A Successful Model of Expedited Antiretroviral Therapy for Clinically Stable Patients Living With HIV in Haiti

Moise, Colette Guiteau; Rivera, Vanessa; Hennessey, Kelly A.; Bellot, Clovy; Nicholas, C.; Fang, Anna; Verdier, Rose Irène; Sévère, Patrice; Sainvil, Alix; Charles, Benedict; Dorval, Derothy; Amour, Juseline St.; Pape, Jean William; Koenig, Serena P.

doi:10.1097/qai.0000000000001725

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Interventions in Haiti to improve care access among the poor must specifically address identified barriers. In Haiti, health system interventions for the care of patients with human immunodeficiency virus have included food packages [6], community health worker-based adherence support [7,8], and improvements in clinic efficiency to shorten wait times and improve the care experience [9]. Health system interventions incorporating task shifting and task sharing to decentralize care towards smaller health facilities and communities that are closer to the people can reduce barriers to care access [37].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic sample of 13,277 households were selected within 445 selected clusters nationwide. All women in the sampled households aged 15 to 49 years (14,287), and all men aged 15 to 59 years (9,493) in two thirds of the households were interviewed. Data from health, education, and living standards categories are obtained from each household.…”

Section: Demographic Health Survey Datamentioning

confidence: 99%

“…In Haiti, as in other low-income countries, care of chronic NCD conditions is accomplished primarily in health centers and hospitals, as opposed to community-based dispensaries [5]. However, there are significant barriers to chronic care access in rural Haiti [6][7][8][9]. Such barriers are more challenging for patients struggling with poverty and include long distances to health facilities, high out-of-pocket spending for clinical visits and transportation, and other competing priorities.…”

Section: Introductionmentioning

confidence: 99%

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High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Kwan

Yan

Isaac³

et al. 2020

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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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Section: Discussionmentioning

confidence: 99%

Section: Demographic Health Survey Datamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Kwan

Yan

Isaac³

et al. 2020

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“…Research on DSD to date has largely focused on comparisons between a model and traditional, facility-based care with frequent visits, but has less frequently compared different DSD models with each other, in particular through soliciting patient preferences for different models. Experimental studies suggest 4,7–9 that, in general, patients benefit from peer support and other model components, which reduce visit frequency and waiting time. 10,11 But these studies do not address what services patients most want.…”

Section: Introductionmentioning

confidence: 99%

Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment

Eshun‐Wilson

Mukumbwa-Mwenechanya

Kim

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…We hypothesize that this finding relates to both the difficulty of attending regular clinical follow-up when working (especially if a patient is informally employed, has no days off during the week, and/or has no protections for sick leave) and the link in Haiti between employment and migration, with the inherent challenges of transferring health care in such situations. Nontraditional or flexible clinical follow-up plans with expedited appointments and longer intervals between visits have been associated with low rates of loss to follow-up in urban Haiti [ 31 ] and may be specifically useful for patients with regular income-generating activity. Other innovations around delivery of ART by community health workers and adherence clubs may also be helpful for this population [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality Over Long-term Follow-up for People With HIV Receiving Longitudinal Care and Antiretroviral Therapy in Rural Haiti

Richterman

Léandre

Jerome³

et al. 2020

Open Forum Infectious Diseases

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Introduction Deaths from HIV have fallen dramatically with the increasing availability of fully suppressive antiretroviral therapy (ART), and yet HIV remains the 9th leading cause of death in low-income countries. As more people with HIV enter care and receive ART, the focus will necessarily need to shift from expanding ART to including long-term program effectiveness and outcomes for people with HIV already engaged in care. Methods We evaluated risk factors for mortality among people with HIV on ART receiving longitudinal care in rural Haiti. We assessed baseline characteristics using a household survey and abstracted clinical characteristics from the electronic record. We used multivariable Cox regression models to identify risk factors for mortality. Results There were 464 people included in this study with a median follow up of 69 months (IQR 44-77), during which time 37 (8%) were lost to follow up and 118 (25%) died (median time to death, 29 months [IQR 12-53]). After adjustment, poverty (AHR 1.12 per 10 percentage point increased probability, 95% CI 1.01-1.24) and single marital status (AHR 1.59, 95% CI 1.08-2.36) were associated with increased mortality. Age (AHR 0.78 per ten year increase, 95% CI 0.64-0.94), role function quality of life (AHR 0.75 per quintile increase, 95% CI 0.62-0.90), and CD4 count (AHR 0.66 per 100 cells/uL, 95% CI 0.58-0.75) were associated with decreased mortality. Conclusions Poverty, marital status, and quality of life were associated with mortality. Social protection should be evaluated as a strategy to reduce mortality for people with HIV in concert with increasing access to ART.

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A Successful Model of Expedited Antiretroviral Therapy for Clinically Stable Patients Living With HIV in Haiti

Abstract: RP care was associated with high levels of retention and adherence for clinically stable patients. Timeliness of pre-RP visits was predictive of outcomes after RP initiation.

Cited by 6 publications

References 37 publications

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Differentiated Care Preferences of Stable Patients on Antiretroviral Therapy in Zambia: A Discrete Choice Experiment

Mortality Over Long-term Follow-up for People With HIV Receiving Longitudinal Care and Antiretroviral Therapy in Rural Haiti

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