More than 100,000 patients each year
Since 1982, GHESKIO has provided world-class medical care to the poorest of the poor in Haiti. Because our patients live in extreme poverty, they are at high risk for many diseases. That’s why we always provide healthcare free of charge, including tests, diagnoses, treatment services and medications.
We provide full-scale medical services, with a special focus on several core programs.
HIV testing, diagnosis and treatment
For more than 40 years, we’ve partnered with leading organizations to combat the HIV/AIDS epidemic. Our researchers identified contaminated blood transfusions as a major mode of HIV transmission, and then worked with the government to place the Haitian Red Cross in total control of blood banking. We conducted clinical trials to define effective therapeutic and preventive interventions for HIV. We documented the success of antiretroviral therapy (ART) in resource-poor settings, and published ART treatment initiation criteria that led the World Health Organization to change international guidelines.
In 1985, we opened the country’s first HIV Voluntary Counseling and Testing Center. The number of people seeking testing continues to increase. We partnered with the Ministry of Health to reduce the rate of transmission of HIV from pregnant mother to child from 30% to less than 4%. As our HIV care and prevention services have expanded, HIV prevalence in Haiti has decreased from 6.2% to less than 2% in 2021.
We’ve partnered with the Ministry of Health to implement our prevention and care model to a network of more than 27 healthcare centers. GHESKIO provides training, supervision, financial oversight and quality control for all HIV and TB clinical services at these sites.
TB testing and treatment
Tuberculosis is a major cause of morbidity and mortality worldwide. According to the World Health Organization, only 6.3 million new cases of TB were reported in 2016 compared with the estimated incidence of 10.4 million. In the region, Haiti has the highest TB incidence and prevalence (194 per 100,000 population and 254 per 100,000, respectively).
GHESKIO has been providing TB testing and treatment since its inception.
After the earthquake in 2010, about 1.5 million people lost their homes and were moved to camps for internally displaced persons. An estimated 3,000 TB patients stopped receiving medication and dispersed to crowded refugee camps. It was subsequently found that TB incidence in Port-au-Prince doubled, with an outbreak of multidrug-resistant TB (MDR-TB). This is likely a result of higher case detection as well as an increased burden of disease.
In response, GHESKIO opened a 100-bed TB tent field hospital in May 2010 and increased TB treatment capacity from 600 to 1,800 patients per year. In 2012, GHESKIO documented a rate of 768 TB cases per 100,000 individuals in the neighboring slum, ‘City of God’.
Currently, GHESKIO is the largest TB center in Haiti which diagnoses and treats approximately 3,000 patients per year, including MDR-TB patients.
Although the most common form of TB can be treated in six months, MDR-TB requires significantly longer and more intense treatment, sometimes lasting 18 months to two years. GHESKIO runs one of only three MDR-TB hospitals in the country, which houses up to 33 patients in an open, sunlit space that provides a home for patients receiving treatment.
In addition to testing and treatment, GHESKIO has carried out extensive research on TB over the past three decades, of which the findings have been published in peer-reviewed medical journals.
Community Health Workers
GHESKIO employs a large cadre of Community Health Workers (CHWs) that perform outreach to the communities surrounding GHESKIO. The community includes the surrounding slums of Village de Dieu, Cite l’Eternel, and Cite Plus, which comprise ~120,000 inhabitants. CHWs perform active case finding, follow up for appointments to improve retention in care, provide referrals to the GHESKIO clinics when appropriate, and provide home care for thousands of patients.
Cardiovascular disease
The GHESKIO Cardiovascular Center
GHESKIO has collaborated with the Pan American Health Organization (PAHO), the Haitian Ministry of Health, and local stakeholders including the Haitian College of Cardiology to define the cardiovascular clinical and research priorities of Haiti. Together, they have established the largest CVD population-based cohort in the region which will provide the first reliable estimates of the CVD burden including prevalence, severity, age of onset and progression of disease
GHESKIO has trained over 250 clinic staff in hypertension screening, diagnosis, and treatment skills. We have updated blood pressure equipment to all GHESKIO clinics and provided a rigorous training curriculum for blood pressure measurement, echocardiography, ECG, ultrasounds, hypertension diagnosis, lifestyle modification and treatment using the validated WHO HEARTS packet. The clinic also has a dependable medication supply chain and uses national primary-care hypertension guidelines to provide the utmost care to its patients.
High impact findings:
The GHESKIO CVD Clinic has published key literature reporting previously unknown estimates of CVD risk factors in Haiti. Research has found that heart failure is the most prevalent cardiovascular event estimated at 11.6%, which is 14 times higher than the existing estimates from the Global Burden of Disease which is 0.83%. This data is significant as it differs from current modeling estimates suggesting that ischemic heart disease is the leading cardiovascular disease in Haiti and other low- and middle-income countries.
We also found that over 90% of Haitian adults consume more than the recommended WHO dietary sodium intake. Young adults ages 18-30 years with the highest quartile of salt consumption had increased systolic blood pressure as compared to the lowest quartile. We quantified blood lead levels in our population and found they are 5 times higher than levels in the United States. Furthermore, we found that high blood lead levels are associated with a higher systolic blood pressure.
International feedback on our findings includes a commentary by Dr. Gene Kwan and Dr. Victor Davila-Roman: “GHESKIO is to be congratulated for filling a key gap in evidence regarding HF prevalence in LMICs. The current work emphasizes the need to redouble our efforts to aggressively treat hypertension to prevent the development of hypertensive heart disease.” Our work has also found blood pressure control is 13.1% (Figure 4). It was also found that chronic kidney disease is highly associated with diabetes and hypertension, and that only 12% of those with chronic kidney disease are on treatment. In an editorial in the American Journal of Clinical Nephrology on these findings, Drs Elena Cervantes and Bernard Jaar state “Findings of this study should serve as a call to action for the global community to prioritize CKD as a public health concern and work towards reducing its burden worldwide, especially in LMIC”.
Caring for mothers and children
We care for the most vulnerable in Haiti, especially mothers and children.
Our Mothers’ Program supports the needs of pregnant women and new mothers. Mothers’ Clubs meet monthly so women can learn about prenatal care and infant nutrition and build a support network. Life-skills training builds self-esteem and enables women to improve their health and their lives.
In addition, we conduct community-outreach activities and home visits to refer sick children to our clinic, where they receive best-in-class care.
GHESKIO’s maternal-infant unit receives about 1,500 new pregnant women annually who are followed after childbirth to ensure infants thrive. Nutritional supplements paired with educational counseling sessions on nutrition for mother and child ensure both receive optimal care during critical periods of development; deemed the first 1,000 days of the infant’s life.
Cervical cancer and HPV
Haiti has the highest reported incidence of cervical cancer of any country in the world – 50 times higher than the U.S. Cervical cancer is the leading cause of cancer death in Haitian women.
We’ve made progress in cervical cancer prevention through the introduction of simple and cost-effective “screen and treat” strategies and human papillomavirus (HPV) vaccination.
HPV VACCINATION CAMPAIGN
In 2016, with the support of Merck pharmaceuticals and in collaboration with the Haitian Ministry of Health and Zanmi la santé, we were able to introduce the quadrivalent HPV vaccine for the first time in urban Haiti.
Field workers were trained in HPV awareness, prevention methods and vaccine use, as well as in identifying adolescent girls in vulnerable neighborhoods. Two community vaccination strategies were used: one, non-school-based, in which parents and adolescents are invited to visit our clinic for vaccination; the other, school-based, in which medical staff visit designated schools to administer the vaccine.
2000 adolescent girls aged 9 to 16 were targeted to receive 2 doses of the quadrivalent HPV vaccine (Gardasil). From August to October 2016, 1,994 (99.7%) of the 2,000 targeted adolescent girls received the first dose of vaccine, including 1,306 (65%) at the GHESKIO clinic, and 688 (35%) at their school. The median age was 11 years. From January to April 2017, 1,877/1,994 (94%) received the 2nd dose. The number of people who received the 2nd dose was significantly higher in the group vaccinated at school vs. the group not vaccinated at school.
HIV care to protect young girls
Since 2004, HIV-related deaths for adolescents increased by 50%. Adolescents account for 40% of all new HIV infections in Haiti, and 80% of these occur among girls, many of whom live in poverty with little protection from high-risk behaviors.
While medical interventions can prolong lives, teens are a particularly challenging group to reach. HIV-infected adolescents are three times more likely to be lost to care than adults, with only about 50% of HIV-infected teens remaining in care at one year.
Our innovative model of care improves retention among HIV-positive adolescent girls. HIV care takes place in a community center rather than in a medical clinic to strengthen social support and decrease stigma, plus providers and teens meet to address social isolation, gender inequality and unstable families.
Cholera
In 2010, Haiti was hit by the largest cholera epidemic in recent history, with more than 800,000 suspected cases and nearly 10,000 reported deaths. GHESKIO sprang into action immediately with an emergency treatment center, community outreach, water treatment, vaccinations and a specialized hospital. Cholera cases and deaths plummeted, and Haiti was considered cholera-free by mid-2022.
Unfortunately, cholera re-emerged in late 2022. We once again responded quickly, immediately opening two cholera treatment centers. Our teams directly supported the hardest-hit communities, improving sanitation, delivering clean drinking water and providing cholera vaccinations.
