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Yan LD, Pierre-Louis D, Isaac BD, Jean-Baptiste W, Vertilus S, Fenelon D, Hirschhorn LR, Hibberd PL, Benjamin EJ, Bukhman G, Kwan GF. Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti. BMC Public Health 2020; 20:1545. [PMID: 33054756 PMCID: PMC7556963 DOI: 10.1186/s12889-020-09652-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. METHODS We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. RESULTS We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. CONCLUSIONS Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.
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Affiliation(s)
- Lily D Yan
- Boston Medical Center, 72 East Concord St., Boston, MA, 02118, USA
| | - Dufens Pierre-Louis
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | - Waking Jean-Baptiste
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Serge Vertilus
- Zanmi Lasante, Cange, Haiti
- Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | | | - Lisa R Hirschhorn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patricia L Hibberd
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Emelia J Benjamin
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Gene Bukhman
- Partners In Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Gene F Kwan
- Boston Medical Center, 72 East Concord St., Boston, MA, 02118, USA.
- Boston University School of Medicine, Boston, MA, USA.
- Partners In Health, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Delcher C, Robin EG, Pierre DM. Haiti's HIV Surveillance System: Past, Present, and Future. Am J Trop Med Hyg 2020; 103:1372-1375. [PMID: 32700659 PMCID: PMC7543818 DOI: 10.4269/ajtmh.20-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/02/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chris Delcher
- College of Pharmacy, University of Kentucky, Lexington, Kentucky
| | - Ermane G. Robin
- Programme National de Lutte contre les IST/VIH/SIDA (PNLS) Unite de Coordination des Maladies Transmissibles (UCMIT) Ministere Sante Publique et Popuation (MSPP), Port-au-Prince, Haiti
| | - Daniella Myriam Pierre
- Programme National de Lutte contre les IST/VIH/SIDA (PNLS) Unite de Coordination des Maladies Transmissibles (UCMIT) Ministere Sante Publique et Popuation (MSPP), Port-au-Prince, Haiti
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Kwan GF, Yan LD, Isaac BD, Bhangdia K, Jean-Baptiste W, Belony D, Gururaj A, Martineau L, Vertilus S, Pierre-Louis D, Fenelon DL, Hirschhorn LR, Benjamin EJ, Bukhman G. High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti. Glob Heart 2020; 15:7. [PMID: 32489780 PMCID: PMC7218772 DOI: 10.5334/gh.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.
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Affiliation(s)
- Gene F. Kwan
- Boston University School of Medicine, Boston, MA, US
- Boston Medical Center, Boston, MA, US
- Partners In Health, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | | | | | | | | | | | - Louine Martineau
- Zanmi Lasante, HT
- Tufts New England Medical Center, Boston, MA, US
| | - Serge Vertilus
- Zanmi Lasante, HT
- Hôpital Universitaire de Mirebalais, HT
| | | | | | | | - Emelia J. Benjamin
- Boston University School of Medicine, Boston, MA, US
- Boston University School of Public Health, Boston, MA, US
| | - Gene Bukhman
- Harvard Medical School, Boston, MA, US
- Brigham and Women’s Hospital, Boston, MA, US
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Stafford KA, Nganga LW, Tulli T, Foreit KGF. Factors Associated with Outcomes of Pre-ART HIV Care. J Int Assoc Provid AIDS Care 2019. [PMID: 29534654 PMCID: PMC6748496 DOI: 10.1177/2325958218759602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization recommended removing all CD4 requirements for initiation of
antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period
to identify and assess factors associated with outcomes of pre-ART care. Four modes of
transition out of pre-ART care were considered. Beta estimates from the competing risks
Cox models were used to investigate whether the effects of covariates differed by mode of
transition. Median CD4 counts at entry showed no meaningful change over time. Advanced
disease progression and presence of opportunistic infections were significant predictors
of pre-ART mortality. Men were more likely to die before initiating ART, transfer to
another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not
likely to substantially reduce program mortality prior to ART initiation unless and until
patients enroll earlier in disease progression. Care programs should focus on diagnosis
and treatment of opportunistic infections to reduce pre-ART mortality.
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Affiliation(s)
- Kristen A Stafford
- 1 Division of Clinical Care & Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Tuhuma Tulli
- 3 The Palladium Group, Dar es Salaam, United Republic of Tanzania
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Whitlock G, Carbonell M, Blackwell S, Nwokolo N. Rapid initiation of antiretroviral therapy in those with newly diagnosed HIV infection in London, UK. HIV Med 2019; 20:699-703. [PMID: 31424598 DOI: 10.1111/hiv.12780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In July 2016, as a result of patient demand, we introduced a rapid initiation option (RIO) to offer a first medical appointment and antiretroviral therapy (ART) initiation within 2 days of HIV diagnosis at 56 Dean Street (56DS) , a combined sexual health and HIV treatment service in London, UK. METHODS We performed a retrospective case-note review of patients newly diagnosed with HIV infection at 56DS following the introduction of the new RIO from July to October 2016. In order to assess the effect of the new service on ART uptake, we chose a comparison group of newly diagnosed patients at 56DS from 1 year earlier: July to October 2015. RESULTS In the 4 months following RIO introduction, there was a reduction in the median time from HIV diagnosis to the first medical appointment (7 versus 15 days; P < 0.00001) and to ART initiation (8 versus 21 days; P < 0.00001) compared with the same 4-month period 1 year previously. Uptake of ART at first appointment also significantly increased from 60% to 76% (P = 0.0074). CONCLUSIONS By increasing our clinic capacity and awareness of staff and patients of the RIO service, we were able to fulfil the aim of the service to offer ART more quickly following HIV diagnosis.
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Affiliation(s)
- G Whitlock
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M Carbonell
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Blackwell
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - N Nwokolo
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Jannat-Khah DP, Unterbrink M, McNairy M, Pierre S, Fitzgerald DW, Pape J, Evans A. Treating loss-to-follow-up as a missing data problem: a case study using a longitudinal cohort of HIV-infected patients in Haiti. BMC Public Health 2018; 18:1269. [PMID: 30453995 PMCID: PMC6245624 DOI: 10.1186/s12889-018-6115-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background HIV programs are often assessed by the proportion of patients who are alive and retained in care; however some patients are categorized as lost to follow-up (LTF) and have unknown vital status. LTF is not an outcome but a mixed category of patients who have undocumented death, transfer and disengagement from care. Estimating vital status (dead versus alive) among this category is critical for survival analyses and program evaluation. Methods We used three methods to estimate survival in the cohort and to ascertain factors associated with death among the first cohort of HIV positive patients to receive antiretroviral therapy in Haiti: complete case (CC) (drops missing), Inverse Probability Weights (IPW) (uses tracking data) and Multiple Imputation with Chained Equations (MICE) (imputes missing data). Logistic regression was used to calculate odds ratios and 95% confidence intervals for adjusted models for death at 10 years. The logistic regression models controlled for sex, age, severe poverty (living on <$1 USD per day), Port-au-Prince residence and baseline clinical characteristics of weight, CD4, WHO stage and tuberculosis diagnosis. Results Age, severe poverty, baseline weight and WHO stage were statistically significant predictors of AIDS related mortality across all models. Gender was only statistically significant in the MICE model but had at least a 10% difference in odds ratios across all models. Conclusion Each of these methods had different assumptions and differed in the number of observations included due to how missing values were addressed. We found MICE to be most robust in predicting survival status as it allowed us to impute missing data so that we had the maximum number of observations to perform regression analyses. MICE also provides a complementary alternative for estimating survival among patients with unassigned vital status. Additionally, the results were easier to interpret, less likely to be biased and provided an alternative to a problem that is often commented upon in the extant literature. Electronic supplementary material The online version of this article (10.1186/s12889-018-6115-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deanna P Jannat-Khah
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
| | - Michelle Unterbrink
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
| | - Margaret McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.,Center for Global Health, Weill Cornell Medicine, New York, USA
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince, Haiti
| | - Dan W Fitzgerald
- Center for Global Health, Weill Cornell Medicine, New York, USA.,Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince, Haiti
| | - Jean Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port au Prince, Haiti
| | - Arthur Evans
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
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Lipira L, Kemp C, Domercant JW, Honoré JG, Francois K, Puttkammer N. The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data. Int Health 2018; 10:54-62. [PMID: 29329386 DOI: 10.1093/inthealth/ihx060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
Background Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. Methods This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Results Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Conclusion Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition.
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Christopher Kemp
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jean Guy Honoré
- International Training and Education Center for Health, Port-au-Prince, Haiti and Seattle, WAUSA
| | - Kesner Francois
- Ministry of Public Health and Population (MSPP), Port-au-Prince, Haiti
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Seattle, WA, USA
- International Training and Education Center for Health, Port-au-Prince, Haiti and Seattle, WA USA
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Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B. AIDS Res Treat 2016; 2016:6284290. [PMID: 27651953 PMCID: PMC5019862 DOI: 10.1155/2016/6284290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 01/08/2023] Open
Abstract
Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4–3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed.
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Impact of a youth-friendly HIV clinic: 10 years of adolescent outcomes in Port-au-Prince, Haiti. J Int AIDS Soc 2016; 19:20859. [PMID: 27389256 PMCID: PMC4933795 DOI: 10.7448/ias.19.1.20859] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/18/2016] [Accepted: 05/31/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Adolescents account for over 40% of new HIV infections in Haiti. This analysis compares outcomes among HIV-positive adolescents before and after implementation of an adolescent HIV clinic in Port-au-Prince, Haiti. Methods We conducted a cohort study using programmatic data among HIV-positive adolescents aged 13 to 19. Data from 41,218 adolescents who were HIV tested from January 2003 to December 2012 were included. Outcomes across the HIV care cascade were assessed before and after implementation of an adolescent clinic (2009), including HIV testing, enrolment in care, assessment for antiretroviral therapy (ART) eligibility, ART initiation and 12-month retention. Pre-ART outcomes were assessed 12 months after HIV testing. Factors associated with pre-ART and ART attrition were identified through multivariable competing risk and Cox proportional hazards regression modelling. Results Cumulatively, 1672 (4.1%) adolescents tested HIV positive (80% female, median age 16 years). Retention by cascade step comparing pre- and post-clinic included the following: 86% versus 87% of patients enrolled in care, 61% versus 79% were assessed for ART eligibility, 85% versus 92% initiated ART and 68% versus 66% were retained 12 months after ART initiation. Pre-ART attrition decreased from 61% pre-clinic to 50% post-clinic (p<0.001). Pre-ART attrition was associated with being female (sub-distributional hazard ratio (sHR): 1.59; CI: 1.31–1.93), syphilis diagnosis (sHR: 1.47; CI: 1.16–1.85) and slum residence (sHR: 0.84; CI: 0.72–0.97). ART attrition was associated with syphilis diagnosis (hazard ratio (HR): 2.23; CI: 1.35–3.68) and CD4 <50 cells/µL (HR: 1.88; CI: 1.15–3.06). Conclusions Implementation of a youth-friendly adolescent clinic improved retention in HIV care among adolescents, particularly in the assessment of ART eligibility and ART initiation. Additional interventions are needed to improve retention among pre-ART patients and support long-term retention among ART patients.
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Kwan GF, Jean-Baptiste W, Cleophat P, Leandre F, Louine M, Luma M, Benjamin EJ, Mukherjee JS, Bukhman G, Hirschhorn LR. Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti. Heart 2016; 102:140-6. [PMID: 26729609 DOI: 10.1136/heartjnl-2015-308451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE There is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live. We studied HF epidemiology, care delivery and outcomes in rural Haiti. METHODS Among adults admitted with HF to a rural Haitian tertiary care hospital during a 12-month period (2013-2014), we studied the clinical characteristics and short-term outcomes including length of stay, inhospital death and outpatient follow-up rates. RESULTS HF accounted for 392/1049 (37%) admissions involving 311 individuals; over half (60%) were women. Mean age was 58.8 (SD 16.2) years for men and 48.3 (SD 18.8) years for women; 76 (41%) women were <40 years of age. Median length of stay was 10 days (first and second quartiles 7, 17), and inhospital mortality was 12% (n=37). Ninety nine (36%) of the 274 who survived their primary hospitalisation followed-up at the hospital's outpatient clinic, and 18 (6.6%) were readmitted to the same hospital within 30 days postdischarge. Decreased known follow-up (p<0.01) and readmissions (p=0.03) were associated with increased distance between patient residence and hospital. Among the one-quarter (81) patients with echocardiograms, causes of HF included: non-ischaemic cardiomyopathy (64%), right HF (12%), hypertensive heart disease (7%) and rheumatic heart disease (5%). One-half of the women with cardiomyopathy by echocardiogram had peripartum cardiomyopathy. CONCLUSIONS HF is a common cause of hospitalisation in rural Haiti. Among diagnosed patients, HF is overwhelming due to non-atherosclerotic heart disease and particularly affects young adults. Implementing effective systems to improve HF diagnosis and linkage to essential outpatient care is needed to reduce long-term morbidity and mortality.
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Affiliation(s)
- Gene F Kwan
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Philip Cleophat
- Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Fèrnet Leandre
- Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Martineau Louine
- Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Maxo Luma
- Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joia S Mukherjee
- Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gene Bukhman
- Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA Ariadne Labs, Boston, Massachusetts, USA
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11
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Koenig SP, Bernard D, Dévieux JG, Atwood S, McNairy ML, Severe P, Marcelin A, Julma P, Apollon A, Pape JW. Trends in CD4 Count Testing, Retention in Pre-ART Care, and ART Initiation Rates over the First Decade of Expansion of HIV Services in Haiti. PLoS One 2016; 11:e0146903. [PMID: 26901795 PMCID: PMC4763018 DOI: 10.1371/journal.pone.0146903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/23/2015] [Indexed: 12/26/2022] Open
Abstract
Background High attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions. Methods We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART. Results 24,925 patients (61% female, median age 35 years) were included, and 15,008 (60%) had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding transfers, the proportion of patients who were retained in pre-ART care or initiated ART within the first year after HIV testing was 84%, 82%, 64%, and 64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB) at HIV testing were associated with retention in care. Conclusions The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts.
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Affiliation(s)
- Serena P. Koenig
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Daphne Bernard
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G. Dévieux
- AIDS Prevention Program, Florida International University, Miami, FL, United States of America
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
| | - Patrice Severe
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Adias Marcelin
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Pierrot Julma
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Center for Global Health, Weill Cornell Medical College, New York, NY, United States of America
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12
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Delcher C, Puttkammer N, Arnoux R, Francois K, Griswold M, Zaidi I, Joseph YAP, Marston BJ. Validating Procedures used to Identify Duplicate Reports in Haiti's National HIV/AIDS Case Surveillance System. JOURNAL OF REGISTRY MANAGEMENT 2016; 43:10-15. [PMID: 27195993 PMCID: PMC5222994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Valid deduplication of human immunodeficiency virus (HIV) case reports is critical to the utility of these data to inform HIV programs. The Haitian Ministry of Health (MSPP) and partners operate a case-based, national HIV/AIDS surveillance system (HASS), using deterministic and probabilistic procedures to identify duplicate records. These procedures are described and validated based on expert classifications. METHODS Two samples of HASS records identified as duplicates were selected: 100 pairs from deterministic and 100 pairs from probabilistic matching procedures (total: 200 pairs, 400 case reports). Clinical data from the national electronic medical record (iSanté) were reviewed and consensus gold-standard determinations on the status of duplications were made. False positive rates (FPR) were estimated by reviewing these records, while false negative rates were calculated (FNR) by using LinkPlus™ probabilistic linkage software. The effect of deduplication on total HIV case counts was demonstrated. RESULTS Review of deterministic matches yielded 99 true positives and 1 false positive (FPR, 1 per 100; 95% CI, 0.71-5.4). Review of probabilistic matches yielded a FPR of 6 per 100 (95% CI, 2.7-12.4). LinkPlus identified 1,491 probable matches among 68,393 records, representing a FNR of 2 per 100 (95% CI, 0.55-7.0). After adjustment, the estimated unique count of reported HIV patients in HASS was 211,885 (95% CI, 207, 293-213, 232) as of December 2013. CONCLUSIONS Based on application of the established procedures, HASS conforms to the duplication performance standard recommended by the Centers for Disease Control and Prevention for HIV surveillance.
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Affiliation(s)
| | - Nancy Puttkammer
- International Training and Education Center for Health, Seattle,
Washington
| | - Réginald Arnoux
- International Training and Education Center for Health, Haiti
(I-TECH Haiti), Port-au-Prince, Haiti
| | - Kesner Francois
- Ministère de la Santé Publique et de la Population,
Port-au-Prince, Haiti
| | - Mark Griswold
- National Alliance of State and Territorial AIDS Directors,
Washington, DC
| | - Irum Zaidi
- Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Esperance MC, Koenig SP, Guiteau C, Homeus F, Devieux J, Edouard J, Bertrand R, Joseph P, Bellot C, Decome D, Pape JW, Severe P. A successful model for rapid triage of symptomatic patients at an HIV testing site in Haiti. Int Health 2015; 8:96-100. [PMID: 26180112 DOI: 10.1093/inthealth/ihv042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attrition from HIV testing to antiretroviral therapy (ART) initiation is high. Strengthening linkages in care from testing to treatment may reduce attrition. This study addresses the question: can social workers accurately identify symptomatic patients during HIV testing and fast-track them for rapid provision of services? METHODS This study took place at the Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Port-au-Prince, Haiti. We compared symptoms reported by social workers at HIV testing using a checklist to diagnoses made by physicians on an intake exam to determine if social workers could accurately identify symptomatic patients. RESULTS Among the 437 HIV-positive patients included in the study, social workers reported stage-associated symptoms in 100% of patients diagnosed with WHO stage 3 or 4 conditions and in 87% of patients with WHO stage 1 or 2 conditions. The sensitivity, specificity, positive predictive value, and negative predictive value of social worker-reported symptoms for the diagnosis of a WHO stage 3 or 4 condition was 100%, 47%, 31%, and 100%, respectively. CONCLUSIONS Social workers can identify symptomatic patients at HIV testing and refer them for fast-tracked services. This strategy may increase the rate of ART initiation among eligible patients.
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Affiliation(s)
- Morgan C Esperance
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Serena P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Colette Guiteau
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Fabienne Homeus
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | | | - Jenny Edouard
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Rachel Bertrand
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Clovy Bellot
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Diessy Decome
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
| | - Jean W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Harry Truman Boulevard, Port-au-Prince, Haiti
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Kimmel AD, Fitzgerald DW, Pape JW, Schackman BR. Performance of a mathematical model to forecast lives saved from HIV treatment expansion in resource-limited settings. Med Decis Making 2015; 35:230-42. [PMID: 25331914 PMCID: PMC4297237 DOI: 10.1177/0272989x14551755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND International guidelines recommend HIV treatment expansion in resource-limited settings, but funding availability is uncertain. We evaluated the performance of a model that forecasts lives saved through continued HIV treatment expansion in Haiti. METHODS We developed a computer-based, mathematical model of HIV disease and used incidence density analysis of patient-level Haitian data to derive model parameters for HIV disease progression. We assessed the internal validity of model predictions and internally calibrated model inputs when model predictions did not fit the patient-level data. We then derived uncertain model inputs related to diagnosis and linkage to care, pretreatment retention, and enrollment on HIV treatment through an external calibration process that selected input values by comparing model predictions to Haitian population-level data. Model performance was measured by fit to event-free survival (patient level) and number receiving HIV treatment over time (population level). RESULTS For a cohort of newly HIV-infected individuals with no access to HIV treatment, the model predicts median AIDS-free survival of 9.0 years precalibration and 6.6 years postcalibration v. 5.8 years (95% confidence interval, 5.1-7.0) from the patient-level data. After internal validation and calibration, 16 of 17 event-free survival measures (94%) had a mean percentage deviation between model predictions and the empiric data of <6%. After external calibration, the percentage deviation between model predictions and population-level data on the number on HIV treatment was <1% over time. CONCLUSIONS Validation and calibration resulted in a good-fitting model appropriate for health policy decision making. Using local data in a policy model-building process is feasible in resource-limited settings.
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Affiliation(s)
- April D Kimmel
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA (ADK)
- Department of Public Health, Weill Cornell Medical College, New York, NY, USA(ADK, BRS)
| | - Daniel W Fitzgerald
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA(DWF, JWP)
| | - Jean W Pape
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA(DWF, JWP)
- Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti (JWP)
| | - Bruce R Schackman
- Department of Public Health, Weill Cornell Medical College, New York, NY, USA(ADK, BRS)
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Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: "Group of 6". AIDS Res Treat 2014; 2014:137545. [PMID: 25548659 PMCID: PMC4274858 DOI: 10.1155/2014/137545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/12/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. In Mozambique, a patient-led Community ART Group model developed by Médecins Sans Frontières improved retention in care and adherence to antiretroviral therapy (ART) among persons with HIV. We describe the adaptation and implementation of this model within the HIV clinic located in the largest public hospital in Haiti's Southern Department. Methods. Our adapted model was named Group of 6. Hospital staff enabled stable patients with HIV receiving ART to form community groups with 4–6 members to facilitate monthly ART distribution, track progress and adherence, and provide support. Implementation outcomes included recruitment success, participant retention, group completion of monthly monitoring forms, and satisfaction surveys. Results. Over one year, 80 patients from nine communities enrolled into 15 groups. Six participants left to receive HIV care elsewhere, two moved away, and one died of a non-HIV condition. Group members successfully completed monthly ART distribution and returned 85.6% of the monthly monitoring forms. Members reported that Group of 6 made their HIV management easier and hospital staff reported that it reduced their workload. Conclusions. We report successful adaptation and implementation of a validated community HIV-care model in Southern Haiti. Group of 6 can reduce barriers to ART adherence, and will be integrated as a routine care option.
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Houston E, Fominaya AW. Antiretroviral therapy adherence in a sample of men with low socioeconomic status: The role of task-specific treatment self-efficacy. PSYCHOL HEALTH MED 2014; 20:896-905. [PMID: 25439192 DOI: 10.1080/13548506.2014.986137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Disparities continue to persist in HIV care and treatment outcomes among racial/ethnic minorities, men who have sex with men (MSM), and individuals with low socioeconomic status. Much research has identified treatment self-efficacy as a key factor in antiretroviral therapy adherence and subsequent treatment outcomes. Few studies, however, have elaborated on these links and their potential in reducing HIV treatment disparities by examining the role of task-specific types of treatment self-efficacy. In this study, we examined the effect of four types of task-specific treatment self-efficacy on antiretroviral adherence among patients in a predominantly racial/ethnic minority sample of HIV-seropositive MSM with low socioeconomic status. We grouped participants by duration of treatment to determine whether certain types of self-efficacy were more salient based on treatment experience. We found that participants with optimal adherence tended to have higher levels of task-specific self-efficacy related to medication management and mood management than participants with suboptimal adherence. After a Bonferroni correction for multiple comparisons, only task-specific self-efficacy for medication management showed significant effects on adherence. Findings suggest that using focused, task-specific measures of treatment self-efficacy could strengthen our ability to aid patients at risk for adherence difficulties and tailor interventions to more effectively meet their needs.
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Affiliation(s)
- Eric Houston
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL 60616 , USA
| | - Adam W Fominaya
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL 60616 , USA
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Rouzier V, Farmer PE, Pape JW, Jerome JG, Van Onacker JD, Morose W, Joseph P, Leandre F, Severe P, Barry D, Deschamps MM, Koenig SP. Factors impacting the provision of antiretroviral therapy to people living with HIV: the view from Haiti. Antivir Ther 2014; 19 Suppl 3:91-104. [PMID: 25310257 DOI: 10.3851/imp2904] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
Haiti is the poorest country in the Western Hemisphere and has the highest number of people living with HIV in the Caribbean, the region most impacted by HIV outside of Africa. Despite continuous political, socioeconomic and natural catastrophes, Haiti has mounted a very successful response to the HIV epidemic. Prevention and treatment strategies implemented by the government in collaboration with non-governmental organizations have been instrumental in decreasing the national HIV prevalence from a high of 6.2% in 1993 to 2.2% in 2012. We describe the history and epidemiology of HIV in Haiti and the expansion of antiretroviral therapy (ART) over the past decade, with the achievement of universal access to ART for patients meeting the 2010 World Health Organization guidelines. We also describe effective models of care, successes and challenges of international funding, and current challenges in the provision of ART. We are optimistic that the goal of providing ART for all in need remains in reach.
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Affiliation(s)
- Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
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