Recovery of HIV service provision post-earthquake

Abstract

To describe the level of functionality of President's Emergency Plan for AIDS Relief (PEPFAR)-supported HIV clinical services following the devastating earthquake that struck Haiti in January 2010. Available program-monitoring data from sites providing voluntary counseling and testing for HIV (VCT), antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) services, and antiretroviral treatment (ART) were described, comparing pre-earthquake and post-earthquake periods during October 2008 to May 2010. Pre-earthquake HIV service baselines for VCT, PMTCT, and ART enrollment were defined as monthly mean total number of patients served over 15 months pre-earthquake. ART baseline was defined as total current patients by December 2009. Sites were categorized as high-earthquake or low-earthquake intensity based on location and instrumental shake intensity data. Pre-earthquake mean monthly baselines were 41 087 (VCT), 11 909 (HIV testing at ANC sites), 648 (ART enrollment), and 296 (PMTCT enrollment); baseline total current patients on ART was 24 863. Service provision in January and May 2010, reported as percentage of baseline, was 43 and 78.7% (VCT), 50.8 and 88.7% (HIV testing at ANC), 46 and 81% (PMTCT), and 41 and 82.7% (ART enrollment), respectively. Current patients on ART decreased to 97% of baseline in April, rising to 103.9% by May; the initial decline was restricted to high-earthquake intensity areas. Following the Haiti earthquake, there was a transient, marked decline in VCT and new ART patient enrollment, whereas follow-up of established ART patients remained impressively high. HIV treatment continuity should be reinforced in disaster preparedness and response strategies in HIV epidemic settings.