Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study.
The Caribbean has the highest adult HIV prevalence in the world after sub-Saharan Africa (2011). One sub-population in the Dominican Republic is the migratory Batey community primarily comprised of Haitian immigrants with limited access to healthcare and HIV prevalence rates of between 3.0% and 9.0%, compared to 0.7% nationally. This retrospective cohort study describes the cumulative retention from diagnosis to virological suppression for newly-diagnosed HIV-infected adults presenting to the Clínica de Familia and its Batey programme in La Romana, during 2011. Of the patients diagnosed with HIV, 65% entered into care, 59% completed immunologic testing, 53% were eligible for antiretroviral therapy (ART) initiation, 36% initiated ART within three months of eligibility and 27% were retained in care. Seventeen per cent of those retained on ART with a 12-month viral load measure had undetectable viral load. Attrition primarily occurred before ART initiation. The Batey programme had a first step lost-to-follow-up of 88% compared to 20% at the clinic (p < 0.001). This retrospective study details the continuum of care and indicates where structural changes must occur to increase continuity between steps. The manuscript results are important to help implement programmes to enhance engagement and retention in HIV primary care.
Columbia University Mailman School of Public Health, New York, USA asb2227@cumc.columbia.edu.
Alex S
AS
Bowman
Clínica de Familia, La Romana, Dominican Republic.
Leonel
L
Lerebours
Columbia University Mailman School of Public Health, New York, USA Columbia University Medical Center College of Physicians & Surgeons, New York, NY, USA.
Silvia
S
Amesty
Clínica de Familia, La Romana, Dominican Republic.
Milagros
M
de la Rosa
Clínica de Familia, La Romana, Dominican Republic.
Elizabeth
E
Gil
Clínica de Familia, La Romana, Dominican Republic.
Mina
M
Halpern
Columbia University Mailman School of Public Health, New York, USA Columbia University Medical Center College of Physicians & Surgeons, New York, NY, USA.
Stephen
S
Nicholas
Columbia University Mailman School of Public Health, New York, USA.
Matthew R
MR
Lamb
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D004293:Dominican Republic / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents
AIDS; Caribbean; HAART; HIV; antiretroviral therapy; care cascade; epidemiology; treatment