In 2017, Hurricane Maria (HM) caused devastation to Puerto Rico and its residents. Based on an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we examined the effects of HM on HIV care outcomes among people living with HIV (PLWH) and with a history of substance use.
We measured differences in HIV care outcomes – viral load, viral suppression, and CD4 counts – before and after HM using assessments conducted in 6-month intervals. Data are based on blood collected to measure CD4 and viral load and a social and behavioral assessment completed through a computer-assisted personal interview. Factors associated with HIV care outcomes were evaluated using generalized estimating equations to take into account repeated measures per individual.
219 participants completed a follow-up visit within the 9-month period before and after HM. The mean post-HM viral load was 2.3 log10 copies/ml (se=0.09), significantly higher compared to pre-HM (2.1 log10 copies/ml, se=0.08). CD4 counts also were lower post-HM (mean=553 cells/ul, se=23.2) compared to pre-HM (mean=589 cells/ul, se=24.7) (Figure). Viral suppression (<200 copies/ml) was 72% pre-HM compared to 65% post-HM. After controlling for age, gender, income, health insurance, incarceration history, homelessness, history of living in the mainland United States, severe drug use, and depression at baseline, there was a 9% reduction for viral suppression between pre- and post-HM time points (aIRR=0.91, 95% CI 0.84-0.98). Also, age (aIRR=1.01, 95% CI 1.00-1.02) and homelessness (aIRR=0.78, 95% CI 0.62-0.98) were independent predictors of viral suppression.
PLWH and with a history of substance use in San Juan, Puerto Rico demonstrated an increase in viral load and decrease in both viral suppression and CD4 counts following HM, critical factors in determining disease outcome and potential community transmission. Further post-HM research will focus on the barriers and facilitators related to accessing healthcare and resources and the effects of post-traumatic stress disorder, which may explain long-term HIV care outcomes.