Access to antiretroviral therapy during excess black-water flooding in central Thailand

Abstract

Excess black-water flooding in central Thailand resulted in closure of several healthcare facilities in the Fall of 2011. Persons living with human immunodeficiency virus (HIV) infection were presumably at risk for interruption of antiretroviral therapy (ART), with consequent treatment failure. We conducted a retrospective cohort study of ART use among patients in care at a Thai HIV clinic that closed due to excess flood water. Among 217 patients on ART who had clinic appointments within the one-month interval before the floods through the one-month interval after the clinic re-opened, seven (3%) reported non-sustained ART access. Non-sustained ART access was independently associated with prior low self-reported ART adherence (P<0.001) and less than six-months duration on the ART regimen (P=0.03). Advanced ART receipt or procurement at other flood-free healthcare facilities were strategies associated with ART access. During a flood disaster, identification and close monitoring of at-risk patients, patient–staff communication, flood preparedness plans, “HIV care access for all” policies, and collaboration among patients, healthcare providers and the government are relevant issues within preparedness plans to optimize ART access.

Keywords:

• human immunodeficiency virus
• antiretroviral therapy
• access
• flood
• black-water disaster
• Thailand

Acknowledgments

This study was supported by the Faculty of Medicine, Thammasat University funding (to T.K.) and was partially supported by the National Research University Project of the Thailand Office of Higher Education Commission (to T.K. and A.A.).