Locating and caring for 22,000 HIV patients

A recent report finds that within days of last year’s earthquake, PIH and its sister organization in Haiti, Zanmi Lasante (PIH/ZL), accounted for and continued to treat more than 95 percent of its existing HIV patients.

Beyond providing continued care and social services, a recent report submitted to PEPFAR (US Government’s President’s Emergency Plan for AIDS Relief) documents the HIV-program’s expansion. In the year after the earthquake, the HIV patient load grew by 20 percent, increasing from roughly 16,500 patients to just over 22,000.

“Despite the earthquake our services were actually strengthened because we were able to provide relief, provide health services for our patients, and ensure that our HIV patients adhered to their drug regimens,” says Dr. Fernet Leandre, director of PIH/ZL’s HIV program in Haiti. “Accompagnateurs and community health workers (CHWs) went out to locate HIV patients displaced by the earthquake. It is remarkable that in such a context we were able to find 95 percent of our patients and ensure they continued to receive immediate treatment.”

This feat was not the product of chance or luck, but the result of a decade-long initiative aimed at expanding and integrating HIV services into existing health systems. This allowed the organization’s HIV-related programs to be back up and running within days and weeks of the earthquake.

While patients living with HIV continued to receive traditional social support services – clean water, food, permanent housing, education, and psychosocial services – the earthquake also required that each of these programs expand significantly.

“One family I know are caring for 15 additional family members, all in their small rural home,” continues Dr. Leandre. “That has a huge impact at the household level.” As tens of thousands of displaced people moved in with extended family, social programs in rural areas were strained.

“Despite the influx, PIH/ZL continues to deliver social benefits to people living with HIV,” says Dr. Leandre.

Part of this effort involved hiring and training cadres of CHWs, ensuring that HIV patients continued to receive daily visits from an accompagnateur – a specially trained community health worker – and monthly meetings with trained HIV/TB physicians and nurses.

Patients waiting outside a pharmacy receive medicine for diseases ranging from asthma to HIV.

Highlighting PIH/ZL’s accomplishments

Between October 1, 2010 and March 31, 2011, roughly 22,000 people received HIV care and counseling across PIH/ZL’s 12 facilities in Haiti’s Lower Artibonite and Central Plateau. In addition, nearly 30,000 family members and children affected by HIV also received various health and social services, all of which was made possible by a PEPFAR grant.*

During that period, staff provided:

• HIV counseling and testing to 48,675 people (excluding pregnant women).
• Clinical care and psychosocial support to 21,679 people affected by HIV.
• Antiretroviral therapy to 6,023 HIV-positive people (excluding pregnant women).
• Antiretroviral therapy to 193 HIV-positive pregnant women, with the goal of reducing mother-to-child transmission of HIV.

Preventing a new outbreak of HIV

These efforts ensured that disruptions in the national health system, and an incredible strain on clinical services, did not reverse a decade-long decline in new HIV infections.

Historically, Haiti’s HIV epidemic peaked in 1994. At that time roughly four percent of Haitians – or 281,000 people – were living with the disease. By 2009, that number had dropped to two percent. Prior to the earthquake, PIH/ZL was monitoring 16,547 of those people, of whom 4,220 were receiving antiretroviral therapy.

Dr. Farmer working with HIV patients in Haiti.

Teaching and advocating after the earthquake

The post-earthquake response by PIH/ZL also utilized education and outreach to prevent new infections. Between October and March, PIH conducted 51 formal HIV and cholera-related training sessions in the Artibonite and Central Plateau – many of which took place at PIH/ZL’s National Training Centers in Cange and Hinche. More than 850 staff members were trained, including 330 doctors, nurses, and social workers, and 477 community health workers.
 
PIH/ZL expanded its public outreach initiatives during the same period, with dozens of awareness and education events taking place in clinics, schools, churches, marketplaces, brothels, public plazas, and people’s homes.

On World AIDS Day (December 1), PIH/ZL organized patient and accompagnateur meetings and testimonies, lectures by the clinical staff, contests, debates, games, singing competitions, skits, and a condom distribution.

Radio spots emphasized important prevention messages and hosted HIV-related call-in games. Listeners who correctly answered HIV-related questions won prizes.

As always, counseling and testing services were provided and nurses were present at all events to provide a safe space for HIV testing. Through these efforts, thousands of people were tested throughout central Haiti. Between October 1, 2010, and March 31, 2011, a total of 398,954 Haitians – about 1 of every 6 people living in the PIH/ZL catchment area – were reached with individual and/or small group level preventive interventions.

* These numbers do not include PIH/ZL’s post-earthquake interventions at the organization’s four Port-au-Prince clinics. At those sites during the same period 22,000 people were tested for HIV. Approximately 4.5 percent – or roughly 1,000 people – tested positive for the disease. These patients were referred to GHESKIO - Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections - an nonprofit working in Port-au-Prince since 1982.