Implementation of differentiated service delivery strategies for patients with tuberculosis in Haiti during a severe humanitarian crisis, January–August 2021

Global efforts to control tuberculosis (TB) faced significant challenges during the COVID-19 pandemic, particularly in Haiti, where it coincided with a severe humanitarian crisis. To minimize facility visits for patients, a differentiated service delivery (DSD) model with multi-month dispensing of TB drugs was implemented at two high-volume health facilities in Port-au-Prince, Haiti. All patients aged 18 years and older who initiated drug-susceptible TB treatment from January 1 to August 31, 2022 were included in the prospective cohort. Clinicians first identified clinically stable patients who met criteria for DSD eligibility and offered them enrollment in the DSD model. Those deemed unsuitable for DSD or declined DSD were treated under the standard of care (SOC) model. DSD patients received an initial 2-month supply of medication followed by either a 4-month supply or two additional 2-month supplies. They also received remote follow-up via mobile communication within 24–48 hours of treatment initiation, biweekly during the first two months, and monthly during the last four months. Under SOC, patients came to the facility for clinical review and drug dispensation every 2–4 weeks during the first two months, and monthly during the last four months. Robust Poisson regression was used to analyze the relationship between treatment success and cohort type. During the project period, a total of 551 patients initiated TB treatment: 151 in the DSD model and 400 under SOC. Thirty-nine percent were female; median age was 33 years; and 25% were HIV-positive. Treatment success (defined as those who were cured or completed treatment) was significantly higher in the DSD group at (140/151; 93%), compared to 312/400 (78%) in the SOC group (adjusted risk ratio [aRR]: 1.10, p = 0.02): however, there was no significant difference after excluding patients who were lost-to-follow-up (aRR: 1.00; p = 0.85). This project demonstrates that a DSD model can achieve high TB treatment success rates, even amid challenging circumstances like the COVID-19 pandemic and socio-political unrest. Adapting healthcare systems through innovative service delivery methods is essential to effectively meet patient needs during global health crises.