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Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti.

ABSTRACT: Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor treatment outcome using multivariable logistic regression, adjusting for baseline characteristics and year of treatment. 453 patients initiated treatment for MDR/RR-TB at GHESKIO. Median age was 31 (IQR: 25, 40), 233 (51.4%) were male, and 100 (22.1%) were living with HIV. Three hundred sixty-nine patients (81.5%) achieved cure, 42 (9.3%) died, 40 (8.8%) were lost to follow-up and 2 (<1%) failed treatment. HIV status was associated with poor treatment outcome (aRR: 1.65 (95% CI: 1.09, 2.48)) but there was no difference by year of treatment initiation. Outcomes for patients with MDR/RR-TB remained outstanding, even during the COVID-19 pandemic and severe civil unrest in Haiti. We attribute this resilience in care to the adaptability of program staff and provision of economic and psychosocial support.

SUBMITTER: Vilbrun SC

PROVIDER: S-EPMC10497149 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti.

Vilbrun Stalz Charles SC Souroutzidis Ariadne A Walsh Kathleen F KF Ellis Joshua J Guiteau Colette C Delva Sobieskye S Joissaint Guy G Joseph Patrice P Pape Jean William JW Koenig Serena P SP

PLOS global public health 20230912 9

Globally, treatment outcomes for people with multi-drug/rifampin-resistant tuberculosis (MDR/RR-TB) are sub-optimal, with MDR/RR-TB programs further weakened due to the COVID-19 pandemic, and in Haiti, by severe civil unrest. We assessed the impact of these disruptions on treatment outcomes at GHESKIO, in Port-au-Prince, Haiti. We conducted a retrospective analysis including all adults (age ≥18 years) who initiated MDR/RR-TB treatment at GHESKIO from 2010 to 2020. We assessed predictors of poor ...[more]

PMID: 37698996

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Project description:BackgroundThere are limited data on the effectiveness of differentiated service delivery (DSD) for HIV care during sociopolitical turmoil. We assessed outcomes with a DSD model of care that includes patient choice between community-based antiretroviral therapy (ART) centres, home-based ART dispensing, or facility-based care at GHESKIO clinic during a period of severe civil unrest in Port-au-Prince, Haiti.MethodsThis retrospective analysis included data on patients with at least one HIV visit at GHESKIO between May 1, 2019, and December 31, 2021. Multivariable logistic regression models were used to assess predictors of attending ≥1 community visit during the study period, and failure to attend timely visits. HIV-1 RNA test results were reported among patients who had been ART for ≥3 months at last visit.FindingsOf the 18,625 patients included in the analysis, 9659 (51.9%) attended at least one community visit. The proportion of community visits ranged from 0.3% (2019) to 44.1% (2021). Predictors of ≥1 community visit included male sex (aOR: 1.13; 95% CI: 1.06, 1.20), secondary education (aOR: 1.07; 95% CI: 1.01, 1.14), income > $USD 1.00/day (aOR: 1.24; 95% CI: 1.14, 1.35), longer duration on ART (aOR: 1.08 per additional year; 95% CI: 1.07, 1.09), and residence in Carrefour/Gressier (p < 0.0001 in comparisons with all other zones). Younger age and shorter time on ART were associated with late visits and loss to follow-up. Among 12,586 patients with an on-time final visit who had been on ART for ≥3 months, 11,131 (88.4%) received a viral load test and 9639 (86.6%) had HIV-1 RNA < 1000 copies/mL.InterpretationThe socio-political situation in Haiti has presented extraordinary challenges to the health care system, but retention and viral suppression rates remain high with a model of community-based HIV care. Additional interventions are needed to improve outcomes for younger patients, and those with shorter time on ART.FundingNo funding.

Project description:BackgroundDrug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China.MethodsA spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran's I and Getis-Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA).ResultsIn total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001-1.035).ConclusionsThis study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success.

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Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti.

Publications

Successful outcomes for patients with drug-resistant tuberculosis despite civil unrest and COVID-19 in Haiti.

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