Retention Throughout the HIV Care and Treatment Cascade: From Diagnosis to Antiretroviral Treatment of Adults and Children Living with HIV—Haiti, 1985–2015

Andrew F Auld,Nirva Duval,Kesner Francois,Varough Deyde,Jacob Dee,Ermane G Robin,Gracia Desforges,Ray W Shiraishi,Yrvel Desir,Jean Wysler Domercant,Joelle Deas Van Onacker,David W Lowrance,Mayer Antoine,Valerie Pelletier Valerie Pelletier,Nadjy Joseph,Chris Delcher,Mark Griswold,Yves Anthony Patrice Joseph

doi:10.4269/ajtmh.17-0116

Abstract

.Monitoring retention of people living with HIV (PLHIV) in the HIV care and treatment cascade is essential to guide program strategy and evaluate progress toward globally-endorsed 90–90–90 targets (i.e., 90% of PLHIV diagnosed, 81% on sustained antiretroviral therapy (ART), and 73% virally suppressed). We describe national retention from diagnosis throughout the cascade for patients receiving HIV services in Haiti during 1985–2015, with a focus on those receiving HIV services during 2008–2015. Among the 266,256 newly diagnosed PLHIV during 1985–2015, 49% were linked-to-care, 30% started ART, and 18% were retained on ART by the time of database closure. Similarly, among the 192,187 newly diagnosed HIV-positive patients during 2008–2015, 50% were linked to care, 31% started ART, and 19% were retained on ART by the time of database closure. Most patients (90–92%) at all cascade steps were adults (≥ 15 years old), among whom the majority (60–61%) were female. During 2008–2015, outcomes varied significantly across 42 administrative districts (arrondissements) of residence; cumulative linkage-to-care ranged from 23% to 69%, cumulative ART initiation among care enrollees ranged from 2% to 80%, and cumulative ART retention among ART enrollees ranged from 30% to 88%. Compared with adults, children had lower cumulative incidence of ART initiation among care enrollees (64% versus 47%) and lower cumulative retention among ART enrollees (64% versus 50%). Cumulative linkage-to-care was low and should be prioritized for improvement. Variations in outcomes by arrondissement and between adults and children require further investigation and programmatic response.

Highlights

Haiti has a population of about 11 million people, including 150,000 people living with HIV (PLHIV) and outside of subSaharan Africa, it is one of the countries worst affected by the global HIV pandemic.[1]
The earliest documented HIV diagnosis in SALVH was in 1985, which is 2 years after the first AIDS patient was reported from Haiti in 1983
In 2003 compared with 2002, annual rates of new HIV diagnoses, care enrollments, and antiretroviral therapy (ART) enrollments were 1.8, 3.1, and 18.8 times as high following the release of the first Haitian National HIV/AIDS Strategic Plan and the first Haitian grant from the Global Fund to Fight AIDS, tuberculosis (TB), and Malaria (GFATM) in late 2002

Summary

Introduction

Haiti has a population of about 11 million people, including 150,000 people living with HIV (PLHIV) and outside of subSaharan Africa, it is one of the countries worst affected by the global HIV pandemic.[1]. To facilitate continued scale-up of high-quality care nationwide, in 2008, the Ministry of Health (MOH), with support from the Centers for Disease Control and Prevention (CDC), the National Alliance of State and Territorial AIDS Directors, and other partners initiated a project to create a nationally representative, longitudinal, patient monitoring system.[9] This national monitoring system is called the haitian active longitudinal tracking of HIV system, with the French acronym being SALVH. SALVH was known as the HIV/AIDS surveillance system.[9] SALVH captures patient-level data throughout the clinical care continuum from the point of HIV diagnosis onward.[9]

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