Centers for Disease Control and Prevention, Port-au-Prince, Haiti.
Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.
PLoS One. 2021 Mar 17;16(3):e0247750. doi: 10.1371/journal.pone.0247750. eCollection 2021.
On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti.
We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success.
Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27-0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19-0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33-0.74) were associated with significantly lower rates of treatment success.
Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.
2016 年 10 月 4 日，飓风马修袭击了海地西南部，达到四级风暴强度。本研究旨在评估飓风对海地西南部三个受影响严重的部门（南、大湾和尼普斯）的结核病（TB）服务和患者结局的影响。
我们开发了一份标准问卷，以评估受影响地区的便利抽样卫生机构，一份患者跟踪表，以及一份跟踪所有在飓风前六个月登记在册的耐多药结核病患者的名单。我们分析了国家结核病电子监测系统的数据，以确定在受影响地区接受抗结核治疗的所有患者的结局。我们使用逻辑回归分析确定与治疗成功相关的因素。
在三个受影响部门的 66 个卫生机构中，我们评估了 31 个，占马修飓风在海地登陆时登记在册的 1174 名结核病患者中的 536 名（45.7%）。有 3 个（9.7%）卫生机构遭受中度至重度破坏，而 18 个（58.1%）关闭不到 1 周，5 个（16.1%）关闭 1 周以上。飓风过后四周，评估的 536 个设施中的 398 个（73.1%）患者被找到。飓风后一年，受影响部门的治疗成功率为 81.4%。在居住地市以外接受治疗（调整后的优势比[aOR]：0.46，95%置信区间[CI]：0.27-0.80）和 HIV 阳性（aOR：0.31，95%CI：0.19-0.51）或未知 HIV 状态（aOR：0.49，95%CI：0.33-0.74）与治疗成功率显著降低相关。
尽管面临重大挑战，但在飓风前接受抗结核治疗的大部分患者在海地西南部被找到并成功治疗。这里提出的经验教训和结果可能有助于为类似情况下自然灾害后有效的结核病控制提供政策和指导。
