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APHA Scientific Session and Event Listing

Arachu Castro¹, Mary C. Smith Fawzi¹, Sarah Gillen², Joas Fleurimond², Leneus Joseph², Marie Andrela Alexis², and Richard D'Meza³. (1) Department of Social Medicine / Program in Infectious Disease and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, 617-432-6038, arachu_castro@hms.harvard.edu, (2) Zanmi Lasante, Complexe Médico-Social, Cange, Haiti, (3) National TB Program, Central Plateau District, Port-au-Prince, Haiti

The objective of this study is to identify macroeconomic and political factors that intervene in the implementation of tuberculosis control in Haiti, where TB remains one of the major causes of death. Despite the adoption of the DOTS strategy in Haiti in 1997, case detection is low while the number of multidrug resistant (MDR) cases has increased in recent years. How can case detection of TB and MDR TB improve at the level of the organization of the health system and at the level of the provision of diagnostics and treatment? What are the current obstacles from the perspective of health care providers and patients? The study was based on open-ended interviews and focus group discussions in Port-au-Prince and at a rural site in the Central Plateau. A total of 20 tuberculosis patients and 26 healthcare service providers (medical doctors, nurses, nurse auxiliaries, social workers, pharmacists, laboratory technicians, and community health workers) working directly with patients with tuberculosis were interviewed in 2004-2005, along with a series of focus group discussions. The political instability in Haiti, which was particularly severe during data collection, presented significant changes to strengthening primary health care and tuberculosis control. Lack of resources to effectively build a referral system, to procure antituberculosis drugs throughout the public health system, to initiate the retreatment of patients who fail therapy, or to identify patients with extrapulmonary tuberculosis remain a challenge in maximizing access to care for patients with active tuberculosis and in reducing the incidence of tuberculosis.

Learning Objectives:

• The participant will be able to identify the biosocial mechanisms that account for low case detection of tuberculosis and development of multidrug resistance in Haiti, a setting of limited resources and political instability.

Keywords: Poverty, Tuberculosis

Presenting author's disclosure statement:

Any relevant financial relationships? No