Health Through Walls

HIV/AIDS Assistance for Prisons in Haiti objective is the control and prevention of the spread of contagious diseases in Haiti's 17 prisons. Haiti's prisons do not have a sustainable system of care and HtW through funders help to fill in many gaps that exists to prevent neglect of care of the upwards of ten thousand inmates incarcerated there and eventual death of those who are sick or who contract a deadly disease while incarcerated. HtW has over 130 full time staff including doctors, nurses, laboratory technicians, counselors, radiographers and psychiatrists who work at all locations throughout the country, in the East, North, West and South. HtW is charged with setting up a sustainable system of care providing sanitation for all the prisons and creating a clean working environment for the officers and health care workers and a healthy living environment for the prisoners. HtW implemented a WASH program to ensure clean water for drinking, cooking and showering.

Klinik Solidarite was formed from an alliance with AIDS Healthcare Foundation to provide medical and laboratory services to released prisoners infected with HIV or TB, their affected family members, their sex partners and anyone else infected in the communities where they live. Klinik Solidarite also care for women who were physically abused and abandoned or orphaned children. The clinic has its own lab and clinicians, and it is located in Bourdon, Haiti.

Impact Against TB and HIV is a project formed in collaboration with the Global Fund. These funds allow us to increase and improve prevention, screening and testing of HIV/AIDS and TB in 5 additional prisons in Haiti. These prisons are located outside of the metropolitan area. We also provide care and treatment services for all prisoners indentified as TB+ and HIV+. This program allows us to screen for MDRTB and negotiate and set up isolation areas for those identified. HtW is charged with renovation of prison medical offices and replacing destroyed equipment, development of a hospital ward at the PCPP-M, recruiting and training medical staff for facilities without staff, training Health Promoters and a peer education program in all the prisons.

The Strengthening Haitian Activities in the Prison Environment (SHAPE) is funded by International Narcotic Law Enforcement (INL). This Task Order is implemented by Health through Walls, Inc, with two (2) subcontractors University of Florida and Emory University. The project is to assist the Haitian National Police's capacity and ability to meet the health needs of persons in Haitian prisons; improve the HNP's capacity to meet the nutritional needs of the Haitian prison population; provide the HNP with the tools to sustain the improvements in structure, sanitation and facilities made as a result of this project.

Project ECHO: Ending HIV in Prisons is a collaboration with the Project Echo program, funded by Gilead Foundation that seeks to create a two-pronged Project ECHO learning platform in correctional settings of resource-poor countries to engage prisons systems to share best practices and learn strategies for managing, preventing, treating and ending the HIV epidemic in prisons. This free program will provide virtual training programs to both correctional clinicians and provide peer education programming to incarcerated persons with the objective to reduce new HIV infections and the eventual end to the HIV epidemic. Prisons in resource poor countries face many challenges in delivering adequate health services. The prisons often have extreme conditions of overcrowding, lack of sanitation, safety hazards, poor nutrition, and little access to health professionals. These are often the same countries with the highest prevalence of HIV infection. The ramifications of failing to identify or prevent or properly manage HIV infections pose a threat to the entire prison population, staff, visitors, and community. Incarcerated persons are a key population often missed by traditional HIV programs. HtW also has a joint program with Gilead Foundation to provide HIV management and care services in the prisons in Jamaica, Haiti and Dominican Republic.

This project aims to deliver an integrated model of care that includes the strengthening of TB and HIV identification and treatment and screening and treatment of other illness in two Bangui prisons, namely Ngaragba and Bimbo prisons. Services will be delivered by Amici per il Centrafrica (Amici) and Health through Walls (HtW) in conjunction with the existing health and prison administration within the Central African Republic prisons and national strategic plans for health in prisons. One of the aims of this integrated partnership is to build capacity. The newly commissioned services will be integrated within the health program and include the identification, treatment, health promotion/education, and community referral (when discharge from prison occurs) for TB, HIV, malnutrition, fungal disease, skin conditions, hypertension, diabetes, chronic respiratory disease, cardiovascular diseases, and mental illness. To enhance the TB program, digital interventions are proposed. These include annual digital chest x-ray screenings, artificial intelligence (AI) for rapid x-ray interpretation, and implementation of an electronic patient management system. This project will be aligned with current partners to support the existing work being done in C.A.R. Monitoring and evaluation will help build capacity to meet the holistic health needs of the incarcerated population.

EMERGENCY CHOLERA RESPONSE IN PLACES OF DETENTION IN HAITI. On October 2, 2022, the national authorities reported two confirmed cases of Vibrio Cholerae Port-au-Prince. This was the beginning of the rapid spread of the disease throughout the country not unlike the first appearance a decade earlier. In less than a week there were more than 50 cases and 35 deaths in the West and Central Plateau. Two days after the first confirmed case, on October 4, 2022, cases of cholera were suspected at the Prison Civile of Port-au-Prince (PCPP), the country's the largest prison in Haiti holding an average of over 4000 prisoners daily. Within two weeks, there were 944 cases and 22 deaths at the PCPP. Haiti has 18 places of detention and approximately 11,697 inmates in its facilities. Because of this rapid spread HtW requested support from international agencies to stop the spread. Immediate programmatic, material, and financial support was provided to various degrees by AHF, ICRC, INL, and USAID. HtW worked with the MOH and the DAP to set up processes for identification, isolation, treatment, and care. It took some work to establish the treatment center (TCAD) since it was already being used for something else. The biggest obstacle was adequate space to house patients, there is no triage space in several prisons, and it was necessary to transform a prison cell into a triage room or erect tents to quarantine the infected. HtW, the DAP, the MOH, ICRC and INLE strategized weekly approaches to curb the spread of the disease and minimize deaths. The project began November 1st, 2022, and ended on March 31st, 2023, and was funded by the International Committee of the Red Cross.

General Fund: Used to buy medication and provide support for delivery of food and other HIV/essential services in resource poor countries.

Our project in Partnership with STOP TB/TB Reach is to deliver an integrated model of care that includes the strengthening of the TB care cascade, and the identification, treatment and support for persons with TB and DR-TB In three prison locations. The integrated service called CIPMATOD will be delivered and be enabled by embedding with existing health and prison administration services within Mozambique. The rationale for the Integrated partnership model is to build capacity in existing services offered to incarcerated persons and to provide additional health services. The newly commissioned services will be integrated within TB programs and include the identification, treatment, health promotion/education, and community referral (when discharge from prison occurs) for HIV/AIDS, syphilis, diabetes, chronic respiratory disease, cardlo-vascular disease, mental illness, skin conditions, and malnutrition. The establishment of an ISD model is anticipated to have positive impacts on TB treatment outcomes by focusing on a holistic and comprehensive approach. The integration of TB and HIV services provides an opportunity to address the burden of TB/HIV. The positive outcomes of service integration are to enhance efficiency, quality of care and patient satisfaction. Establishing an ISD will support the effective implementation of the Stop TB Strategy, improve HIV prevention and care, and improve health outcomes. Our service model incorporates the development of communities of clinical practice (Project ECHO) and provides training and deployment of peer educators in prison. The digital interventions include annual digital chest x-ray screenings, and artificial Intelligence (AI) for rapid x-ray readings for staff or persons with active disease released from prison during treatment. The Everwell Hub and SureAdhere patient management system will also be employed to support exceptional multi-disciplinary work, enhance medication compliance with DOT and VDOT. Some of our clinical interventions Include a medical history, screening questionnaire for TB, mental illness and depression screening, vital signs with weight and pulse oxlmetry, chest x-ray, point-of-care testing for HIV and syphilis and diabetes, and physical examination.

This project STORC project in conjunction with the Bill & Melinda Gate Foundation is a research endeavor into testing the specificity and sensitivity of tongue swabs to detect TB diseases in the absence of a sputum specimen. Health through Walls Inc. will work closely with the PI from Emory University to identify strategies for the execution of the overall research project. The Chief Executive Officer will travel to Manica Province in Mozambique to help the health service of Mozambique Prison System (SERNAP) oversee the TB screening Blitz in December 2023. HtW will provide stipends to clinical staff in order to have sufficient staffing for the screening blitz. Funds will also support transport of testing supplies and equipment, such as the portable x-ray machine. HtW will provide expertise and leadership in ensuring that the program of work is delivered to time, quality, and budget.