Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study

Abstract

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.

Antiretroviral therapy use in selected countries in Latin America during 2013–2017: results from the Latin American Workshop in HIV Study Group

“…Despite these differences, clinical guidelines published after 2016 from all the Latin American countries participating in this study, with the exception of the Chilean one, recommend early ART initiation regardless of the CD4 count (Gobierno Federal de Mexico, 2018;Instituto Guatemalteco de Seguridad Social, 2017;Ministerio de Salud de Chile, 2017;Ministerio de Salud del Peru, 2018; Ministerio de Salud Publica de Ecuador, 2018; Ministerio de Salud y Desarrollo Social de Argentina, 2018). Only three methodologically comparable studies explored the latency of ART initiation in Latin America, all of which reported data collected before 2013 (Bowman et al, 2016;Cevallos LC et al, 2017;Garcia et al, 2015;Rebeiro et al, 2016).…”

Health and Social Needs in Three Migrant Worker Communities around La Romana, Dominican Republic, and the Role of Volunteers: A Thematic Analysis and Evaluation

“…Responses on common diseases in the community were concordant between care providers and batey residents. Notably, few community responses identified HIV/AIDS as a common disease on the part of batey residents, despite high rates of prevalence documented in the literature [ 12 ]. This concurs with published factors in Rojas et al's study [ 5 ] which suggest that a lack of awareness or unwillingness to address HIV/AIDS is related to social stigma, lack of knowledge as to status, and limited access to testing and care providers.…”

Saúde de imigrantes haitianos: revisão de estudos empíricos qualitativos

“…Assim como os estudos brasileiros, outros países das Américas têm investigado questões de pesquisa sobre saúde de haitianos, visto que são países que também recebem contingentes significativos desses imigrantes. Observou-se que, na maior parte dos estudos publicados nesses países, Estados Unidos 21,22 , Canadá 23,24 e República Dominicana 25,26 também enaltecem métodos quantitativos. Essas pesquisas mensuram e quantificam variáveis apresentando de forma importante como as doenças afetam os imigrantes haitianos.…”