Before and after the earthquake: a case study of attrition from the HIV antiretroviral therapy program in Haiti
Before and after the earthquake: a case study of attrition from the HIV antiretroviral therapy program in Haiti
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DOI：
10.3402/gha.v7.24572
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发表时间：
2014-01-01
影响因子：
2.6
通讯作者：
Barnhart, Scott
中科院分区：
文献类型：
--
作者：
Puttkammer, Nancy H.;Zeliadt, Steven B.;Barnhart, Scott
背景资料：2010年1月12日，海地西部省发生7.0级地震，造成20多万人死亡，更多人受伤或流离失所。这场灾难威胁到HIV护理和治疗服务的连续性。Objectives：This case study examined the effect of the destructive 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy（ART）program.Design：The study triangulated retrospective data from existing sources，including：1）个人-水平纵向患者数据来自两个大型公共部门医院的ART患者的电子病历，地震;和2）汇总数据的艾滋病毒相关的服务交付量在两所医院之前和之后的earthquake.Methods：该研究比较了ART损耗和服务交付在雅克梅勒，一个网站在“非常强”的地震影响区，并在Jeremie，一个网站在“轻”的地震影响区。该分析使用时间到事件分析方法的个人层面的病人数据，和描述性统计方法的总服务交付data.Results：调整后的ART损耗风险较低，在雅克梅勒医院后与地震前（HR=0.51; p=0.03），并且在地震前（HR=0.55; p=0.01）和地震后（HR=0.35; p =0.001），Jacmel与Jeremie相比均较低。地震发生后，雅克梅勒的抗逆转录病毒治疗新患者登记、新艾滋病毒患者登记和艾滋病毒临床就诊人数立即显著下降，但随后迅速反弹。平均而言，有没有变化，在新的ART登记后，每月与地震前在任何site.Conclusion：这些研究结果强调海地ART供应商和患者的弹性，并提供证据表明，它是可能的，即使在复杂的人道主义危机的背景下，保持ART服务的连续性。
Background: On January 12, 2010, a devastating 7.0 magnitude earthquake struck the West Department of Haiti, killing more than 200,000 people and injuring or displacing many more. This disaster threatened continuity of HIV care and treatment services.Objectives: This case study examined the effect of the devastating 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy (ART) program.Design: The study triangulated retrospective data from existing sources, including: 1) individual-level longitudinal patient data from an electronic medical record for ART patients at two large public sector departmental hospitals differently affected by the earthquake; and 2) aggregate data on the volume of HIV-related services delivered at the two hospitals before and after the earthquake.Methods: The study compared ART attrition and service delivery in Jacmel, a site in the 'very strong' zone of earthquake impact, and in Jeremie, a site in the 'light' zone of earthquake impact. The analysis used time-to-event analysis methods for the individual-level patient data, and descriptive statistical methods for the aggregate service delivery data.Results: Adjusted ART attrition risk was lower at the hospital in Jacmel after vs. before the earthquake (HR=0.51; p=0.03), and was lower in Jacmel vs. Jeremie both before (HR=0.55; p=0.01) and after the earthquake (HR=0.35; p=0.001). The number of new ART patient enrollments, new HIV patient registrations, and HIV clinical visits dropped notably in Jacmel immediately after the earthquake, but then rapidly rebounded. On average, there was no change in new ART enrollments per month after vs. before the earthquake at either site.Conclusion: These findings underscore the resilience of Haitian ART providers and patients, and contribute evidence that it is possible to maintain continuity of ART services even in the context of a complex humanitarian crisis.