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

OBJECTIVES: To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs. METHODS: Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes. RESULTS: All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression. PARTICIPANTS: 219 participants completed follow-up visits between April 2017 and January 2018, before and after HM. CONCLUSIONS: People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.

Practical Guide for the Prescription of Malaria Chemoprophylaxis for the Primary Care Physician.

Malaria is considered an important health threat around the world. Travelers from non-endemic countries are at risk of contracting the parasite that causes malaria. Those traveling on humanitarian missions and military personnel are at the greatest risk. Mosquito avoidance is an important intervention, but chemoprophylaxis is the most effective method for the prevention of this infection. The selection of a specific regimen can be a difficult task. It is a decision that is not based solely on the region in which a given patient is traveling but also on that patient's comorbidities and the potential adverse effects of the medications to be used. This review is intended to be a simple guide for the primary care physician. We discuss the selection of chemoprophylaxis for patients in the general population. We also address the specifics of chemoprophylaxis during pregnancy and breast feeding and in people diagnosed with epilepsy.