Abstract
Background On January 12, 2010, a devastating 7.0 magnitude earthquake struck the West Department of Haiti, killing more than 200,000 people and injuring or displacing many more. This disaster threatened continuity of HIV care and treatment services. Objectives This case study examined the effect of the devastating 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy (ART) program. Design The study triangulated retrospective data from existing sources, including: 1) individual-level longitudinal patient data from an electronic medical record for ART patients at two large public sector departmental hospitals differently affected by the earthquake; and 2) aggregate data on the volume of HIV-related services delivered at the two hospitals before and after the earthquake. Methods The study compared ART attrition and service delivery in Jacmel, a site in the ‘very strong’ zone of earthquake impact, and in Jérémie, a site in the ‘light’ zone of earthquake impact. The analysis used time-to-event analysis methods for the individual-level patient data, and descriptive statistical methods for the aggregate service delivery data. Results Adjusted ART attrition risk was lower at the hospital in Jacmel after vs. before the earthquake (HR=0.51; p=0.03), and was lower in Jacmel vs. Jérémie both before (HR=0.55; p=0.01) and after the earthquake (HR=0.35; p=0.001). The number of new ART patient enrollments, new HIV patient registrations, and HIV clinical visits dropped notably in Jacmel immediately after the earthquake, but then rapidly rebounded. On average, there was no change in new ART enrollments per month after vs. before the earthquake at either site. Conclusion These findings underscore the resilience of Haitian ART providers and patients, and contribute evidence that it is possible to maintain continuity of ART services even in the context of a complex humanitarian crisis.
Highlights
On January 12, 2010, a devastating 7.0 magnitude earthquake struck the West Department of Haiti, killing more than 200,000 people and injuring or displacing many more
Design: The study triangulated retrospective data from existing sources, including: 1) individual-level longitudinal patient data from an electronic medical record for antiretroviral therapy (ART) patients at two large public sector departmental hospitals differently affected by the earthquake; and 2) aggregate data on the volume of HIVrelated services delivered at the two hospitals before and after the earthquake
The study explored differences in characteristics of new ART patients, differences in ART attrition risk after adjustment for patient characteristics, and differences in HIV service delivery patterns by site among patients newly enrolled on ART before vs. after the earthquake
Summary
On January 12, 2010, a devastating 7.0 magnitude earthquake struck the West Department of Haiti, killing more than 200,000 people and injuring or displacing many more This disaster threatened continuity of HIV care and treatment services. Objectives: This case study examined the effect of the devastating 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy (ART) program. This case study examines the effects of Haiti’s earthquake on the phenomenon of ART attrition, or the drop-out of patients from the national ART program due to death or other reasons for loss-to-follow-up. The study explored differences in characteristics of new ART patients, differences in ART attrition risk after adjustment for patient characteristics, and differences in HIV service delivery patterns by site among patients newly enrolled on ART before vs after the earthquake. By exploring the hypothesis that HIV-related services were negatively impacted in the area of greater earthquake intensity, this case study contributes to the literature on the relationship between natural disaster and continuity of ART services
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