Reduction in time to viral suppression among persons living with HIV in Jamaica between 2017-2019.

INTRODUCTION: HIV viral suppression is important for effective treatment and for reducing new infections. In 2019, only 66% of persons on antiretroviral treatment (ART) in Jamaica were virally suppressed. We aim to compare time to viral suppression by ART initiation year and type of treatment site to understand the implications for programming. METHODS: We assessed time to viral suppression among 4560 persons who received viral load testing either pre or post ART initiation from 2017-2019. We used descriptive statistics and Kaplan-Meier estimates to compare survival curves by ART year (2017, 2018, 2019), sex and type of treatment site (public and non-governmental organizations). Persons were censored if suppression was not achieved. Mixed effects Cox regression was used to determine the effect of covariates on the likelihood of viral suppression. We report hazard ratios and 95% confidence intervals. RESULTS: Pre-ART viral load testing decreased from 36% in 2017 to 30% in 2019. For post-ART viral load tests, approximately 78% (n = 1589) of persons achieved suppression, 51% (n = 809) were female and 86% (n = 1341) used a public treatment site. The median time to suppression decreased by 3 months from 2017 to 2019. The likelihood of suppression was almost 2 times greater in 2018 (HR = 1.56, CI = 1.39-1.75) and 3 times greater in 2019 (HR = 3.17, CI = 2.76-3.64) compared to 2017. NGO treatment sites were also significantly associated with the likelihood of viral suppression compared to public sites. CONCLUSION: Pre-ART viral load testing and the time to viral suppression decreased over three years. Initiating ART after 2017 and early use of NGO treatment sites were found to significantly increase the likelihood of achieving suppression. This demonstrates improvements in the national HIV response but there is need to increase the number of persons on ART and achieving viral suppression.

Correction: HIV program outcomes for Jamaica before and after "Treat All": A population-based study using the national treatment services database.

[This corrects the article DOI: 10.1371/journal.pone.0255781.].

Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean.

Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.

A review of immunization legislation for children in English- and Dutch-speaking Caribbean countries / Revisión de los marcos legislativos sobre vacunación infantil en países de habla inglesa y neerlandesa del Caribe / Revisão da legislação relativa à imunização em crianças nos países do Caribe de língua inglesa e holandesa

ABSTRACT Objective. To assess the legislative frameworks concerning childhood vaccination in the English- and Dutch-speaking Caribbean and propose a model legislative framework for Caribbean countries. Methods. This study included a survey of 22 countries and territories in the Caribbean regarding legal vaccination mandates for school entry, budget allocations, sanctions, or exemptions. A legal consultant conducted a comprehensive search and analysis of legislation regarding vaccination among 13 Caribbean countries/territories. A comparative analysis of the legislation under five themes—legislative structure, mandatory vaccination, national immunization schedule, sanctions, and exemptions—formed the basis for the proposed model legislation. Results. Among the 22 Caribbean countries/territories, 17 (77%) had legislation mandating vaccination, 16 (94%) mandated vaccination for school entry, 8 (47%) had a dedicated budget for immunization programs, and 13 (76%) had no legislated national schedules. The source of legislation includes six (35%) using the Education Act, eight (47%) the Public Health Act, and five (29%) a free-standing Vaccination Act. Three countries/territories—Jamaica, Montserrat, and Saint Lucia—had immunization regulations. In 12 (71%) of the 17 countries with legislation, sanctions were included, and 10 (59%) permitted exemptions for medical or religious/philosophical beliefs. Conclusions. Several countries in the Caribbean have made failure to vaccinate a child an offense. By summarizing the existing legislative frameworks and approaches to immunization in the Caribbean, the analysis guides policymakers in making effective changes to immunization legislation in their own countries.

RESUMEN Objetivo. Evaluar los marcos legislativos relativos a la vacunación infantil en el Caribe de habla inglesa y neerlandesa y proponer un modelo de marco legislativo para los países del Caribe. Métodos. En este estudio se incluyó una encuesta en 22 países y territorios del Caribe sobre los requisitos legales de vacunación para el ingreso escolar, asignaciones presupuestarias, sanciones o exenciones. Un consultor jurídico realizó una búsqueda y un análisis exhaustivos de la legislación relativa a la vacunación en 13 países y territorios del Caribe. Un análisis comparativo de la legislación dividido en cinco temas (estructura legislativa, vacunación obligatoria, calendario nacional de vacunación, sanciones y exenciones) formó la base del modelo de legislación propuesto. Resultados. Entre los 22 países y territorios del Caribe, 17 (77%) contaban con leyes sobre vacunación obligatoria, 16 (94%) exigían la vacunación para el ingreso escolar, 8 (47%) tenían un presupuesto dedicado a los programas de vacunación y 13 (76%) no disponían de calendarios nacionales estipulados por ley. Entre las fuentes de la legislación, seis países y territorios (35%) empleaban la ley de educación, ocho (47%) la ley de salud pública y cinco (29%) una ley independiente de vacunación. Tres países y territorios —Jamaica, Montserrat y Santa Lucía— disponían de regulaciones sobre vacunación. Doce (71%) de los 17 países con legislación tenían sanciones y 10 (59%) permitían exenciones por creencias médicas o religiosas o filosóficas. Conclusiones. Varios países del Caribe han tipificado como delito el no vacunar a un niño o niña. Al resumir los enfoques y marcos legislativos existentes para la vacunación en el Caribe, este análisis ofrece orientaciones a los responsables de formular las políticas para que realicen modificaciones efectivas en la legislación relativa a la vacunación en sus propios países.

RESUMO Objetivo. Avaliar as estruturas da legislação relativas à vacinação em crianças no Caribe de língua inglesa e holandesa e propor um modelo de legislação para os países caribenhos. Métodos. Este estudo incluiu uma pesquisa relativa à exigência legal em 22 países e territórios do Caribe de vacinação para admissão em escolas, alocações orçamentárias, sanções ou isenções. Um consultor jurídico realizou ampla pesquisa e análise da legislação relativa à vacinação em 13 países/territórios do Caribe. Uma análise comparativa da legislação referente a cinco temas - estrutura legislativa, vacinação obrigatória, cronograma nacional de imunização, sanções e isenções - formou a base para o modelo de legislação proposto. Resultados. Entre os 22 países/territórios caribenhos, 17 (77%) tinham legislação que exigia a vacinação; em 16 (94%), a vacinação era obrigatória para admissão na escola; 8 (47%) tinham orçamento exclusivo para programas de imunização; e em 13 (76%), a legislação não contemplava cronogramas nacionais. Com relação à fonte da legislação, seis (35%) países usavam a legislação de educação; oito, (47%) a Legislação de Saúde Pública; e cinco (29%), legislação de vacinação independente. Três países/territórios - Jamaica, Montserrat e Santa Lúcia - tinham regulamentações para imunização. Dos 17 países com legislação, 12 (71%) incluíam sanções e 10 (59%) permitiam isenções por crenças médicas ou religiosas/filosóficas. Conclusões. Diversos países do Caribe estabelecem que não vacinar uma criança é violação da lei. Ao resumir as estruturas de legislação existentes e as abordagens da imunização no Caribe, a análise orienta os formuladores de políticas a realizar mudanças efetivas na legislação de imunização em seus próprios países.

The Expanded Program on Immunization in the English- and Dutch-speaking Caribbean (1977-2016): reasons for its success / Programa Ampliado de Inmunización en el Caribe de habla inglesa y holandesa (1977-2016): las razones de su éxito / Programa Ampliado de Imunização nos países do Caribe de língua inglesa e holandesa (1977-2016): motivos para um programa bem-sucedido

ABSTRACT The year 2017 marks the 40th year of the establishment of the Expanded Program on Immunization (EPI) by the Pan American Health Organization (PAHO), the regional office of the World Health Organization (WHO) in the Americas, the first WHO region certified as eliminating poliomyelitis (1994), measles (2016), and rubella and congenital rubella syndrome (CRS) (2015). The English- and Dutch-speaking Caribbean subregion of the Americas paved the way in eliminating these diseases. This report highlights the innovative strategies used in this subregion that helped make the EPI a success. A review of published/unpublished reports and written and oral accounts of the experiences of Immunization Advisors and national EPI managers was conducted to identify the strategies used to strengthen the Immunization program in the subregion since its implementation by countries in 1977. The results show that these include strong collective political commitment, country-specific immunization legislation, joint use of a standard coverage monitoring chart, annual meetings of national EPI managers, collaborative development of annual national Plans of Action for Immunization, coordinated implementation of vaccination campaigns, subregional oversight of surveillance and laboratory support, a performance award system for countries, and subregional standardized templates for immunization manuals and procedural guidelines. Political will and support for immunization has been particularly strong in this subregion, where 99% of EPI costs are borne by governments. Dedicated health staff and multi-country agreement and application of strategies have led to high sustained coverage and good-quality surveillance, resulting in the absence of wild polio for 34 years, measles for 25 years, CRS for 17 years, and rubella for 15 years.

RESUMEN En el 2017 se celebra el cuadragésimo año de la instauración del Programa Ampliado de Inmunización (PAI) por la Organización Panamericana de la Salud (OPS), la Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas. Esta fue la primera región de la OMS que obtuvo la certificación de la eliminación de la poliomielitis (1994), el sarampión (2016) y la rubéola y el síndrome de rubéola congénita (2015). La subregión de habla inglesa y holandesa del Caribe en las Américas abrió el camino a la eliminación de estas enfermedades. En el presente artículo se destacan las estrategias innovadoras utilizadas en esta subregión que contribuyeron al éxito del PAI. Se llevó a cabo una revisión de los informes publicados e inéditos y de los relatos escritos y orales de las experiencias de los Expertos en Inmunización y los gerentes nacionales del PAI con el objeto de determinar las estrategias utilizadas con miras a fortalecer el programa de vacunación en la subregión, desde su introducción en los países en 1977. Los resultados ponen de manifiesto que los programas comportaban un fuerte compromiso político colectivo, legislaciones en materia de inmunización propias de cada país, la utilización común de un registro gráfico normalizado de monitoreo de coberturas de vacunación, reuniones anuales de los gerentes nacionales del PAI, la elaboración conjunta de planes de acción anuales nacionales sobre vacunas, la ejecución coordinada de campañas de vacunación, la supervisión de la vigilancia y el apoyo a los laboratorios a escala subregional, un sistema de reconocimiento al desempeño de los países y plantillas subregionales normalizadas de los manuales de vacunación y los procedimientos recomendados. La voluntad política y el apoyo a la vacunación han sido muy sólidos en esta subregión, donde los gobiernos sufragan 99% de los costos del PAI. La existencia de personal sanitario dedicado y los acuerdos multinacionales y la aplicación de las estrategias permitieron alcanzar una alta cobertura de manera sostenida y una vigilancia de buena calidad, cuyo resultado fue la ausencia de poliomielitis salvaje durante 34 años, de sarampión durante 25 años, del síndrome de la rubéola congénita durante 17 años y de la rubéola durante 15 años.

RESUMO O ano de 2017 marca o 40° aniversário da criação do Programa Ampliado de Imunização (PAI) pela Organização Pan-Americana da Saúde (OPAS), Escritório Regional da Organização Mundial da Saúde (OMS) nas Américas, primeira Região da OMS certificada como tendo eliminado a poliomielite (1994), o sarampo (2016) e a rubéola e síndrome da rubéola congênita (2015). A sub-região das Américas constituída pelos países do Caribe de língua inglesa e holandesa abriu caminho ao eliminar essas doenças. Este relato destaca as estratégias inovadoras usadas nesta sub-região que contribuíram para tornar o PAI um programa bem-sucedido. Foi realizada uma análise de informes publicados/inéditos e relatos orais e escritos da experiência dos assessores para assuntos de imunização e coordenadores nacionais do PAI visando identificar as estratégias aplicadas para consolidar o programa nos países da sub-região desde a sua implementação em 1977. Os resultados demonstram firme compromisso político coletivo, legislação de vacinação própria em cada país, uso conjunto de uma lista padrão para o monitoramento da cobertura, reuniões anuais dos coordenadores nacionais do PAI, desenvolvimento colaborativo de planos de ação nacionais anuais para vacinação, campanhas coordenadas de vacinação, supervisão sub-regional da vigilância e infraestrutura laboratorial, sistema de premiação dos países por bom desempenho, modelos padronizados para os manuais de vacinação e protocolos de procedimentos. A sub-região se caracteriza sobretudo pela vontade e apoio políticos para vacinação, sendo 99% do custo do PAI financiados pelos governos. Equipes de saúde diligentes, acordos entre vários países e emprego de estratégias são fatores que contribuem para elevada cobertura sustentada e vigilância de boa qualidade com a consequente não ocorrência de casos de poliomielite por vírus selvagem por 34 anos, de casos de sarampo por 25 anos, de casos de síndrome da rubéola congênita por 17 anos e de casos de rubéola por 15 anos.

Absence of impact of aerial malathion treatment on Aedes aegypti during a dengue outbreak in Kingston, Jamaica

During an outbreak of dengue fever in Jamaica from October to December 1995, a study was carried out to determine the impact of aerial ultra-low volume malathion treatment on adult Aedes aegypti. This was done by monitoring oviposition rates of the vector in three urban communities in Kingston and by exposing caged mosquitoes both directly and inirectly to the aerial malathion treatment. The insecticide was delivered at a rate of 219 mL/ha between 7:10 a.m. and 8:45 a.m. The results of the study clearly showed that the insecticide application was ineffective in interfering with Aedes aegypti oviposition, and adult mosquitoes held in cages inside dwellings were largely unaffected. Consequently, this type of intervention seemed to have little significant impact in arresting or abating dengue transmission

Absence of impact of aerial malathion treatment on Aedes aegypti during a dengue outbreak in Kingston, Jamaica / Falta de impacto del rociamiento aéreo con malatión a volúmenes muy bajos en Aedes aegypti durante un brote de dengue en Kingston, Jamaica

During an outbreak of dengue fever in Jamaica from October to December 1995, a study was carried out to determine the impact of aerial ultra-low volume malathion treatment on adult Aedes aegypti. This was done by monitoring oviposition rates of the vector in three urban communities in Kingston and by exposing caged mosquitoes both directly and inirectly to the aerial malathion treatment. The insecticide was delivered at a rate of 219 mL/ha between 7:10 a.m. and 8:45 a.m. The results of the study clearly showed that the insecticide application was ineffective in interfering with Aedes aegypti oviposition, and adult mosquitoes held in cages inside dwellings were largely unaffected. Consequently, this type of intervention seemed to have little significant impact in arresting or abating dengue transmission

Durante un brote de dengue que ocurrió en Jamaica de octubre a diciembre de 1995, se llevó a cabo un estudio a fin de determinar el impacto del rociamiento con volúmenes muy bajos de malatión en mosquitos Aedes aegypti adultos. Se observaron las tasas de ovipostura del vector en tres comunidades urbanas de Kingston y se expusieron mosquitos colocados en trampas directa e indirectamente a rociamientos aéreos con malatión. El insecticida se roció a una velocidad de 219 mL/ha entre las 7.10 y las 8.45 h. Los resultados del estudio claramente demostraron que la aplicación del insecticida no interfirió con la ovipostura de Aedes aegypti, y los mosquitos adultos colocados en trampas dentro de las viviendas casi no sufrieron ningún efecto. Por consiguiente, este tipo de intervención parece haber tenido muy poco impacto en la interrupción o atenuación de la transmisión del dengue.

Health trends in Jamaica: significant progress and a vision for the 21st century

Health trends in Jamaica have improved considerably during the past century. Life expectancy at birth increased from 38 years in 1900 to 72 years in 2000. The crude death and infant mortality rates declined significantly from 35.7 and 174.3 deaths to 5.1 and 24.4 deaths, respectively in the same period. The seven leading causes of death in 1945 were infectious diseases while the main causes of mortality and morbidity are now the chronic non-communicable lifestyles diseases, and injuries. Over the past few decades, considerable progress has been made in controlling vaccine preventable diseases and eliminating poliomyelitis and measles. Rates of infectious syphilis and gonorrhoea have declined significantly in recent years although chlamydia and herpes are common and the HIV/AIDS epidemic is a growing concern. Over the past few decades health expenditure has grown more rapidly in the private health sector than in the public health sector although services in the public sector are provided at significantly lower cost. Jamaica provides good health at low cost. However, more funds are needed to support the public health system. The current health reform process needs to be informed by a better understanding of the factors that have contributed to Jamaica's achievements in health and needs a clear health focus. The Ministry of Health has articulated a vision of health for the 21st century that requires a significant reorientation of health staff as well as empowering people to take responsibility for adopting healthy lifestyles. (AU)

The new public health: vision for the future

On the fortieth anniversary of the Department of Social and Preventive Medicine, now renamed the Department of Community Health and Psychiatry, the contribution of the Department to the development of public health in Jamaica is briefly reviewed. The paper focuses on the challenges, goals and aspirations for the development of a "new" public health. The challenges include the need for more effective public health leadership, health promotion, better management of the health services and health reform. The latter should provide greater autonomy for the health regions and alternate ways of financing health, and should improve the quality of services provided. The Department is challenged to contribute by establishing a Public Health Residency Programme for doctors leading to a Doctor of Medicine or Doctorate in Public Health; to ensure that epidemiology becomes a basic science in the undergraduate medical curriculum, and that research plays a signifciant role in postgraduate training of clinical specialists; and to participate more actively in the actual practice of public health. A vision for health in the twenty-first century is given.(AU)

Risk factors for heterosexual transmission of HIV infection in Jamaica - abstract

Between November, 1990 and January, 1991, HIV status was assessed in 522 men and 484 women attending the Comprehensive Health Centre in Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV-I infection was 3.1 percent, a 10-fold rise in seroprevalence compared to 1986. Nineteen of 517 (3.7 percent) heterosexual males, 3 of 5 (60 percent) homosexual/bisexual males and 9 of 484 (1.9 percent) females were HIV infected. In heterosexual males, factors associated with HIV infection after age-adjustment included present complaint of genital ulcer (Odds Ratio [OR] 7.3, 95 percent Confidence Interval [CI] 1.4-72), past history of genital ulcer (OR 4.3, CI 1.4-12), positive MHATP syphilis serology (OR 3.4, CI 1.1-10), sex with a prostitute in the past month (OR 3.8, CI 1.1-11), 3 or more sex partners in the month prior to complaint (OR 3.6, CI 1.0-12), and bruising during sex (OR 4.0, CI 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR 3.0, CI 1.11-8.3), positive MHATP syphilis serology (OR 3.2, CI 1.1-9.5) and history of genital ulcer (OR 2.9, CI 1.0 - 8.0). Among females, history of "bad blood" (syphilis) (OR 6.6, CI 1.4-30), self perception of high risk for AIDS (OR 8.6, CI 0.9 - 108), positive gonorrhoea culture (OR 12, CI 2.1 - 72), HTLV-I seropositivity (OR 5.7, CI 0.9-29), past history of producing a still birth (OR 7.6, CI 1.3-43) and current abnormality of the uterine cervix (OR y, CI 1.7 - y) were associated with HIV infection. Disruption of the genital epithelium in the male caused by bruising during sex or genital ulcers may facilitate HIV transmission from female to male. Inflammation of the uterine cervix may facilitate male to female HIV transmission (AU)

Is serious research possible in the Caribbean?

This essay describes the rich tradition of research in the English-speaking Caribbean and the possibilities for meaningful colloboration between Caribbean researchers and scientists from developed countries. Significant contributions includes work related to the human T-lymphotropic virus (HTLV-I), Jamaican vomiting sickness, veno-occlusive disease of the liver, J-type diabetes, and the role of skin sepsis and streptococcal infection in the etiology of glomerulonephritis. In the fields of malnutrition, human metabolism, child development, and sickle cell anemia, the Caribbean has been at the forefront of medical research internationally. Many characteristics of the Caribbean population including the disease profile, offer advantages and unique opportunities for significant research, despite difficulties related to the "brain drain" and weaknesses of the infrastructure. (Au)

Survey of patients with sexually transmitted diseases seen by private physicans in Jamaica

A survey of physicians in private practice in Jamaica was conducted between March and September 1993 to provide a descriptive analysis of the occurrence of patients with sexually transmitted diseases (STDs) seen in their practices. Questionnaires were delivered to 371 physicians of whom 127 (34 percent) responded, completing 683 (men 353, women 330) individual patient questionnaires. Each physician collected data over a period of one week. The median ages of the men and women were 27 years and 26 years, respectively. 464 (68 percent) patients were being seen for the first time for symptomatic STDs, and the visit was a follow-up for 132 (19 percent) who had been previously diagnosed; 40 (6 percent) patients were asymptomatic contacts referred by a sex partner, and 12 (2 percent), who were asymptomatic, asked for a "check up". A history of previous STD was given by 358 (52 percent) patients. 470 (69 percent) patients had a genital discharge (M, 65 percent; F, 73 percent; p = 0.017), 52 (8 percent) had anogenital lesions (M, 10 percent; F, 5 percent; p = 0.013) and 45 (7 percent), inguinal lymphadenopathy (M, 10 percent; F, 3 percent; p = 0.002). Among women, 131 (40 percent) had lower abdominal pain on examination and 105 (32 percent) had cervical excitation tenderness or pain suggesting pelvic inflammatory disease (PID). A working diagnosis of gonorrhoea was made in 273 (40 percent) patients, trichomoniasis in 121 (18 percent), nongonococcal infection in 114 (17 percent), syphilis in 60 (9 percent), herpes genitalis in 20 (3 percent) and chancroid in 11 (2 percent). PID was diagnosed in 121 (37 percent) women and nongonococcal urethritis in 98 (28 percent) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlated well with clinical observations and treatment given, matched with diagnosis according to national guidelines. A comparison of the STD burden between the public and private sectors was not possible because of sample bias. (AU)

The epidemiology of HTLV-1 and risk of disease and outcome: Jamaica

HTLV-1 is a human retrovirus endemic in the Caribbean and Japan. The crude prevalence in Jamaica is 5-6 per cent but there is a steady increase with age peaking in the 8th decade at 17 per cent among females and 9 per cent among males. The majority of persons infected with HTLV-1 do not manifest any clinical disease. However, some persons develop adult T-cell lymphoma, tropical spastic paraparesis or infective dermatitis. Associations with arthropathy, uveitis, polymyositis and panbronchiolitis have also been reported. HTLV-1 is transmitted via sexual contact, mother to child (mainly through breast milk) and by transfusion of cellular blood product. Male to female sexual transmission is far more efficient than female to male. Control of HTLV-1 requires screening blood transfusions and reducing sexual and vertical transmission. (AU)

Rapid assessment of an acute flaccid paralysis surveillance system in Jamaica

The sensitivity of hospital-active-surveillance (HAS) system for acute flaccid paralysis (AFP) was reviewed at six acute-care hospitals and one rehabilitation facility in Jamaica for the years 1991, 1992 and 1993. HAS evaluated cases at a rate of 0.70, 0.35, and 0.35 AFP cases per 100,000 population under 15-years-of-age for the years 1991, 1992 and 1993, respectively. Analysis of admission registers and discharge diagnoses determined six additional cases meeting the Pan American Health Organization (PAHO) case definition of AFP in 1991, and one additional case in 1993. Thus, the prevalence of AFP was 1.41, 0.35 and 0.47 for the three years under review. In only one year (1991) did the prevalence of AFP exceed 1.0, the rate considered by PAHO norm was derived from large continental countries in South America. This rate may not apply to small island nations (AU)

Surveys of STDs seen by private physicians in Jamaica

A survey of physicians in private practice in Jamaica was conducted between March and September of 1993. It attempted to provide a descriptive analysis of the occurrence of conventional STDs seen in their practices. Questionnaires were delivered to a sample of 371 physicians of whom 127 (34 percent) responded, completing a total of 683 individual patient questionnaires (men 353, women 330). Each physician collected data over a period of one week. The mean age of the 683 patients seen was 28 years. Of these: 464 (68 percent) were first visits for asymptomatic STD condition, 132 (19 percent) were follow-ups for the same condition, 40 (6 percent) were asymptomatic contacts referred by a sex partner, and 12 (2 percent) were symptomatic first visits for a 'check-up'. A history of previous STD was given by 358 (52 percent) patients. A total of 52 (8 percent) patients had anogenital lesions, 45 (7 percent) inguinal lymphadenopathy, and 470 (69 percent) a genital discharge (men 65 percent, women 73 percent). Among women, 131 (40 percent) had lower abdominal pain on examination and 105 (32 percent) evidence of PID on moving the cervix. A working diagnosis of gonorrhoea was made in 273 (40 percent), trichomoniasis in 121 (18 percent), syphilis in 60 (9 percent), herpes genitalis in 20 (3 percent) and chancroid in 11 (2 percent) STD patients. PID was diagnosed in 121 (17 percent) women and nongonococcal urethritis in 98 (62 percent) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlated well with clinical observations and treatment given matched with diagnosis according to national guidelines (AU)

Is under-reporting of AIDS a problem in Jamaica? - abstract

A survey of physicians in Jamaica was conducted between March and September 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 418, a response rate of 35 percent. Of the physicians responding, 46 percent were in private practice only, 22 percent in the public sector only and 32 percent in both. Two-thirds (66 percent) of the physicians in private practice had not diagnosed a case of AIDS and 65 percent had not had a patient with a positive HIV test result. Half (54 percent) the private physicians had reported all their AIDS cases, 8 percent reported some and 38 percent (45 doctors) had reported none. The main reasons for not reporting were: " thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9 percent of private practitioners were currently seeing an AIDS patient and 12 percent were seeing an HIV-infected person. Of physicians with current AIDS patients 16 percent preferred not to report, 21 percent intended to report and 63 percent had reported. Nearly a third (29 percent) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75 percent) public sector physicians had seen one or more AIDS patients; 64 percent of these physicians said that all of their AIDS cases were reported, 4 percent said some, 4 percent said none and 28 percent didn't know. Reporting of AIDS cases is better in the public sector than among private physicians. It is likely that some, if not many, of the AIDS cases not reported by private physicians, are reported when admitted to hospital. It is not possible to estimate the precise level of under-reporting of AIDS in Jamaica from this survey. However, more needs to be done to address the reservations of some private physicians and to convince them of the need for timely reporting of HIV/AIDS cases (AU)

Is under-reporting of AIDS a problem in Jamaica?

A survey of physicians in Jamaica was conducted between March and September, 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 518, a response rate of 35 per cent. Of the physicians responding, 46 per cent were in private practice only, 22 per cent in the public sector only and 32 per cent in both. Two-thirds (66 per cent) of the physicians in private practice had not diagnosed a case of AIDS and 65 had not had a patient with a positive HIV test result. Half (54 per cent) of the private physicians had reported all their AIDS cases, 8 per cent had reported some and 38 per cent (45 doctors) had reported none. The main reasons for not reporting were: "thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9 per cent of private practitioners were currently seeing an AIDS patient and 12 per cent were seeing an HIV-infected person. Of physicians with current AIDS patients 16 per cent preferred not to report, 21 per cent intended to report and 63 per cent had reported. Nearly one-third (29 per cent) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75 per cent) public sector physicians had seen one or more AIDS patients. Sixty-four per cent of these physicians said that all of their AIDS cases were reported, 4 per cent said some, 4 per cent said none and 28 per cent didn't know. Reporting of AIDS cases is better in the public sector than among private physicians. It is likely that some, if not many, of the AIDS cases not reported by private physicians are reported when admitted to hospital. It is not possible to estimate the precise level of under reporting of AIDS in Jamaica from this survey. However, more needs to be done to address the reservations of some private physicians and convince them of the need for timely reporting of HIV/AIDS cases (AU)