Influence of Transportation Cost on Long-Term Retention in Clinic for HIV Patients in Rural Haiti

Sowah, Leonard A; Turenne, Franck V.; Buchwald, Ulrike K.; Delva, Guesly; Mesidor, Romaine N.; Dessaigne, Camille G.; Previl, Harold; Patel, Devang; Edozien, Anthony; Redfield, Robert; Amoroso, Anthony

doi:10.1097/qai.0000000000000315

Cited by 13 publications

(9 citation statements)

References 16 publications

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“…Patient factors include limited time to attend clinic, low income, food insecurity, poor social support, and cultural norms [31][32][33]. Environmental factors include transport costs [34], lack of healthcare facilities close to patients, road conditions, seasonal weather, and political disruptions. Health system factors include negative experience at hospitals, medicine costs [35], and complex systems [36].…”

Section: Discussionmentioning

confidence: 99%

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%

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

Kwan

Yan

Isaac³

et al. 2020

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“…Another significant finding is the association between rapid initiation of ART after HIV diagnosis and elevated risk of attrition. The absence of or inadequate pre-ART adherence counseling before enrollment may be the explanation [15]. However, a study conducted at the GHESKIO Centers in Haiti has shown higher retention among the same-day ART initiation group than the standard ART initiation group [28].…”

Section: Discussionmentioning

confidence: 99%

Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti

Domerçant

Puttkammer

Young

et al. 2017

Global Health Action

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Background: Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+.Objective: To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti.Methods: Longitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan–Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition.Results: Among 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9–37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6–52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001).Conclusions: ART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.

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“…However, in Haiti, fewer than half of patients newly diagnosed with HIV who are eligible for ART initiate treatment within 2 years [ 3 ], and retention rates one year after initiating ART are below 80% [ 4 ]. These low retention rates are likely due to stigma, lack of understanding about HIV or ART, work and family commitments, long clinic wait times, and poverty, which makes high transportation costs to distant ART facilities a significant burden [ 5 ]. Further, inadequate staffing and few resources at health care facilities dedicated to improving retention in care contribute to these low rates.…”

Section: Introductionmentioning

confidence: 99%

Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

Naslund

Dionne-Odom

Destine

et al. 2014

AIDS Research and Treatment

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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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Influence of Transportation Cost on Long-Term Retention in Clinic for HIV Patients in Rural Haiti

Cited by 13 publications

References 16 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

Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti

Adapting and Implementing a Community Program to Improve Retention in Care among Patients with HIV in Southern Haiti: “Group of 6”

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