The Centers for Disease Control and Prevention in the Dominican Republic (CDC/DR) has three disease impact goals:

1. prevent new cases of HIV in key populations of men who have sex with men (MSM), female sex workers, and priority populations (migrants)
2. reduce the prevalence of tuberculosis (TB)
3. reduce the impact of infectious disease outbreaks

To achieve these goals, CDC/DR works closely with the Ministry of Health (MoH) and other nongovernmental partners in epidemiology and surveillance initiatives; works to strengthen laboratory systems; implements HIV and TB prevention strategies; and improves the provision of health services for these populations.

CDC/DR, through the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), has three main HIV- related goals: 1) increase detection, access to care, and retention of people living with HIV to reduce mortality and HIV transmission, 2) improve the quality of care and HIV clinical cascade of individuals who are seen at public health facilities, and 3) increase access to, and uptake of, HIV testing and counseling, condoms, and other evidence-based interventions focused on key and priority populations.

Local partners conduct outreach and perform rapid HIV testing to priority, difficult-to-reach populations at risk for HIV infection in Mao, Valverde. Photos by: Juan J. de los Santos

• Assisted the MoH in implementing a national strategy for the PMTCT of HIV and syphilis
• Launched a national laboratory accreditation program and strengthened laboratory capacity
• Designed and implemented HIV prevention interventions among MSM, sex workers, and migrant populations
• Trained >200 field epidemiologists at basic, intermediate, and advanced levels (FETP) since 2012
• Developed an electronic HIV Patient Monitoring System (FAPPS) in 2013, that has allowed tracking of individuals on ARV

CDC/DR supports the MoH to characterize its HIV/AIDS epidemic and assists in the implementation of a national electronic surveillance system, an electronic TB reporting system, a monitoring system for patients receiving treatment for HIV/AIDS, and a sentinel surveillance system for sexually transmitted infections. CDC also supports the MoH in conducting several large population surveys to characterize the HIV/AIDS epidemic and builds human resource capacity within the MoH by mentoring HIV and TB health professionals through its Field Epidemiology Training Program (FETP). In April 2017, CDC/DR launched two mobile clinics to support the MoH and to provide comprehensive health services, and it is strategically positioned to successfully promote the “Test and Start” treatment strategy for HIV to achieve the goal of an AIDS-free generation.

CDC actively supports the binational public health agenda between the Dominican Republic and Haiti. Projects place special emphasis on strengthening collaboration between MoH and the malaria, TB, and HIV control programs.

At the regional level, CDC works collaboratively with the CDC Regional Office for Central America in Guatemala and the CDC Caribbean Regional Office to coordinate and jointly respond to public health emergencies.

CDC/DR laboratory efforts are concentrated on implementing the Stepwise Laboratory Improvement Program Towards Accreditation (SLIPTA), developed by CDC and WHO. After completing 20 national and regional laboratories, CDC/DR also supported countries in Central and South America to introduce SLIPTA into their regions. SLIPTA-enrolled labs have decreased turnaround time for HIV results from several days to two hours.

To assist the country achieve the ambitious UNAIDS 90-90-90 treatment targets, CDC/DR supports HIV testing services to diagnose patients and to achieve sustained viral load suppression of those receiving antiretroviral therapy. In addition, CDC supports the country in meeting its obligations under the International Health Regulations by helping it develop laboratory capacity for disease surveillance including training laboratory technicians in basic epidemiology and surveillance, installing molecular and genetic testing capacity in the national reference laboratory, and developing a public health laboratory network.

In April 2017, CDC/DR launched two mobile clinics to support the MoH to provide comprehensive health services in two cities, including HIV prevention, to difficult-to-reach and migrant populations. With the launch of the mobile clinics, CDC/DR and its partners are strategically positioned to successfully promote the "Test and Start" treatment strategy for HIV to achieve the goal of an AIDS-free generation.

Emerging infectious diseases greatly affect developing countries, but they also affect the United States with far-reaching consequences for people, the U.S. public health system, its delivery of medical care, and the economy. Preventing, detecting, and containing outbreaks at their source protects Americans from deadly diseases and preserves stable markets for U.S. exports that support millions of U.S. jobs. Helping other countries to control disease outbreaks prevents those diseases from spreading to the United States, saving lives and dollars. CDC provides support to the MoH in the detection and response to disease outbreaks such as cholera, chikungunya, histoplasmosis, and Zika.

Tourism has had a significant impact on public health in the Dominican Republic due to the importation and spread of pathogens.

• In 2014, over 5 million visitors, mostly from North America, flocked to the DR (a country of 10 million) for a variety of reasons, including all-inclusive Caribbean vacations, medical tourism, and conventions.
• The DR outpaced all islands in the Caribbean with 5 million visitors, followed by Cuba with 2.8 million visitors and Jamaica with 2 million.

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