Política Nacional para la Prevención, Control y Atención Integral a las ITS, VIH y Sida

Objectives

Nicaragua’s national policy seeks to end AIDS and sexually transmitted infections (STIs) as public-health problems by ensuring universal, person-centred access to health promotion, prevention and comprehensive care. It applies human-rights, gender-equity, life-course, interculturality, inclusion and equity approaches within the Family and Community Health Model.[1]

• Strengthen stewardship, governance and institutional capacity across government, civil society, community organisations, businesses, trade unions, faith-based organisations and associations of people living with HIV.[2]
• Promote health and prevent STIs and HIV through accurate, accessible and culturally appropriate information, sexual education, community health action, condoms and lubricants, voluntary HIV testing and counselling, and integrated sexual and reproductive health services.[3][4][5]
• Expand free, equitable, comprehensive and good-quality prevention, diagnosis, treatment, care, support, recovery and rehabilitation services, including clinical, psychosocial, nutritional and family-participation components.[6][7]
• Reduce vulnerability, stigma, discrimination, gender inequality, gender-based violence and legal or structural barriers that restrict access to HIV and STI services.[8][7]
• Protect the rights and improve the wellbeing of people living with HIV, key and vulnerable populations, children and adolescents affected by HIV, pregnant women, Indigenous and Afro-descendant communities, people in detention, migrants, people with disabilities and other priority groups.[1][9][4]
• Prevent vertical transmission of HIV and syphilis through evidence-based measures, including prevention of primary HIV infection among women and respectful care that safeguards the reproductive rights of women living with HIV.[5]
• Improve strategic information, surveillance, monitoring, evaluation and sustainable financing for the HIV, STI, coinfection and comorbidity response.[2][10]

The policy is aligned with the HIV treatment cascade objectives originally framed as 90-90-90, covering diagnosis, antiretroviral treatment and viral suppression.[3]It also seeks to advance towards the later 95-95-95 targets, regional prevention goals, and elimination of mother-to-child transmission of HIV and syphilis.[11]

Implementation

Implementation uses an integrated, interdisciplinary and multisectoral model, coordinated nationally and territorially through the Nicaraguan AIDS Commission (CONISIDA), Regional AIDS Commissions (CORESIDA) and CORLUSIDA.[11][12]The five-year National Strategic Plan operationalises the policy with participation from government bodies, social and community organisations, people living with HIV, academia, media, private-sector actors and international cooperation agencies.[12]

• Coordinate national and regional plans, shared targets and a single surveillance, monitoring and evaluation system under the “Three Ones” principle.[11]
• Deliver integrated services through local health systems, facilities and service networks, adapting provision to local epidemiology and the needs of key populations, vulnerable groups and culturally diverse communities.[7]
• Provide comprehensive care across the continuum from HIV testing and counselling to linkage, treatment initiation, adherence, viral suppression, prophylaxis, treatment of STIs and opportunistic infections, safe blood, family planning, contact follow-up, palliative care and psychological support.[7]
• Decentralise treatment and strengthen first-level services, with multidisciplinary teams supporting clinical care, nutrition, psychology, epidemiology, medical supplies and social work.[13][14][15]
• Build health-worker and community capacity through updated standards, manuals, algorithms, protocols, teaching plans and continuing training on care, treatment, human rights, stigma, discrimination and culturally appropriate service delivery.[4][5][16]
• Expand combined prevention among key populations through State institutions, community health networks and partnerships with social organisations, while strengthening the sustainability of those organisations.[16][14]
• Engage workplaces, formal and informal employers, trade bodies, unions and cooperatives in HIV and STI prevention, health promotion and stigma-reduction measures.[11][9]
• Update legislation, administrative provisions, public policies and technical norms, including Law 820, to strengthen protection of human rights and remove barriers to prevention, care and treatment.[17][8][12]

The Ministry of Health leads technical policy implementation, while the State is responsible for financing, monitoring, evaluation and dissemination through relevant institutions under CONISIDA, CORESIDA and CORLUSIDA coordination.[12]Public institutions, social organisations, private actors and international cooperation agencies are expected to harmonise decisions and activities across territories and population groups.[6][1]

Strategic information arrangements include systematic collection, processing and analysis of data from public and private institutions to guide continuation, adaptation, expansion or redirection of interventions.[18]The HIV Information System, SIVE-HIV, supports surveillance, response monitoring, situation reporting and analysis, and is coordinated through the Vital Statistics System, the national STI/HIV/AIDS component and the Ministry of Health’s Directorate-General for Public Health Surveillance.[18]The system is intended to incorporate social-security and private-health-system information in the medium term.[18]

Operational monitoring covers HIV case notification, paediatric cases, vertical transmission, morbidity, mortality, STIs, HIV-associated tuberculosis, social determinants, treatment adherence, drug resistance, adverse reactions and opportunistic infections.[13]The approach also calls for behavioural, prevalence, population-size, service, prevention-cascade, treatment-continuum, adherence and access studies, using standardised indicators and methodologies.[13]

Financing measures include developing a nationally agreed sustainability plan, closing the HIV resource gap, reducing essential medicine and commodity prices, strengthening procurement mechanisms, mobilising partnerships and guaranteeing annual General State Budget allocations for implementing institutions.[10][12]The source does not provide numeric budget amounts, detailed allocations or quantified funding-gap values.[10][12]

Monitoring & Evaluation

The policy establishes information, monitoring and evaluation as a strategic line within a coordinated national HIV and sexually transmitted infection response. It envisages a single surveillance, monitoring and evaluation system across national and regional plans, with shared targets and periodic reporting on progress.[2][11]

• Monitor progress against the HIV testing, treatment and viral-suppression cascade. The 2020 objectives sought 90% diagnosis, 90% treatment among diagnosed people and 90% viral suppression among people receiving treatment; reported 2019 results were 93.5%, 82.5% and 61.2% respectively.[3]
• Track progress towards the later “95-95-95” targets, regional HIV-prevention objectives and elimination of mother-to-child transmission of HIV and syphilis through periodic national response reports.[11]
• Use the HIV Information System, SIVE-HIV, for surveillance of people living with HIV, response monitoring, situation reports and analysis. It is coordinated through the Vital Statistics System, the national sexually transmitted infection, HIV and AIDS component, and the Ministry of Health Directorate-General for Public Health Surveillance.[18]
• Integrate data from Ministry of Health facilities and, over the medium term, incorporate information from social-security and private health systems.[18]
• Strengthen confirmed-case follow-up, active surveillance and data-quality controls, as existing implementation requires further reinforcement.[19][20]
• Collect, process and analyse information from public and private institutions and implementing organisations so that evidence on results and impact informs continuation, adaptation, expansion or redirection of interventions.[18]
• Measure epidemiological and programme indicators, including prevalence, incidence, population size, behaviours, practices, drug resistance, treatment adherence, service coverage, HIV morbidity and mortality, sexually transmitted infections, HIV-related tuberculosis and social determinants of health.[13]
• Conduct behavioural, prevalence, population-size, service, prevention-cascade, treatment-continuum, adherence and access studies, including second-generation surveillance among key populations and other populations experiencing heightened vulnerability.[13]
• Institutionalise antiretroviral drug-resistance surveillance through early-warning indicators in treatment facilities, alongside monitoring of adverse drug reactions, opportunistic infections and advanced HIV disease.[10]

Available monitoring evidence identifies substantial service gaps. In 2019, the care cascade recorded 9,499 estimated people living with HIV, 8,878 knowing their status, 6,901 linked to care, 5,696 receiving antiretroviral therapy, 4,414 with a viral-load result and 3,488 with viral suppression.[21]Late diagnosis and treatment discontinuation remained concerns: 35.3% of new cases had a CD4 count below 200 cells, 60% below 350 cells/mm³, and 17.4% of people living with HIV had abandoned treatment.[21]

Accountability mechanisms include monitoring systems, periodic reporting, participation by regional coordination structures and civil-society actors, and planned human-rights compliance monitoring.[22][11][17]However, monitoring and evaluation of the National Strategic Plan is characterised as incipient and insufficient for action-oriented feedback; annual reporting by commission members and complaint-platform reporting are incomplete, the Information, Education and Prevention Committee is inactive, and a human-rights compliance monitoring plan is absent.[22][19]The source does not provide a complete indicator matrix, standard reporting timetable, evaluation calendar or detailed allocation of accountability responsibilities.[11][13][18]

Costing & Financing

The policy makes equitable, sufficient and sustainable financing a strategic priority, with the objective of closing the national HIV resource gap and fully financing the response to HIV, sexually transmitted infections, coinfections and comorbidities.[10][2]It assigns the State responsibility for financing implementation and requires an annual General State Budget allocation for institutions responsible for operationalising the policy.[12]

• Develop a nationally agreed sustainability plan defining priorities, lines of action, financing requirements and monitoring arrangements.[10]
• Mobilise additional resources and partnerships, establish supplementary financing sources, and develop mechanisms for resource allocation, distribution and administration.[10][12]
• Improve efficiency in service delivery, procurement and supply distribution, while reducing prices for essential medicines and commodities through national and international procurement mechanisms.[10]
• Undertake forecasting, costing and expenditure studies to optimise interventions and guide procurement and distribution of medicines and supplies.[13]
• Maintain investment in diagnostic capacity, viral-load monitoring, laboratory services, decentralised treatment, workforce development and the availability of tests and supplies throughout the health-service network.[23][16]

Financing pressures include reliance on external funding for prevention among key populations and for combined prevention activities delivered by social organisations.[16]HIV viral-load reagents also depend on external financing while being purchased through public and Global Fund resources.[23]The transition to costly second- and third-line antiretroviral regimens is identified as a risk to public financing and to the sustainability of therapeutic options in the national formulary.[23]

Additional resource constraints include insufficient funding for free legal assistance and gaps in financing condoms and lubricants for key populations.[22][24]Although the policy calls for quantified financing requirements in its sustainability plan, the supplied material does not provide monetary budget totals, allocations, funding-gap values, currency denominations, donor amounts, unit costs or economic assumptions.[10][12]