Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: Strategic information to reduce the proportion of undiagnosed infections.

BACKGROUND: Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana. METHODS: CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis. RESULTS: The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (ß = +3.7 years, P = 0.001), Surinamese (ß = +4.2 years, P<0.0001), Haitian origins (ß = +1.5 years, P = 0.049) but not for those originating from Guyana (ß = -0.03 years, P = 0.9); Men independently had a longer interval than women (ß = +3.5 years, P<0.0001). CONCLUSIONS: Despite great efforts in French Guiana regarding HIV testing both in terms of diversification and intensification we still need to tailor the offer to better reach the communities in need. These results should help authorities scale up and optimize initiatives to reduce the proportion of patients who are unaware of their infection. They also raise the question of the role of stigma and discrimination as a barrier to HIV testing in small communities, and further emphasize the importance of reducing it.

Rapid monitoring in vaccination campaigns during emergencies: the post-earthquake campaign in Haiti.

PROBLEM: The earthquake that struck Haiti in January 2010 caused 1.5 million people to be displaced to temporary camps. The Haitian Ministry of Public Health and Population and global immunization partners developed a plan to deliver vaccines to those residing in these camps. A strategy was needed to determine whether the immunization targets set for the campaign were achieved. APPROACH: Following the vaccination campaign, staff from the Ministry of Public Health and Population interviewed convenience samples of households - in specific predetermined locations in each of the camps - regarding receipt of the emergency vaccinations. A camp was targeted for "mop-up vaccination" - i.e. repeat mass vaccination - if more than 25% of the children aged 9 months to 7 years in the sample were found not to have received the emergency vaccinations. LOCAL SETTING: Rapid monitoring was implemented in camps located in the Port-au-Prince metropolitan area. Camps that housed more than 5000 people were monitored first. RELEVANT CHANGES: By the end of March 2010, 72 (23%) of the 310 vaccinated camps had been monitored. Although 32 (44%) of the monitored camps were targeted for mop-up vaccination, only six of them had received such repeat mass vaccination when checked several weeks after monitoring. LESSONS LEARNT: Rapid monitoring was only marginally beneficial in achieving immunization targets in the temporary camps in Port-au-Prince. More research is needed to evaluate the utility of conventional rapid monitoring, as well as other strategies, during post-disaster vaccination campaigns that involve mobile populations, particularly when there is little capacity to conduct repeat mass vaccination.

Vaccination coverage in Haiti: results from the 2009 national survey.

INTRODUCTION: Since 1977, vaccinations to protect against tuberculosis, diphtheria, tetanus, pertussis, polio, and measles (and rubella since 2009) have been offered to children in Haiti through the routine immunization program. From April to July 2009, a national vaccination coverage survey was conducted to assess the success of the routine immunization program at reaching children in Haiti. METHODS: A multi-stage cluster survey was conducted using a modified WHO method for household sampling. A standardized questionnaire was administered to collect vaccination histories, demographic information, and reasons for under-vaccination of children aged 12-23 months. A child who received the eight recommended routine vaccinations was considered fully vaccinated. The routine vaccination schedule was used to define valid doses and estimate the percentage of children vaccinated on time. RESULTS: Among 1345 children surveyed, 40.4% (95% CI: 36.6-44.2) of the 840 children with vaccination cards had received all eight recommended vaccinations. Coverage was highest for the Bacille Calmette-Guérin vaccine (87.3%), the first doses of the diphtheria-tetanus-pertussis vaccine (92.0%), and oral poliovirus vaccine (93.4%) and lowest for measles vaccine (46.9%). Timely vaccination rates were lower. Assuming similar coverage for the 505 children without cards, coverage with the complete vaccination series among all surveyed children 31.9%. Reasons for under-vaccination included not having enough time to reach the vaccination location (24.8%), having a child who was ill (13.8%), and not knowing when, or forgetting, to go for vaccination (12.8%). CONCLUSIONS AND RECOMMENDATIONS: Coverage for early-infant vaccines was high; however, most children did not complete the full vaccination series, and many children received vaccinations later than recommended. Efforts to improve the immunization program should include increasing the frequency of outreach services, training for vaccination staff to minimize missed opportunities, and better communicating the timing of vaccinations to encourage caregivers to bring their children for vaccinations at the recommended age. Efforts to promote the benefits of vaccination and card retention are also needed.

Haiti 2007-2008 national measles-rubella vaccination campaign: implications for rubella elimination.

BACKGROUND: A national campaign was conducted in Haiti in 2007-2008 to vaccinate all children and adolescents aged 1-19 years with measles-rubella vaccine in support of achieving the Region of the Americas' 2010 goal of eliminating rubella and congenital rubella syndrome (CRS). Measles-rubella vaccine was introduced into the country's routine childhood immunization schedule after the campaign. METHODS: A nationwide, stratified, multistage cluster sample survey of 20859 children was conducted to assess coverage using house-to-house interviews. RESULTS: Estimated national coverage with measles-rubella vaccine was 79.2% (95% confidence interval, 77.6%-80.7%), ranging from 90.2% in Nord-Ouest Department to 70.0% in Cite Soleil Metropolitan Area. National coverage was lower for children aged 1-5 years (76.7%) than for those aged 6-19 years (80.3%) (P< .001) but similar in rural departments (79.4%) and metropolitan areas (78.6%; P = .61). The reasons most frequently cited for nonparticipation in the campaign were that the child was ill or unavailable (18.6%), did not know vaccinations were important (13.8%), did not know when to go or forgot to go (13.3%), and did not have enough time (12.3%). CONCLUSIONS: The measles-rubella vaccination campaign was critical for raising rubella immunity levels in children and adolescents in Haiti. To remain free of rubella transmission and CRS, Haiti must also achieve and sustain high routine measles-rubella vaccination coverage and maintain high-quality integrated measles-rubella and CRS surveillance, including laboratory-based confirmation for reported rash illnesses. If routine measles-rubella vaccination coverage is suboptimal or if gaps in coverage are identified, additional mass campaigns with measles-rubella vaccine will be necessary.

The use of rapid coverage monitoring in the national rubella vaccination campaign, Haiti 2007-2008.

BACKGROUND: Prior to introduction of rubella vaccine in Haiti's national immunization program, the Haitian government conducted a nationwide rubella-measles immunization campaign targeting persons 1-19 years of age to accelerate elimination of rubella and congenital rubella syndrome, while strengthening measles elimination. The national immunization campaign was conducted in phases by geographic region and combined multiple interventions to reach high coverage in all districts. METHODS: We analyzed reported data on number of doses administered and results of rapid monitoring by "commune" (district) to evaluate coverage for each vaccine and intervention in target populations. We reviewed measles and rubella surveillance data from Haiti's national surveillance system. RESULTS: Immunization registers recorded 4.7 million doses of measles-rubella (MR) vaccine administered to persons 1-19 years of age, reaching 80.2% of the estimated population of 1-4 year-olds and surpassing the target among 5-19 year-olds. In addition, 1 million children under 5 years of age received oral polio vaccine and vitamin A supplements, 1.5 million school children received deworming treatment nationwide, and over 500000 women 15-49 years old in 2 major population centers received diphtheria-tetanus vaccine. Based on administrative data, 102 (76.7%) of 133 communes attained 95% or greater coverage with MR vaccine among persons 1-19 years of age. Rapid monitoring in 118 communes indicated that coverage targets were reached in 52.5%. From 2007 to 2010, no confirmed cases of measles or rubella were reported from Haiti. CONCLUSIONS: The experience in Haiti suggests that rubella and congenital rubella syndrome can be eliminated through mass vaccination in countries with weak national immunization programs. However, high routine immunization coverage and improved surveillance are urgently needed to maintain measles and rubella elimination.