Assessing HIV Care Outcomes Among Persons Who Use Drugs in Puerto Rico Before and After Hurricane Maria

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Disaster Medicine

Background:

• Hurricane Maria (HM) posed significant challenges to healthcare systems.
• People with HIV (PWH) who use drugs may be particularly vulnerable to health disruptions during disasters.

Purpose of the Study:

• To assess the health impacts of Hurricane Maria on HIV care outcomes.
• To examine changes in viral load, viral suppression, and CD4 counts among PWH who use drugs post-disaster.

Main Methods:

• Utilized data from the Proyecto PACTo cohort study in San Juan, Puerto Rico.
• Compared HIV care outcomes (viral load, viral suppression, CD4 counts) before and after Hurricane Maria.
• Employed generalized estimating equations to identify associated factors.

Main Results:

• Significant deterioration in HIV care outcomes observed post-Hurricane Maria.
• Mean viral load increased, CD4 counts decreased, and viral suppression rates declined.
• Age, homelessness, and health insurance status were independently associated with viral suppression.

Conclusions:

• People with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes after Hurricane Maria.
• Socio-environmental factors significantly influenced these outcomes.
• Findings inform disaster response, recovery efforts, and public health program planning for vulnerable populations.