RESUMO
BACKGROUND: The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC. METHODS: Under the technical guidance of CAREC and CDC, the Ministry organized a technical working group which included representatives from key national HIV program services and technical assistance partners. This working group reviewed internationally-recognized best practices for HIV rapid testing and proposed a program that could be integrated into the national HIV programs of Trinidad and Tobago. The working group wrote a consensus protocol, defined certification criteria, prepared training materials and oversaw implementation of "same-visit" HIV testing at two pilot sites. RESULTS: A Ministry-of-Health-supported program of "same-visit" HIV testing has been established in Trinidad and Tobago. This program provides confidential testing that is independent of laboratory confirmation. The program allows clients who want to know their HIV status to obtain this information during a single-visit to a testing location. Testers who are certified to provide testing on behalf of the Ministry are also counselors. Non-laboratory personnel have been trained to provide HIV testing in non-laboratory locations. The program includes procedures to assure uniform quality of testing across multiple testing sites. Several procedural and training documents were developed during implementation of this program. This report contains links to those documents. CONCLUSIONS: The Ministry of Health has implemented a program of "same-visit" HIV testing in Trinidad and Tobago. This program provides clients confidential HIV test reports during a single visit to a testing location. The program is staffed by non-laboratory personnel who are trained to provide both testing and counseling in decentralized (non-laboratory) settings. This approach may serve as a model for other small countries.
Assuntos
Sorodiagnóstico da AIDS , Infecções por HIV/diagnóstico , Implementação de Plano de Saúde/métodos , Visita a Consultório Médico , Desenvolvimento de Programas , Centers for Disease Control and Prevention, U.S. , Certificação , Protocolos Clínicos/normas , Feminino , Pessoal de Saúde/educação , Política de Saúde , Humanos , Masculino , Materiais de Ensino , Trinidad e Tobago , Estados UnidosRESUMO
BACKGROUND: The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC. METHODS: Under the technical guidance of CAREC and CDC, the Ministry organized a technical working group which included representatives from key national HIV program services and technical assistance partners. This working group reviewed internationally-recognized best practices for HIV rapid testing and proposed a program that could be integrated into the national HIV programs of Trinidad and Tobago. The working group wrote a consensus protocol, defined certification criteria, prepared training materials and oversaw implementation of "same-visit" HIV testing at two pilot sites. RESULTS: A Ministry-of-Health-supported program of "same-visit" HIV testing has been established in Trinidad and Tobago. This program provides confidential testing that is independent of laboratory confirmation. The program allows clients who want to know their HIV status to obtain this information during a single-visit to a testing location. Testers who are certified to provide testing on behalf of the Ministry are also counselors. Non-laboratory personnel have been trained to provide HIV testing in non-laboratory locations. The program includes procedures to assure uniform quality of testing across multiple testing sites. Several procedural and training documents were developed during implementation of this program. This report contains links to those documents. CONCLUSIONS: The Ministry of Health has implemented a program of "same-visit" HIV testing in Trinidad and Tobago. This program provides clients confidential HIV test reports during a single visit to a testing location. The program is staffed by non-laboratory personnel who are trained to provide both testing and counseling in decentralized (non-laboratory) settings. This approach may serve as a model for other small countries.
Assuntos
Humanos , Masculino , Feminino , Sorodiagnóstico da AIDS , Certificação , Protocolos Clínicos/normas , Infecções por HIV/diagnóstico , Pessoal de Saúde/educação , Implementação de Plano de Saúde/métodos , Política de Saúde , Visita a Consultório Médico , Desenvolvimento de Programas , Materiais de Ensino , Trinidad e Tobago , Estados UnidosRESUMO
OBJECTIVE: To establish and evaluate an internet-based pilot programme for sentinel surveillance of emerging health problems among the private sector physicians in three Caribbean countries. DESIGN AND METHODS: Participating physicians were identified in cooperation with local chapters of the Caribbean College of Family Physicians in Jamaica, Trinidad andTobago and St Lucia. A menu-driven Epi Info programme was used for reporting as well as on-site analysis of individual site data. Hardware was installed,participants were trained and surveillance data entry began in September-October, 1999. Three disease entities were chosen by consensus as the initial targets for surveillance - diarrhoeal disease, fever/rash syndrome, and sexually transmitted diseases. Evaluation criteria for the programme included the achievement of timely data entry and reporting, the establishment of regular feedback, and the regular use of internet-based data transfer for reporting and communication. RESULTS: The practices of twenty-one physicians were chosen as initial pilot sites. All Ministries valued the enhancement of their existing surveillance through the project and cited improved public-private partnership as a positive impact. Reduced cost of communication through use of theinternet was partially offset by the high initial cost of computer hardware, and the relatively high cost of local internet connections. Other limitations included a constrained communication infrastructure, limited baseline computer skills administrative barriers, and cost. CONCLUSION: The strengths of the programme were simplicity; potential for improved data quality; and improved competency in computer skills and surveillance among participating physicians. Proposed changes in the next phase include improvement in the software programme and development of a more extended network and e-mail forum. (Au)
Assuntos
Humanos , Vigilância de Evento Sentinela , Internet/estatística & dados numéricos , Projetos Piloto , Região do Caribe , Papel do MédicoRESUMO
Simultaneous or sequential circulatin of dengue serotypes 1, 2 and 4 has been detected in several Caribbean countries. This may increase the chances of persons experiencing secondary infections with heterotypic dengue serotypes. Consequently there may be an increased risk of dengue haemorrhagic fever/dengue shock syndrome. Furthermore, Caribbean populations may not have been exposed to dengue serotype 3 in over 20 years and a large proportion of the population may not have immunity to this virus. Dengue type 3 has been recently isolated during epidemics in Central America and its introduction poses a further threat to the Caribbean. Sentinel surveillance was undertaken in a pilot study during August to December 1995 to improve the monitoring of Dengue serotypes on the islands of Jamaica, Trinidad and Dominica. Virological investigations were performed on a total of 92 patients who presented at designated community and hospital health care facilities on the 3 islands. Dengue virus types 1 and 2 were isolated from Jamaican patients. No dengue isolates were obtained from Dominica or Trinidad, although IgM capture ELISA test results suggested current or recent exposure to dengue virus in one Dominican patient. Improved surveillance for dengue could lead to detection of the emergence of new dengue serotypes, or detection of increased virus activity. Using surveillance data to target efforts to control the Aedes aegypti mosquito vector in areas where infection cases reside could reduce the impact of dengue disease in the Caribbean. (AU)
Assuntos
Humanos , Dengue/epidemiologia , Vigilância de Evento Sentinela , Jamaica , Trinidad e Tobago , Região do Caribe , Aedes , Controle de MosquitosRESUMO
One hundred and twenty delegates at a major hotel in Trinidad attended a breakfast meeting soon after which some complained of being unwell and sought medical attention. 17 were treated of whom 2 were admitted to the Port of Spain General Hospital, 6/22 were admitted to a private hospital and 5 were treated by a private practitioner. Stool samples or rectal swabs were taken from the in-patients and from 3 hotel staff members who were also ill. Samples of the food served were sent for analysis. Of 30 delegates who were investigated, 24 had symptoms of vomiting and 17 had diarrhoea in combination with other symptoms. The mean incubation time was 3 hours, suggestive of toxin ingestion. The food specfic attack rates identified "saltfish buljol" as the contaminated food. All stool samples taken from the hospitalized delegates yielded Staphylococcus aureus which was also found in the swabs from the hotel staff members. All S. aureus isolates were sent for phage grouping and typing. Three delegates and one food item shared the identical phage group with that from the nasal swab of a worker. The other hospitalized delegate and another food item shared the identical phage group from the rectal swab of the same worker. It was concluded that the outbreak was due to food contaminated with Staphylococcus aureus originating from hotel staff. (AU)
Assuntos
Humanos , Doenças Transmitidas por Alimentos/diagnóstico , Staphylococcus aureus/isolamento & purificação , Trinidad e Tobago , Higiene dos AlimentosRESUMO
A KAPB study on non-communicable disease conducted in Trinidad and Tobago in 1989 measured the prevalence of selected behavioural risk factors for the non-communicable diseases in the adolescent and adult populations. A two-staged sample of 1,700 households was designed to interview 4,000 adults and 33 adolescents (15 - 19 years old). A total of 1,448 (36 percent of target sample) persons, including 306 adolescents (16 - 19 years old), was interviewed; 4.8 percent of adolescent males and 14.9 percent of adult males were former or current smokers (z 100 cigarettes per lifetime). Smoking started in most cases before age 25 years. One in 3 of all smokers had attempted to stop smoking but were susceptible to advertising. Forty-two point five per cent (42.5 percent) of adolescent males, 11.3 percent of adolescent females and 21.9 percent of adult females were drinking at least once per month. Acute heavy drinking (z 5 drinks on a single occasion) was more prevalent in adolescent females than in adult females, pointing to a change in female drinking behaviour (AU)