Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

Examining Health Disparities Present in Haitian Patients at the VCOM Clinics in Punta Cana, DR Gayatri Rathod, MPS; Juhi Patel, MA; Ellena Varnadoe, BS; Tom Lindsey, DO Edward Via College of Osteopathic Medicine, Spartanburg, SC

Introduction

Results

Discussion

References 1. Leventhal, S. (2013). A Gap Between Ideals and Reality: The Right to Health and the Inaccessibility of Healthcare for haitian Migrant Workers in the Inaccessibility of Healthcare for Haitian Migrant Workers in the Dominican Republic. Emory International Law Review , 27 (2), 1249. 2. Keys, H. M., Kaiser, B. N., Foster, J. W., Burgos Minaya, R. Y., & Kohrt, B. A. (2015). Perceived discrimination, humiliation, and mental health: a mixed-methods study among Haitian migrants in the Dominican Republic. Ethnicity & health , 20 (3), 219–240. https://doi.org/10.1080/13557858.2014.907389 3. Rojas, P., Malow, R., Ruffin, B., Rothe, E. M., & Rosenberg, R. (2011). The HIV/AIDS Epidemic in the Dominican Republic: Key Contributing Factors. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002) , 10 (5), 306–315. https://doi.org/10.1177/1545109710397770 4. Centers for Disease Control and Prevention. (2022, June 6). PrEP Effectiveness . Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html 5. Turner, L. (2021, August). Do You Have Parasites? Five signs you may have these bad bugs, and how to get rid of them. Better Nutrition , 83 (8), 16+. https://link.gale.com/apps/doc/A678821843/AONE?u=anon~cb1c03c1&sid=googleScholar&xid=f895a720 Acknowledgements The evaluation of health disparities at the VCOM clinics reveals significant findings, addressing a vital data gap for mostly uninsured patients (Fig. 1C) among the Haitian and Dominican communities in Punta Cana. Haiti is recognized as having the highest HIV prevalence in the Western Hemisphere, likely due to factors such as early sexual activity, teenage pregnancy, rural-to-urban migration and limited prevention access. 3 Our analysis supports this finding (Fig. 2, Table 1) , and suggests: (1) a special consideration for enhanced prevention efforts, including educational resources in Creole and access to Pre-Exposure Prophylaxis (PrEP), which has shown efficacy in reducing the risk of getting HIV from sex by 99% if taken as prescribed. 4 Conversely, Dominicans utilized preventative services more, with 407 pediatric annual exams compared to 313 among Haitians, which may be due to Haitian perceived discrimination and experiences of humiliation among the local population. 2 Haitian pediatric patients also experienced more parasitic infections and obesity/iron-deficiency anemia/malnutrition than Dominicans (Table 2) , suggesting: (2) that Haitian housing may exhibit inadequate living conditions and lack of clean water, which lead to higher exposure to parasites, 5 and (3) Haitian communities may face higher levels of food insecurity leading to early-onset dietary conditions in children. Limitations include the study's one-year, cross-sectional scope and constraints in capturing co-morbidities in the ECR. Future research should consider a five-year cohort analysis, focusing on food insecurity and housing disparities by expanding data collection in the CREDO system to include surveys that provide deeper insights into healthcare barriers. In conclusion, assessing health disparities at the VCOM clinics has highlighted insights into the challenges in healthcare faced by Dominican and Haitian communities. By prioritizing prevention alongside treatment and fostering inclusive healthcare practices, the region can progress towards equitable healthcare outcomes for all individuals.

De-identified clinical and descriptive data was collected from electronic case reports (ECR) documented in the Clinical Rotation Evaluation and Documentation Organizer (CREDO) platform for VCOM-sponsored free health clinics for a cross-sectional 1-year analysis. A total of 88,416 case reports between October 2022 and October 2023 were analyzed. Place of birth was utilized to designate Haitian and Dominican patients. Statistical calculations: ● Descriptive statistics and frequencies for categorical variables to understand patient population ● Incidence rates, including recurrent cases, for all existing acute condition ICD codes in CREDO, along with the contingency chi-squared results for each condition, denoted by place of birth ● Highest incidence diagnoses with significant disparities were selected, along with those significant results whose disparities showed a clinical pattern evidenced by literature. For chronic conditions (HIV), prevalence was calculated based on initial case encounter for each patient only. Despite sharing an island, Haiti and the Dominican Republic possess intricate socioeconomic and political histories, fostering a complex environment. This complexity particularly affects the numerous Haitian migrants seeking refuge in the Dominican Republic in pursuit of the better life. 1 Among the challenges they face, access to healthcare stands out prominently. 2 Despite a Dominican law mandating healthcare provision for all residents, including Haitians, barriers persist, causing distress and exacerbating their plight. 2 For example, historically Haitians have faced higher rates of HIV prevalence compared to Dominicans, attributed to limited access to healthcare, education, and resources. Stigma and discrimination surrounding HIV further marginalize affected populations. 3 Given the presence of the VCOM-sponsored free health clinics (Verón Clinic and Oscar de la Renta Pediatric Clinic) in the DR serving both Haitian refugees and the local Dominican population, it is imperative to investigate differences in health utilization. The historical tensions, migration challenges, and socioeconomic factors affecting these communities emphasize the importance of understanding these differences to ensure equitable healthcare provision and promote the overall well-being of all patients. Research Objective: Therefore, we conducted this study to understand and discover if differences in health utilization exist between the local Dominican population and Haitian refugees at the VCOM-sponsored free health clinics in Punta Cana, Dominican Republic concerning diagnosis, visit type, and frequency of clinic use. Methods

During the year spanning from October 2022 to October 2023, the VCOM free clinics in Punta Cana, DR, attended to a total of 24,689 Dominican patients and 15,013 Haitian patients.

Population Demographics by Place of Birth in VCOM Clinics in Punta Cana

B

C

A

HIV emerged as the most frequent reason for adult visits to VCOM clinics in the DR between October 2022 - 23 and the highest disparity (Fig. 2) in prevalence encompassing both Haitian and Dominican adult populations, between the two populations. Figure 1. One-year population demographics shown by (A) adult and pediatric (B) male and female, and (C) insured and uninsured proportions

The highest incident diagnoses were broadly categorized as acute primary care conditions. Dominican individuals demonstrated a higher prevalence of primary care diagnoses, whereas Haitian patients exhibited elevated rates of HIV, injuries, and abdominal pain (Fig. 2).

T

Figure 2. Highest incident case diagnoses were analyzed for Dominican and Haitian adult patients between Oct 2022-23 utilizing contingency chi-squared analysis. *HIV prevalence was calculated due to its chronic characteristic *p<0.05, **p<0.01, ***p<0.001

HIV Disparities in Adult Haitian Patients

To further understand Haitian and Dominican HIV utilization, HIV drug prescriptions were totaled (Table 1), including tenofovir and emtricitabine, and dolutegravir, still showing a higher burden for Haitian patients despite a 50% smaller sample size.

Dominican (n = 11,838)

Haitian (n = 5,674)

396

439

HIV Patient Counts**

2487

2529

HIV Drug Prescriptions**

Table 1. HIV unique patient counts and number of respective HIV drug prescriptions in 1 year time period. **p<0.01

Dominican case reports showed statistically higher utilization for child health exams and other preventable care visits, while Haitian pediatric case reports showed significantly higher incidence of tinea fungal infections and parasitic infections, including scabies and ascariasis. pediatric

Pediatric Disparities in Haitian Patients

Dominican (n = 12,851)

Haitian (n = 9,339)

407

313

Physicals/Preventable Care**

345

399

Parasitics**

Obesity/Iron-Def Anemia/Malnutrition**

176

210

Table 2. Pediatric patient counts highlighting disparities in preventable care services, parasitic incidence and dietary-related conditions, analyzed through contingency chi-squared analysis. **p<0.01

We would like to thank Cameron Sumpter for providing CREDO data and Dr. Stoner for analysis insight.

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2024 Research Recognition Day