Access to antiretroviral therapy during excess black-water flooding in central Thailand

Abstract

Excess black-water flooding in central Thailand resulted in closure of several healthcare facilities in the Fall of 2011. Persons living with human immunodeficiency virus (HIV) infection were presumably at risk for interruption of antiretroviral therapy (ART), with consequent treatment failure. We conducted a retrospective cohort study of ART use among patients in care at a Thai HIV clinic that closed due to excess flood water. Among 217 patients on ART who had clinic appointments within the one-month interval before the floods through the one-month interval after the clinic re-opened, seven (3%) reported non-sustained ART access. Non-sustained ART access was independently associated with prior low self-reported ART adherence (P<0.001) and less than six-months duration on the ART regimen (P=0.03). Advanced ART receipt or procurement at other flood-free healthcare facilities were strategies associated with ART access. During a flood disaster, identification and close monitoring of at-risk patients, patient-staff communication, flood preparedness plans, "HIV care access for all" policies, and collaboration among patients, healthcare providers and the government are relevant issues within preparedness plans to optimize ART access.

Provision of antiretroviral care to displaced populations in humanitarian settings: a systematic review

“…Five studies reported outcomes in a setting of post-election violence (Unge et al 2010;Pyne-Mercier et al 2011;Bamrah et al 2013;Doumbouya et al 2012;Yoder et al 2012); these studies were undertaken mainly in sub Saharan African, where both HIV and conflicts are most prevalent (Mills et al 2009), including Kenya, Northern Uganda and the Ivory Coast. Three studies reported outcomes from natural disaster settings (Bhakeecheep et al 2012 Walldorf et al 2012;Khawcharoenporn et al 2013). Finally, two studies only reported results for children (Kiboneka et al 2008;Yoder et al 2012).…”

“…Nine of the studies did not statistically adjust for confounders and seven studies did not follow up patients for more than six months. Two studies were given a 'higher rating' of overall strength of study quality (Kiboneka et al 2009;Yoder et al 2012), five studies were given a 'medium' rating, (Garang, Odoi, and Kalyango 2009;O'Brien et al 2010;Autino et al 2012;Walldorf et al 2012;Khawcharoenporn et al 2013) and seven studies a 'lower' rating (Kiboneka et al 2008…”

“…During floods in Thailand 10% (4167/41,673) of patients had missed one appointment or more (Bhakeecheep et al 2012). Only 7/217 HIV patients on ART at one HIV clinic in Thailand reported no access to treatment during the disaster (Khawcharoenporn et al 2013). Walldorf et al (2012) reported that 97% of current patients on ART from the baseline pre-earthquake were followed up in the following four months post-earthquake.…”

“…Other authors recommended ensuring drug regimens are standardized across the region in case of population displacement (O'Brien et al 2010). The importance of disaster preparedness and collaborative activities between patients, healthcare providers and government was highlighted, with Khawcharoenporn et al (2013) separating strategies into preflood, flood and post-flood period.…”

Interruptions to HIV Care Delivery During Pandemics and Natural Disasters: A Qualitative Study of Challenges and Opportunities From Frontline Healthcare Providers in Western Kenya

“…10 The resulting economic and livelihood-related challenges could also have led to adverse consequences related to HIV care access and engagement. 11 , 12 Within the more disadvantaged populations and residents living in these impacted areas, these consequences were experienced in an even greater magnitude. 7 For example, unemployment, food insecurity, financial insecurity, lack of transportation, and inability to afford preventive measures such as physical distancing and protective equipment during this period could have further reduced patient motivation to continue engaging in HIV care.…”