
sex work venues and socializing sites in and around high prevalence communities. In
2017, the services provided by outreach staff included: risk assessment and risk reduction
conversations, condom negotiations and demonstrations, condom and lubricant
distribution, HIV and Syphilis screening and referral for treatment.
HIV Testing
Increasing access to HIV testing continues to be a priority and is largely carried out by
the Prevention Unit. During the year, four mobile testing units were operational in three
Regional Health Authorities (South East Regional Health Authority (SRHA), North East
Regional Health Authority (NERHA) and Western Regional Health Authority (WRHA)) and
were scheduled to operate five days per week, targeting high prevalence communities,
high transmission sites and key affected populations.
During the period under review, the Prevention Unit tested a total of 48,697 persons for
HIV; 18,262 (38%) males and 30,435 (62%) females. Two thirds of the persons tested
(32,152) were adults over 25 years old, followed by the young adults age 20-24 (11,165)
and then adolescents in the 15-19 age range (5,380).
Fig. 6 Persons tested for HIV by Age and Gender
Syphilis Testing
During the year, the Programme continued to monitor Syphilis in outreach settings.
Screening was done using the SD Bioline in accordance with the Ministry of Health’s
testing protocol. The Prevention team tested a total of 47,034 persons for Syphilis; 18,089
males and 28,945 females.
Fig. 7 Persons tested for Syphilis by Age and Gender
More females accessed the testing services than the males. This could be attributed to the
fact that males have demonstrated poor health seeking behaviour. Additionally, males
in the high-risk communities, often use the status of their female partners to assess their
status.
HIV PREVENTION AMONG KEY POPULATIONS

In 2017, 10,693 MSM were reached through the efforts of the Prevention Unit; just over
50% were tested (5,759 persons). The challenges to reach the transgender population
persists, however 654 were reached in 2017 and just over a half of that number (361) were
tested.
With respect to female sex workers, the cumulative number reached by the Unit in 2017
totalled 10,230 and 65% (6,694) were tested. These KPs were primarily reached and
tested through the outreach strategy which involved the distribution of condoms and
lubricants and self efficacy skills building activities.
Men who have Sex with Men

Strategic and deliberate focus was given to this group by the Prevention Unit over the
reporting period. As a result, 10,693 men were reached and 5,759 were tested. Children
First reported reaching the most men, which accounted for a fraction over 20% of the total.
Fig. 8 MSM Reached and Tested
The strategies employed took the form of workshops, site based and venue-based
interventions and use of peer links, one-to-one and snowballing. During the year, efforts
were made to increase workplace interventions in hotels and call centres and to use
home-based sites (also known as “lymes”) and social media to increase reach and test of
the population. MSM/TG were also reached at PLACE sites across the island, including
popular restaurants, plazas/malls in the main town centres in the parishes, private homes
and churches. Site visits facilitated HIV prevention activities such as risk assessment and risk
reduction conversations and discussions, condom skills building, as well as the distribution
of condoms and lubricants to the population.
There was a significant reduction in the distribution of lubes to the MSM population in
2017 because of a national stock out of lubricants. Nonetheless the interactions with the
population continued with an increased emphasis on condom building skills and condom
distribution to heighten the awareness of the population of the need to protect against
HIV.
Persons of Trans-experience
This is still a relatively new area of focus. While the Prevention teams have improved testing
among TGs, efforts to reach this group during the reporting period were hampered by the
team’s limited knowledge of the population. The team has indicated that in conversations
with the TG population, some persons were having difficulty in identifying as “trans-
gender”; they are still working through the dynamics of the change and are not yet ready
to identify as trans-gender. Persons of trans-experience tend to be gender fluid and will
change their gender often, sometimes identifying as males and sometimes as females.
They also tend to change their sexual orientation. Therefore, the skills of the Prevention
team members must be strengthened to work more effectively with this community.
In 2017, lyming continued to be the prime activity for engaging the TG community. The
NFPB hosted one lyme for persons of trans-experience during the year; 15 participants were
engaged in make-up artistry and provided with fashion tips and sexual and reproductive
health information. The participants who attended the lyme had previously participated
in MSM activities. Additionally, the Prevention Unit collaborated with two Kingston based
party promoters and got the opportunity to engage with persons who would not have
attended a site or venue-based intervention.
A total of 654 TGs were reached during 2017 and 361 were tested. Jamaica AIDS Support
for Life reported reaching the most persons.
Fig. 9 TG Reached and Tested
Challenges
The Unit faced several challenges in 2017 with regards to the TG population, including:
1. Incentivized Participation. Lymes are mostly attended by MSM from the lower social
and economic strata that have admittedly been to several other workshops. They have
also become accustomed to receiving stipends for participating in programmes and
have become unwilling to participate in interventions unless monetary incentives or
care packages are being offered.
2. Lack of safe spaces. This hampers the progress of the intervention as team members
are hesitant to work at known MSM sites for fear of flare-up of violence or police raids.
Both staff and participants are compromised by threats of violence.
3. Real and perceived stigma. Stigma within the community continues to hinder the
progress of intervention. Persons fearful of receiving a positive result tend not to
access testing services. In order to allay some of the fear the interactions with the
population rely heavily on the ‘Test and Start’ strategy. Persons are provided with
information on the possibility of becoming virally suppressed as an outcome of starting
treatment if diagnosed as positive.
Trans Jamaicans Qualitative Research
A qualitative research was undertaken during the year to uncover information to assist
HIV Programme planners in developing strategies and approaches to effectively identify,
locate and engage people of trans-experience in comprehensive rights-based HIV
programmes. Data was gathered from focus group discussions and interviews with thirty-
one (31) persons of trans-experience.
The following are some key recommendations from the study:
QQ The Ministry of Health and the Medical Association of Jamaica should take a policy
approach and position on transgender health care to support capacity building and
training of health providers and implement best practices and standards.
QQ Engage transgender people through a range of networks and offer HIV prevention,
testing and treatment services that are delivered by trans-people to trans-people.
QQ Develop counselling service for people of trans-experience that could take the form
of a co-counselling model by training trans-people in basic counselling skills to assist
and support others.
QQ Stigma and discrimination and violence towards trans-people must be addressed. Key
messages should be disseminated through public education campaigns on gender
based violence and gender diversity.
QQ Identify trans friendly and trans competent health care providers in the public, private
and civil society sectors to build a skill set of local expertise that can respond to the
needs of trans Jamaicans.
Female Sex Workers

In 2017, the main strategy for engaging FSWs continued to be “reach and test” as a means
of transition to the ‘Test and Start’ programme. A total of 10,230 females were reached and
6,694 were tested. Over 90,000 condoms were distributed. The women were engaged
at clubs, street sites and massage parlours. The Prevention team maintained the emphasis
on reaching female patrons who, as studies have shown, are also engaging in sex work.
Fig. 10 FSW Reached and Tested
The 2017 Bio-behavioural Study carried out among FSW and female workers and patrons
has identified a new prevalence of 2% among the population. This is a decrease from 2.9%
in 2014. The decrease may be attributed to the continuous presence of the Prevention
team in the field.
During the year, a quantitative study was also conducted to gain insight into the
challenges faced by HIV positive FSWs in accessing treatment care and support and to
propose strategies to address the challenges identified. A few challenges were identified,
including:
1. Perceptions and practices about eating food and medication.
2. Coping with the side effects of the medication.
3. Mobility of the sex workers to seek work locally and overseas.
4. Lack of privacy at the worksites.
5. Club operators demanding test results prior to employment.
6. FSW negative attitude towards HIV+ FSW.
The study outlined several recommendations to address some of the challenges:
1. Implement a strategy to improve treatment literacy among the population.
2. Strengthen the link between the Prevention and Care team.
3. Scale up and maintain site-based sensitization sessions with club operators .
4. Revise the system for providing HIV results at sex work sites.
5. Intensify strategies to work with families and communities to reduce stigma and
discrimination and encourage support for family members.
These recommendations were accepted by the Prevention team and will form the basis of
the work going forward.
Challenges
Overall, the challenges in reaching the FSWs include:
1. Duplication of efforts. FSW move from one parish or region to another, which leads to
multiple agencies reaching and testing the same persons.
2. Identifying new sex work sites. The traditional sex work sites such as massage parlours
and clubs have not been yielding new FSWs.
3. Migratory nature of FSW. The population is very mobile and this limits the opportunities
for continuous interventions and monitoring.
4. Increase in the use of social media. It has become more difficult to engage FSWs in
site-based interventions as more of them work from home and use their phones to
contact their clients.
Correctional Institutions
Prevention interventions were conducted primarily in four (4) adult correctional institutions
throughout the year: Tower Street Adult Correctional Centre (TSACC), St. Catherine Adult
Correctional Centre (ST. CACC), Tamarind Farm Adult Correctional Centre (TFACC) and
Fort Augusta Adult Correctional Centre (FAACC). Through collaboration with Health
Thru Walls, additional testing was done in Horizon Adult Remand Centre (HARC), New
Broughton Adult Correctional Centre (NBACC) and Richmond Farm Adult Correctional
Centre (RFACC).
The objective of the SRH Programme in correctional institutions is two-fold: 1) to identify

and provide treatment and care for STIs, specifically Syphilis, HIV and Hepatitis B, and 2)
to assist the Department of Correctional Services with healthy lifestyle initiatives for the
incarcerated population. Screening for HIV and other STIs is offered upon intake of all new
inmates and those currently housed in correctional institutions. The provision of treatment
for STIs, including antiretroviral therapy (ART) and adherence support, are offered to HIV
positive inmates and upon release they are assigned to a Peer Navigator in their respective
parishes.
Cumulatively, 1,858 inmates were tested for HIV and Syphilis in 2017. This resulted in the
identification of 60 new cases of HIV and 21 new cases of Syphilis. Testing figures also
included fourteen (14) self-identified MSMs and two (2) FSWs. All persons reactive for HIV
and Syphilis were linked to care and the necessary follow up tests carried out. One-to-one
and group educational sessions continued during the year with special emphasis on ‘Test
and Start’. The Unit also conducted educational sessions with visiting family members
and friends at the visitor’s area at TSACC and ST. CACC.
Table 1 Inmates Tested at Various Correctional Facilities
FACILITY TESTED HIV+ SYPHILIS

TSACC 522 15 9
FAAC 206 5 0
ST. CACC 667 26 9
TFACC 185 6 1
HARC 197 1 1
NBACC 37 1 1
RFACC 44 0 0
TOTAL 1,858 60 21
Challenges
Working with this vulnerable group presents unique challenges. These include:
1. Delay in results from National Public Health laboratory. Confirmatory results that
should take two weeks can sometimes take up to six weeks or in some cases the results
go missing.
2. Refusal to do blood work. Some inmates refuse to get their blood work done for
varying reasons including, but not limited to, denial of their HIV status.
3. Medical information not being transferred with inmates. Inmates, including those who
are HIV positive, are being transferred to other correctional institutions without their
medical charts. This creates additional challenges for follow up care in the correctional
system.
4. Staffing issues at TSACC result in difficulty assigning an escort to the Programme Officer.
This was further complicated by the assault of a female human rights practitioner by
an inmate. Escorting protocols have since changed. An escort is to be accompanied
by a member of the patrol team for both entry and exit of the respective areas within
the institution.
5. Lack of condoms in institutions. The “no condoms in prison” policy makes it difficult
for inmates to practice safe sex. Ongoing efforts will be made to advocate for the best
interest of this population.
GENERAL POPULATION INTERVENTIONS

Peer Navigation
The Peer Navigation system was officially rolled out in January 2017. HIV navigation involves
service delivery aimed at assisting clients
to obtain timely, essential and appropriate
HIV-related medical and social services to
optimize their health and eventually achieve
viral suppression. Navigation includes linking
persons to health care systems, identifying
and reducing barriers to care, and tailoring
health education to the client to influence his
or her health-related attitudes and behaviours.
One hundred and twenty (120) persons from
the RHAs, NFPB and seven (7) Civil Society
Organizations (CSOs) were trained, certified
and deployed in 2016. Coaching seminars are
ongoing to keep the Navigators current with
information to assist their clients. Their work
in the field will be guided by a Peer Navigation Protocol that was also developed and
disseminated.
Condom Demonstration and Distribution

In 2017, 304 condom outlets were established by NFPB and the RHAs. Through these
outlets and outreach activities 5,599,330 condoms were distributed and the condom skills
of 59,691 persons were enhanced.
Table 2 Summary of Condom Distribution & Demonstration by Region
CONDOMS SERHA NERHA WRHA SRHA NFPB NGO TOTAL

Outlets established 40 74 146 30 14 304
Condoms 1,788,800 820,476 1,714,100 974,500 109,454 192,000 5,599,330
distributed
Demonstrations 2,091 566 16,241 12,110 16,223 12,460 59,691
Themed Events
The National HIV/STI Programme commemorates three annual special events. These
special events are Safer Sex Week during Valentines week, Regional Testing Day (on
the last Friday in June) and World AIDS Day on December 1. These events are essential
in normalizing testing and creating awareness around HIV transmission, other STIs and
condom use.
Safer Sex Week

Safer Sex Week was observed during the period February 13-17, 2017. In commemorating
this special week, the national event was hosted at Prison Oval, Spanish Town, in St.
Catherine on Tuesday, February 14 (Valentine’s Day). A total of 1,675 persons were tested
for both HIV and Syphilis during the Safer Sex Week of activities.
Counsellor at work at the NFPB/AHF Safer Sex Week at Spanish Town Prison Oval
Information Booth at the NFPB/AHF Safer Sex Week, Spanish Town Prison Oval
Regional Testing Day

The National Family Planning Board supported by Scotiabank, and with the partnership
of the South East Regional Health Authority, commemorated Regional Testing Day on
Friday, June 30. A total of 545 persons were tested for HIV/ Syphilis on that day.
Regional Testing Day 2017, Mandela Park
NFPB Information Booth at Regional Testing Day 2017
(L-R) The Hon. Minister of Health, Dr. Christopher Tufton, Dr. Denis Chevannes, Former Executive Director, NFPB, Ms. Manoela
Manova, Country Director, UNAIDS and a representative from Scotiabank Jamaica at Regional Testing Day 2017
World AIDS Day

World AIDS Day 2017 themed ‘Keep the Promise, Don’t turn your back on me” was held
in collaboration with AIDS Healthcare Foundation and JN+. The national activities for
the period started with a media launch on November 16 at the Courtleigh Hotel. Guest
Speaker, the Honourable Minister of Health, Mr. Christopher Tufton commended the
efforts of the National Programme in its continuous work to achieve the UNAIDS 90-90-90
targets. The church service in honour of World AIDS Day was held at St. Luke’s Anglican
Church on November 26.
Hon. Minister of Health, Mr. Christopher Tufton at the Launch of World AIDS Day, 2017
World AIDS Day Church Service, St. Luke’s Church, Kingston
The World AIDS Day 2017 celebration also featured a Song and Arts Competition targeting
adolescents and young people between the age of 10 and 25 years. The competition was
aimed at assessing their knowledge of AIDS/HIV issues while engaging their artistic skills
to produce a poster or a song based on the theme. Entries were received from over
30 schools island-wide; 53 entries were received for the song competition and 72 for
the visual arts competition. World AIDS Day activities culminated with a road march on
December 1. Over 500 participants marched from Mandela Park to the Health Fair and
Arts Competition finals at Emancipation Park.
The Song competition was won by the Greater Portmore Ensemble, Greater Portmore
High School (10-15 age group category) and Tyrell Cammock from Excelsior High School
(16-25 age group category). The winners for the Art competition were Odain Bryan from
Bridgeport High School (10-15 age group category) and Haleem Lazaru from Pembroke
Hall High School (16-25 age group category).
Students from Greater Portmore High School pose with their cheque after winning first place in the World AIDS Day song
competition (10-14 age group). Director of Health Promotion and Prevention, Andrea Campbell, handed over the prize.
World AIDS Day 2017 Road March, Emancipation Park, St. Andrew
CAPACITY BUILDING OF OUTREACH WORKERS

During 2017, Outreach Workers were engaged in various in-service training activities to
build their capacity to effectively execute their responsibilities. Training topics included:
QQ Motivational Interviewing - Outreach officers were introduced to practical techniques

that can be used to assist their clients in resolving ambivalent feelings and insecurities
that are preventing them from making healthier sexual choices.
QQ Gender Diversity - Outreach Officers were given tools to help develop a better
understanding of gender and steps to gain support in the design of strategies to
target individuals from diverse populations.
QQ Micro Planning - in collaboration with LINKAGES – Outreach officers were introduced

to strategies that can be used to assess, prioritize and document the needs of individuals
from the KPs in an effort to build rapport, encourage the building of networks and the
development and maintenance of healthy sexual practices.
QQ Behaviour Change Communication Refresher - Strategies were introduced to assist

in the creation of a supportive environment that enables individuals to initiate, sustain
and maintain positive and desirable sexual reproductive health behaviours.
QQ Global Positioning System (GPS)/Geographic Information System (GIS) Mapping -
Training was provided by the Ministry of Health on how to improve the work done with
the key populations through geo-location.
QQ Peer Navigation Refresher – Peer navigation training sessions in linkage to care and
treatment literacy were conducted across the island to equip Outreach Officers to
guide their clients to become virally suppressed.
QQ Provider Initiated Testing and Counselling (PITC) - This training was conducted to
increase the number of Outreach Officers offering HIV and Syphilis testing and
counselling to clients who access care in public, private and NGO health facilities.
Officers were provided with the opportunity to get accurate information on HIV/
AIDS, HIV prevention, transmission and treatment and learn about the benefits and
challenges of HIV Testing. Additionally, the training covered issues of confidentiality
and consent and how to apply these in practice settings. Officers were trained how to
administer HIV/Syphilis rapid screening tests and deliver results including referral to
treatment, care and prevention support and partner notification.
QQ Social Media Platforms for Social Media Managers – Social Media Managers were
trained on how to use various social media platforms to reduce the gap in reaching
key populations. However, the implementation of this strategy on a wide-scale basis is
still underway due to lack of the necessary devices and data plans.
QQ Treatment Literacy and Readiness – The training aimed to increase access to HIV
care and treatment services by equipping Peer Navigators/Outreach Officers with the
knowledge to dialogue with clients on matters related to treatment, care and support.
QQ Introduction to District Health Information System 2 (DHIS2) - DHIS2 is a tool used for
collecting, validating, analyzing and presenting aggregated data. It allows for data to
be captured in one central place. The system also assists in improving and increasing
Programme impact by providing instantaneous reports. Outreach officers can gain
feedback on work done, which helps to improve the facility’s response and hence
national response.
CHAPTER 3: TREATMENT, CARE
AND SUPPORT
OVERVIEW
The Treatment, Care and Support Unit (TCS) is the technical arm of the HIV/STI/Tb Unit.
The TCS team is charged with the responsibility of providing oversight in the treatment
and holistic management of persons diagnosed with HIV/STIs and Tuberculosis (Tb). This
involves several key activities and interagency collaborations that ultimately affect the
patient outcomes and the outcome of the National HIV/STI/Tb Programme. The attainment
of targets is necessary for not only patient outcomes, but also for national validation and
continued donor support. Ongoing training, sensitization and evaluation are therefore
essential.
The National Integrated Plan for Sexual and Reproductive Health has specific targets for
the HSTU to achieve over the period 2014 - 2019. These include:
1. Increase coverage of ARV treatment for PLHIV to 65% by 2019
2. Increase to 90% the proportion of PLHIV on ART one year after initiating therapy
3. Reduce the number of HIV related deaths by 25% by 2019
4. Eliminate vertical transmission of HIV and Syphilis by 2015
Based on 2017 data, approximately 78% of the estimated number of PLHIV have been
diagnosed, 34% retained in care on ARVs and 17% virally suppressed. The aforementioned
evidence is showing that much effort will be needed to scale up activities towards achieving
significant improvement in the second and third “90’s”.
While there is significant focus on HIV, the plan also includes strategies geared at addressing
the prevention and treatment of other STIs and Tb. Risky sexual behaviour increases the
risk of acquiring a STI. Revamping the National STI Programme is therefore critical.
Tuberculosis is one of the major opportunistic infections affecting PLHIV. In 2015,

Tuberculosis was one of the top ten causes of death globally and the leading cause of
death worldwide from a single infectious agent. In 2015, it was responsible for more deaths
than HIV and malaria and is the leading cause of death globally in persons affected by HIV.
In response to the need to strengthen the TCS response, additional staff were recruited
including a Clinical Mentor to offer clinical assistance in managing PLHIV and Programme
Development Officers charged with responsibility for the Tb, STI, elimination of mother-
to-child transmission (EMTCT) and prevention of mother-to-child Transmission (PMTCT)
programmes. All national TCS officers are assigned responsibilities related to programme
management and implementation of work plan activities for the RHAs
TEST AND START MEDIA CAMPAIGN

“Get on yu meds and get on wid life” was the call to action for the HIV campaign launched
in August 2017. The campaign focussed on adherence to anti-retroviral therapy, retention
in care and reducing lost to follow up.
The campaign had three objectives: 1) complement and support the roll out of the ‘Test
and Start’ programme which started in January 2017, 2) highlight the benefits of starting
ART soon after diagnosis and 3) to encourage those who have started to stay on their
medication and build awareness about HIV treatment by providing easily understood
information about ART. It was targeted at: newly diagnosed persons; persons that are
lost to follow up, who may not have been eligible for ART under the previous guidelines
(CD4 of 500); PLHIV that practice a healthy lifestyle such as special diet, exercise and use
alternative medicine to maintain good health and avoid ART and all PLHIV. The campaign
which is still running features:
One 30 seconds television

commercial: “Conscience”
This commercial shows an HIV positive
young woman who is very conscious of her
appearance. She is seen exercising as part
of her healthy lifestyle routine. The only
thing missing from this healthy routine is her
ARVs. Even though she is living a “healthy”
lifestyle and seems to be in good health, her conscience warns her about the vagaries of
the disease and finally convinces her to not take any chances and start taking her meds.
Three 20 seconds social media video treatments: New diagnosis, Side

effects and Why Everyday
These videos are intended for social media placement but can also be placed on national
television. They cover three major issues faced by persons living with HIV:
QQ What happens if I test positive for HIV?
QQ Why do I have to take the medication every day?
QQ How do I cope with side effects?
The video clips provide brief and simple information about each of these frequently asked
questions.
One 30 seconds radio commercial

The radio commercial shares a conversation between two persons, one of whom has just
tested positive for HIV. He is encouraged by a fellow PLHIV not to be daunted because
there is medication available to support a long and healthy life. The importance of
adherence is also reinforced with the message of taking ARVs every day!
Two posters
These posters reinforce the ‘Test and Start’ messages and were placed in both private and
public health facilities as well as among civil society partners.
Poster 1: Very popular among younger PLHIV as it simply depicts how the ARVs “control”
the HIV virus. The virus is shown locked in a cage with the key being held by the ARV (pill).
Poster 2: Support for people living with HIV is always critical in coping with the diagnosis
and maintaining treatment regimen. This poster shows hands holding as a sign of care
and support.
CONTINUUM OF CARE
Linkage to Care
The HIV and AIDS epidemic, despite improvement in areas of the prevention of mother-to-
child transmission and the reduction of HIV related deaths, still faces serious challenges.
Gaps in the continuum of care continue to pose a problem especially in the areas of linkage
and retention in care, and ARV coverage and viral suppression. This is compounded by
barriers to care such as stigma and discrimination, staff shortages, inadequate linkages
with civil society and private sector organizations among others. Despite this, efforts
continue to be made to strengthen these links.
In 2017, the Ministry of Health adopted the 2015 WHO guidelines to “Treat All” based on
findings noted in several studies which showed a reduction in morbidity and mortality if
treatment was started at diagnosis.
The national treatment cascade illustrates the deficiencies in the continuum of HIV
treatment and care that the country faces in meeting its treatment targets.
Fig. 11 National Treatment Cascade by Gender, December 2017
Of the 34,000 individuals estimated to be living with HIV infection in Jamaica, approximately
78% have been diagnosed. There are various issues surrounding testing that limit the
effectiveness of the response. Routine HIV testing is still not fully implemented throughout
the health system. There continues to be low levels of Provider Initiated Testing in Accident
and Emergency departments at some facilities, especially among patients admitted to
hospitals. There has been a scale up of PITC training across the RHAs and reinforcement
from the regional level, which has resulted in an improvement in uptake. This effort needs
to be sustained.
With regards to linkage, 75% of patients diagnosed have been linked to care, and of those
linked, 62% have been retained in care. Of those retained in care, 95% are on ARVs but
only 52% of those retained in care and on ARVs are virally suppressed. Through Quality
Improvement (QI) activities, there is an emphasis on closing the gaps regarding lost to
follow up and viral suppression at all sites and this process will continue into 2018. In
order to formalize the institutionalization of QI activities, the Liaison and TCS Officers have
been given the responsibility of overseeing implementation and ensuring that all sites
have an active QI programme.
Youths and Adolescents

The data suggests that there is need for more focus on this population. Eighty-seven
percent (87%) of the adolescent population were diagnosed HIV positive, all are linked
to care (100%); 48% are retained in care on ARV, and 34% are virally suppressed. There
are pending initiatives such as guidelines for adolescent support groups and adolescent
specific assessment tools which are expected to improve the overall treatment, care and
support offered to this population.
The Late Adolescent Cascade shows that 37% are linked to care; 16% are retained in care,
14% are retained in care on ARV, and only 4% are virally suppressed, indicating that there
is need for more focus on this population. A lot of the patients transition from paediatric
care to adult treatment sites during this age range. The transitional period can be difficult
and if not carefully monitored the patients can be negatively affected. This population is
also likely to benefit from the guidelines for adolescent support groups and adolescent
specific assessment tools.
Fig. 12 Adolescent (Ages 10-14) Treatment Cascade for 2017
The Cascade for youths, ages 20-24, shows that 32% are linked to care, 18% are retained
in care, 15% are retained in care on ARV, and only 6% are virally suppressed. Overall, the
cascades highlight the need for more work to be done with the key population groups
and the different age groups. The virally suppressed percentage is low in all the cascades.
This could indicate that while persons are being tested and linked to care, there continues
to be adherence issues.
Fig. 13 Adolescent (Ages 15-19) Treatment Cascade for 2017
Fig. 14 Youth (Ages 20-24) Treatment Cascade for 2017
The treatment cascades for some of the key populations are presented in the remainder
of this section. Lack of disclosure of KP status in treatment settings is a major influence on
the cascades of FSWs and MSM.
Female Sex Workers

There have been great successes with the female sex worker community. The infection
rates among sex workers have shown reductions, falling from a high of 12% in 1990 to 9%
in 2004, and from 4.1% in 2011/2012 to 2% in 2017. The diagnosis of this key population
is still a challenge. There is less success with linkage to care, adhering to medication and
achieving viral suppression. The FSW cascade reflects that only 17% of FSWs are virally
suppressed. In an attempt to address the gaps in the cascade, a study was conducted to:
identify the gaps/challenges in HIV positive FSWs accessing treatment, care and support;
determine the factors influencing the adherence to medication and viral suppression
among FSWs and identify measures which can be implemented to address the challenges
highlighted by the study. Based on the study, the factors hindering adherence include
the mobility of FSWs, treatment illiteracy, non-disclosure and stigma and discrimination
among other factors. After the dissemination of the findings of the research, each region
designed plans to address the gaps and improve the number of virally suppressed FSWs.
Fig. 15 National Female Sex Workers Treatment Cascade 2017
Men who have Sex with Men

The MSM and the FSW cascade have a common thread with linkage to care, the FSWs
with more success that MSM. MSM are doing better in terms of viral suppression. The
workshops and sensitizations sessions being conducted with the MSM community may
have contributed to the 40% viral suppression.
Fig. 16 National Men who have sex with men (MSM) Treatment Cascade 2017
HIV TESTING
Testing data received from 8 of 14 private laboratories across the island are shown in
Table 3. For 2017, these laboratories report having conducted 39,190 HIV tests with 184
(0.5%) being positive. This is a decline over the number of tests conducted in 2016, 47,330
with a yield of 0.8% (368), as reported by private laboratories.
Table 3 HIV Testing in the Jamaican Private Laboratories, January to December 2017
TOTAL HIV TESTS HIV POSITIVE TEST

MONTH % POSITIVE
DONE RESULTS
January 3,526 16 0.5
February 3,692 12 0.3
March 1,183 3 0.3
April 86 1 1.2
May 184 2 1.1
June 4,203 17 0.4
July 5,916 28 0.5
August 4,347 25 0.6
September 5,194 29 0.7
October 3,535 18 0.5
November 3,447 16 0.5
December 3,877 17 0.4
Total 39,190 180 0.5
Eight (8) of 14 labs reported throughout 2017, however of these only 5 submitted more
than 50% of the expected monthly reports. For the months of March and April only 2
laboratories reported and only 3 for the month of May.
In 2017, at least 136,454 HIV tests were conducted in the public sector across all regions
(Table 4). This reflects a slight increase of 168 in the number of conducted tests reported
when compared to 2016. Some challenges experienced in 2017 contributed to decreased
numbers of testing and testing results received in the months of September and October.
These include absent data due to reports not being received for some key parishes and
a shortage of HIV Determine Test Kits in September 2017 due to shipment delays arising
from adverse weather events in the region. The number of positive tests in 2017 resulted
in a yield of 1.9%, which was a slight decrease compared to 2.0% in 2016.
Table 4 HIV Testing in the Jamaican Private Laboratories, January to December 2017
TOTAL HIV TESTS HIV POSITIVE TEST

MONTH % POSITIVE
DONE RESULTS
January 12,298 276 2.2
February 13,029 231 1.8
March 11,319 190 1.7
April 12,217 293 2.4
May 11,297 259 2.3
June 13,280 201 1.5
July 13,538 300 2.2
August 11,475 209 1.8
September 6,229* 240 3.9
October 6,612** 79 1.2
November 13,826 202 1.5
December 11,334 180 1.6
Total 136,454 2,660 1.9
* No HIV regional/ parish lab report received from St. Catherine for this month
** No HIV parish lab report received from St. Catherine, Kingston and St. Andrew
Provider Initiated Testing and Counselling

The RHAs continued to build the capacity of health care workers in public health facilities
and CSOs to conduct PITC. Persons trained in 2016 conducted training sessions throughout
2017 for new staff within their respective regions.
Improvements were seen in PITC for two RHAs for 2017. Each region developed an
action plan to improve testing rates; among the activities that they have embarked upon
is re-sensitization of critical members to the importance and process of early diagnosis.
Additionally, PITC graphs were distributed across sites to allow for the tracking of testing
figures on a weekly basis. This gave each site the opportunity to track their performance
and discuss ways for improvement. Scientific approaches learnt through the Quality
Improvement (QI) Collaborative can also be used to measure the impact of interventions.
Fig. 17 PITC Uptake in Jamaican Hospitals January to December 2017
In 2017, there was an average PITC uptake of 28.7% in SERHA and 25.3% in NERHA.
Compared to 2016, this represents a marginal increase of 0.7% and 0.3%, respectively.
SRHA’s uptake was 29.5%, a decline of 3.5% compared to the previous year. WRHA also
showed a decline of 2.4%. The environmental issues persist at Cornwall Regional Hospital
(CRH) and may be contributory factors to the decrease in PITC figures reported for this
region.
Treatment with ARVs

The ‘Test and Start’ initiative was rolled out in January 2017. A constant supply of ARVs
is essential to support this initiative. The challenges experienced with ARV stock levels
in 2016 demanded changes in the forecasting and planning mechanisms to prevent
national stock outs of ARVs. Through the assistance of USAID, training was carried out with
members of the TCS and SI Unit on the Quantimed and Pipeline software. This software
assists with the forecasting of ARV needs and allows planned ordering of ARVs based on
data inputted relating to the number of patients on the various treatment regimens, usage
pattern and expected attrition, movement between treatment lines and number of new
cases detected.
An ARV tracking tool was developed by the TCS Unit which records quantities of ARVs
and test kits in stock at the National Health Fund warehouse. This tool details the average
monthly usage of the ARVs, expected deliveries of ARVs, expiry dates, expected duration
of ARVs in stock and the expected duration of ARVs with upcoming deliveries. This tool
has allowed the easy visualization and early identification of ARV levels allowing timely
ordering and delivery lead times. Increased collaboration with the NHF warehouse team
has also been initiated. This involves quarterly meetings with NHF warehouse staff, sharing
of monthly inventory, receival and dispatch reports, and biannual auditing of stock levels
of pharmaceuticals and non-pharmaceuticals.
Two ARV orders were procured through the Global Fund pooled procurement mechanism
(WAMBO) process in 2017. Delays in receiving some of these shipments resulted in a
stock out of ARVs at some treatment sites. Recirculation of ARVs between ARV dispensing
pharmacies minimized the interruption of patient treatment and prevented patients from
being switched to alternate regimens.
Pharmacy reports were not received from all ARV dispensing pharmacies throughout the
period. Notably, the National Health Fund assumed the management of all government
pharmacies in 2017. This change will lead to a standardized management structure, which
is expected to result in improved compliance with reporting schedules.
A quality assurance plan is being prepared with the assistance of the USAID. This plan
will aid in ensuring the quality of ARV drugs obtained through the WAMBO process. It is
expected that the completed plan will be implemented in 2018.
Laboratory Monitoring Tests

The number of PCR tests conducted in 2017 decreased compared to the previous year with
a notable decrease in the rejected samples. CD4 testing also decreased with a decrease
in the number of rejected samples. The number of viral load tests conducted increased
during the year. This was expected with the initiation of ‘Test and Start’ in January 2017.
Table 5 Monitoring Tests for 2015-2017
PCR CD4 VIRAL LOAD
YEAR 2015 2016 2017 2015 2016 2017 2015 2016 2017
Received 978 1,124 982 14,627 14,227 10,295 15,097 17,743 19,232
Processed 912 1,070 953 14,053 13,749 9,956 14,775 17,331 18,917
Positive 11 15 12
Rejected 66 56 29 574 478 339 322 412 315
Rejection 6.7 4.9 2.0 3.9 3.4 3.2 2.1 2.3 1.6
Rate %
Early Diagnosis of HIV Exposed Infants - DNA PCR Testing

DNA PCR testing is used as a means of early detection for HIV in perinatally exposed
infants. The testing algorithm dictates that HIV exposed infants are given a PCR test at 6
weeks and then 3 months. Additionally, at 18 months, an ELISA test (HIV antibody test)
should be done to complete the algorithm. In 2017, 982 DNA PCR tests were conducted
with 12 positive results. Of those tested positive, 6 represented first PCR tests for babies
born in 2017, 2 represented second PCR tests for babies born in 2017 and the remaining
4 were second and third PCR tests for babies born in 2016.
There was a decrease in the number of rejected DNA PCR samples in 2017 compared
to previous years. This may be attributed to the interventions by the Immunology and
Quality Assurance Units of the National Public Health Lab in re-sensitizing officers to use
the correct technique for sample collection and packaging. There was no stock out of
reagents in 2017.
CD4 Testing
The CD4 test acts to monitor the HIV disease stage of PLHIV as it indicates the level of
immune system impairment. As per national guidelines, all diagnosed persons should
receive an initial test to determine their CD4 count upon linkage to the care team and
twice annually until stable, then discontinue. However, treatment should start regardless
of one’s CD4 count based on the WHO 2015 “Treat All” guidelines that were implemented
in January 2017.
In 2017, 10,295 CD4 tests were received. This was a 27% reduction in the number of
requests received in 2017 compared to the previous year, which was anticipated based
on the shift in the guideline. There was also a reduction in the number of rejected samples
in 2017 compared to previous years. The issuing of job aides and re-sensitization sessions
on sample collection and storage, conducted by the NPHL and the HSTU, contributed to
this reduction.
The FACS Calibur machine at Cornwall Regional Hospital was in a state of disrepair for
most of 2017 but the FACS Count from SRHA was utilized in the interim. A FACS Presto
machine was assigned to WRHA.
Approximately 30% of CD4 testing was done on point of care machines, with a rejection
rate of less than 1%. In 2017, all PIMA machines were serviced by the manufacturer and a
retraining session was conducted. All sites have subsequently been certified except Black
River which is currently undergoing certification. With regards the FACS Presto platform,
only one site remains to be certified; certification is currently underway. There were no
stock out of FACS Presto and PIMA reagents in 2017.
Viral Load Testing

Viral load testing is used as an indicator to see how well the immune system is fighting
the HIV virus. National guidelines dictate that viral load assessment should be done six
months after starting ART and then twice annually until the patient is virally suppressed.
Thereafter the test should be conducted annually.
In 2017, viral load testing increased by 11% compared to the previous year. Improvements
were also seen in the number of rejected samples for 2017 when compared to both 2016
and 2015. Notably, 282 requests for viral load tests were submitted to the Immunology
Unit of the NPHL in 2017 without accompanying samples. This issue is currently being
addressed by the NPHL.
There was an increase in the turnaround time for viral load results, which was brought
to the attention of the NPHL. NPHL subsequently implemented the following guidelines,
which resulted in a reduction in delays towards the latter part of 2017:
1. A direct telephone line was established at Sample Reception so that sites are able to
call directly to check on the status of their results.
2. A line listing template was developed so that the sites can document pertinent
information about the samples that are being sent as well as use the tool to follow up
on the results.
The NPHL has tested these two interventions using Plan Do Study Act (PDSA) cycles and
have found them to yield some level of success in improving efficiency.
At the national level, the HSTU, in collaboration with University of California, San Francisco,
is in the process of merging the Treatment Site Information System and DISA Lab. Sites
that have completed the merger are able to access viral load results in real time, provided
that the information in TSIS is identical to the information in DISA Lab. It is anticipated that
the merger will be completed for all sites in 2018.
Site Mentoring Team

During 2017, the Site Mentoring team was conceptualized as a new initiative to focus on
the steps needed to achieve the UNAIDS 90-90-90 target. It is comprised of a Clinical
Mentor (Team Lead), Pharmacist, Strategic Information officers and Treatment & Liaison
Officers from the NFPB. As a first step, the team performs audits on the HIV treatment sites
by assessing:
1. Clinical, laboratory and pharmaceutical services
2. PITC and PMTCT programmes
3. Linkage to care, adherence and missed appointment process
4. The presence of the QI initiative
In an attempt to improve the retention in care, there is also an assessment of: patient’s
aspects of privacy and confidentiality; whether the site is KP friendly or not and how sexual
and reproductive health has been incorporated into HIV care. The first region assessed
was SRHA. The audit findings were analyzed and site-specific plans were formulated to
address the gaps identified. The recommendations from the preliminary analysis of the
audit are outlined below:
1. Documentation of clinical notes needs to be improved.
2. More detailed notes should be prepared by the Psychosocial team and included in
the docket.
3. Completed Treatment Readiness Assessment and Social Intake Assessment Tools

should be included in the docket.
4. Social Work Sessional Forms should be used to document visits with the Social Worker
and included in the docket.
5. Evidence of objective adherence assessments e.g. pill counts should be performed

and documented in the docket.
6. Input from the nutritional service needs to be more regularized and improved.
7. Regular review of dockets of PLHIVs on ART, who have elevated viral loads, need to be
done so that cases of poor adherence and viral resistance can be identified.
8. The name and position of team members should be clearly written on notes that are
placed in the docket.
SUPPORT
Psychosocial Support
The TCS Component of the HSTU provides support for PLHIVs through the Psychosocial
Support team which includes Adherence Counsellors (ACs), Social Workers (SWs),
Psychologists and Case Managers (CMs). This cadre of staff assists PLHIVs through
counselling, psychosocial support and mental health assessments. The team also assists
with addressing social and emotional barriers in accessing HIV treatment, care and support
services.
In 2017, a lot of emphasis was placed on building the capacity of team members and
standardizing practice and documentation systems across the four RHAs. With the
assistance of the International Training and Education Center for Health, Washington,
Seattle, the Unit completed the development of the CMs’ curriculum and successfully
implemented a training of trainers (TOT) activity. The Unit now has access to 23 trained
CM Trainers, drawn from several departments in the MOH, who will be implementing
the CM curriculum early in 2018. Also completed was the ACs’ protocol, which will guide
the standardization of adherence counselling practice across RHAs. The ACs’ curriculum
was also initiated, and Psychologists were given access to PsycArticles on the American
Psychological Association online platform.
In 2016 the Unit established itself as the initiator and driver of the treatment readiness
campaign, in preparation for the January 2017 adoption of the WHO guidelines for
the management of HIV, “Treat All”. This necessitated ongoing capacity building of all
levels of staff in 2017; priority was given to staff that were not exposed in the 2016 round
of training. These included Community Health Aides, Community Facilitators and the
Prevention team. The year also saw the full implementation of the treatment readiness
assessment tool (TRAT), which is now the standard means of determining the readiness
of PLHIV for ART. The Home Visit Form was also introduced, and along with the TRAT, is
steadily gaining in popularity.
In 2017, the Unit took several tangible steps geared at improving retention in care and on
ARVs, as well as viral suppression. Among them was the introduction of food vouchers
for PLHIVs in collaboration with AIDS Healthcare Foundation (AHF). Although the national
spread of this facility was and still is, somewhat limited, the initial reviews are promising;
PLHIVs are expressing more interest in attending clinic.
Another major intervention during the year was the emphasis placed on developing and
operating real support groups. After discovering that several different types of groups
were being mislabelled “support groups”, the Unit set out to correct the error and build
capacity of staff around support groups. Genuine support groups are now established
across all the RHAs; only a few treatment sites do not have at least one active group.
Among the greatest challenges for the team is the chronic absence of adequate spaces
for members of the Psychosocial Support team to meet and work with clients. It is not
unusual to see three officers, each having a client, sharing a small meeting room.
Quality Improvement Programme

Supported by the International Training and Education Center for Health (I-TECH), a center
in the University of Washington’s Department of Global Health, TCS Unit continued to
work on Quality Improvement at the HIV Treatment sites. As per the PEPFAR/HIV Testing
Services Jamaica work plan, ITECH worked with 12 of the 21 previous participating sites
that are considered as high priority sites. Quality Improvement activities at the non-PEPFAR
sites resumed in April 2017 after a brief halt, with monitoring by the TCS Officers at the
regional and national levels.
The sites focused on adherence and retention to care to increase viral suppression at the
treatment sites. The treatment site teams tested different PDSA cycles throughout the year.
With the increased emphasis on differentiated care, sites were encouraged to test change
concepts on stable versus unstable patients. Mandeville Health Centre tested whether
stable patients will pick up medication and complete laboratory work on time, when given
a six months appointment. Some sites also focused on improving the documentation of
adherence through the administration of Self reporting questionnaires (SRQ). Other sites
tested if telephone calls would result in patients keeping their appointment.
All the QI teams at treatment sites included a community representative (patient). This
patient would attend and actively participate in QI team meetings and bring fresh
perspective and insights from the patients’ point of view. Sites were encouraged to focus
on incorporating and replicating those PDSAs that yielded positive test results.
Towards the latter part of 2017, there was a shift in focus to the sustainability of the QI
initiative. In order to strengthen this new thrust, a sustainability committee was established
with all the key stakeholders. Meetings were held, and will continue, with the regional
authorities, Medical Officers of Health and MOH representatives to create awareness and
garner support at the leadership level.
The final learning session for the year was held in December. It focused on more aggressive
management of the unsuppressed ART patient in order to improve the viral suppression
rate of the treatment sites; a viral load algorithm was presented and reviewed as a first
step. The early detection of viral resistance will continue to be an important focus of the
QI initiative in 2018.
ELIMINATION OF MOTHER-TO-CHILD TRANSMISSION OF

HIV & SYPHILIS
The Elimination of Mother-To-Child Transmission of HIV & Syphilis by 2015 in the Americas
continues to be the aim of the Prevention of Mother-To-Child Transmission of HIV & Syphilis
Programme in Jamaica. This WHO target has been subsumed into Jamaica’s National
Integrated Strategic Plan (NISP) for Sexual and Reproductive Health, ensuring the efforts
of the HSTU are in tandem with those of the Family Health Unit (FHU) and the NFBP, the
two main providers of SRH care in the island.
At the National level, capacity building within the programme improved in 2017 with the
assignment of a Programme Development Officer from within the HSTU to PMTCT. The
Development Officer works in collaboration with focal points within the SI Unit. Confirmation
of positive cases of HIV & Syphilis infants continued through a robust notification process
at the National Surveillance Unit (NSU). The NSU serves a dual purpose as it also enables
the validation of field reports received directly by the HSTU. The EMTCT Oversight
Committee inclusive of paediatricians, gynaecologists, past Jamaica Paediatric, Perinatal
and Adolescent HIV/AIDS Programme (JaPPAIDS) committee members, donors and NGO
representatives continued to give technical expertise and guidance to this aspect of the
nation’s response to the epidemic.
At the sub-national level, the PMTCT programme begins with PITC testing during the
antenatal period at both public and private health care facilities. Documentation of
positivity rates in both HIV and Syphilis, appropriate treatment inclusive of drugs and
dosing, outcome and final status of delivered infants were recorded in the monthly PMTCT
reports submitted to the HSTU via an electronic reporting account, which was introduced
in 2017. Challenges specific to Syphilis, such as comparatively lower testing rates than
HIV and poor documentation of the clinical follow-up and treatment of the mother/infant
pair, were countered with the introduction of Maternal Syphilis and Syphilis Exposed
Infant Registers in the latter quarter of 2017. PMTCT Coordinators, Nurses, Clinicians
and relevant support staff such as Regional Coordinators, Contact Investigators (CIs),
Social Workers and Adherence Counsellors have been trained in the use of these new
and updated quality data collection tools. The relevant private sector health care workers
(HCWs) were also included to enable an all-encompassing national response. In keeping
with the latest WHO standards, the PMTCT program has set out to achieve:
QQ 2% or less rate of MTCT for HIV
QQ 0.3 per 1000 live births annual rate of new infections of HIV and
QQ 0.5 per 1000 live births annual rate of Congenital Syphilis
Table 6 EMTCT validation indicators for Jamaica 2015 – 2017
Impact
indicators Target 2015 2016 2017
Result Num Den Result Num Den Result Num Den
HIV MTCT rate <2% 1% 5 345 1% 5 429 6% 16 270
Annual rate of <0.3 0.13 5 37,556 0.139 5 35,959 0.47 10 33,979
new inf. Per
1000 infections
Annual rate of <0.5 0.08 3 37,556 0.22 8 35,959 0.24 8 33,979
CS per 1000 live
births
Number of confirmed cases of Congenital Syphilis by case surveillance definition obtained from the HSTU/NSU
The target for HIV MTCT rate was not met for the year (Table 6). Discussions are ongoing
within the HSTU on the best approach to managing this emergent issue. A detailed case-
based investigation is in progress.
The Way Forward
In 2018, all efforts will be geared to Jamaica’s achievement of Elimination Status.
Maintenance of this status involves the following:
1. Proper PITC testing at all labour ward and delivery suites in the 3rd trimester and for
un-booked mothers. This gap was made evident by the 2017 PMTCT programme
analysis and the results of an ongoing Site Mentoring Team evaluation.
2. Improved user-friendly data collection mechanisms with a by-product of enhanced

monitoring and evaluation of the programme through:
a. A web-based PMTCT monthly reporting form capable of producing comprehensive

annual reports that may be site specific, region specific or give the national
picture, inclusive of specific EMTCT indicator filtering that aids in donor reporting
mechanisms.
b. Offered consultancies with organizations such as the University of California

San Francisco (UCSF) on improved data visualization to improve delays in
implementing corrective measures for each site and motivating sub-national staff
in the achievement and maintenance of elimination targets.
3. Capacity Building through: the employment of an EMTCT National Validation Field

Coordinator to monitor and bridge programme gaps between the national and
sub-national level; printing of the updated PMTCT Manual and Easy Reference
Guides and continued training of staff, at both national and sub-national levels of
programme management, on updated PMTCT protocols and guidelines. These
will be made possible with funding assistance from UNAIDS United Budget, Results
and Accountability Framework (UBRAF), UNICEF and the Pan American Health
Organization (PAHO), respectively.
4. Sustainability of the programme with the absorption of the cadre of PMTCT Nurses
by the regions and the GOJ budget providing programme specific funding for
2018/2019.
5. Adaptation of EMTCT plus, to include the MTCT of Hepatitis B, as prioritized by the

WHO. This will warrant close collaboration with the FHU.
SEXUALLY TRANSMITTED INFECTIONS

Jamaica’s response to sexually transmitted infections has been overshadowed by the
ongoing response to HIV. Nevertheless, all other STIs such as Syphilis, Gonorrhea,
Chlamydia and Trichomonas remain a global and national issue. The risky behaviour
profile and demographic and cultural factors that predispose persons to contracting STIs
remain rampant in our population. These were reported in the 2012 KABP survey and
included: early initiation of sexual activity, at an average of 15 years; a culture of multiple
sex partners; gender inequality and gender roles; homophobia; stigma and discrimination
and economic hardships. Knowledge of STIs is declining in both sexes, which is reflected
in the worsening trend of risky behaviour choices.
Antimicrobial resistance of several pathogens responsible for STIs was seen globally in
2017, especially for gonorrhoea, threatening the effectiveness of current curative regimes.
A sentinel survey is underway. Samples are being tested in Sweden for the possibility of
drug resistance in the treatment of Gonorrhoea, Syphilis, Trichomoniasis and Mycoplasma.
Data for some major STIs, obtained from the NSU, are shown in Table 7 and indicates a
downward trend for most despite the Jamaican cultural and socio-economic context.
Table 7 STIs Reported, 2016 – 2017
Sexually Transmitted
Infections Male Female
2016 2017 2016 2017
Syphilis 482 471 590 566
Chlamydia 567 425 694 575
Genital Discharge Syndrome 7,532 7,581 29,995 28,384
Genital Ulcer Disease 15 0 23 4
Trichomoniasis 15 0 409 544
Genital Warts 440 387 487 463
The NISP for 2014-2019 ensures that the MOH’s mandate for the integration of SRH
and HIV/STI services into Jamaica’s priority health targets are met. Whilst efforts geared
towards the comprehensive management of SRH involves prevention and contraception
mechanisms such as condom use and dual family planning methods from the NFBP and
the FHU respectively, the HSTU is tasked with program management of treatment, care
and support for STIs.
Syndromic management of STIs continued to be the cornerstone of the strategy to

decrease its spread and the associated adverse effects in Jamaica. STI treatment is
accessible, affordable and appropriate on the first encounter with a physician in the public
health system at a primary health care facility. At this point, identifying and treating a
common set of signs and symptoms (syndromes) is the most feasible option for Jamaica.
Whilst capacity building of clinicians for curative services and CIs for partner notification
and testing continues to be adequate, surveillance of STIs as Class 3 Notifiable Diseases
and laboratory identification of pathogens is less than ideal. Despite the decreasing
trends noted prior, more steps are necessary in strengthening of the national and sub-
national STI programme. A recently conducted SITAN made possible through funding
from PAHO gave several recommendations and reiterated the importance of those given
in the Pan Caribbean Partnership against HIV/AIDS STI Surveillance Report (2012). One of
the recommendations was the establishment of an STI Technical Working Group (TWG),
which will be formed in the first quarter of 2018, with key stakeholders from the NPHL,
ITECH, medical stalwarts in the field of STIs and representatives from PAHO and UCSF.
The Way Forward

Over the next year, and beyond, the TCS Unit is aiming to:
1. Formulate an overarching roadmap for STIs in Jamaica, that considers the current
state of affairs, implements recommendations from the 2017 SITAN and determines
the most feasible approach for the continued holistic management of STIs. This is
especially needed in the context of syndromic versus case based management. The
HSTU will be looking to determine what patterns, from the State of California, which
transitioned from syndromic to case-based management of STIs, can be applied in the
Jamaican context.
2. Capacity building through the retraining of clinicians, FNPs, curative nurses and
current CIs in STI management. The continuation of CI training will be made possible
by USAID and aims to increase the manpower needed for proper partner notification
and testing for HIV and other STIs.
3. Improved visibility of the national STI response via:
a. Updating of the MOH’s website with available STI information such as the 2017
SITAN.
b. Linking the NSU database, which is used to report aggregate STI data, to a main
server within the HSTU for associated dashboards at a sub-national level.
4. Improved quality data collection of STIs by:
a. Revamping the use of the STI Clinical Summary Sheet for all patients being treated
for a STI at all primary health care facilities.
b. Engaging the Health Records department to obtain STI data from the MCSR so
that it may be triangulated with data received by the NSU from CIs in the field.
c. Conducting a STI prevalence study at the main STI clinics initially to get a true
representation of the burden of STIs in our population. This will be sustained by
a possible pairing of the annual STI prevalence survey with the annual HIV sero-
prevalence survey.
d. Determining the response of the private sector in the management of STIs through
both private physicians and private laboratories.
5. Improve surveillance of STIs by establishing sentinel site surveillance of the most

prevalent STIs at one main referral STI clinic in each region. This will enable the
Comprehensive Health Center to become the main and final referral point for STIs in
Jamaica.
6. Establish Jamaica as a WHO STI sentinel site in Latin America so that STI prevalence
data for the region may be obtained.
TUBERCULOSIS
Tuberculosis is the leading cause of death worldwide from a single infectious agent and is
also the leading cause of death in persons affected with HIV. Accordingly, it has received
an intensified global response and action including the World Health Organization’s
END Tb strategy. This END Tb strategy provides a unified response to ending Tb deaths,
disease and suffering, and builds on three pillars:
1. Integrated patient-centered Tb care and prevention
2. Bold policies and supportive systems.
3. Intensified research and innovation.
In Jamaica, the Tuberculosis prevention and control programme was integrated with the
National HIV/STI Programme in 2016 to form the HIV/STI/Tb Unit. This integration was
an effort to improve the efficiency and effectiveness of the Tb programme. Despite this
integration, challenges persisted due to a lack of adequate staff both in the HSTU and the
NSU, which delayed activities associated with the Tb arm of the Programme. To alleviate
this the HSTU employed additional staff in 2017, including a Programme Development
Officer whose tasks include management of the Tuberculosis component.
Table 8 Tuberculosis cases in Jamaica 2012-2017
CASES 2012 2013 2014 2015 2016 2017

Number of Tb 94 96 86 103 103 124
cases detected
Number screened 65 95 79 66 56 99
for HIV
% of Tb cases 69.1 98.9 91.9 64.1 54.4 79.8
screened for HIV
Of cases 15 16 19 15 28 20
screened, # co-
infected
% of cases co- 23 16.8 24.1 22.7 50 16.12
infected
Data Source: WHO Global Tb Report Jamaica
Several major programme challenges were identified in 2017, including some in the areas
of case detection and laboratory testing. Initiatives to address these include:
1. Revision of the National Tuberculosis Treatment Manual. This will consist of a series
of technical working group meetings involving members with expertise in laboratory
and clinical management of Tuberculosis as well as epidemiological and surveillance
expertise. These meetings are scheduled to begin in January 2018.
2. Development of the National Strategic Plan for Tuberculosis 2019-2023. A Consultant

was recruited, with the assistance of PAHO, and the draft strategic plan was completed
in December 2017. The Tb TWG will be tasked with reviewing and finalizing this
document.
3. Strengthening the National Public Health Laboratory’s capacity in Tuberculosis testing.

Smear microscopy was restarted in December 2016. The HSTU with the assistance of
the Health Promotion and Prevention Unit, will be procuring GeneXpert cartridges,
which are expected to arrive in January 2018.
4. Development of National treatment and laboratory algorithms. This is in keeping

with global standards for Tb diagnosis and treatment, which will build the capacity of
HCWs.
5. Improvements in reporting mechanisms and monitoring and evaluation. This will

strengthen surveillance and improve the quality of Tb data collected.
These initiatives coupled with increased collaboration between the HSTU and NSU are
expected to enable a decrease in the incidence of Tb in Jamaica and improve the delivery
of service to affected persons and their families.
CHAPTER 4: ADOLESCENT HEALTH
OVERVIEW
The Adolescent Health component of the National HIV/STI Programme is a relatively new
addition to the HIV response. The specific focus on adolescents re-emerged in 2015 with
the introduction of the ALL In initiative and the continued partnership between the Ministry
of Health and UNICEF. The primary goal of All In is to reduce AIDS related deaths and new
HIV infections among adolescents.
The mandate of the Adolescent Health component is guided by the All In Youth and
Adolescent Technical Working Group (YATWG) and the Adolescent Policy Working Group
(APWG). Below are highlights of some of the major activities carried out in 2017.
TEEN HUB- HALF WAY TREE TRANSPORT CENTRE

The Teen Hub located at the Half Way Tree Transport Centre opened its doors to
adolescents and youths in May 2017. Interventions at the Teen Hub are implemented
through the collaborative efforts of the HIV/STI/Tb Unit and the Family Health Unit. The
services offered are HIV and Syphilis testing, mental health screening, career guidance
and wrap sessions. During the year, a total of 2,665 young people visited the Hub and
657 HIV tests were conducted by the National Family Planning Board and Civil Society
Partners.
The Teen Hub was introduced as a response to reports of negative behaviours such as
violence, truancy and risky sexual behaviours of adolescents at the Half Way Tree Transport
Centre. Importantly, the Teen Hub provides a safe space for young people to access
services such as HIV and Syphilis testing and prevention-risk reduction interventions.
Hon. Minister of Health Dr. Christopher Tufton (centre) and State Minister in the Ministry of Education, Youth and Information,
Floyd Green (right), cut the ribbon to open the ‘Teen Hub’ in the Half Way Tree Transport Centre, St. Andrew
A baseline survey was conducted among teens 16-24 years before the Hub commenced
operations. The mean age of participants was 17 years. They were asked a wide range
of questions regarding their physical, mental and emotional health. The survey results
showed an urgent need for intervention, as seen below:
QQ 73% of participants reported being in a relationship
QQ 58% reported being sexually active
QQ 35% reported not using a condom the last time they had sex
QQ 76% said they had never done an HIV test
These behaviours increase the risk of HIV infection and other STIs. Going forward,
programme implementation will involve ongoing evaluation of the strategies designed to
mitigate against these risks.
YOUTH AND ADOLESCENT TECHNICAL WORKING
GROUP
The Youth and Adolescent Technical Working Group met quarterly throughout 2017 to
discuss “hot button” issues and to plan advocacy strategies for getting their voices heard
in order to make a difference. The main topics that young people wanted to address were
the revision of the sexual offences act and comprehensive sexuality education in schools.
YATWG members also benefitted from training in sexual and reproductive health rights,
human rights, understanding social and legal barriers and advocacy.
Members of the Youth and Adolescent Technical Working Group
ADOLESCENT STANDARDS AND CRITERIA

Ten (10) quality standards and related criteria were approved by the Ministry of Health
and a process to pilot test them was implemented in June 2015. Following the pilot test in
seven sites, the MOH introduced a limited rollout of the standards (Cycle 1) in two health
centres and will implement a full rollout in each health region (Cycle 2) in 2018. The table
below provides information on each of the facilities selected to participate in the Cycle 2
rollout in the four health regions. At the end of this rollout cycle, a total of 18 health facilities
would have been introduced to the quality standards for adolescent health, bringing the
total number of adolescent friendly health facilities to 18.
Table 9 Health Facilities Selected in Cycle 2 of the Rollout of Adolescent
Health Standards
HEALTH FACILITIES
HEALTH REGION Number Name Type
Selected
North East (NERHA) 2 Annotto Bay HC III
Port Antonio HC IV
South East (SERHA) 3 Comprehensive HC V

Edna Manley HC III
Morant Bay HC IV
Southern (SRHA) 2 Christiana HC III

May Pen HC III
Western (WRHA) 2 Albert Town HC III

Darliston HC III
During the year, the fifth round of training linked to implementation of the adolescent
health standards was hosted for the 9 new rollout sites (Cycle 2) that serve adolescent
clients. The training, which was completed between March 27 and May 5, 2017, was a
collaboration between the Adolescent Health Unit and the HIV (All-In) Programme of the
Ministry of Health. Financial support for the series of workshops was provided by PEPFAR/
USAID, PAHO through its Jamaica Office and the United Nations Children’s Fund (UNICEF)
Kingston Office.
CHAPTER 5: ENABLING
ENVIRONMENT & HUMAN RIGHTS
OVERVIEW
The work of the National Family Planning Board’s Enabling Environment and Human Rights
Unit is a critical component of Jamaica’s programming for HIV/AIDS, STIs and sexual and
reproductive health. The promotion and protection of human rights inclusive of sexual
and reproductive health rights are integral to the creation of a supportive, discrimination
free environment for all Jamaicans to access SRH information, goods and services.
During 2017, the Unit engaged service level staff, programme implementers and
policymakers to ensure that all Jamaicans have equitable access to HIV and sexual and
reproductive health treatment, care, prevention services and support. This was done
through advocacy and the promotion of multi-sectoral policies and programmes. The
Unit made notable achievements during the year:
• Facilitated collaboration and partnerships among internal and external stakeholders

to revise the National HIV Policy.
• Successfully advocated for stronger accountability mechanisms to support complaints

of HIV-related discrimination in employment settings at the Ministry of Labour and
Social Security (MLSS).
QQ Developed a protocol and directory of service providers for inclusion in a national
referral mechanism that links social protection agencies and civil society with national
health systems in order to mitigate social and economic risks for key and vulnerable
persons in the national response for HIV and SRH.
QQ Strengthened community systems to promote greater involvement of communities

in the promotion and protection of human rights through policy monitoring and
accountability tools and mechanisms.
QQ Promoted training strategies and interventions that reduce stigma and discrimination
(S&D) associated with SRH issues, including family planning, HIV and other STIs for key
and vulnerable populations.
QQ Established a multidisciplinary legal and policy review committee to coordinate

the development of policy positions, use of findings from previous legal reviews,
compilation of best practices and production of other communications to inform and
guide SRH Advocacy Strategy.
Devon Gabourel, Director of the Enabling Environment and Human Rights Unit, speaking at a Safer Sex Week event
ADDRESSING GAPS IN POLICY AND LEGISLATIVE
FRAMEWORK
During 2017, the EEHR Unit pursued actions to strengthen policy and legal framework for
SRH and HIV prevention, treatment and care services. These initiatives were to address
policy and legislative barriers to SRH information, goods and services.
A legal and policy review committee was established to coordinate the development
of policy positions, use of findings from previous legal reviews, compilation of best
practices and production of other communications to inform and guide SRH Advocacy
Strategy. The Unit convened six (6) legal and policy review committee meetings and two
(2) dissemination meetings to coordinate the development, printing and dissemination
of policy positions and legal briefs. The Committee was established in March 2017 and
comprised representatives from key Government Ministries, Departments and Agencies,
civil society organisations, and international development partners. Two policy briefs were
drafted and endorsed by the Committee on the topics of HIV Sensitive Social Protection
and Recommendations to address discrimination based on health status with particular
focus on HIV and SRH needs.
The Legal and Policy Review Committee in session
During the year, the Unit pursued actions to update and finalise the National HIV/AIDS
Policy to reflect the outcomes of public consultations held in 2016 as well as policy
developments in the sexual and reproductive health response. An updated version of the
Policy, along with the requisite validation tools, was produced and agreement secured
with the Social Development Commission (SDC) to coordinate five (5) regional public
meetings during the third quarter of 2018 to validate the finalised policy document. The
National Family Planning Board will present the validated document and the respective
submissions to Cabinet for approval in 2018.
The EEHR Unit continued to manage and support Technical Working Groups as a forum
for partnerships and networks among and between organizations to share lessons learnt
and best practices, strengthen coordination to reduce duplication and maximize impact
and facilitate dialogue between duty bearers and rights holders.
Enabling Environment and Human Rights Technical Working Group

(EEHRTWG)
Three (3) EEHRTWG meetings were held in 2017 with multi-sector stakeholders to:
1. Develop a stakeholder S&D Collaboration Map indicating the S&D activities being
implemented across the national SRH response and identifying opportunities for
collaboration.
2. Present the preliminary recommendations and findings of a review of HIV related S&D
training processes to enhance the capacity development of health care workers in
Jamaica.
3. Disseminate and explore programme implications from the preliminary S&D Baseline
Assessment results emanating from a study conducted by Health Policy Plus, MOH
and NFPB. The study was titled “Supporting the HIV response in Jamaica through
understanding and responding to stigma and discrimination in selected health
facilities”.
The EEHR TWG in session
Youth and Adolescent Technical Working Group (YATWG)
In 2017, the strategic focus of the Youth and Adolescent Technical Working Group
(YATWG) was advanced through a two-day capacity building workshop held from May 27
to 28, 2017, with youth leaders drawn from the YATWG and the Jamaica Youth Advocacy
Network (JYAN).
The primary objective of the training was to increase participants’ knowledge and
awareness of sexual reproductive health and rights through their engagement in evidence-
based dialogue around the contentious issues of access to SRH information, products and
services by minors and the human rights perspective. Among the outcomes of the training
was the development of a roadmap for the engagement of high-level leaders in follow up
discussions.
HUMAN RIGHTS AND POLICY MONITORING

In 2017, a partnership was forged between the NFPB and the Caribbean Vulnerable
Communities Coalition to develop and validate policy monitoring tools to assess the quality
of HIV-related treatment, care and support services provided at treatment sites across the
island. Notably, two (2) Scorecards were developed to assess the implementation of the
MOH’s “Test and Treat” Guidelines, which were rolled out in January 2017. While both
Scorecards were created to assess the delivery of ART services, one Scorecard focuses
on service delivery to new patients, while the other focuses on existing and specialised
categories of patients. Coming out of the validation process which also happened
during the year, it was agreed that the Scorecards should be updated in 2018 to address
additional needs of vulnerable populations. The EEHR Unit will be responsible for roll out
and monitoring.
Through funding provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the
NFPB secured agreement with the Jamaica Employers’ Federation to build the capacity
of 20 MSM, PLHIV and CSW as trainers to conduct sessions with their peers in advocacy,
legal literacy and employability skills (entrepreneurship, resume writing, interviewing skills,
completing forms, basic computer skills). Additionally, during the year, human resource
and project management skills training workshops were conducted for project staff and
peer leaders of CSOs that engage with key and vulnerable populations.
During the year, the EEHR Unit maintained Greater Involvement of Persons with HIV/AIDS
(GIPA) as an approach to empower PLHIV and affected key populations by building their
capacity for meaningful involvement and participation in the response. The Unit finalised
the revision of the Positive Health Dignity and Prevention (PHDP) curriculum for use with
key populations through the GIPA Core Group; the second edition was published in
August 2017 and launched in October 2017. Graduates conducted workshop sessions
with over 160 HCWs using select PHDP modules. Additionally, 40 MSM were trained by
GIPA in 2017 in aspects of PHDP, bringing the total number of MSM participating in PHDP
workshops since 2015 to over 500. The MOH TCS Unit and 2 NGOs reported that they
used the curriculum with their beneficiaries in 2017.
Through Collaboration with Health Policy Plus and The Jamaican Network of Seropositives (JN+), the GIPA Coordinator Mr.
Ainsley Reid (4th from left) presented copies of the PHDP Curriculum (Second Edition) to representatives of the Ministry of
Health, National Family Planning Board, and the Global Network of PLHIV (GNP+). Ms. Laurel Sprague, Executive Director of
GNP+, (Centre) commended Jamaica on this landmark achievement for PLHIV contribution to the National Response.
The Unit scaled up GIPA activities in 2017 to support the deployment of Community
Facilitators (CFs) by the Jamaican Network of Seropositives. The deployment of PLHIV as
lay providers was piloted as an approach to involve PLHIV in the delivery of HIV and SRH
services. With technical support from the TCS Unit and Health Policy Plus (HP+), the Unit
facilitated dialogue among RHAs and JN+ that resulted in the further strengthening of
the Community Facilitator deployment by JN+. One CF was stationed at JN+. The EEHR
mentored the Facilitators and conducted a series of PHDP refresher training workshops
for the CFs and their respective site-level supervisors. The engagement of CFs initiated
the formal inclusion of PLHIV participation as lay providers in health systems. This resulted
in the creation of various tools to strengthen peer support activities, as a precursor to
the development and implementation of PLHIV Support Group Guidelines. The aim is
to improve facilitation of peer-led PLHIV groups that help clients lost to follow-up to be
retained in care and achieve viral suppression.
The EEHR Unit provided technical support to HP+ to conduct a review of the PHDP training
framework and to develop a national PHDP Framework for Jamaica. The recommendations
articulated a more robust approach to involve PLHIV in the delivery of HIV and SRH related
services and improve patient outcomes.
NON-DISCRIMINATION IN HEALTH SETTINGS
In 2017, the Unit pursued several strategic actions that promoted the provision of non-
discriminatory health services to all, particularly youth, women and key populations. A
collaboration was forged with LINKAGES, a US Government implementing partner, to
review past and present S&D Curricula and Training Workshops targeted at HCWs and
recommended best approaches to develop and assess same. The primary objective of
this exercise was to elicit and articulate specific and targeted recommendations that will
inform training and future capacity development exercises delivered to HCWs aimed at
reducing stigma and discrimination in health care settings. Additionally, the Unit promoted
a Self-review tool to be used as a reference point in the preparing health care workers for
training in how to respond to HIV-related stigma and discrimination. The tool provides
useful information to assist in designing training and S&D reduction initiatives for all levels
of health care staff.
An electronic poster (ePoster), with audio features, displaying the WRHAs’ Charter of Rights
and Responsibilities was launched on October 26, 2017 at the Cornwall Regional Hospital.
Over 100 persons were in attendance including clients of the hospital, representatives of
JN+ and staff of the WRHA and NFPB. The Charter sets out the rights and responsibilities
of both the client and the health care facility. The ePoster was developed through the
collaborative efforts of the Investigation and Enforcement Branch of the MOH, the EEHR,
NFPB and the WRHA. Designed to increase awareness and accountability, the e-Poster
will be piloted at Cornwall Regional Hospital, Montego Bay Type V, Savanna-la-mar Public
General Hospital, Falmouth Hospital and Noel Holmes Hospital. Smart televisions and
jump drives were issued to these facilities for use in broadcasting the ePoster.
In October 2017 the NFPB handed over smart televisions to display the e-Posters
The Unit supported the Regional Health Authorities in the development of orientation
training material and toolkits on agreed modules. The NFPB provided oversight to develop
and finalise a training manual and toolkit, with specific modules addressing stigma and
discrimination within public health facilities, targeted at new and existing staff. This was
part of an initiative which began in 2015 to revamp the WRHA’s orientation programme
and implement a pilot project from which best practices could be identified and exported
to other Regional Health Authorities. The manual is envisaged as an integral tool in
developing a human rights culture to mitigate the various interpersonal challenges that
are currently being experienced within the public health facilities. During the year, eight
(8) consultations were conducted among stakeholders including frontline health care
workers, senior managers, supervisors in the health care sector, key population groups
and members of WRHA’s Discrimination Reduction Steering Committee which includes
representatives from the MOH, NFPB, WRHA and civil society organisations.
The Unit collaborated with the Western Regional Health Authority to develop a staff orientation training manual to help build
capacity of staff around issues of diversity, dignity and human rights- based approaches to service provision.
During the year, the EEHR Unit also facilitated negotiations, dialogue and consultations
to establish a formal referral mechanism between the RHAs, CSOs, Religious Groups and
Social Service Support Providers. The Unit led consultations among technical, medical
and non-medical teams including primary and secondary HCWs from the Regional Health
Authorities and groupings of key populations and PLHIV; a total of 67 persons were
reached through this initiative.
REDRESS FRAMEWORK IN ALL SETTINGS
During the year, the National HIV-Related Discrimination Reporting and Redress System
(NHDRRS) underwent a restructuring process aimed
at improving the efficiency of the redress system. The
rebranded Jamaica Anti-Discrimination System for HIV
was launched on November 10, 2017. The launch was
an excellent opportunity to raise awareness and promote
redress. As part of the restructuring process, the following
actions were taken to improve the efficiency of the system:
1. JN+ hired two additional Redress Officers resulting

in a marked increase in the number of complaints
received from 9 in 2015 to 31 in 2016 and 47 between
January and October 2017.
2. Chaired by the NFPB, the JADS Steering Committee

established the Case Review Panel with a revised
mandate and Terms of Reference.
3. The Steering Committee and the NFPB developed

new standard operating procedures and policies to
ensure more efficient and effective management of
the System by JN+.
4. JN+ linked JADS to the Shared Incident Database,

which electronically documents and monitors
complaints; this was done to ensure that all complaints
are tracked from receipt to redress and to provide
more accurate data management and reporting.
5. The Steering Committee commissioned a renaming and rebranding process to

increase awareness of the HIV-related redress system and to generate use of the
system by affected persons.
In 2017, the Unit spearheaded four (4) redress consultations to solicit feedback from multi-
sector stakeholders, including key government representatives and CSOs, to inform the
development of a comprehensive Redress Framework, of which the JADS is one aspect.
The consultations provided an opportunity to: 1) explore the provision of redress under
the proposed Occupational Safety and Health (OSH) Act for incidents of workplace-based
HIV-related discrimination; 2) increase awareness of the redress system at the community
level, by mobilising participants from SDC-based community groups and engaging them
in dialogue on the provisions of the System and 3) examine how the National HIV/AIDS
Policy forms part of the legislative framework for the provision of redress in cases of HIV-
related discrimination.
Through the Global Fund grant, the Unit maintained partnership with the MLSS during the
year to support the Voluntary Compliance Programme among private sector employers.
A Project Officer was assigned to the HIV Unit of the the Occupational Safety and Health
Department of the Ministry and is responsible to provide strategic interventions with private
sector workplaces while Ministry moves the process forward to enact a comprehensive OSH
legislation for the entire Jamaican workforce. Recognizing
that the passage of the draft OSH Act into law may take some
time, and that several workplace safety and health concerns,
including HIV, now require urgent attention, a programme
of voluntary compliance to prepare enterprises for the key
requirements under the draft Act was initiated. In 2017, a
combination of assessments, audits and enrolments were
performed with fourteen (14) corporate entities.
The MLSS, supported by the Global Fund grant, hosted series

of Legal Literacy Trainings from September 13 to October
30, 2017 in Kingston, Manchester, St. Ann and St. James. The
workshops facilitated interactive discussions, between MLSS
staff and members of the Industrial Disputes Tribunal, around
strategies for addressing HIV and AIDS related issues such
as terms and conditions of employment, labour laws/policies
and anti-discrimination. A total of 115 MLSS employees were
engaged during the five (5) workshop sessions. Participants
explored adaptation options, planning strategies, application
The MLSS and stakeholders exploring the
provision of redress under the proposed OSH of existing procedures for operation and management and
Act for incidents of workplace-based HIV-related appropriate application of the National Workplace Policy on
discrimination.
HIV and AIDS within a legislative framework.
CHALLENGES
QQ Sustaining civil society participation in EEHR led initiatives was challenging; the Civil
Society Advocacy Plan was not finalized to articulate civil society priorities and concerns.
Representation by civil society on working groups was not high level or consistent and
some civil society partners did not actively contribute to the collaboration mapping
exercises.
QQ Stigma and Discrimination among key populations continued to be a barrier to

recruiting and securing commitments for greater involvement from key populations.
QQ High personnel turnover among health care players reduced the impact of interventions.
QQ Despite the scale up of efforts to sensitise PLHIV and KPs to customer service principles
and the reporting and redress mechanisms, the number of documented complaints to
the HIV-related discrimination reporting and redress system was suboptimal.
THE WAY FORWARD
Moving forward, the EEHR Unit will maintain its mandate to design and coordinate sexual and reproductive health strategies
and interventions that promote a supportive environment facilitated by policies, programmes and legislation wherein all
Jamaicans, including persons with HIV, youth and other vulnerable populations are socially included and their human rights
protected.
In pursuit of this objective the Unit intends to focus on the following strategic priorities
in 2018:
1. Work through the Youth and Adolescent Technical Working Group to develop,
implement and monitor HIV and SRH policies and protocols to support adolescents
and youth. In particular, the unit will pursue collaborations and partnerships that
promote and expand access to SRH information and address and reshape social
norms that support risky sexual behaviours and unplanned pregnancies.
2. Foster the creation of a more enabling workplace environment for key populations. In
order to address the unmet needs for these marginalized communities, the Unit will,
among other things, partner with the MLSS to pursue the support of the International
Labour Organization to engage a consultant to develop the confidentiality protocol
and the process flow chart for the management of HIV related workplace complaints.
3. Collaborate with LINKAGES Jamaica to study internalised stigma among MSM and
TG persons in order to better plan, programme for and target these groups with
information on family planning/reproductive health, HIV/AIDS and STIs.
4. Collaborate with Health Policy Plus (HP+) to facilitate and train health care workers
at selected public health facilities in stigma and discrimination reduction strategies
geared towards improving service delivery and further enabling universal access to
HIV and SRH services for key and vulnerable populations at those institutions.
5. To pursue efforts, as part of NFPB’s overarching objective to enhance engagement of

the general population, to reduce gender based violence (GBV) and encourage health
care facilities to address the immediate needs of victims of GBV by training health
providers to recognize signs of violence against women and girls, assess women’s risk
of violence and provide women-centred care.
6. Improve programming at public health facilities for delivery of SRH services for men.
This would include the development of a Guide for Promoting Sexual and Reproductive
Health Products and Services for Men that focuses on meaningfully engaging men and
creating an enabling environment to increase men’s use of SRH products and services.
7. Strengthen the Technical Working Group mechanism to accomplish more targeted

and focused policy and advocacy across disciplines outside health sector and HIV
centric civil society partners.
8. Coordinate the final deliverables to enable the revision of the National HIV Policy.
9. Develop a national PHDP framework for people living with HIV or AIDS in Jamaica and
guide its full integration into the national response.
10. Collaborate with Youth and Adolescents Technical Working Group to identify advocacy
initiatives to promote the delivery of SRH services to adolescents and youth.
11. Expand policy advocacy to remove the Legislative and Policy Barriers to integrated
health and social development. A critical element of this approach will be joint
advocacy with the Office of Public Defender and the Civil Society Joint Advocacy
Forum for the promulgation of Anti-Discrimination Legislation in Jamaica.
CHAPTER 6: STRATEGIC
INFORMATION
OVERVIEW
As the overarching goal to end the HIV epidemic emerged and the work of the HIV/STI/
Tb Unit expanded, the need for a more comprehensive approach to data capture, analysis
and use became increasingly critical. The National HIV/STI Programme needed a strategic
information component that exceeded the boundaries of monitoring and evaluation to
include surveillance, research and health information systems. The move from Monitoring
and Evaluation to Strategic Information was undertaken during the year.
The SI Unit collects, analyses and disseminates data that is used to evaluate and expand
the efficiency and appropriateness of programmes, which are aimed at prevention of
HIV transmission, early detection of new HIV infections and treatment of HIV infected
individuals. The NHP relies on the SI component to shape its objectives, inform and
improve strategy and programming and monitor progress through research, analysis
and forecasting. Programme Managers, policy-makers and stakeholders rely on quality
information to make informed decisions that are in the best interest of the people and
groups they serve. The SI component enables the NHP to respond proactively to the
epidemic.
SURVEILLANCE
In collaboration with the Surveillance Unit, the SI Component monitored HIV, STIs, Tb,
Hepatitis B and Hepatitis C. In 2017, the HIV case-based surveillance system resulted
in the submission of 3,792 Class 1 notifications and confidential reporting forms to the
MOH (Table 10). Of these, 950 were notifications with 641 confirmed cases. Further
investigation is being done on the remaining 309 suspected cases, and generally on all
cases, to determine the number of new infections for the year.
Table 10 HIV Surveillance log

NO. OF NO. OF
NO. OF NO. OF PERSONS
NO. OF NOTIFICATIONS CONFIDENTIAL NO. OF PARISHES
NOTIFICATIONS WITH CRF AND
NOTIFICATIONS NOT CONFIRMED REPORTING FORM REPORTING
CONFIRMED NOTIFICATIONS
(SUSPECTED) (CRF)
950 641 309 2,842 230 14
The Class 1 notification reporting by parish is depicted in the graph below.
Fig. 18 Class 1 Notifications and Confirmed Results by Parish, 2017
Hepatitis & Tuberculosis
Hepatitis monitoring showed an increase in the number of cases in 2017 compared to
2016; there was a 100% and 325% increase in the number of Hepatitis B infections and
Hepatitis C infections, respectively. There is currently no National Hepatitis Programme.
Tuberculosis on the other hand has shown a marked decrease of 41% in the number of
cases in 2017 compared to 2016. Actual numbers can be seen in the table below.
Table 11 Hepatitis and Tb Surveillance
YEAR HEPATITIS B HEPATITIS C TUBERCULOSIS

2017 54 13 62
2016 27 4 105
Sexually Transmitted Infections

In 2017, a total of 42,235 cases of STI was reported to the MOH; the majority (85%) of these
were infections associated with genital discharge. Compared to 2016, there was a 3%
decline in the total number of STIs reported and this decrease was noted in all categories
of STIs.
HEALTH INFORMATION SYSTEM

Improving the health information system is critical to achieving epidemic control. This
need resulted in the design of two electronic databases that allow individual patient
tracking from outreach testing through treatment to viral suppression. Designed in 2016,
the two DHIS2 web-based databases, for HIV treatment and HIV prevention services were
officially rolled out in 2017; dubbed the Treatment Services Information System and
the Prevention Services Information System (PSIS), respectively. These databases were
implemented to ensure the production of clean de-duplicated data in real time to allow
analysis, dissemination and usage of reliable information in decision-making.
Prior to the general use of the PSIS, training workshops were conducted at the National
Family Planning Board. Additional workshops were subsequently held. All regions and
outreach teams commenced use of the system by September 2017.
The TSIS was piloted in the Comprehensive Health Centre, Jamaica AIDS Support for
Life Kingston Office and National Chest Hospital in the first half of the reporting year.
Regional training workshops were also conducted prior to the general use of the system.
By August, the system was rolled out in all the treatment sites. Training workshops were
also conducted at the site level.
The databases replaced the stand-alone systems, which were not linked or accessible from
a central location. With the introduction of the new system, which provides data at the
national level, the Unit has been able to generate timely reports to local and international
stakeholders.
Jamaica’s efforts toward elimination of mother-to-child transmission status must be

supported by reliable data. A new database, which was designed for the Prevention of
Mother-to-Child Transmission programme was implemented during 2017. This web-
based database, which is available at all PMTCT sites, allows data to be quickly captured
at the national level. This means that challenges faced at local PMTCT sites, that can affect
our elimination status, can be met with an immediate national response.
All viral Load samples collected throughout the island are processed centrally at the
National Public Health Laboratory. In the past, patient care has been hampered by delays
in the return of viral load results using the paper-based system. In 2017, this was rectified
by the merger of the TSIS with the NPHL database. This merger occurred in August
and resulted in viral load results being immediately available in TSIS and notably, at the
fingertips of the treatment teams dispersed throughout the island.
RESEARCH
In 2017, four research activities were conducted: Bio-Behavioural Surveillance Survey of
Female Sex Workers, Bio-Behavioural Surveillance Survey of Men who have Sex with Men,
the HIV Sentinel Survey and the Knowledge, Attitude, Behaviour and Practices Survey.
The FSW Survey was conducted among Female Sex Workers, Female Patrons and Workers
of Sites where Persons Meet Sex Partners or Participate in Sexual Activity in Jamaica. This
study determined the prevalence of HIV and Syphilis and the risk behaviours among FSW,
patrons and workers at the sites where people meet sex partners to guide programme
interventions for these group. The study was conducted from August to November 2017
and included all four health regions.
Data collected for the Integrated Biological and Behavioural Surveillance Survey with
Population Size Estimation among Men who have Sex with Men and Transgender (TG)
Persons in Jamaica began in December 2017. The study will be used to estimate the size
of the MSM, TG population and to determine HIV prevalence and risk behaviours for these
groups.
The Annual HIV Sentinel Surveillance Sero-survey was conducted in sentinel sites from
three urban parishes and three rural parishes from all four health regions. This survey is
used to determine the prevalence of HIV in the general population and at-risk populations.
This survey includes STI clinic attendees and antenatal care clinic attendees.
The Knowledge Attitude Behaviour and Practice Survey was conducted over a six months
period beginning in August 2017. The survey aimed to track the attitude and behaviour
of the public to the HIV/AIDS epidemic as well as to monitor the impact of current
interventions. Data was collected island-wide from a cross-sectional, household-based,
survey among randomly selected sample of 2,000 persons aged 15-49 yrs.
MONITORING AND EVALUATION
Monitoring is an ongoing process of data collection and analysis, which allows assessments
of the various activities and interventions undertaken by the Programme. It aims to track
performance and improve the decision-making process that guides all projects. This
function is undertaken through site audits, supportive supervision and data extraction
from the electronic HIV prevention and treatment databases. The existing databases allow
extraction of reports that reflect prevention outreach activities targeting key populations.
Testing data is de-duplicated, a process that is facilitated by the unique identifier code
(UIC) that is produced by the database. This allows individual tracking of clients being
tested and their movement, if tested positive, through the continuum of care.
The treatment database strengthens monitoring through the available reports generated
at the national, regional and site levels. These reports allow monitoring of:
QQ PLHIV who are lost to follow-up, so they can be identified in the community setting and
returned to care.
QQ PLHIV who are defaulting so interventions can be done to prevent lost to follow-up.
QQ PLHIV who are retained in care and their ART status to ensure all clients are initiated in
keeping with ‘Test & Start’ initiative.
QQ PLHIV on ART to ensure suppression.
THE WAY FORWARD

The Unit achieved some significant milestones during 2017, notably in research and health
information systems. In 2018 the Unit will continue to deliver on its mandate to collect,
analyse and convert data into sound, reliable information for decision-making. Toward
this end, building the capacity of the team to execute its functions more effectively and
efficiently will be a key focus going forward.
The Unit will conduct a 12 Component M&E Assessment to assess the current M&E System
and provide a roadmap to benchmark progress made and identify gaps and areas in need
of system strengthening. The findings of this assessment will serve as a platform for the
development of an Integrated Monitoring and Evaluation Plan (2019 - 2024) which will be
aligned to the National Integrated Strategic Plan.
The year 2018 will see more improvements to databases to enhance functionality, greater
collaboration with health planners and decision-makers, more research activities and
ongoing work to improve data quality, timeliness and relevance; these are all building
blocks of any successful HIV/STI Programme.
One of the database improvements will be a merger of the HIV/AIDS Tracking Database,
a repository for all diagnosed cases in Jamaica and the Prevention Services Information
System, the repository of people reached and tested in community settings, with the
Treatment Services Information System, allowing monitoring of PLHIV from diagnosis to
viral suppression.
The Treatment Services Information System, which was developed in 2016, will be
upgraded to a new platform with enhanced security features and better data visualization
tools. Currently, treatment data for PLHIV linked to care is only captured within the public
sector. A collaboration with the private sector is expected to produce a private sector
database on the new platform like TSIS. This will further aid the NHP in monitoring the
epidemic and intervening for control by 2030.
Even though the MSM study will span the year 2018, there will be another research
focusing on ART outcomes, which will assess the factors contributing to treatment failure,
loss to follow-up and mortality. The outcome of these studies will improve programme
planning and decision-making and impact the quality of care given to PLHIV in Jamaica.
The need for quality data cannot be overemphasized. Toward this end, the Unit will
be embarking on a major data cleaning initiative to ensure that all data captured in its
databases is correct, complete, consistent and useable. This will be augmented through
continued data audits to identify and correct gaps in data collection and reporting.
Additionally, improvements in the M&E capacity of staff at the regional, parish and site
level will be prioritized through the specialized training activities focusing on data analysis
and use.
CHAPTER 7: GRANTS
MANAGEMENT
OVERVIEW
The national HIV/AIDS response is funded primarily by the Government of Jamaica, the
Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States Agency for
International Development. The Ministry of Health is the Principal Recipient (PR) of the
funds and the HIV/STI/Tb Unit, which exists within the MOH is the Project Coordinating
Unit (PCU) for the national response.
Jamaica receives funds under the GF New Funding Model (NFM) Grant, titled “Support
to the national HIV/AIDS response in Jamaica” and under the PEPFAR/USAID grant titled
“Threats to the Environment and Citizen Vulnerability Reduced – Prevalence of HIV/AIDS
in Key populations reduced”.
Both international donors, the PEPFAR/USAID and GF, support activities and interventions
that target key populations (female sex workers & men who have sex with men) and PLHIV.
The GOJ is responsible for targeting general populations as well as key populations and
PLHIV.
The funding received from all three entities supports the main components of the HIV/
AIDS response, which include:
QQ Treatment, Care and Support
QQ Prevention
QQ Enabling Environment and Human Rights
QQ Monitoring and Evaluation
QQ Governance and Programme Management
FUNDERS
Global Fund
The Global Fund was established in 2001. Based in Geneva, its governance and
management structures comprise the GF Board, the Secretariat and the Technical Review
Panel (TRP). Other key structures are the Office of the Inspector General (OIG) and the
Partnership Forum, a Local Funding Agent (LFA) contracted to provide independent
advice to the GF on programme performance and the Country Coordinating Mechanism
(CCM).
The Global Fund Grant Cycle

Under the GF New Funding Model grant cycle there are three major stages:
1. Concept note development and approval
2. Grant making and approval
3. Grant implementation
Global Fund New Funding Model Grant

The reporting period January to December 2017 is the second of a three (3) year
performance period based on the Grant Agreement signed with the Global Fund. Under
the NFM, there are 19 Implementing Stakeholders – four (4) Sub-recipients, six (6) Sub sub-
recipients, three (3) Implementing Partners and six (6) other Implementing Stakeholders.
The pace of implementation of some activities were affected by challenges in recruiting
and retaining staff and in identifying suitable candidates for consultancies. Lengthy
procurement processes and under-estimation of the time required to execute studies
continued to impact the timely completion of activities during the second year of the grant.
Global Fund NFM Program
(DISEASE) COMPONENT: HIV/AIDS

Program Title: Support to the national HIV/AIDS response
in Jamaica
Grant Name: JAM-H-MOH
GA Number: 914
Grant Funds: Up to the amount of US$15,242,178
(Fifteen Million Two Hundred Forty Two
Thousand One Hundred and Seventy
Eight US Dollars) or its equivalent in other
currencies.
Implementation Period: From 01 January 2016 to 31 December
2018
Goals:
1. Reduce AIDS related morbidity and mortality with effective Biomedical and supporting
interventions.
2. Reduce new HIV infections among key populations through behavioural and structural
interventions.
Strategies:
1. Prevention: targeted prevention interventions for key populations primarily through
outreach services.
2. Treatment, Care and Support: support procurement of ARVs and improve adherence
and availability and quality of counselling and psychosocial support for PLWHA.
3. Enabling Environment and Human Rights: empowering beneficiaries of HIV national

policies to understand their rights and pursuing efforts to reduce stigma and
discrimination.
Categories for Planned Activities

QQ Scaling up Prevention among key populations
QQ Improved access to treatment, care and support and improvements along the
treatment cascade
QQ Strengthening Community Systems and Removing Legal Barriers
QQ Health Information Systems and Monitoring and Evaluation
Target Group/Beneficiaries
QQ Men who have sex with men
QQ Female sex workers
QQ Transgender people
QQ People living with HIV
QQ Homeless drug users
QQ Youth and adolescents, within the key populations and PHLIV
PEPFAR/USAID
The Office of the Global AIDS Coordinator (OGAC), Washington, USA works with the
PEPFAR Caribbean Regional Office, the USAID mission in Jamaica, the MOH and other
in-country stakeholders in the design of the programme, annual work plans and budgets,
as well as monitoring the performance of the HIV/AIDS grant. The MOH represents the
government and is responsible for the management of the grant and ensuring the planned
results are achieved.
USAID Grant Cycle

The USAID grant cycle has five major stages:
1. HIV programme (intervention/activities) development
2. HIV programme approved
3. Detailed work plan & budget development
4. MOH consolidated work plan and budget approved
5. Grant implementation
The Jamaica PEPFAR/USAID Grant

The PEPFAR/USAID grant implementation period is October 2016 to September 2017.
The total amount approved for this implementation grant period was US$3.1M. Although
the implementation period commenced October1, 2018, the first tranche was disbursed
to the MOH in the later part of January 2017. The lengthy delay in finalizing the work plan
and the subsequent late disbursement of the funds created a level of uncertainty among
the staff of the implementing entities. This affected their ability to effectively plan and
execute activities in a timely manner. As a result, the entities were unable to successfully
liquidate the funds and implement all their activities within the implementation period.
The MOH requested and received approval for a six (6) month “no cost” extension until
March 2018.
Objective 1: To support key population groups (MSM and SW) and PLHIV in accessing
Combination Prevention, improve retention in the clinical cascade and reduce barriers to
access and retention in care.
Objective 2: To support health systems strengthening and the capacity of stakeholders

(KP, PLHIV, CBO/NGO and government) to improve programme and policy outcomes
through the use of strategic information.
CONTRACTS AND AGREEMENTS

Overview of the Structure
IMPLEMENTATION FUNDS
FUNDER PRIORITY AREA COMMENT
PERIOD EARMARKED
GF January 2016 – All 14 parishes US$15,242,178 Funding agreement signed
December 2018 for 3 years
PLHIV, MSM, FSW, TGs
PEPFAR October 2016 – Select Parishes and US$3,105,000 Funding agreement signed
September 2017 treatment sites for 1 year and based on
/USAID
availability of funds
PLHIV, MSM, FSW
PEPFAR October 2017 – Select Parishes and US$3,100,000 Funding agreement signed
September 2018 treatment sites for 1 year and based on
/USAID
availability of funds
PLHIV, MSM, FSW
GOJ Unlimited All J$ as approved As donor funding decrease,

in the Estimates GOJ continuously increases
of Expenditure its contribution
(GOJ) Budget.
Overview of the Partners

The Country representatives signing the agreements are as follows:
GF agreement is signed on behalf of the Government of Jamaica by the MOH and the
Ministry of Finance and Public Service (MoFPS) as well as by Jamaica Country Coordinating
Mechanism (JCCM) members (the Chair & NGO representatives).
The USAID grant agreement is signed by the MOH and the Ministry of Finance and Public
Service (MoFPS). Following this process, the MOH signs an implementation agreement
with the implementing stakeholders. The grants are performance based hence the amount
of funds disbursed to the country is associated with its performance in meeting the targets
and the indicators. The functions of the entities/structures in the response are described
below.
ENTITY DESCRIPTION
Ministry of Finance and the Legal representative to sign and manage loans, credits and grants on behalf of the
Public Service GOJ and passes the responsibility of management of loans/grants to the MOH
Annually, approves and creates fiscal space to accommodate the HIV/STI Programme
budget
Provides the Recurrent GOJ and the GOJ contributions budget complementing the
donors’ grants
Issues warrants based approved budgetary allocation to support PCU’s warrant

requests. Warrants are non-cash for grant resources and cash for GOJ resources
Jointly (with MOH) manages the GF US Currency Special Account
Facilitates transfer of funds from the Bank of Jamaica to the MOH via processing of
Withdrawal Applications.
The Ministry of Health The preeminent government organization whose mandate is “To ensure the provision
of quality health services and to promote healthy lifestyles and environmental
practices”
Manages health sector donor-funded projects channelled through the GOJ which
includes the funds that support the National HIV response Programme
Refers to as the Principal Recipient (PR) under the HIV response
Contracts implementing stakeholders under the GF and USAID grants

(Implementation Agreement)
The HIV/STI/Tb Unit (PCU) Responsible for the National HIV response and is the MOH arm entrusted with the
management, coordination and monitoring of HIV donor-funded programmes.
Referred to as the Project Coordinating Unit (PCU) that supports MOH in its capacity as
Principal Recipient (PR) of the Global Fund grant resources
Responsible for providing technical support and guidance in Treatment, Care and
Support, Grant Management, Financial Management; Procurement and Supply
Management, M&E and HR& Administration
Procures and coordinates the supply and distribution of health products and non-
health products which includes ART and test kits for the response
Submits reports/updates to the MoF&P, JCCM, USAID, GF and Planning Institute of

Jamaica (PIOJ)
ENTITY DESCRIPTION
The National Family Planning Responsible for the development of the National Integrated Strategic Plan (NISP)
Board (NFPB-SHA) which includes the response
Responsible for providing technical support, guidance and monitor the

implementation of the Prevention, Enabling Environment and Human Rights (EEHR)
Components and M&E of the HIV/AIDS response
Provides and coordinates storage and distribution of condoms, lubricants and IEC
materials
Receives donor funding from MOH to implement prevention and EEHR interventions/
activities
Submits reports/updates to the PCU/PR
The Jamaica Country Multi-sectoral body that has oversight for the GF grant since February 14, 2003
Coordinating Mechanism
Comprises of representatives from all stakeholders involved in HIV/AIDS response
(JCCM)
including: International partners, private sector non-governmental organizations, civil
society and the Government
Provides leadership and direction to the GF programmes in Jamaica
Coordinates the development and submission of concept notes to the GF
Nominates the principal recipient and overseeing grant implementation, performance

and closeout
Implementing Stakeholders (IS) Selected through a transparent and competitive process and undergoes annual
capacity assessment exercise to determine capacity to directly manage funds and
implement interventions/activities
Classified as Class A or Class C entity (defines whether the entity directly or indirectly
manages funds)
Contracted to implement designated programmatic interventions/activities under GF

and USAID grants
Plays a pivotal role in the implementation of and reporting on programme activities,

management of grant resources and the timely achievement of indicators and targets.
Refers to as Sub-Recipients (SRs), Sub Sub-Recipients (SSRs), Implementing Partners

(IPs), other implementing entities and government agencies & statutory bodies.
Submits reports/updates to PR/PCU, NFPB-SHA and JCCM
IMPLEMENTING STAKEHOLDERS
There is a total of 21 implementing stakeholders (IS). Ten (10) of which receive funds from
both the PEPFAR/USAID and GF grants.
QQ Global Fund Grant has four (4) Sub-Recipients (SRs). Three (3) of the SRs manages
funds for a total of six (6) Sub-sub-Recipients while the other SR sub-contracts three (3)
implementing partners through service level agreements.
QQ USAID grant has 12 Sub-recipients
Implementing Stakeholders under GF and USAID
GF USAID
IS Priority area IS Priority area
JASL (SR) Prevention, EEHR & TCS JASL (SR) Prevention, TCS and
EEHR
JFLAG, JN+, JCW+ & EEHR & TCS
EFL
ASHE (SR) Prevention ASHE (SR) Prevention
RISE Prevention
Children First (SR) Prevention Children First (SR) Prevention
HWW
NFPB-SHA (SR) Prevention & EEHR Jamaica Red Cross (SR) Prevention
MLSS, JEF, UWIHARP EEHR & HSS

MOH/NERHA TCS & Prevention JFLAG (SR) EEHR
MOH/SERHA TCS & Prevention JN+ (SR) EEHR & Support
MOH/WRHA TCS & Prevention NFPB-SHA (SR) Prevention & EEHR
MOH/SRHA TCS & Prevention NERHA (SR) TCS & Prevention
MOH/NCDA Prevention SERHA (SR) TCS & Prevention
MOH/Children of Faith TCS & Prevention WRHA (SR) TCS & Prevention
SRHA (SR) TCS & Prevention
CHARLES(SR) TCS
GRANT MANAGEMENT UPDATES
QQ Technical Reports: Over the period, the implementing partners have shown
improvements in completing the technical and financial reports correctly. The
PR continued to work on a one-on-one basis with entities. The PR would like to
acknowledge the SRs and implementing entities for their commitment and efforts to
submitting the financial and technical reports on time.
QQ Risk Management: Based on the 2016 audit findings report, the PR submitted a
detailed Audit Action Plan to the MOH Permanent Secretary (PS) and the GF. Over
the period, the PR submitted quarterly updates on the progress of implementation
of the Audit Action Plan to the PS and GF. During the third and fourth quarters,
the PR intensified its site visits and provided technical support to all implementing
stakeholders as they implemented their corrective measures. All entities submitted
their Audit Risk Mitigation Plans to the PR. The relationship between the PR and the
SRs have improved as they work together to improve their communication and internal
controls mechanisms.
QQ Financial and Procurement Management: During year 2 of the NFM Grant, the changes
implemented to enhance Financial Management and improve internal controls
resulted in improvements in the quality of records maintained at the field level. The
PCU and Sub-Recipient Operations Manuals and revised reporting templates were
institutionalized and are in active use by stakeholders. There were improvements
in the timely submission of reports. Disbursement of funds to SRs is now better
streamlined and there is a clearer understanding of the forms to be completed to
facilitate the process. The challenges in the recruitment and retention of suitable staff,
consultants and suppliers resulted in a delay in the timely completion of deliverables
and activities within the year 2 grant implementation period.
QQ Accounting System Upgrade: At the HSTU, the Accounting Software - ACCPAC/Sage

300 was upgraded during 2017, to include revised Chart of Accounts and redefinition
of reporting templates, which are now fully designed. The roll out of the system
required a huge investment of time with the same complement of staff who have also
conducting more site visits. This approach placed constraints on staff and resulted in
delays, which impacted the timely entry of accounting transactions.
QQ Health Information Systems Strengthening:
• DHIS2 treatment database was installed in all thirty-eight (38) treatment sites, with
thirty-three (33) sites regularly utilizing the system. The remaining five (5) treatment
sites have internet connectivity issues.
• DHIS2 prevention database was installed in all outreach sites. A few of these sites
are also experiencing internet connectivity issues.
QQ GF Mission: During the year, the GF Country Portfolio Manager and an M&E Specialist
attended the HIV Annual Review as well as met with the PS and CCM members.
QQ WAMBO: The MOH used WAMBO twice to procure ARVs and lubes. The first
procurement was lengthy due to changes in staff at the PR and the newness of the
process. However, the second process was timelier. In both cases, there were delays
in deliveries as the ETAs were not met. Additionally, it was found that the overall cost
of procuring through WAMBO PPM resulted in a budget overrun due to a higher than
budgeted unit cost for one ARV and additional PSM costs (PSA fees, Insurance Buffer
etc.) which are related to the WAMBO process. The additional cost was covered by
efficiencies. A change of Customs Broker also resulted in overruns on the amounts
allocated for in-country clearance and services charges.
QQ Human Resources: It has been a challenge to find suitable candidates to fill the position
of Adolescent Psychologists.
QQ MOH Restructuring: The restructuring process within the MOH accounted for lengthy
delays in receiving approval for documents. These delays impacted the timely
implementation of programme activities and hindered the effective management of
the grant.
SUMMARY OF CHALLENGES – TECHNICAL AREAS

Prevention
1. The internal migration of KPs resulted in ongoing challenges with duplication of testing.
Reaching the MSM population was a challenge, considering the high targets and the
process of de-duplication. The de-duplication process has had a negative effect on
the morale of the outreach staff and the working relationship between implementing
entities, as is expected when a new system is implemented.
2. Finding, reaching and testing new MSM continue to be a challenge as the implementing
entities try different strategies to identify hidden MSM. Unfortunately, strategies
like peer links and lymes are not always effective and have their limitations. During
lymes, KPs will attend but not all are willing to be tested. The success of peer links is
dependent on the size of peer networks. Hence, after a few months, some peer links
have no new MSM to link. The sexual networks also overlap and result in duplication.
3. The crime and violence impacted negatively on the achievement of reach and test
targets in the Western region and some parishes in the South East region.
4. The unavailability of lubes to distribute with the condoms limited comprehensive

prevention services being offered to the KPs. It is anticipated that the lubes will be
available for the next implementation period, as USAID has agreed to assist with
providing supplies. A lengthy procurement process is expected in this regard.
5. The recruitment and retention of suitable peer links continued to be a challenge for
implementing entities.
6. It is extremely difficult or even impossible to effectively conduct follow-up sessions

with MSM who give incorrect or incomplete personal information because they want
to remain hidden.
EEHR
1. It takes a long time to receive approval for the implementation of interventions involving
health care workers or that require input from the Regional Health Authorities.
2. The successful implementation of these types of activities is heavily dependent on the

availability of key stakeholders and their willingness to complete follow-up actions.
Attempts to address the issues include early engagement of decision-makers and
ensuring their involvement in the design, planning and implementation stages.
3. Stigma and Discrimination among PLHIV and key populations continued to be a

barrier to the recruitment and securing of commitments for greater involvement of
PLHIV and key populations, e.g. fear of involuntary disclosure through peer groupings
or by association.
TCS
1. The delay in the timely completion of the ‘Test and Start’ campaign was as a result of
the lengthy process to confirm key stakeholders’ availability and involvement in the
launch.
2. The implementation of the PLHIV peer facilitator pilot project was delayed due to the
lengthy process to finalize the concept note and the candidate selection process.
3. Some clients are unwilling to access services outside of the public health system;
appointments for referrals are not kept or the process is not completed.
4. The case management training was not implemented because the development of
the curriculum took longer than expected.
5. Internal and external stigma continue to prevent PLHIV and KPs from participating in
activities that are specifically designed for them.
6. Efforts to increase RTC can be daunting because contact information for some patients
is not up to date; the telephone numbers are no longer in service and the home
addresses are either incorrect or persons have moved to another location.
7. The hiring of consultants continues to be a lengthy process, as suitable candidates, with

the requisite skills to conduct research or studies, are limited and often unavailable.
MER
1. Connectivity and limited internet access at some of the treatment and outreach sites
delayed and/or disrupted the roll out of the DHIS2 database.
2. Data entry is sporadic in some entities because of the absence of a data entry clerk.
This has led to limited ownership and monitoring of the databases at the site level.
SUCCESS STORIES & THE WAY FORWARD

1. Partnership between the government and civil society.
A major strength of the response is the collaboration and partnership between the
government and civil society entities. The multi-sectoral response is evident at the
national and site levels where multi-sectoral committees and technical working groups
are established to manage the design, planning, development and implementation of
all major events and innovative interventions.
Efforts to strengthen the collaboration and referral mechanism between CSOs and
the RHAs will be scaled-up. This will help to reduce the time it takes for the RHAs
decision-makers and implementers to buy-in and support collaborative interventions
with CSOs. It will also reduce the time it takes to successfully implement interventions.
2. PLHIV Facilitators
The engagement of PLHIV Facilitators to provide one-on one support to their peers
at the treatment sites, and work as members of the treatment team, is one innovation
that has the potential to increase the number of clients who adhere to their treatment
and eventually become virally suppressed.
Additional PLHIV Facilitators will be engaged to work with their peers at the treatment
sites to expand the service and increase coverage.
3. Safe Spaces and Facilities
The expansion of safe spaces and facilities has assisted in improvements to the quality
of service and care provided at the site level.
The expansion of retrofitted containers and other safe spaces at the site level will
continue. The expansions will reduce some of the barriers caused by the limited
infrastructure and provide more private spaces for clients and HCWs to interact.
4. Case Management Approach
The case management approach has helped the workers at the treatment sites to work
better as a team. Teams engage a collaborative approach to reviewing, assessing,
facilitating and coordinating care for each client resulting in the best suited treatment
team member(s) being assigned to guide and assist individual PLHIV cases.
The scale-up of the case management approach to ensure that clients receive quality
services and care from entrance to exit of the health facilities is critical to the response.
This includes continuous training and the use of the data to make strategic decisions
on how to improve and/or expand the services offered at the site level.
5. Treatment Site Mentoring Team
The implementation of the Treatment Site Mentoring Team to conduct audits, provide
recommendations on corrective measures and provide technical support to the
treatment team has been helpful in addressing some critical gaps at the site level.
The team will increase their site visits and provide technical support to ensure
corrective measures are implemented in a timely manner. They will also ensure that
improvements are properly documented.
6. Peer Navigation System
The Peer Navigation System has facilitated the link between HIV prevention and
treatment; PLHIV and KPs are navigated to reach and be retained in care and treatment
services.
In an effort to scale-up the Peer Navigation System, the Navigators will participate in
the treatment team meetings and receive training in the case management approach.
94
CHAPTER 8: PROCUREMENT
OVERVIEW
In 2017, the Procurement Unit continued to lead in the strategic procurement of third party
goods and services, delivering the best value and quality, in accordance with the GOJ
Handbook of Public Sector Procurement Procedure (revised March 2014). The activities
of the Unit are underpinned by the fundamental principles of public sector procurement:
accountability, competition, economy, fairness, integrity, openness and transparency.
During the year, the Unit focused on developing and strengthening its involvement
with and support of internal and external customers/partners. This move allowed the
Unit to gain a better understanding of customer/partner needs and consequently make
recommendations to improve procurement management processes and enhance the
skills of the people involved.
Substantial progress was made in enhancing procurement processes through ongoing

site reviews and training at both government affiliated entities and NGOs. Going forward,
activities will be geared towards results and performance, streamlining internal processes,
strengthening capacity building and leveraging resources for service delivery.
PROCUREMENT THROUGH THE GOJ & DONOR
MECHANISM
Government of Jamaica
Procurement processes using GOJ resources was significantly improved through better
forecasting and earlier commencement of major procurement processes, for example
procurement of ARVs. Assessments of stock levels are ongoing, and projections of needs
were done well in advance of the fiscal period holding the funding to allow sufficient time
for processing at the various procurement committees. During 2017, there were no major
delays with any of the committees (Evaluation, Procurement, Goods Specialist Sector
Committee and Cabinet) that impacted drug procurement or created a threat of stock
outs.
Donor
Procurement activities are also guided by the donor agencies procurement guidelines
and checklists. Open competition was emphasized as the basis for efficient and effective
public procurement and the most suitable method for conducting procurement activities
was selected.
A major development concerning donor agencies procurement within the year was the
introduction of WAMBO, the Global Fund online procurement platform. Two instances
of procurement for the National HIV Programme was undertaken using the platform; this
was for the purchase of ARV drugs and test kits. The use of the platform was intended
to secure better prices and minimize the length of time it would ordinarily take to buy
these items through the standard process. There were some minor challenges using the
platform and delays with delivery. However, the overall procurement time frame remains
shorter than the standard GOJ process.
Zero-Rating of Suppliers Invoices

The HSTU faced challenges in getting zero-rating approvals returned from Tax
Administration Jamaica (TAJ) in a timely manner using the online portal. This situation has
since been improved through better communication with the TAJ and lobbying with our
internal customers to ensure that suppliers’ invoices meet all the necessary requirements.
The assignment of TAJ Customer Service Representatives to MOH has also helped to
keep the HSTU updated and abreast of applications for zero-rating.
IMPROVING PROCUREMENT EFFICIENCY

E-Procurement System
Some 2,000 persons, including procurement practitioners and suppliers, were trained
during the year. Some of the features of the system are: online access to procurement
legislation and regulations for all agencies and stakeholders; online advertising of bids;
downloading of bid documents; contract award publication; electronic bid submission;
e-mail notification of new bids to suppliers and an electronic procurement management
information system that facilitates audit, as well as the extraction of data, for statistical
purposes.
Although the Procurement Unit commenced using the E-Procurement System in 2017,
the wider HSTU has not been trained and hence full integration of the system within the
Programme has been delayed. No timetable has been established to date for delivery of
training to the team.
Goods Specialist Sector Committees

Following from the July 2016 commissioning of the five new Special Committees by the
National Contracts Commission, the HSTU utilized the Goods Specialist Sector Committee
in 2017 to receive approval for the procurement of Viral Load Tests, Reagents and Supplies
valuing over JMD 60M. This new system is notably more efficient; the HSTU had access
to specific persons on the Committee, which made for easier communication and faster
processing time.
CAPACITY BUILDING
During 2017, the Unit conducted training workshops in Procurement Management for
both project staff and implementing partners. The training delivered covered areas like:
procurement policies and procedures, procurement planning, managing suppliers and
review of audits findings with recommendations of required actions to mitigate against
their reoccurrence. Some of the topics covered included developing specifications,
preparing Request for Quotation (RFQ) documents and applying the public procurement
guideline to the process as required by the Operations Manual. Standard templates were
re-distributed as reminders. The workshops were designed to enhance the skills and
competencies of officers supporting the procurement function in the various entities.
Site audits were also conducted quarterly to assess compliance, governance and risk
management. Relevant feedback and recommendations were shared with each entity,
and then formally dispatched, for the requisite actions to be taken.
CHAPTER 9: FINANCE &
ADMINISTRATION
FINANCE
Overview
The objectives of the National HIV/STI/Tb Programme are primarily guided by the National
Integrated Strategic Plan for SRH and HIV and specific objectives of Vision 2030 Jamaica,
the National Development Plan. A substantial portion of the funding for the HIV/AIDS
response has been supported through agreements with donor agencies such as Global
Fund New Funding Mechanism and United States Agency for International Development.
However, contributions from the Government of Jamaica have increased significantly
since 2013, representing an investment in a more sustainable national response.
The budgetary contribution for the HIV/AIDs response in 2017 was J$1.95B; this represents
an approximately 16% (J$269M) increase over the previous year. The largest increase was
in the Global Fund contribution (18% or J$132.84M). The total GOJ contributions through
the recurrent budget and through its contribution towards the USAID & Global Fund grant
funded projects was J$765.38M. The GOJ’s contributions in 2017 increased by 19% or
J$118.84M, making the GOJ the largest overall contributor by a slight margin, over the
Global Fund. Resources were also received from the GOJ through in-kind contributions.
The Global Fund New Funding Mechanism, which was signed in 2016 was in the second
year of implementation and contributed 39% of the budget (J$762.31M). This is an increase
of approximately 21% over the previous year. Under USAID, the Year 7 agreement (532-IL-
532-HE-DOAG-000005) was signed in the amount of US$3.1M; this grant is expected to
end in September 2018. Operating concurrently during 2017 was Year 6 Implementation
Letter (IL) 4 (532-IL-532-HE-DOAG-000005); this grant had an originally end date of
September 2017, however, it was extended to March 2018. The Programme also received
J$0.11M in small grants from UNICEF.
Fig. 19 Budgetary Contribution by Calendar Year 2017
Source: National HIV/STI Programme Financial Statements
Expenditure
The budgeted expenditure for 2017 was J$1.95B; 83% (J$1.62B) of this amount was spent.
Of the total expenditure for the year, the Principal Recipient was responsible for spending
45% (J$573.38M) while 55% (J$629.48M) was spent at the Sub-recipient level. The main
areas of under-expenditure relate to the GF NFM Grant as delays were experienced in
the finalization of external consultancies and the settling of invoices for ARVs procured
through WAMBO. Savings were also realized from the GOJ contribution made through
the Global Fund Grant.
Over the years, there have been fluctuations in the amount of resources made available to
the Programme, but expenditure was largely equivalent to the resources received (Figure
21). However, in 2016 and 2017 expenditure was lower than projected by J$286M and
J$331M, respectively. The analysis was done using calendar year figures in keeping with
the requirements of the Annual Report. The cash basis of accounting is applied in the
Programme.
Fig. 20 National HIV/STI Expenditure by Calendar Years, 2012-2017
Source: National HIV/STI Programme Financial Statements
The Programme has several components, expenditure in these areas are detailed in the
remainder of this section.
Prevention
The National Family Planning Board is the technical lead for all prevention interventions
for the national response. In 2017, the budget for prevention activities was J$400.48M.
This allocation was approximately 23% lower than the amount allocated in 2016. The
Prevention Unit expended J$359.08M or 90% of its budgeted allocation.
Most of the resources of the component are being expended at the SRs level; activities
are aimed at reducing the spread of HIV and target most at-risk populations and the
general population. The work of the Unit entails targeted interventions for MSM and FSW
populations, peer education, procuring of condoms and lubes, procuring HIV test kits
and training and capacity building for CSOs that are implementing prevention activities.
Costs related to staffing, travel assistance/stipend and support for certified skills training
for vulnerable groups were supported by the component. Significant work was also done
by the Prevention component for the Adolescent group; funding for this was provided
through the Global Fund, USAID and UNICEF.
Treatment, Care and Support

The TCS component of the national response is focused on ensuring that there is a
comprehensive system of care for PLHIV. Over the years TCS was allotted with the largest
portion of the Programme resources; 2017 was no different with the introduction of the
‘Test and Start’ initiative. A total of J$864.14M was allocated for year which represents an
increase of J$106.96 or 14% over the allocation made in 2016. The TCS Unit expended
J$740.70M or 86% of its budgeted allocation.
During the year, the Unit continued to support the national response by providing ARVs,
test kits, reagents, alternative nutrition for new-borns of HIV infected mothers and other
medicinal supplies required by the Programme based on available funding. Other
initiatives undertaken during the year was the strengthening of the case management
protocol and adherence counselling efforts, monitoring and preventing ARV resistance
and improving the standardized method of tracking adherence and ARV resistance. Other
expenditures were mainly from the GF NFM Grant resources. One of the major challenge
faced during the year under the component was the reduction in the GOJ contributions
through the recurrent budget.
Enabling Environment/Advocacy & Policy

The NFPB is the technical lead for the EE&HR/Advocacy and Policy Component. During
the year, significant worked was done through Jamaica AIDS Support for Life (JASL). In
2017 J$82.67M was allocated to the component; this was an increase of 76% over the
previous year. The component expended 86% (J$71.07M) of its budgeted allocation.
Funding for the component was made available largely through the USAID and Global
Fund NFM resources.
The component continues to work actively to reduce stigma and discrimination.
During 2017, focus was placed on implementing strategies to achieve an effective
redress framework. This involved facilitating stakeholder involvement, developing and
implementing policy and protocols on referral mechanisms and training and sensitizing
key populations.
Strategic Information
In 2017, J$67.62M was allocated for surveillance, monitoring and evaluation and research.
The component spent J$40.60M (60%) of its budgeted allocation; J$17.27M more was
spent in 2017 than in the previous year.
Strategic Information is a critical to the national response. The component is tasked with
the responsibility of collecting, collating and analyzing all the data in support of targets
and indicators for the Programme. A major achievement during the year was launch of
Treatment Site Information System using the DHIS2 platform. The component continues
to train the out stations in the use of the DHIS2, which links the database at all the treatment
sites throughout the country for HIV patient management, to ensure that information is
being captured timely and accurately. The component continues to face challenges with
unique identifier code and TSIS in that, there are confidentiality concerns surrounding the
database configuration. Also, some sites are having connectively issues when trying to
access TSIS. One major activity that was not done during the year was the completion of
the Human Rights Baseline Assessment, which was being supported through the Global
Fund resources.
Capacity Building/Administration
The successful implementation of the Programme activities is achieved through the people
and the tools that are in place to support the work to be done. Twenty-eight percent
(28%) of the annual budget was allocated to this component in 2017. The mandate of
this component was also achieved through training and capacity building activities for the
staff.
In 2017, J$516.99M was allocated for Capacity Building/Administration, of which

J$409.58M (79%) was spent. Both the budgeted allocation and expenditure for 2017
was higher than the previous year; the additional funding was made available from the
GOJ resources. The majority of the spending occurred in the following areas: staffing,
administrative fees for the SRs, audit costs, site reviews for SRs and workshops.
The diagram below shows a comparison of budgeted and actual expenditure for the
components over the years 2014 – 2017.
Table 16 Comparative Summary of Component Expenditures, 2014 - 2017
CALENDAR YEAR CALENDAR YEAR CALENDAR YEAR CALENDAR YEAR

COMPONENTS 2014 2015 2016 2017
Budget Actual Budget Actual Budget Actual Budget Actual
J$M J$M J$M J$M J$M J$M J$M J$M
Cash Basis
Prevention 329.17 311.15 288.79 285.01 520.29 441.01 400.48 359.08
Treatment Care 175.00 189.41 368.02 345.03 757.18 656.68 884.14 740.70
& Support
Monitoring & 23.68 30.56 38.47 33.75 63.21 23.33 67.62 40.60
Evaluation
Capacity 247.38 236.16 334.50 384.42 295.25 227.61 516.99 409.58
Building/
Administration
Enabling 62.95 44.03 54.81 62.14 46.91 44.16 82.67 71.07
Environment/
Policy
Sub total 838.19 838.32 1084.60 1100.34 1682.84 1392.79 1961.90 1621.08
In Kind 73.35 80.69 68.59 379.92

Contribution
Grand Total 838.19 911.67 1084.60 1181.03 1682.84 1461.38 1951.90 2000.95
Funding Sources
Global Fund NFM Grant

Funding from the Global Fund NFM Grant, which commenced in 2016 is in its second
year of implementation. It is slated to end in December 2018. The total value of the grant
is US$15.24M. The main goals of the Global Fund NFM Program are as follows:
QQ Reduce AIDS related morbidity and mortality with effective Biomedical and supporting
interventions;
QQ Reduce new HIV infections among key populations through behavioural and structural
interventions.
The resources of the Program were primarily used for the procuring of ARVs, testing
supplies, condoms, staffing (especially at the SRs) and scaling up of prevention and
advocacy activities. With the approval of the reprogrammed budget for year 2 (2017),
the funding allocation was J$762M, of which J$589.85M (77%) was liquidated. From
the unliquidated variance of J$172.47M, J$86.53M has been committed to: finalize
outstanding administrative fees to NGOs; salary costs; payments for ARVs processed
through WAMBO; support the payment of consultancies relating to the Audit Fees;
Human Rights Baseline Assessment and FSW and CSW surveys.
USAID/PEPFAR
During 2017, the USAID PEPFAR grant contributed J$415M to the Programme budget, this
is a 5% (J$19.47M) increase in the amount budgeted over the previous year. Expenditure
for the year was J$413.40 or approximately 100% of the annual budget. The resources
for the grant agreement spans two financial years; as the USAID financial year runs from
October to September, the budget and expenditure relates to USAID YRs 6 & 7, which
were being managed concurrently during the reporting period. The resources of the
project were used to achieve two main objectives under Year 6 and Year 7:
Year 6
QQ To support key population groups (MSM and SW) and PLHIV in accessing Combination
Prevention, improve retention in the clinical cascade and reduce barriers to access
and retention in care.
QQ To support health systems strengthening and the capacity of stakeholders (KP, PLHIV,
CBO/NGO) and government through use of strategic information to improve program
and policy outcomes.
Year 7
QQ To increase treatment coverage in Jamaica so that 75% of diagnosed PLHIV are on

treatment and 80% of PLHIV on ART achieve viral suppression by the end of FY 19;
QQ To improve data access, quality and use, particularly for KP.
Government of Jamaica
The GOJ contributed 39% of the cash resources of the Programme during the year.
This was made available through the recurrent budget and contributions to the USAID
and Global Fund Grants. In 2017, the GOJ contributed J$765.38 when compared with
J$646.54 in 2016. The Programme liquidated 80% (J$613.01M) of the GOJ’s allocation.
A significant portion of this funding was used to cover staff cost; J$263.37M of the total
expenditure for the year related to human resources.
During the year, the Programme benefited from in-kind contributions, from the Government
of Jamaica, valued at J$379.92M. These contributions include salaries, office space rental
and maintenance, security and janitorial services.
The diagram below shows an analysis of the budget and expenditure for the respective
funding sources during 2017.
Fig. 21 Budget vs Expenditure by Funding Source, 2017
Challenges
During the year, the Programme was faced with several challenges. These include:
QQ The significant reduction of the recurrent budget under object 25.
QQ Not receiving warrants in a timely manner after projections are submitted to the FAD
for the recurrent budget.
QQ Frequent adjustments to the budget and reallocations both at the PR and SR levels
under the USAID Grant.
QQ Scheduling conflicts, between capacity building activities and the school schedule, as
it relates to the UNICEF resources. This resulted in delays in the timely liquidation of
the resources.
QQ Changing of the reporting template and method for the Global Fund Progress report
as at December 2017.
QQ A shortage of human resources which created a backlog in the Unit. Finance staff had
to increase monitoring of the SRs while managing the day to day operations of their
individual desks.
Despite these challenges the Unit was able to submit on-time quarterly Progress Reports
to the Global Fund and the Expenditure Analysis and Financial Audit to USAID. The Unit
was able to increase monitoring and assist in strengthening internal controls within the PR
and SRs. Unqualified audit opinions were received from both the USAID and Global Fund
grants during the year.
Appraisals
The close out financial audit for the period April 2016 to March 2017 for USAID was due
on December 31, 2016. The draft report was shared with USAID as per the due date.
However, the signed report was submitted later. The audit was conducted by BDO audit
firm.
The Global Fund audit, which covers the period January to December 2017, is due to the
Global fund on March 31, 2018. The audit will be conducted by Mair Russell Grant Thorton
who has a three-year contract to conduct the NFM audit, as instructed by the Global Fund.
ADMINISTRATION
Overview
The Administration Component leads the human resource management and
administration functions of the National HIV/STI Programme. The Component plays a key
role in supporting and strengthening stakeholders both at the HSTU and field levels as
well as streamlining the planning of major activities.
Staffing
Grant funding and GOJ contribution, approved and included in the Government of
Jamaica ‘Estimates of Expenditures’, supported approximately 150 officers across the
public sector and non-governmental organizations (NGOs) working in both technical and
administrative areas. Within the 2017 calendar year, 12 new officers were on-boarded at
the Head Office while 2 officers resigned. At the field level there were challenges with the
identification and retention of some key experts such as Case Managers, Psychologist,
Peer links, Adherence Counsellor and Procurement Officers, owing to the specialized skill
set required to work with key populations and an unattractive compensation package.
Active steps were taken to address the latter through approvals sought from our donors.
At least eighty-five (85%) of all vacancies within all partner organization were filled as at
the end of 2017.
Some key vacancies were filled within the year including four posts within the newly formed
Strategic Information Unit, formerly Monitoring and Evaluation, which is responsible for
collating, analysing and disseminating reliable data for decision-making within the National
HIV/STI Programme. This restructuring was implemented during the year in response
to the need for strategic information that exceeded the boundaries of monitoring and
evaluation to include surveillance, research and health information systems.
The Treatment Component was restructured to include a Clinical Mentor, an additional
Programme Development Officer and a Pharmacist. All the vacancies in the Unit were
filled, except for the Pharmacist position which was still vacant at the end of year. In 2017,
a process also commenced to re-activate two GOJ positions. This is a collaborative process
with the HR Department within the Ministry and remains a work in progress at the end of
the calendar year.
The Administrative Unit played a key role for contract officers and SRs and in some
case facilitated gratuity payments for staff. Active follow up was done with the various
internal departments of the Ministry as well as individuals entities. Mechanisms are being
streamlined to strengthen the efficiency of the process. The recommendations of the
internal auditor’s report are being implemented as far as is practicable.
With the push to transition from donor funding to domestic reliance, one of the missions
of the HSTU is to ensure the full integration and absorption of staff within and by their
respective entities. Efforts will be revisited within the upcoming calendar year to
collaborate with our Government affiliated partners to map out their sustainability cost,
gradual/progressive absorption by their home entity over time and support of their efforts
to incorporate their programme cost including HR costing in their budgetary submissions
to the Ministry of Finance and the Public Service (MoFPS).
Team Meetings
In 2017, the Administrative section of the HSTU coordinated and hosted a total of five (5)
Administrative Regional Team Meetings with the Regional Health Authorities and non-
governmental entities. Components of the Programme involved in these administrative
meetings were Finance, Procurement, Grants Management and Human Resource &
Administration. The ART/ANT meetings were designed to provide the teams with an
avenue to discuss the challenges and best practices in administering grant resources
at the site level. Some of the key areas highlighted during the meetings held in 2017
were maintenance of human resource files, audit findings and how to mitigate them,
understanding and application of the procurement guidelines, grant updates and
progress of technical deliverables. The meetings provided a forum to build capacity and
share information across entities and an opportunity to understand the site-level issues that
have the potential to delay Programme implementation and identify mitigating strategies.
Ultimately, the aim is to deliver a high standard of administrative support to ensure the
success of the National HIV/STI Programme.
Monitoring and Oversight

During 2017, there was an increase in monitoring and oversight to field stakeholders
to review human resource records and practices and support related functions, such as
recruitment of officers and/or providing the requisite document templates to ensure
compliance. These visits were made mandatory as a strategy to mitigate against adverse
audit findings in HR management and other areas. Written feedback and close out
meetings enhanced the quality of files. Inroads were made in respect of corrective actions;
however, the site reviews still revealed some adverse findings in respect of adherence to
internal controls and quality of records. It was also observed that there is a protracted
delay in the implementation of recommended corrective actions at subsequent site
reviews. Check-lists were developed and shared with the entities to guide the processes
being undertaken. The HSTU continues to extend support to ensure that consistently high
standards are maintained.
HIV Annual Review

The HIV/STI/Tb Unit held its 27th Annual Review and Planning Retreat from November
22 – 24, 2017, under the theme: “Navigating with Purpose: Examining the status of the
National HIV Response and planning the way forward”. The focus was particularly relevant
as the national response sought to ensure that all Jamaicans access optimum healthcare
in respect of their sexual and reproductive rights. The meeting served as a forum to
review the national HIV response over the last calendar year, highlight best practices and
explore ways to treat with the gaps in the response going forward. Two hundred and
Fifty (250) participants, including representatives from the HSTU and the four Regional
Health Authorities, National Family Planning Board, People Living with HIV/AIDS, non-
government organisations, Ministry Departments and Agencies, the Joint United Nations
Programme on HIV/AIDS, the United States Agency for International Development
President Emergency Plan for AIDS Relief, the Global Fund to fight AIDS, Tuberculosis and
Malaria and other international and civil society organisations were in attendance.
The event was coordinated by the Administrative Component with support from the
Administrative Officers across the Programme.
Capacity Building
The Programme is vested in developing staff capacity to ensure that individuals have the
skills they need to function effectively in the response. Budgetary support, through GOJ
Object 29, ‘Scholarship and Awards’ facilitated training for officers at the RHAs and HST
Unit. The topics included Training & Development, INPRI and Cabinet Submission and
Drop box.
Notably, there are ongoing training opportunities within each component involving the
HSTU and field officers for each specialized area. These are delivered in a classroom
setting and on a one-on-one basis, as needed.
Office Space
Lack of adequate office space remained a challenge for the HSTU necessitating creative
solutions to ensure adequate workspace for the team. Options for relocating staff and files
to alternative spaces are being explored; financial support would be required.
New Initiatives
The Admin Corner

During the year, a monthly newsletter was created to inform and educate HSTU staff on key
matters including: 1) management of attendance through proper use of the attendance
register, which can impact timeliness and accuracy of gratuity payments; 2) content
of health insurance plan and 3) new human resource and administrative procedures
developed by the MOH.
HSTU Orientation Manual

During the year, the Unit developed an Orientation Manual with accompanying delivery
schedule for new staff. New officers are now oriented on the operations of the Ministry of
Health and the HSTU through formal orientation sessions using written manuals to ensure
a seamless on-boarding process.
The Acquisition of Prevention Testing Units

The Administrative Component in conjunction with the Procurement Unit led the
procurement/retrofitting of a coaster bus, which was assigned to the NERHA and SERHA.
The bus will be used for Prevention and Treatment work within the respective regions.
HIV & AIDS FACTS AND FIGURES 2017
DATA TABLES
Table 1: Summary of HIV Cases Diagnosed by Year and Sex, 1982 - 2017
YEAR MALE (%) FEMALE (%) UNKNOWN (%) TOTAL

1982-1996 2770 62.7% 1613 36.5% 37 0.8% 4420
1997 698 60.9% 447 39.0% 2 0.2% 1147
1998 652 58.6% 460 41.3% 1 0.1% 1113
1999 831 56.0% 651 43.9% 2 0.1% 1484
2000 853 54.4% 714 45.6% 0 0.0% 1567
2001 795 50.0% 791 49.7% 5 0.3% 1591
2002 729 51.7% 681 48.3% 1 0.1% 1411
2003 844 50.1% 838 49.8% 1 0.1% 1683
2004 865 45.8% 1023 54.2% 0 0.0% 1888
2005 896 45.7% 1063 54.3% 0 0.0% 1959
2006 994 48.3% 1063 51.7% 1 0.0% 2058
2007 823 48.4% 879 51.6% 0 0.0% 1702
2008 944 47.5% 1040 52.4% 2 0.1% 1986
2009 798 48.2% 859 51.8% 0 0.0% 1657
2010 849 52.1% 782 47.9% 0 0.0% 1631
2011 823 49.2% 850 50.8% 0 0.0% 1673
2012 835 51.3% 793 48.7% 0 0.0% 1628
2013 680 53.7% 586 46.3% 0 0.0% 1266
2014 585 49.2% 604 50.8% 0 0.0% 1189
2015 543 51.1% 519 48.9% 0 0.0% 1062
2016 661 53.3% 580 46.7% 0 0.0% 1241
2017 621 51.9% 576 48.1% 0 0.0% 1197
Total 19089 52.2% 17412 47.6% 52 0.1% 36553
Table 2: Summary of Aids Deaths in Jamaica, 1982 – Dec. 2017
YEAR MALE FEMALE TOTAL

1982-1996 768 428 1288
1997 248 145 375
1998 233 142 442
1999 341 207 538
2000 359 257 557
2001 329 258 616
2002 402 285 696
2003 380 269 677
2004 378 285 700
2005 306 203 548
2006 263 168 513
2007 202 117 293
2008 236 164 429
2009 234 143 390
2010 198 135 397
2011 234 158 342
2012 155 101 282
2013 169 129 159
2014 121 96 196
2015 136 118 136
2016 185 133 260
2017 170 139 293
Total 6047 4080 10127
Table 3: Summary of Aids Death by Parish in Jamaica, 1982 – Dec. 2017
PARISH 2017 1982 - 2017

Kingston & St Andrew 183 3850
St Thomas 3 124
Portland 2 215
St Mary 4 375
St Ann 9 449
Trelawny 6 310
St James 8 1622
Hanover 3 307
Westmoreland 7 673
St Elizabeth 5 286
Manchester 7 341
Clarendon 6 284
St Catherine 45 1265
Parish Unknown 5 19
Overseas address 0 7
Total 293 10127
Table 4: Rate of Persons Living with HIV/AIDS in Jamaica by Parish of Residence (2017
and cumulative)
RATE PER
TOTAL HIV/ DEATHS AMONG PLHIV TOTAL PARISH
PARISH 100,000
AIDS CASES 1982-2017 PLHIV POP.
POPULATION
1982 - 2017 N Rate 1982 - 2017 STATIN 2017
Kingston & St 13056 3850 0.29 9206 670312 1373.4
Andrew
St Thomas 614 124 0.20 490 95015 515.7
Portland 804 215 0.27 589 82710 712.1
St Mary 1203 375 0.31 828 114959 720.3
St Ann 2533 449 0.18 2084 174343 1195.3
Trelawny 1007 310 0.31 697 76043 916.6
St James 4799 1622 0.34 3177 185846 1709.5
Hanover 937 307 0.33 630 70322 895.9
Westmoreland 2081 673 0.32 1408 145746 966.1
St Elizabeth 968 286 0.30 682 151961 448.8
Manchester 1269 341 0.27 928 192036 483.2
Clarendon 1912 284 0.15 1628 247902 656.7
St Catherine 5018 1265 0.25 3753 521669 719.4
Parish Unknown 319 19 NA 300 N/A N/A
Overseas 33 7 NA 26 N/A N/A
address
Total 36553 10127 0.28 26426 2728864 968.4
Table 5: HIV Seroprevalence (%) Among ANC Attendees by Parish – 2017
PARISH TOTAL TESTED TOTAL POSITIVE % POSITIVE (95% CI) EXACT

Kingston & St 1313 18 1.37 0.87 – 2.16
Andrew
St Catherine 1,057 12 1.14 0.65 – 1.97
St Ann 523 2 0.38 0.05 – 1.37
Clarendon 803 2 0.25 0.03 – 0.90
St James 460 8 1.74 0.88 – 3.39
Westmoreland 610 1 0.16 0.00 – 0.91
Total 4766 43 0.90 0.67 – 1.21
Table 6: HIV Seropositive Prevalence Among STI Clinic Attendees by Parish – 2017
PARISH TOTAL TESTED TOTAL POSITIVE % POSITIVE (95% CI) EXACT

Kingston & St 1224 76 6.21 4.92 – 7.71
Andrew
St Catherine 307 8 2.61 1.13 – 5.07
St Ann 181 3 1.66 0.34 – 4.77
Clarendon 82 1 1.22 0.03 – 6.61
St James 275 7 2.55 1.03 – 5.17
Westmoreland 34 2 5.88 0.72-19.68
Total 2103 97 4.61 3.76 – 5.60

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This document presents the National HIV/STI Programme report covering the period

January to December 2017. It reflects the implementation of the National Integrated

STRATEGIC INVESTMENTS IN THE FIGHT AGAINST HIV/AIDS 1

STRENGTHENING THE APPROACH TO FIGHTING HIV/AIDS 2

KEY ACHIEVEMENTS IN THE FIGHT AGAINST HIV/AIDS 3

CHAPTER 1: EPIDEMIOLOGY OF HIV IN JAMAICA 7

NEWLY DIAGNOSED CASES  10

RISK BEHAVIOURS AND OTHER FACTORS FUELLING THE EPIDEMIC IN JAMAICA 12

CHAPTER 2: HEALTH PROMOTION AND PREVENTION 13

HIV PREVENTION AMONG KEY POPULATIONS 16

Female Sex Workers  20

GENERAL POPULATION INTERVENTIONS 24

Condom Demonstration and Distribution 24

CAPACITY BUILDING OF OUTREACH WORKERS 31

CHAPTER 3: TREATMENT, CARE AND SUPPORT 33

TEST AND START MEDIA CAMPAIGN 34

Provider Initiated Testing and Counselling  45

Treatment with ARVs 46

Laboratory Monitoring Tests  47

Early Diagnosis of HIV Exposed Infants - DNA PCR Testing 48

Viral Load Testing 49

Site Mentoring Team 49

Quality Improvement Programme 51

The Way Forward 54

SEXUALLY TRANSMITTED INFECTIONS 54

The Way Forward 56

CHAPTER 4: ADOLESCENT HEALTH 59

TEEN HUB- HALF WAY TREE TRANSPORT CENTRE 59

YOUTH AND ADOLESCENT TECHNICAL WORKING GROUP 61

ADOLESCENT STANDARDS AND CRITERIA  61

CHAPTER 5: ENABLING ENVIRONMENT & HUMAN RIGHTS 63

ADDRESSING GAPS IN POLICY AND LEGISLATIVE FRAMEWORK  65

HUMAN RIGHTS AND POLICY MONITORING  67

NON-DISCRIMINATION IN HEALTH SETTINGS 69

REDRESS FRAMEWORK IN ALL SETTINGS 71

THE WAY FORWARD 73

CHAPTER 6: STRATEGIC INFORMATION 75

Hepatitis & Tuberculosis 77

Sexually Transmitted Infections 77

HEALTH INFORMATION SYSTEM 77

THE WAY FORWARD 79

CHAPTER 7: GRANTS MANAGEMENT 81

CONTRACTS AND AGREEMENTS 85

Overview of the Structure 85

Overview of the Partners 85

GRANT MANAGEMENT UPDATES 89

SUMMARY OF CHALLENGES – TECHNICAL AREAS 90

SUCCESS STORIES & THE WAY FORWARD 92

PROCUREMENT THROUGH THE GOJ & DONOR MECHANISM 96

Zero-Rating of Suppliers Invoices 96

IMPROVING PROCUREMENT EFFICIENCY 96

Goods Specialist Sector Committees 97

CHAPTER 9: FINANCE & ADMINISTRATION 99

Funding Sources  104

Team Meetings  108

Monitoring and Oversight 108

HIV Annual Review 109

Capacity Building  109

Office Space 109

New Initiatives 110

STRATEGIC INVESTMENTS IN THE FIGHT AGAINST HIV/AIDS 1

STRENGTHENING THE APPROACH TO FIGHTING HIV/AIDS 2

KEY ACHIEVEMENTS IN THE FIGHT AGAINST HIV/AIDS 3

CHAPTER 1: EPIDEMIOLOGY OF HIV IN JAMAICA 7

NEWLY DIAGNOSED CASES 10

RISK BEHAVIOURS AND OTHER FACTORS FUELLING THE EPIDEMIC IN JAMAICA 12

CHAPTER 2: HEALTH PROMOTION AND PREVENTION 13

HIV PREVENTION AMONG KEY POPULATIONS 16

Female Sex Workers 20

GENERAL POPULATION INTERVENTIONS 24

Condom Demonstration and Distribution 24

CAPACITY BUILDING OF OUTREACH WORKERS 31

CHAPTER 3: TREATMENT, CARE AND SUPPORT 33

TEST AND START MEDIA CAMPAIGN 34

Provider Initiated Testing and Counselling 45

Treatment with ARVs 46

Laboratory Monitoring Tests 47

Early Diagnosis of HIV Exposed Infants - DNA PCR Testing 48

Viral Load Testing 49

Site Mentoring Team 49

Quality Improvement Programme 51

The Way Forward 54

SEXUALLY TRANSMITTED INFECTIONS 54

The Way Forward 56

CHAPTER 4: ADOLESCENT HEALTH 59

TEEN HUB- HALF WAY TREE TRANSPORT CENTRE 59

YOUTH AND ADOLESCENT TECHNICAL WORKING GROUP 61

ADOLESCENT STANDARDS AND CRITERIA 61

CHAPTER 5: ENABLING ENVIRONMENT & HUMAN RIGHTS 63

ADDRESSING GAPS IN POLICY AND LEGISLATIVE FRAMEWORK 65

HUMAN RIGHTS AND POLICY MONITORING 67

NON-DISCRIMINATION IN HEALTH SETTINGS 69

REDRESS FRAMEWORK IN ALL SETTINGS 71

THE WAY FORWARD 73

CHAPTER 6: STRATEGIC INFORMATION 75

Hepatitis & Tuberculosis 77

Sexually Transmitted Infections 77

HEALTH INFORMATION SYSTEM 77

THE WAY FORWARD 79

CHAPTER 7: GRANTS MANAGEMENT 81

CONTRACTS AND AGREEMENTS 85

Overview of the Structure 85

Overview of the Partners 85

GRANT MANAGEMENT UPDATES 89

SUMMARY OF CHALLENGES – TECHNICAL AREAS 90

SUCCESS STORIES & THE WAY FORWARD 92

PROCUREMENT THROUGH THE GOJ & DONOR MECHANISM 96

Zero-Rating of Suppliers Invoices 96

IMPROVING PROCUREMENT EFFICIENCY 96

Goods Specialist Sector Committees 97

CHAPTER 9: FINANCE & ADMINISTRATION 99

Funding Sources 104

Team Meetings 108

Monitoring and Oversight 108

HIV Annual Review 109

Capacity Building 109

Office Space 109

New Initiatives 110

HIV & AIDS FACTS AND FIGURES 2017 111

DATA TABLES 112