title: Before and after the earthquake: a case study of attrition from the HIV antiretroviral therapy program in Haiti.
abstract: 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.
  
  
  OBJECTIVE
  This case study examined the effect of the devastating 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy (ART) program.
  
  
  METHODS
  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 Jérémie, 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. Jérémie 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA; nputt@uw.edu.
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Puttkammer
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
authors.affiliation: International Training and Education Center for Health (I-TECH) Haiti Program, Pétionville, Haiti.
authors.forename: Jean Gabriel
authors.initials: JG
authors.lastname: Balan
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Janet G
authors.initials: JG
authors.lastname: Baseman
authors.affiliation: International Training and Education Center for Health (I-TECH) Haiti Program, Pétionville, Haiti.
authors.forename: Rodney
authors.initials: R
authors.lastname: Destiné
authors.affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Port-au-Prince, Haiti.
authors.forename: Jean Wysler
authors.initials: JW
authors.lastname: Domerçant
authors.affiliation: Hôpital St. Antoine de Jérémie, Ministère de la Santé Publique et de la Population d'Haïti, Jérémie, Haiti.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Duvilaire
authors.affiliation: International Training and Education Center for Health (I-TECH) Haiti Program, Pétionville, Haiti.
authors.forename: Nernst Atwood
authors.initials: NA
authors.lastname: Raphael
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sherr
authors.affiliation: Center for AIDS Research Biometrics Core, University of Washington, Seattle, WA, USA.
authors.forename: Krista
authors.initials: K
authors.lastname: Yuhas
authors.affiliation: International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Barnhart
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D004190:Disasters; D055866:Earthquakes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006205:Haiti; D006801:Humans; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D011635:Public Health Administration; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; Haiti; antiretroviral therapy; attrition; earthquake
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