High Prevalence of HIV-1 Drug Resistance and Dynamics of Transmission Among High-Risk Populations in Port-au-Prince, Haiti.

Background: In low HIV prevalence settings, understanding the transmission dynamics and the impact of drug resistance is critical to curb down the epidemic. This study aims to explore the prevalence and dynamics of transmission of HIV drug-resistance mutations (DRMs) among key populations in Haiti.

Settings: Eligible participants (naive, treated) were selected from 7 key population friendly health care centers in Port-au-Prince, Haiti, from September 2018 to July 2019.

Prevalence of and in men having sex with men in Port-au-Prince, Haiti: a cross-sectional study.

Objectives: Over the last 15 years, the prevalence of HIV in Haiti has stabilised to around 2.0%. However, key populations remain at higher risk of contracting HIV and other sexually transmitted infections (STIs).

A retrospective review of facility-level obstetric complications and stillbirths in southern Haiti, 2013 - 2016.

Objective: To assess the incidence of obstetric complications-eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths-in hospitals in southern Haiti in 2013 - 2016 and to discuss implications for improvements to the surveillance of birth outcomes.

Methods: This was a cross-sectional, retrospective study of data for 32 442 deliveries recorded in 2013 - 2016 by the Integrated Monitoring, Evaluation, and Surveillance System for facilities across three departments and one high-volume hospital in southern Haiti. Annual incidence rates of eclampsia, dystocia, cesarean section, postpartum hemorrhage, and stillbirths (both macerated and fresh) were calculated.

High Levels of HIV-1 Drug Resistance in Children Who Acquired HIV Infection Through Mother to Child Transmission in the Era of Option B+, Haiti, 2013 to 2014.

Background: The main objective of this study was to determine the frequency and patterns of HIV drug resistance-associated mutations among children under 18 months of age born to HIV-1-positive mothers enrolled in the prevention of mother-to-child transmission services in Haiti.

Methods: Between January 1, 2013 and December 31, 2014, HIV-positive remnant dried blood spots collected from children under 18 months of age for Early Infant Diagnosis at the National Public Health Laboratory were used for HIV-1 genotyping. HIV drug resistance mutations were analyzed using the Stanford Drug Resistance HIVdb program.

External quality assessment for HIV rapid tests: challenges and opportunities in Haiti.

HIV rapid diagnostic tests (RDTs) are instrumental in scaling-up HIV testing services (HTS) in low-income and middle-income countries (LMICs). HIV misdiagnosis is a growing concern in the era of expanded and decentralised access to HTS. External quality assurance (EQA) programme including proficiency testing (PT) for HIV RDTs is a priority to guarantee the accuracy and reliability of the patients' result.

ART Attrition across Health Facilities Implementing Option B+ in Haiti.

Background: Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti.

Methods: We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients.

Results: There were 1989 Option B+ clients who initiated ART in 45 health facilities.

Virologic outcome among patients receiving antiretroviral therapy at five hospitals in Haiti.

Introduction: Viral load (VL) assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy (ART). We conducted a retrospective cross-sectional study to evaluate the virologic suppression rate among patients on ART for ≥6 months in five hospitals around Port-au-Prince, Haiti.

Methods: Plasma VL was measured and patients with VL <1,000 copies/mL were defined as virologically suppressed.

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

Background: Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti.

The experience of violence against children in domestic servitude in Haiti: Results from the Violence Against Children Survey, Haiti 2012.

Background: There have been estimates that over 150,000 Haitian children are living in servitude. Child domestic servants who perform unpaid labor are referred to as "restavèks." Restavèks are often stigmatized, prohibited from attending school, and isolated from family placing them at higher risk for experiencing violence.

Retention Throughout the HIV Care and Treatment Cascade: From Diagnosis to Antiretroviral Treatment of Adults and Children Living with HIV-Haiti, 1985-2015.

Monitoring retention of people living with HIV (PLHIV) in the HIV care and treatment cascade is essential to guide program strategy and evaluate progress toward globally-endorsed 90-90-90 targets (i.e., 90% of PLHIV diagnosed, 81% on sustained antiretroviral therapy (ART), and 73% virally suppressed).

Seroprevalence of Herpes Simplex Virus type-2 (HSV-2) among pregnant women who participated in a national HIV surveillance activity in Haiti.

Background: Herpes simplex virus type 2 (HSV-2), one the most common causes of genital ulcers, appears to increase both the risk of HIV acquisition and HIV transmission. HSV-2/HIV co-infection among pregnant women may increase the risk of perinatal transmission of HIV. This study describes rates of HSV-2 among pregnant women in Haiti and HSV-2 test performance in this population.

Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti.

Background: Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+.

Objective: To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti.

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.

Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti.

Background: We report patient outcomes after antiretroviral therapy (ART) initiation in a network of HIV facilities in Haiti, including temporal trends and differences across clinics, during the expansion of HIV services in the country.

Methods: We assessed outcomes at 12 months after ART initiation (baseline) using routinely collected data on adults (≥15 years) in 11 HIV facilities from July 2007-December 2013. Outcomes include death (ascertained from medical records), lost to follow-up (LTF) defined as no visit > 365 days from ART initiation, and retention defined as being alive and attending care ≥ 365 days from ART initiation.

ART attrition and risk factors among Option B+ patients in Haiti: A retrospective cohort study.

Objectives: In October 2012, the Haitian Ministry of Health endorsed the "Option B+" strategy to eliminate mother-to-child transmission of HIV and achieve HIV epidemic control. The objective of this paper is to assess and identify risk factors for attrition from the national ART program among Option B+ patients in the 12 months after ART initiation.

Design: This retrospective cohort study included patients newly initiating ART from October 2012-August 2013 at 68 ART sites covering 45% of all newly enrolled ART patients in all regions of Haiti.

Cardio-Oncology: A Focused Review of Anthracycline-, Human Epidermal Growth Factor Receptor 2 Inhibitor-, and Radiation-Induced Cardiotoxicity and Management.

Background: Cardio-oncology is a collaborative approach between cardiologists and oncologists in the treatment of patients with cancer and heart disease. Radiation and chemotherapy have played a major role in the decreased cancer-related mortality achieved in the past 2 decades. However, anthracycline-, tyrosine kinase-, and radiation-based therapies are each associated with independent cardiovascular (CV) risks, and these risks are cumulative when these therapies are used in combination.

Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B.

Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding.

LIPOMATOUS HYPERTROPHY OF INTRA ATRIAL SEPTU.

Lipomatous hypertrophy of the intra-atrial septum (IAS) is often misdiagnosed on routine imaging as a possible intra-cardiac mass, often leading to unnecessary and invasive surgical interventions. The use of transesophageal echocardiography can help to better diagnose this condition and avoid needless invasive procedures.

Specimen Referral Network to Rapidly Scale-Up CD4 Testing: The Hub and Spoke Model for Haiti.

Objectives: Regular and quality CD4 testing is essential to monitor disease progression in people living with HIV. In Haiti, most laboratories have limited infrastructure and financial resources and have relied on manual laboratory techniques. We report the successful implementation of a national specimen referral network to rapidly increase patient coverage with quality CD4 testing while at the same time building infrastructure for referral of additional sample types over time.

Hepatitis B virus infection among pregnant women in Haiti: A cross-sectional serosurvey.

Background: Hepatitis B vaccine administered shortly after birth is highly effective in preventing mother to child transmission (MTCT) of infection. While hepatitis B vaccine was introduced in Haiti as part of a combined pentavalent vaccine in 2012, a birth dose is not yet included in the immunization schedule.

Objectives: Determine the seroprevalence of hepatitis B virus (HBV) infection among pregnant women to evaluate the risk of MTCT.

Update on progress in selected public health programs after the 2010 earthquake and cholera epidemic--Haiti, 2014.

On January 12, 2010, an earthquake devastated Haiti's infrastructure, killing an estimated 230,000 persons and displacing more than 1.5 million. Ten months later, Haiti experienced the beginning of the largest cholera epidemic ever reported in a single country.

Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.

Background: The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk.

Methods: Among adult patients enrolled on ART from 2005-2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6-12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics.

Before and after the earthquake: a case study of attrition from the HIV antiretroviral therapy program in Haiti.

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.

Cholera prevention training materials for community health workers, Haiti, 2010–2011.

Stopping the spread of the cholera epidemic in Haiti required engaging community health workers (CHWs) in prevention and treatment activities. The Centers for Disease Control and Prevention collaborated with the Haitian Ministry of Public Health and Population to develop CHW educational materials, train >1,100 CHWs, and evaluate training efforts.