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First CHART Caribbean Conference on the Clinical Management of HIV/AIDS: A Multidisciplinary Team Approach

The First CHART Caribbean Conference on the Clinical Management of HIV/AIDS: A Multidisciplinary Approach was held June 16th – 19th at the Half Moon Hotel in Montego Bay, Jamaica. More than 350 participants from 27 countries in the Caribbean region came together to learn the latest information about caring for people with HIV/AIDS. The conference was opened by the Honorable John Junor, Jamaica’s Minister of Health, and special greetings were delivered by Ms. Karen D. Turner, Mission Director, USAID/Jamaica & the Caribbean Regional Program; Dr. Michael Johnson, Director, Centers for Disease Control and Prevention/Global AIDS Program Caribbean Office; Dr. Bilali Camara, Head, Special Program on Sexually Transmitted Infections, Caribbean Epidemiology Centre; Renee West-Mendoza, Chief Operations Officer, Caribbean Coalition of National AIDS Programme Coordinators; and Dr. Brendan Bain, Director, CHART Regional Coordinating Unit, University of the West Indies.

It is often stated that the Caribbean Region has the highest HIV prevalence rate of any region of the world outside of sub-Saharan Africa. To underscore the point, 9 of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean basin. The good news, however, is that antiretroviral drugs (ARVs) are increasingly accessible to those who need them, and with the growth in resources from the Global Fund, the World Bank, and other donors, promise to become even more so in the very near future. While this is an extremely positive development, it highlights the urgent need to develop infrastructure for providing care and to train health care providers from across the Caribbean Region who will be counseling and testing for HIV and managing and administering therapies for HIV-infected individuals.

This conference was the first of its type on such a scale in the region, focusing on a multidisciplinary team approach. The goal was to increase human capacity for the care, treatment and support of people living with HIV/AIDS in the Caribbean Region. This conference provided a unique opportunity to present the draft Caribbean Guidelines for the Care and Treatment of Persons with HIV Infection, and then reinforce key components of the guidelines through focused presentations and workshops. These guidelines, developed by the Caribbean Epidemiology Centre and with technical and scientific contributions from many experts in the region, will help physicians, nurses and other health workers effectively care for people with HIV. In addition, the conference was the official kick-off for CHART, which promises to play a leading role in HIV clinical training throughout the Caribbean.

Faculty included some of the most prominent leaders in HIV/AIDS treatment in the region, including Dr. Jean William Pape of Haiti, Dr. Nicholas Adomakoh of Barbados, Dr. Perry Gomez of Bahamas, and Dr. Celia Christie-Samuels, Dr. Peter Figueroa, Dr. Kevin Harvey and Prof. Brendan Bain of Jamaica. Internationally known experts included Dr. Lynne Mofenson of the US National Institutes of Health, Dr. Michael Saag of the University of Alabama at Birmingham, Dr. Jonathan E. Kaplan of the Centers for Disease Control and Prevention-Global AIDS Program, and Dr. King Holmes of the University of Washington.

Several disciplines were represented, including physicians, nurses and midwives, counselors and social workers, psychologists, pharmacists, dentists, laboratory technicians, and health educators. More than 30 people living with HIV/AIDS participated, coming from five countries. The vast majority of conference participants are actively providing care to HIV/AIDS patients or plan to do so in the near future. Conference attendees reflect the rich diversity of the region, traveling from The Bahamas, the Dominican Republic, Guyana, Haiti, the Netherland Antilles, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Turks and Caicos Islands, and many other Caribbean countries. Simultaneous interpretation into both French and Spanish was provided.

The CHART conference was notable for several reasons. A multidisciplinary team approach was modeled by presenters and reflected in the pool of conference participants. Clinical case studies were used throughout the conference in tandem with an audience response system, encouraging more interaction on the part of participants. The plenary sessions reflected the priorities of the new draft regional treatment guidelines, while the workshops created a space for examining how to implement these best practices, based on the experiences of strong country programs. These same guidelines were made available on CD-ROM to all participants, with clinical pocket resources reinforcing the most critical content.

Several evaluation strategies were used to gather data on the effectiveness and impact of the training on participants. Overall, conference participants consistently reported significant strengthening of their skills and knowledge of several HIV-related topics, including the ability to describe and assess clinical and socio-behavioral issues around adherence and antiretroviral therapy; preventing mother-to-child transmission of HIV and caring for HIV-infected infants; diagnosing and managing opportunistic infections in HIV-infected patients; and designing a team-based approach to HIV care and treatment. These self-reported improvements were supported by an increase in pre/post-test scores, in some instances as much as a 27% improvement for individual questions.

In addition to improving their clinical practice in caring for and treating HIV-infected patients, participants reported that the conference helped increase their understanding of the needs and challenges faced by persons living with and affected by HIV/AIDS. Several reported that, as a result of the conference, they would integrate a more multidisciplinary approach to care and they better understood the need to strengthen clinical referral systems. Participants also noted that the content and presentation styles of conference faculty would help improve their own clinical training and teaching skills. This is of special importance, given the need to increase the number of trained providers in order to support scale-up of HIV care and treatment.

The conference organizers are committed to a regional approach to the management of HIV/AIDS, and hope that the relationships fostered at the conference will be the beginning of ongoing collaborations that support both regional and multidisciplinary approaches to care and treatment.

The conference was sponsored by CHART -- The Caribbean HIV/AIDS Regional Training Network. The CHART Initiative began in 2001 under the leadership of the Caribbean Community (CARICOM) Secretariat and calls for training centers to be established in the Bahamas, Barbados, Haiti, Jamaica, Trinidad & Tobago, and perhaps other sites as well. The CHART plan reflects an important lesson learned in the Caribbean?the need for regional unity when addressing problems that have personal and societal costs too great for any individual nation to bear. Its primary purpose is to address the severe shortage of health care personnel in the Caribbean region who are trained in HIV/AIDS, particularly in the clinical management of the HIV-infected patient. The work of CHART is facilitated by a Regional Coordinating Unit, which is part of the University of the West Indies HIV/AIDS Response Programme (UWI HARP) on the Mona Campus of the University of the West Indies in Kingston, Jamaica. CHART collaborators include the Caribbean Epidemiology Centre (CAREC), the Coalition of Caribbean National AIDS Programme Coordinators (CCNAPC), Pan Caribbean Partnership Against HIV/AIDS (PANCAP) and other local, regional, and international stakeholders.

The CHART Network is currently funded through a collaborative effort by the US Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA) and the United States Agency for International Development (USAID), with additional support from UNAIDS.