The Oral Rehydration Unit
In September 1980, the Rehydration Unit dedicated to the treatment of infants with diarrhea and dehydration was established by Dr. Pape at the State University Hospital in Port-au-Prince. The Unit served as a teaching center in the use of oral rehydration for physicians, nurses, and students. After its inception, there was a decrease in hospital pediatric mortality for diarrhea from 40% to 1%. As of December 2001, this Unit provided care for over 100,000 children with dehydration and trained over 14,000 healthcare workers throughout Haiti. The training in oral rehydration provided by this Unit is largely credited with the dramatic decrease in national infant mortality from 140 per 1,000 live births in 1982 to 74 per 1,000 live births in 2004. With the expansion of the program and training of parents, more mothers utilize oral rehydration therapy at home, resulting in a marked decrease in hospital admissions in the Rehydration Unit. Of note, GHESKIO’s early, dramatic success in treating infantile diarrheal illnesses led to the development of related treatments for the growing number of HIV/AIDS patients with diarrhea during the early 1980s.
Decreasing HIV and Syphilis Seroprevalence in Haiti
As GHESKIO’s care and prevention services for HIV and sexually transmitted infections have been expanded, there has been a decrease in the prevalence of HIV and syphilis in Haiti. In 1993, 6.2% of Haitians were HIV-positive and 7.6% had syphilis. As illustrated in the figure below, the rate of HIV infection in Haiti decreased to 3.1% in 2003. The rate of syphilis infection was also reduced to 3.5%. In partnership with the Haitian government and other non-profit organizations fighting HIV/AIDS in Haiti, GHESKIO has set a national goal of an HIV seroprevalence rate of 1.5% in 2013.
Seroprevalence of HIV and Syphilis in Haiti
Blood Banks and the Haitian Red Cross
Early in the HIV epidemic, GHESKIO identified contaminated blood products as a major route of HIV transmission. As a result, in 1985 the Haitian Red Government closed closed for-profit blood banks and designated the Red Cross as the sole institution in Haiti responsible for blood safety. For the past twenty years, GHESKIO’s laboratory has provided training and quality control for the Red Cross laboratories. GHESKIO Director Dr. Jean Pape serves on the Board of the Haitian Red Cross. The Joint United Nations Program on HIV/AIDS (UNAIDS) credits this prompt response to protect blood safety as a key factor in the decrease in HIV prevalence in Haiti from 6% in 1993 to 3% in 2003.
The Elimination of Congenital Syphilis
Congenital syphilis is one of the major causes of perinatal deaths in Haiti and other developing countries, despite the fact that it can be prevented by screening pregnant women with a blood test and administering penicillin to those testing positive for syphilis. In the past, pregnant women in Haiti either did not have access to syphilis screening or were screened under a centralized lab testing system. Under this system, blood samples are collected at a community dispensary and then sent to a central hospital for testing. The results must be returned to the dispensary and patients testing positive for syphilis must come back to the clinic for treatment. In collaboration with the World Health Organization, GHESKIO researchers have developed a model for decentralized screening, allowing same-day testing and treatment of pregnant women for syphilis. This model relies on new rapid syphilis tests which can be simply performed by clinicians working in remote rural clinics. In Haiti’s rural Artibonite Valley, the rate of congenital syphilis decreased by 75% when the new screening model was implemented.
Rates of Congenital Syphilis Before and After the Decentralization of Syphilis Prenatal Screening
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