{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:17:48Z","timestamp":1778084268790,"version":"3.51.4"},"reference-count":74,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Haiti\u2019s unprecedented sociopolitical upheavals have severely impacted health care services. Limited research exists on HIV clinic operations under such strain. We examined the potential interruptions to antiretroviral treatment (ART) provision through discrete time periods using Haiti\u2019s national HIV surveillance system. We analyzed weekly count data from HIV clinics (January 2018\u2013December 2024). Time segments were bounded by the COVID-19 emergency period (April 2020\u2013September 2020), hospital strikes (November 2020), the presidential assassination (July 2021), protests over increases in fuel prices (September 2022), and intensifying gang violence (March 2024). We accounted for autocorrelation in weekly time series and measured immediate, level, and trend changes in new ART enrollment. We triangulated this series with Google\u2019s weekly cell phone mobility reports to cross-validate our event selection. In Haiti, ART enrollment declined 25% from 13,304 (CY2018) to 11,773 (CY2024) people per year (mean = 222 people\/week in 2024). Only the fuel protests had an immediate impact on ART enrollment (\u03b2 = \u2212111.1 [95% CI: \u2212179.3, \u221242.9]) and this was isolated to the largest clinical electronic medical record. Mean weekly ART enrollment in most periods was lower. Trend visualization suggests that historical patterns of disruption followed by numerical rebound may have changed after the gang violence in 2024. ART enrollment declined substantially in Haiti from 2018 to 2024. Future work should discern whether the epidemiology of HIV transmission is changing after accounting for these health systems disruptions.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0491","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T15:01:36Z","timestamp":1774969296000},"page":"966-972","source":"Crossref","is-referenced-by-count":0,"title":["Trends and Disruptions in Antiretroviral Treatment Enrollment in Haiti, 2018\u20132024"],"prefix":"10.4269","volume":"114","author":[{"given":"Chris","family":"Delcher","sequence":"first","affiliation":[{"name":"Institute for Pharmaceutical Outcomes and Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheolwoo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of South Korea;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jungjun","family":"Bae","sequence":"additional","affiliation":[{"name":"Institute for Pharmaceutical Outcomes and Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA;"},{"name":"Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella Myriam","family":"Pierre","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, USA;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackyvens","family":"Camille","sequence":"additional","affiliation":[{"name":"Ayiti Analytics, Port-au-Prince, Haiti;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred J.","family":"Noel","sequence":"additional","affiliation":[{"name":"Programme National de Lutte Contre les IST\/VIH\/SIDA, Unit\u00e9 de Coordination des Maladies Infectieuses et Transmissibles, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ermane G.","family":"Robin","sequence":"additional","affiliation":[{"name":"Programme National de Lutte Contre les IST\/VIH\/SIDA, Unit\u00e9 de Coordination des Maladies Infectieuses et Transmissibles, Minist\u00e8re de la Sant\u00e9 Publique et de la Population, Port-au-Prince, Haiti"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Eur J Med Res","first-page":"346","article-title":"Repercussions of the COVID-19 pandemic on the HIV care continuum and related factors in economically disadvantaged nations: An integrated analysis using mixed-methods systematic review","volume":"29","author":"Ojukwu","year":"2024"},{"key":"b2","series-title":"Nat Med","first-page":"1314","article-title":"COVID-19 and resilience of healthcare systems in ten countries","volume":"28","author":"Arsenault","year":"2022"},{"key":"b3","series-title":"J Acquir Immune Defic Syndr","first-page":"153","article-title":"Toward universal HIV treatment in Haiti: Time trends in ART retention after expanded ART eligibility in a national cohort from 2011 to 2017","volume":"84","author":"Puttkammer","year":"2020"},{"key":"b4","article-title":"ASG Jen\u010da Warns of Deepening Crisis in Haiti, Urges Urgent International Action to Prevent Collapse of State Authority.","year":"2025"},{"key":"b5","series-title":"AIDS Behav","first-page":"1366","article-title":"Short-term effects of the COVID-19 pandemic on HIV care utilization, service delivery, and continuity of HIV antiretroviral treatment (ART) in Haiti","volume":"25","author":"Celestin","year":"2021"},{"key":"b6","article-title":"Haiti.","year":"2026"},{"key":"b7","series-title":"J Infect Dis","first-page":"S135","article-title":"PEPFAR investments in country data systems support HIV treatment continuity: An example from Haiti","volume":"232","author":"Mattocks","year":"2025"},{"key":"b8","series-title":"Lancet HIV","first-page":"e158","article-title":"The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: An interrupted time series analysis","volume":"8","author":"Dorward","year":"2021"},{"key":"b9","series-title":"BMC Health Serv Res","first-page":"428","article-title":"Reduction in initiations of HIV treatment in South Africa during the COVID pandemic","volume":"22","author":"Benade","year":"2022"},{"key":"b10","series-title":"AIDS Behav","first-page":"2630","article-title":"The impact of COVID-19 on the HIV cascade of care in Botswana \u2013 An interrupted time series","volume":"28","author":"Sehurutshi","year":"2024"},{"key":"b11","series-title":"BMJ Open","first-page":"e084244","article-title":"Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: A retrospective longitudinal study","volume":"14","author":"Amhare","year":"2024"},{"key":"b12","series-title":"PLoS One","first-page":"e0290823","article-title":"The changes in health service utilisation in Malawi during the COVID-19 pandemic","volume":"19","author":"She","year":"2024"},{"key":"b13","series-title":"J Acquir Immune Defic Syndr","first-page":"1","article-title":"Time to treatment initiation and HIV viral suppression in people diagnosed with HIV-1 during COVID-19 pandemic in ex-Aquitaine, France (ANRS CO3 AQUIVIH-NA Cohort-QuAliCOV Study)","volume":"95","author":"Ben Farhat","year":"2024"},{"key":"b14","series-title":"Trop Med Health","first-page":"48","article-title":"Safeguarding equitable HIV service delivery at the health facility-level in a resource-limited setting during the pandemic","volume":"50","author":"Tactacan-Abrenica","year":"2022"},{"key":"b15","series-title":"Clin Infect Dis","first-page":"e1145","article-title":"Potential effects of the coronavirus disease 2019 (COVID-19) pandemic on human immunodeficiency virus (HIV) transmission: A modeling study in 32 US cities","volume":"75","author":"Fojo","year":"2022"},{"key":"b16","series-title":"Braz J Infect Dis","first-page":"102771","article-title":"Mobility restrictions during the COVID-19 pandemic and reduced outpatient HIV and syphilis testing in Brazil","volume":"27","author":"Seara-Morais","year":"2023"},{"key":"b17","series-title":"AIDS Behav","first-page":"186","article-title":"HIV testing disruptions and service adaptations during the COVID-19 pandemic: A systematic literature review","volume":"28","author":"Mude","year":"2024"},{"key":"b18","series-title":"BMC Public Health","first-page":"18","article-title":"Stakeholder perspectives on barriers and facilitators to hypertension control in urban Haiti: A qualitative study to inform a community-based hypertension management intervention","volume":"25","author":"St Sauveur","year":"2025"},{"key":"b19","series-title":"J Int AIDS Soc","first-page":"e26419","article-title":"Early initiation of fast\u2010track care for persons living with HIV initiating dolutegravir\u2010based regimens during a period of severe civil unrest in Port\u2010au\u2010Prince, Haiti: A pilot randomized trial","volume":"28","author":"Marc","year":"2025"},{"key":"b20","series-title":"Rev Panam Salud P\u00fablica","first-page":"1","article-title":"Timely initiation of HIV antiretroviral therapy in Haiti 20042018: A retrospective cohort study","volume":"45","author":"Puttkammer","year":"2021"},{"key":"b21","series-title":"AIDS","first-page":"777","article-title":"Impact of the 12 January 2010 earthquake on HIV case reporting in Haiti","volume":"34","author":"Delcher","year":"2020"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"57","article-title":"Retention throughout the HIV care and treatment cascade: From diagnosis to antiretroviral treatment of adults and children living with HIV\u2014Haiti, 1985\u20132015","volume":"97","author":"Auld","year":"2017"},{"key":"b23","series-title":"PLoS One","first-page":"e0240817","article-title":"Risk factors for delayed viral suppression on first-line antiretroviral therapy among persons living with HIV in Haiti, 2013\u20132017","volume":"15","author":"Rich","year":"2020"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"1372","article-title":"Haiti\u2019s HIV surveillance system: Past, present, and future","volume":"103","author":"Delcher","year":"2020"},{"key":"b25","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"933","article-title":"Launching a national surveillance system after an earthquake \u2013 Haiti, 2010","volume":"59","year":"2010"},{"key":"b26","article-title":"Three Years Experience with the Implementation of a Networked Electronic Medical Record in Haiti.","author":"Lober","year":"2008"},{"key":"b27"},{"key":"b28","series-title":"Stud Health Technol Inform","first-page":"883","article-title":"Developing an electronic medical record for interlinked care services in Haiti","volume":"216","author":"Marcelin","year":"2015"},{"key":"b29","series-title":"BMJ","first-page":"1142","article-title":"An information system and medical record to support HIV treatment in rural Haiti","volume":"329","author":"Fraser","year":"2004"},{"key":"b30","series-title":"Lancet Reg Health Am","first-page":"100847","article-title":"Continuity of care during severe civil unrest with a model of community-based HIV care: A retrospective cohort study from Haiti","volume":"37","author":"Joseph","year":"2024"},{"key":"b31","article-title":"A Timeline of Haiti\u2019s Gang Violence and How the Country Got to Where It Is.","author":"Sanon","year":"2024"},{"key":"b32","year":"2002"},{"key":"b33","series-title":"Lancet HIV","first-page":"e572","article-title":"GHESKIO\u2019s model of patient care during civil unrest in Haiti","volume":"11","author":"Deschamps","year":"2024"},{"key":"b34","series-title":"Nat Med","first-page":"964","article-title":"Health systems resilience in managing the COVID-19 pandemic: Lessons from 28 countries","volume":"27","author":"Haldane","year":"2021"},{"key":"b35","article-title":"Impact of US Funding Freeze on HIV Programmes in Haiti.","year":"2025"},{"key":"b36","article-title":"Haiti Country Operational Plan (COP\/ROP) 2020: Strategic Direction Summary.","year":"2020"},{"key":"b37","series-title":"Open Forum Infect Dis.","first-page":"ofaf526","article-title":"Three year outcomes after programmatic transitioning to dolutegravir in the context of severe civil unrest in Haiti","volume":"12","author":"Liautaud","year":"2025"},{"key":"b1","series-title":"Eur J Med Res","first-page":"346","article-title":"Repercussions of the COVID-19 pandemic on the HIV care continuum and related factors in economically disadvantaged nations: An integrated analysis using mixed-methods systematic review","volume":"29","author":"Ojukwu","year":"2024"},{"key":"b2","series-title":"Nat Med","first-page":"1314","article-title":"COVID-19 and resilience of healthcare systems in ten countries","volume":"28","author":"Arsenault","year":"2022"},{"key":"b3","series-title":"J Acquir Immune Defic Syndr","first-page":"153","article-title":"Toward universal HIV treatment in Haiti: Time trends in ART retention after expanded ART eligibility in a national cohort from 2011 to 2017","volume":"84","author":"Puttkammer","year":"2020"},{"key":"b4","article-title":"ASG Jen\u010da Warns of Deepening Crisis in Haiti, Urges Urgent International Action to Prevent Collapse of State Authority.","year":"2025"},{"key":"b5","series-title":"AIDS Behav","first-page":"1366","article-title":"Short-term effects of the COVID-19 pandemic on HIV care utilization, service delivery, and continuity of HIV antiretroviral treatment (ART) in Haiti","volume":"25","author":"Celestin","year":"2021"},{"key":"b6","article-title":"Haiti.","year":"2026"},{"key":"b7","series-title":"J Infect Dis","first-page":"S135","article-title":"PEPFAR investments in country data systems support HIV treatment continuity: An example from Haiti","volume":"232","author":"Mattocks","year":"2025"},{"key":"b8","series-title":"Lancet HIV","first-page":"e158","article-title":"The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: An interrupted time series analysis","volume":"8","author":"Dorward","year":"2021"},{"key":"b9","series-title":"BMC Health Serv Res","first-page":"428","article-title":"Reduction in initiations of HIV treatment in South Africa during the COVID pandemic","volume":"22","author":"Benade","year":"2022"},{"key":"b10","series-title":"AIDS Behav","first-page":"2630","article-title":"The impact of COVID-19 on the HIV cascade of care in Botswana \u2013 An interrupted time series","volume":"28","author":"Sehurutshi","year":"2024"},{"key":"b11","series-title":"BMJ Open","first-page":"e084244","article-title":"Assessing the impact of COVID-19 on HIV care cascade for people living with HIV in Ethiopia: A retrospective longitudinal study","volume":"14","author":"Amhare","year":"2024"},{"key":"b12","series-title":"PLoS One","first-page":"e0290823","article-title":"The changes in health service utilisation in Malawi during the COVID-19 pandemic","volume":"19","author":"She","year":"2024"},{"key":"b13","series-title":"J Acquir Immune Defic Syndr","first-page":"1","article-title":"Time to treatment initiation and HIV viral suppression in people diagnosed with HIV-1 during COVID-19 pandemic in ex-Aquitaine, France (ANRS CO3 AQUIVIH-NA Cohort-QuAliCOV Study)","volume":"95","author":"Ben Farhat","year":"2024"},{"key":"b14","series-title":"Trop Med Health","first-page":"48","article-title":"Safeguarding equitable HIV service delivery at the health facility-level in a resource-limited setting during the pandemic","volume":"50","author":"Tactacan-Abrenica","year":"2022"},{"key":"b15","series-title":"Clin Infect Dis","first-page":"e1145","article-title":"Potential effects of the coronavirus disease 2019 (COVID-19) pandemic on human immunodeficiency virus (HIV) transmission: A modeling study in 32 US cities","volume":"75","author":"Fojo","year":"2022"},{"key":"b16","series-title":"Braz J Infect Dis","first-page":"102771","article-title":"Mobility restrictions during the COVID-19 pandemic and reduced outpatient HIV and syphilis testing in Brazil","volume":"27","author":"Seara-Morais","year":"2023"},{"key":"b17","series-title":"AIDS Behav","first-page":"186","article-title":"HIV testing disruptions and service adaptations during the COVID-19 pandemic: A systematic literature review","volume":"28","author":"Mude","year":"2024"},{"key":"b18","series-title":"BMC Public Health","first-page":"18","article-title":"Stakeholder perspectives on barriers and facilitators to hypertension control in urban Haiti: A qualitative study to inform a community-based hypertension management intervention","volume":"25","author":"St Sauveur","year":"2025"},{"key":"b19","series-title":"J Int AIDS Soc","first-page":"e26419","article-title":"Early initiation of fast\u2010track care for persons living with HIV initiating dolutegravir\u2010based regimens during a period of severe civil unrest in Port\u2010au\u2010Prince, Haiti: A pilot randomized trial","volume":"28","author":"Marc","year":"2025"},{"key":"b20","series-title":"Rev Panam Salud P\u00fablica","first-page":"1","article-title":"Timely initiation of HIV antiretroviral therapy in Haiti 20042018: A retrospective cohort study","volume":"45","author":"Puttkammer","year":"2021"},{"key":"b21","series-title":"AIDS","first-page":"777","article-title":"Impact of the 12 January 2010 earthquake on HIV case reporting in Haiti","volume":"34","author":"Delcher","year":"2020"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"57","article-title":"Retention throughout the HIV care and treatment cascade: From diagnosis to antiretroviral treatment of adults and children living with HIV\u2014Haiti, 1985\u20132015","volume":"97","author":"Auld","year":"2017"},{"key":"b23","series-title":"PLoS One","first-page":"e0240817","article-title":"Risk factors for delayed viral suppression on first-line antiretroviral therapy among persons living with HIV in Haiti, 2013\u20132017","volume":"15","author":"Rich","year":"2020"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"1372","article-title":"Haiti\u2019s HIV surveillance system: Past, present, and future","volume":"103","author":"Delcher","year":"2020"},{"key":"b25","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"933","article-title":"Launching a national surveillance system after an earthquake \u2013 Haiti, 2010","volume":"59","year":"2010"},{"key":"b26","article-title":"Three Years Experience with the Implementation of a Networked Electronic Medical Record in Haiti.","author":"Lober","year":"2008"},{"key":"b27"},{"key":"b28","series-title":"Stud Health Technol Inform","first-page":"883","article-title":"Developing an electronic medical record for interlinked care services in Haiti","volume":"216","author":"Marcelin","year":"2015"},{"key":"b29","series-title":"BMJ","first-page":"1142","article-title":"An information system and medical record to support HIV treatment in rural Haiti","volume":"329","author":"Fraser","year":"2004"},{"key":"b30","series-title":"Lancet Reg Health Am","first-page":"100847","article-title":"Continuity of care during severe civil unrest with a model of community-based HIV care: A retrospective cohort study from Haiti","volume":"37","author":"Joseph","year":"2024"},{"key":"b31","article-title":"A Timeline of Haiti\u2019s Gang Violence and How the Country Got to Where It Is.","author":"Sanon","year":"2024"},{"key":"b32","year":"2002"},{"key":"b33","series-title":"Lancet HIV","first-page":"e572","article-title":"GHESKIO\u2019s model of patient care during civil unrest in Haiti","volume":"11","author":"Deschamps","year":"2024"},{"key":"b34","series-title":"Nat Med","first-page":"964","article-title":"Health systems resilience in managing the COVID-19 pandemic: Lessons from 28 countries","volume":"27","author":"Haldane","year":"2021"},{"key":"b35","article-title":"Impact of US Funding Freeze on HIV Programmes in Haiti.","year":"2025"},{"key":"b36","article-title":"Haiti Country Operational Plan (COP\/ROP) 2020: Strategic Direction Summary.","year":"2020"},{"key":"b37","series-title":"Open Forum Infect Dis.","first-page":"ofaf526","article-title":"Three year outcomes after programmatic transitioning to dolutegravir in the context of severe civil unrest in Haiti","volume":"12","author":"Liautaud","year":"2025"}],"container-title":["The American 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