Continuity of care during severe civil unrest with a model of community-based HIV care: a retrospective cohort study from Haiti

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-08-12 DOI:10.1016/j.lana.2024.100847

Patrice Joseph , Rochelle Sun , Colette Guiteau , Marc Antoine Jean Juste , Nancy Dorvil , Stalz Vilbrun , Rode Secours , Karine Severe , Parnel Raymond , Fernande Cetoute , Wilnide Jean Baptiste , Guyrlaine Forestal , Stanley Cadet , Adias Marcelin , Marie Marcelle Deschamps , Margaret L. McNairy , Akanksha Dua , Hoi Ching Cheung , Jean William Pape , Serena P. Koenig

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引用次数: 0

Abstract

Background

There are limited data on the effectiveness of differentiated service delivery (DSD) for HIV care during sociopolitical turmoil. We assessed outcomes with a DSD model of care that includes patient choice between community-based antiretroviral therapy (ART) centres, home-based ART dispensing, or facility-based care at GHESKIO clinic during a period of severe civil unrest in Port-au-Prince, Haiti.

Methods

This retrospective analysis included data on patients with at least one HIV visit at GHESKIO between May 1, 2019, and December 31, 2021. Multivariable logistic regression models were used to assess predictors of attending ≥1 community visit during the study period, and failure to attend timely visits. HIV-1 RNA test results were reported among patients who had been ART for ≥3 months at last visit.

Findings

Of the 18,625 patients included in the analysis, 9659 (51.9%) attended at least one community visit. The proportion of community visits ranged from 0.3% (2019) to 44.1% (2021). Predictors of ≥1 community visit included male sex (aOR: 1.13; 95% CI: 1.06, 1.20), secondary education (aOR: 1.07; 95% CI: 1.01, 1.14), income > $USD 1.00/day (aOR: 1.24; 95% CI: 1.14, 1.35), longer duration on ART (aOR: 1.08 per additional year; 95% CI: 1.07, 1.09), and residence in Carrefour/Gressier (p < 0.0001 in comparisons with all other zones). Younger age and shorter time on ART were associated with late visits and loss to follow-up. Among 12,586 patients with an on-time final visit who had been on ART for ≥3 months, 11,131 (88.4%) received a viral load test and 9639 (86.6%) had HIV-1 RNA < 1000 copies/mL.

Interpretation

The socio-political situation in Haiti has presented extraordinary challenges to the health care system, but retention and viral suppression rates remain high with a model of community-based HIV care. Additional interventions are needed to improve outcomes for younger patients, and those with shorter time on ART.

Funding

No funding.

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以社区为基础的艾滋病毒护理模式在严重内乱期间提供持续护理：海地的回顾性队列研究

背景在社会政治动荡期间，有关提供差异化服务（DSD）治疗艾滋病效果的数据十分有限。在海地太子港发生严重内乱期间，我们评估了差异化服务提供模式的效果，该模式包括患者在社区抗逆转录病毒疗法（ART）中心、家庭抗逆转录病毒疗法配药或 GHESKIO 诊所的设施护理之间进行选择。方法这项回顾性分析纳入了 2019 年 5 月 1 日至 2021 年 12 月 31 日期间在 GHESKIO 至少就诊过一次的 HIV 患者数据。多变量逻辑回归模型用于评估在研究期间接受≥1次社区就诊和未能及时就诊的预测因素。研究结果在纳入分析的 18625 名患者中，9659 人（51.9%）至少参加了一次社区就诊。社区就诊比例从 0.3%（2019 年）到 44.1%（2021 年）不等。≥1次社区就诊的预测因素包括男性（aOR：1.13；95% CI：1.06，1.20）、中等教育（aOR：1.07；95% CI：1.01，1.14）、收入> $USD1.00/天（aOR：1.24；95% CI：1.14，1.35）、接受抗逆转录病毒疗法的时间较长（aOR：每增加一年为 1.08；95% CI：1.07，1.09），以及居住在 Carrefour/Gressier （与所有其他地区相比，p< 0.0001）。年龄较小、接受抗逆转录病毒疗法的时间较短与就诊时间较晚和失去随访机会有关。在接受抗逆转录病毒疗法≥3 个月且最后一次按时就诊的 12586 名患者中，11131 人（88.4%）接受了病毒载量检测，9639 人（86.6%）的 HIV-1 RNA 为 1000 拷贝/毫升。需要采取更多干预措施来改善年轻患者和接受抗逆转录病毒疗法时间较短患者的治疗效果。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.