Life expectancy, death, and disability in Haiti, 1990-2017: a systematic analysis from the Global Burden of Disease Study 2017.

OBJECTIVE: To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. METHODS: We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, cause-specific deaths, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life-years (DALYs), and risk factors associated with DALYs. RESULTS: LE and HALE increased substantially in Haiti. People may hope to live longer in 2017, but in poor health. The Caribbean countries had significantly lower YLLs rates than Haiti for ischemic heart disease, stroke, lower respiratory infections, and diarrheal diseases. Road injuries were the leading cause of DALYs for people aged 5-14 years. Road injuries and HIV/AIDS were the leading causes of DALYs for men and women aged 15-49 years, respectively. Ischemic heart disease was the main cause of DALYs for people older than 50 years. Maternal and child malnutrition were the leading risk factors for DALYs in both sexes. CONCLUSION: Haiti faces a double burden of disease. Infectious diseases continue to be an issue, while non-communicable diseases have become a significant burden of disease. More attention must also be focused on the increase in worrying public health issues such as road injuries, exposure to forces of nature and HIV/AIDS in specific age groups. To address the burden of disease, sustained actions are needed to promote better health in Haiti and countries with similar challenges.

OBJETIVO: Investigar la magnitud y la distribución de las principales causas de muerte, discapacidad y factores de riesgo en Haití. MÉTODOS: Se llevó a cabo un análisis ecológico con datos estimados a partir del estudio Carga Global de Morbilidad 2017 para el período 1990-2017 para presentar la esperanza de vida (LE), la esperanza de vida saludable (HALE), la mortalidad por causas específicas, los años de vida perdidos (YLL), los años vividos con discapacidad (YLD), los años de vida ajustados por discapacidad (DALY), y los factores de riesgo asociados a los DALY. RESULTADOS: La LE y la HALE aumentaron sustancialmente en Haití. En 2017, la población puede esperar vivir más, pero con mala salud. Los países del Caribe tuvieron tasas de YLL significativamente más bajas que Haití en cuanto a cardiopatías isquémicas, accidentes cerebrovasculares, infecciones respiratorias bajas y enfermedades diarreicas. Las lesiones debidas a accidentes de tránsito fueron la principal causa de DALY para las personas de 5 a 14 años. Las lesiones debidas a accidentes de tránsito y el VIH/sida fueron las principales causas de DALY en hombres y mujeres de 15 a 49 años de edad, respectivamente. Las cardiopatías isquémicas fueron la principal causa de DALY para las personas mayores de 50 años. Las desnutriciones materna e infantil fueron los principales factores de riesgo de DALY en ambos sexos. CONCLUSIÓN: Haití se enfrenta a una doble carga de enfermedad. Las enfermedades infecciosas siguen siendo un problema, mientras que las enfermedades no transmisibles se han convertido en una carga significativa de enfermedad. También debe prestarse más atención al aumento de problemas de salud pública preocupantes, como las lesiones por accidentes de tránsito, la exposición a fenómenos naturales y el VIH/sida en grupos etarios específicos. Para hacer frente a la carga de morbilidad es necesario adoptar medidas sostenidas para promover una mejor salud en Haití y en los países con desafíos similares.

Life expectancy, death, and disability in Haiti, 1990- 2017: a systematic analysis from the Global Burden of Disease Study 2017

[ABSTRACT]. Objective. To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. Methods. We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, cause-specific deaths, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life-years (DALYs), and risk factors associated with DALYs. Results. LE and HALE increased substantially in Haiti. People may hope to live longer in 2017, but in poor health. The Caribbean countries had significantly lower YLLs rates than Haiti for ischemic heart disease, stroke, lower respiratory infections, and diarrheal diseases. Road injuries were the leading cause of DALYs for people aged 5-14 years. Road injuries and HIV/AIDS were the leading causes of DALYs for men and women aged 15-49 years, respectively. Ischemic heart disease was the main cause of DALYs for people older than 50 years. Maternal and child malnutrition were the leading risk factors for DALYs in both sexes. Conclusion. Haiti faces a double burden of disease. Infectious diseases continue to be an issue, while non-communicable diseases have become a significant burden of disease. More attention must also be focused on the increase in worrying public health issues such as road injuries, exposure to forces of nature and HIV/AIDS in specific age groups. To address the burden of disease, sustained actions are needed to promote better health in Haiti and countries with similar challenges.

[RESUMEN]. Objetivo. Investigar la magnitud y la distribución de las principales causas de muerte, discapacidad y factores de riesgo en Haití. Métodos. Se llevó a cabo un análisis ecológico con datos estimados a partir del estudio Carga Global de Morbilidad 2017 para el período 1990-2017 para presentar la esperanza de vida (LE), la esperanza de vida saludable (HALE), la mortalidad por causas específicas, los años de vida perdidos (YLL), los años vividos con discapacidad (YLD), los años de vida ajustados por discapacidad (DALY), y los factores de riesgo asociados a los DALY. Resultados. La LE y la HALE aumentaron sustancialmente en Haití. En 2017, la población puede esperar vivir más, pero con mala salud. Los países del Caribe tuvieron tasas de YLL significativamente más bajas que Haití en cuanto a cardiopatías isquémicas, accidentes cerebrovasculares, infecciones respiratorias bajas y enfermedades diarreicas. Las lesiones debidas a accidentes de tránsito fueron la principal causa de DALY para las personas de 5 a 14 años. Las lesiones debidas a accidentes de tránsito y el VIH/sida fueron las principales causas de DALY en hombres y mujeres de 15 a 49 años de edad, respectivamente. Las cardiopatías isquémicas fueron la principal causa de DALY para las personas mayores de 50 años. Las desnutriciones materna e infantil fueron los principales factores de riesgo de DALY en ambos sexos. Conclusión. Haití se enfrenta a una doble carga de enfermedad. Las enfermedades infecciosas siguen siendo un problema, mientras que las enfermedades no transmisibles se han convertido en una carga significativa de enfermedad. También debe prestarse más atención al aumento de problemas de salud pública preocupantes, como las lesiones por accidentes de tránsito, la exposición a fenómenos naturales y el VIH/sida en grupos etarios específicos. Para hacer frente a la carga de morbilidad es necesario adoptar medidas sostenidas para promover una mejor salud en Haití y en los países con desafíos similares.

Local and national stakeholders' perceptions towards implementing and scaling up HIV self-testing and secondary distribution of HIV self-testing by Option B+ patients as an assisted partner service strategy to reach men in Haiti.

HIV self-testing (HIVST), which allows people to test in private, is an innovative testing strategy that has been shown to increase HIV testing among men. Delivering HIVST kits to men via women is one promising assisted partner service strategy. Little research has been conducted on HIVST secondary distribution to men by women living with HIV (WLWH) in the Caribbean and other settings. The purpose of this study was to assess the perspectives of WLWH, their male partners, and healthcare professionals on the perceived advantages and disadvantages of HIVST, and recommendations for implementing HIVST in Haiti, with a focus on secondary distribution of HIVST to men by WLWH. Sixteen key informant interviews and nine focus groups with 44 healthcare workers, 31 Option B+ clients, and 13 men were carried out in Haiti. Key informants were representatives of the Ministry of Health and of a non-governmental agency involved in HIV partner services. Focus group members included program leads and staff members from the HIV care and treatment program, the Option B+ program, the community health service program, and the HIV counseling and testing services from 2 hospitals. Perceived HIVST advantage included an increase in the number of people who would learn their HIV status and start treatment. The perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner's reaction, risk of violence towards women delivering HIVST kits after receiving an HIVST kit from a woman, and the inability of women to counsel a man in case his self-test result is positive. Recommendations for integrating HIVST and secondary distribution of HIVST by WLWH included coupling HIVST distribution with public information, education, and communication through media and social marketing, relying on community health workers to mediate use of HIVST and ensure linkage to care, piloting HIVST programs on a small scale. HIVST is an appropriate and feasible strategy HIV prevention for men and women; however, more research is needed on how best to implement different strategies for this approach in the Caribbean.

The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study.

INTRODUCTION: Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under-represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. METHODS: Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. RESULTS: Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co-infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one-third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. CONCLUSIONS: This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high-impact interventions may include venue-based, peer navigator-led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.