A new landmark HIV program in the Dominican Republic

	The new program in in Elias Piña, Dominican Republic, will operate in collaboration with Zanmi Lasante's hospital in Belladerè, Haiti.
	Staff of PIH's new program in the Dominican Republic.

On February 11, 2011 Zanmi Lasante (ZL) – Partners In Health’s (PIH) sister organization in Haiti--celebrated the expansion of its first HIV program in the Dominican Republic (DR). The program based at the Rosa Duarte Hospital in Elias Piña will serve hundreds of Haitians and Dominicans living and working in the border town, and marks a major step towards strengthening health systems in the DR.

Alongside members of the Elias Piña community, officials from the Dominican Republic’s Ministry of Health, the United States Agency for International Development (USAID), and PIH/ZL celebrated the landmark event with music, dancing and speeches from the project’s supporters. Following the ceremony, guests were invited to visit the hospital for a guided tour of the medical facility and services offered onsite.

This project is the culmination of a years-long effort. “Since 2004, we've tried to build a partnership with the Dominican health authorities to assure that the Haitian migrant patients--especially those with HIV and tuberculosis--can find a facility that delivers PIH’s approach to care,” says Dr. Ralph Ternier, director of Community Health. Ternier has been a driving force behind the project right from the beginning, starting when he was the director of PIH/ZL’s program at Hôpital de la Nativité in the Haitian border town of Belladère.    

Haitian economic migrants in the DR are a vulnerable patient population, said Ternier. These communities are made up of migrant farm workers who face social, cultural, and economic biases that make it difficult to access health care. Furthermore, their migrant status creates barriers for patients to receive continuing medical care, particularly for diseases requiring intensive treatment regimens, such as HIV/AIDS.

PIH/ZL signed a grant contract with the USAID in Santo Domingo, DR, to reinforce HIV services, from prevention to care, for the inhabitants of Elias Piña as well as the border’s transient population. Not only does the project seek to strengthen the existing health care systems in the DR, but it will also train and mobilize more than 100 community health workers to provide treatment and social support to HIV patients in their homes.

The ZL program took on new urgency after the earthquake when thousands of Haitians fled to the DR in search of medical care, housing, and food. People who were receiving treatment for HIV, TB, and MDR-TB in Haiti were forced to abandon their treatments, not only endangering their own health, but also potentially compounding the risk to public health if disruptions in treatment enabled their diseases to become drug-resistant.

	Dancers performed to celebrate the opening of the new project in the Dominican Republic.
	Rosa Duarte Hospital in Elias Piña

Since then, PIH/ZL has been working with Community Service Alliance, the Ministry of Health in the Dominican Republic, and USAID-DR to organize this expansion. Many of the Haitian and Dominican staff members participating in this cross-border project have been working in the region for years, if not decades. Ternier says that ZL programs in the DR will build on their efforts and lessons learned during ZL’s 25 years in Haiti, and on its successful HIV/AIDS treatment program. 

ZL currently provides support and antiretroviral drug therapies (ART)--medications for the treatment of infection by retroviruses related to HIV--to roughly 5,000 patients in Haiti, and monitors 14,000 patients who have tested positive for HIV, but who are healthy enough to not be on an ART regimen. This expansion will increase ZL’s catchment area by 60,000 people, as well as enhance the collaboration between Hôpital de la Nativité in Belladère, Haiti, with Hospital Rosa Duarte.

ZL staff will optimize quality of life for HIV-infected patients and their families, and prevent the transmission of HIV and other sexually transmitted infections (STIs). Voluntary HIV counseling and testing will be offered, and women-specific health care--including a program to prevent mother-to-child transmission of HIV--will be provided.

As with all PIH programs, success in the DR will rely largely on the efforts of accompagnateurs--men and women from the local community who are trained and employed by PIH/ZL as community health workers. Accompagnateurs work with patients in their communities to ensure that that they are able to take their medications as prescribed, and connect patients to social and economic services and support. They are a pivotal force in raising awareness of the existence and success of HIV treatment and care in these communities.

“The launch of the ZL project in the Dominican Republic is a huge victory on an international, political and medical level,” says Haitian project director in Elias Pina, Dr. Jennifer Severe. “The fruitful collaboration between Haitians and Dominicans involved in this project will ensure that the Dominican Republic’s Ministry of Health will see PIH as a strong and long-term partner in health care.”