Hispaniola Initiative Articles by Carter Center Experts

September 2024
Over 25 Years of Hope: Development of Lymphatic Filariasis Patient Support Groups in Haiti
Published by The American Journal of Tropical Medicine and Hygiene.
Authors: Valery Madsen Beau De Rochars, Jeannine Coreil, Martha Désir, Gladys Mayard, Marie Carmel Michel, Marie Denise Milord, Rand Carpenter, Thomas G. Streit, Luccène Désir, Gregory S. Noland, and David G. Addiss
Description: Support groups can create environments that are conducive to healing and well-being, particularly for persons with stigmatizing chronic diseases. In 1998, the support group concept was adapted in Haiti for persons with disabling lymphedema caused by lymphatic filariasis (LF). The project was developed with the expectation that the support group model conceived in the developed world be interpreted and modified by persons affected with lymphedema in the Haitian setting. Initiated with modest financial support within a research initiative to eliminate LF, a total of 50 “Hope Clubs” were formed from 1998 to 2023 across seven communes (districts) located in 3 of Haiti’s 10 regional Departments. Documented benefits of the support groups included improved limb self-care, decreased incidence of inflammatory episodes (adenolymphangitis), enhanced self-efficacy, economic benefit through microenterprise, and improved quality of life. Despite challenges of funding shortfalls, natural disasters, and political insecurity, persistence of LF support groups in Haiti highlights the crucial role of group ownership by affected persons and the freedom to reinvent the support group concept in light of local social, cultural, and economic conditions.

September 2024
Results of Integrated Transmission Assessment Surveys for Lymphatic Filariasis and Malaria in Haiti, 2017–2022
Published by The American Journal of Tropical Medicine and Hygiene.
Authors : Luccène Désir, Karen E. S. Hamre, Valéry Madsen Beau De Rochars, Jean F. Lemoine, Marc-Aurèle Telfort, and Gregory S. Noland
Description: Haiti is endemic for lymphatic filariasis (LF) and malaria, two mosquito-transmitted parasitic diseases targeted for elimination. The World Health Organization recommends a transmission assessment survey (TAS-1) to determine if LF prevalence is significantly beneath putative transmission thresholds (<2% antigen prevalence in Haiti, where Culex is the primary vector for Wuchereria bancrofti) to stop mass drug administration (MDA). Repeated TASs (TAS-2 and TAS-3) are recommended at 2–3-year intervals during post-treatment surveillance. From 2017 to 2022, The Carter Center assisted the Haitian Ministry of Public Health and Population in conducting 15 TASs in 11 evaluation units (EUs) encompassing 54 of the country’s 146 districts. Children 6–7 years old were assessed for circulating filarial antigen (CFA) by Filariasis Test Strip: n = 5,239 in TAS-1; n = 11,866 in TAS-2; and n = 1,842 in TAS-3, of whom eight (0.15%), 20 (0.17%), and eight (0.43%) tested positive, respectively. The number of positive results in children was less than the threshold in each EU. When available, participants (n = 16,663) were also tested for malaria by rapid diagnostic test, with 31 (0.19%) children testing positive for Plasmodium falciparum. Integrated TASs provided an efficient means to collect epidemiological data for LF and malaria in Haiti. Results indicated thresholds for stopping and maintaining the halt of MDA for LF have been achieved in all EUs, with the halt of MDA for 571,358 people in four districts and the first TAS-3 surveys conducted in Haiti. Investigations are needed to assess the potential of ongoing LF transmission, especially in areas where CFA-positive samples were detected in TAS-3.

March 2024
A Pilot Study to Address the Mental Health of Persons Living With Lymphatic Filariasis in Léogâne, Haiti: Implementing a Chronic Disease Self-Management Program Using a Stepped-Wedge Cluster Design (PDF)
Published by International Health. doi.org/10.1093/inthealth/ihae006
Authors: Shanze Sadiq, Karen E S Hamre, Samhita Kumar, Sarah Bazur-Leidy, Luccène Désir, M Martha Désir, Murielle C Gilbert, V Madsen Beau de Rochars, Marc-Aurèle Telfort, Gregory S Noland, Eve Byrd.
This paper presents a pilot study to assess the effectiveness of a chronic disease self-management program (CDSMP) that was introduced to lymphatic filariasis peer support groups in Léogâne, Haiti. We used household surveys at baseline and endpoint to measure self-rated health, depression, disease self-efficacy, perceived social support, and quality of life.

July 2023
Was Lockdown Worth It? Community Perspectives and Experiences of the Covid-19 Pandemic in Remote Southwestern Haiti (PDF)
Published by Social Science & Medicine. doi: 10.1016/j.socscimed.2023.116076
Authors: Kevin Bardosh, Lorence Jean, Luccene Desir, Sarah Yoss, Brianna Poovey, Madsen Valerie Beau de Rochars, Gregory S. Noland.
Summary: In this paper, we present a qualitative analysis of community perceptions and experiences of the pandemic from one remote, rural department of southwestern Haiti, vulnerable to natural disasters and ongoing political crisis. We integrate data on disease perceptions and experiences with those of the state lockdown response (March–August 2020) to make five arguments.

May 9, 2023
Acceptability, Feasibility, Drug Safety, and Effectiveness of a Pilot Mass Drug Administration with a Single Round of Sulfadoxine-Pyrimethamine Plus Primaquine and Indoor Residual Spraying in Communities with Malaria Transmission in Haiti, 2018.
Published by The American Journal of Tropical Medicine and Hygiene. doi: 10.4269/ajtmh.22-0623.
Authors: Michelle A. Chang, Daniel Impoinvil, Karen E. S. Hamre, Paul-Emile Dalexis, Jean-Baptiste Mérilien, Amber M. Dismer , Bernadette Fouché, Luccene Desir, Kathleen Holmes, Willy Lafortune, Camelia Herman, Eric Rogier, Gregory S. Noland, Alyssa J. Young, Thomas Druetz, Ruth Ashton, Thomas P. Eisele, Justin Cohen, Lotus van den Hoogen, Gillian Stresman, Chris Drakeley, Emilie Pothin, Ewan Cameron, Katherine E. Battle, John Williamson, Marc-Aurèle Telfort, and Jean Frantz Lemoine.
For a malaria elimination strategy, Haiti's National Malaria Control Program piloted a mass drug administration (MDA) with indoor residual spraying (IRS) in 12 high-transmission areas across five communes after implementing community case management and strengthened surveillance.

February 27, 2023
Results from a Knowledge, Attitudes, and Practices Survey in Two Malaria Transmission Foci of Santo Domingo, Dominican Republic
Published by The American Journal of Tropical Medicine and Hygiene; 108(4): 755-767.
Authors: Hunter Keys, Kevin Bardosh, Keyla Ureña, Luccene Desir, Manuel Tejada, and Gregory S. Noland.
Malaria outbreaks in Santo Domingo pose a new and complicated challenge for malaria elimination in the Dominican Republic and on the island as a whole. This study sought to characterize malaria knowledge, attitudes, and practices of residents in two transmission foci. Findings demonstrate gaps in knowledge and community-based interventions and highlight the need to improve community engagement for malaria elimination in affected areas.

Feb. 9, 2023
Evaluating a Community Engagement Model for Malaria Elimination in Haiti: Lessons from the Community Health Council Project (2019–2021)
Published by Bio Med Central, Part of Springer Nature; Malaria Journal 22(1): 47.
Authors: Kevin Bardosh, Luccene Desir, Lorence Jean, Sarah Yoss, Brianna Poovey, Andrew Nute, Madsen Valerie Beau de Rochars, Marc-Aurèle Telfort, Fabiola Benoit, Ginette Chery, Marie Carmelle Charlotin, and Gregory S. Noland.
Community engagement (CE) plays a critical role in malaria control and elimination. CE approaches vary substantially, with more participatory programs requiring higher levels of adaptive management. This study evaluates the effectiveness of a volunteer-based CE program developed in Haiti in 2018. The approach was based on local leaders organizing and implementing monthly anti-malaria activities in their communities and was implemented as part of Malaria Zero Consortium activities.

May 15, 2022
Following Misdirection and Multiple Malarias in Santo Domingo, Dominican Republicm (PDF)
Author: Hunter Keys
Misdirection can be understood as a social process of pursuing certain kinds of evidence while drawing attention away from others. This paper explores misdirection in the context of malaria elimination in the Dominican Republic.

Jan. 28, 2022
Simulating the Effect of Evaluation Unit Size on Eligibility to Stop Mass Drug Administration for Lymphatic Filariasis in Haiti (PDF)
Published by PLOS Neglected Tropical Diseases.
Authors: Natalya Kostandova, Luccene Desir, Abdel Direny, Alaine Knipes, Jean Frantz Lemoine, Carl Renand Fayette, Amy Kirby, Katherine Gass
In this study, Transmission Assessment Survey (TAS) data from Haiti were used to perform simulations to explore the programmatic implications of evaluation units (EU) size. In particular, the effect of using larger EUs for classifying an area as ready, or not, to stop mass drug administration was explored by combining adjacent smaller EUs. In addition, the potential of using a TAS with a reduced sample size, referred to as a ‘mini-TAS’, in smaller EUs was considered as a potential cost-saving approach.

Aug. 10, 2021
Lymphatic Filariasis Elimination in the Dominican Republic: History, Progress, and Remaining Steps
Published by PLOS Neglected Tropical Diseases.
Authors: Manuel Gonzales, Gregory S. Noland , Eileen F. Mariano, and Stephen Blount
Lymphatic filariasis (LF) is a mosquito-transmitted parasitic disease that is a leading cause of disability globally. The island of Hispaniola, which the Dominican Republic shares with Haiti, accounts for approximately 90% of LF cases in the Americas region. In 1998, the Dominican Ministry of Public Health created the Program to Eliminate Lymphatic Filariasis (PELF) with the goal of eliminating LF transmission by 2020.

April 19, 2021
Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic (PDF)
Published by the American Journal of Hygiene and Tropical Medicine.
Authors: Valery E. Madsen Beau De Rochars, Hunter Keys, Shenae K. Samuels, Ara Jo, Gregory S. Noland, Manuel Gonzales, Stephen Blount, and Arch G. Mainous III
This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country’s three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c).

Feb. 8, 2021
Rapid Ethnographic Assessment For Potential Anti-Malarial Mass Drug Administration In An Outbreak Area Of Santo Domingo, Dominican Republic (PDF)
Published by Malaria Journal.
In the Dominican Republic, a recent outbreak of malaria in the capital, Santo Domingo, threatens efforts to eliminate the disease. Mass drug administration (MDA) has been proposed as one strategy to reduce transmission. The success of MDA is contingent upon high levels of acceptance among the target population.

Aug. 8, 2020
Malaria Outbreak Response in Urban Santo Domingo, Dominican Republic: Lessons Learned for Community Engagement
Published by PAHO (Pan American Health Organization).
Authors: Dianelba Valdez, Hunter Keys, Keyla Ureña, Domingo Cabral, Francisco Camilo, Eulalia C. Ogando, Luz Mercedes, Gregory S. Noland, Stephen B. Blount, James V. Lavery, Luccene Desir, and Jose Puello
Community involvement is crucial to public health initiatives, but it remains a poorly studied process within national disease elimination programs. This report presents the main lessons learned regarding community participation practices during the response to the malaria outbreak in the Los Tres Brazos neighborhood of the urban area of ​​Santo Domingo, Dominican Republic, from 2015 to 2016.

May 29, 2020
The Roles of Stakeholder Experience and Organizational Learning in Declining Mass Drug Administration Coverage for Lymphatic Filariasis in Port-au-Prince, Haiti: A Case Study
Published by PLOS Neglected Tropical Diseases.
Authors: Breanna K. Wodnik, Didié Hérold Louis, Michel Joseph, Lee T. Wilkers, Susan D. Landskroener, Luccene Desir, Jean Frantz Lemoine, and James V. Lavery
The World Health Organization (WHO) defines an effective round of mass drug administration (MDA) for lymphatic filariasis (LF) as one that reaches at least 65% of the target population. In its first round of MDA in 2011–2012, the National Program to Eliminate LF in Haiti achieved a 79% epidemiological coverage in urban Port-au-Prince.

May 21, 2020
Combination of Serological, Antigen Detection, and DNA Data for Plasmodium falciparum Provides Robust Geospatial Estimates for Malaria Transmission in Haiti (PDF)
Published by Scientific Reports.
Authors: Adan Oviedo, Alaine Knipes, Caitlin Worrell, LeAnne M. Fox, Luccene Desir, Carl Fayette, Alain Javel, Franck Monestime, Kimberly Mace, Michelle A. Chang, Venkatachalam Udhayakumar, Jean F. Lemoine, Kimberly Won, Patrick J. Lammie, and Eric Rogier.
In this study, the authors measure and compare multiple indicators of malaria infection or exposure from school-based surveys in two locations in Haiti conducted in conjunction with lymphatic filariasis transmission assessment surveys. As Haiti and other countries near malaria elimination, identifying the most practical and robust tools for malaria surveillance will aid in finding the last reservoirs of Plasmodium falciparum parasites in the population.

Nov. 12, 2019
Perceived Discrimination in Bateyes of the Dominican Republic: Results from the Everyday Discrimination Scale and Implications for Public Health Programs
Published by BMC Public Health.
Authors: Hunter M. Keys, Gregory S. Noland, Madsen Beau De Rochars, Thomas H. Taylor, Stephen Blount and Manuel Gonzales
Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural ‘company towns,’ often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts.

May 27, 2019
Prevalence of Malaria and Lymphatic Filariasis in Bateyes of the Dominican Republic (PDF)
Published by Infectious Diseases of Poverty.
Authors: Hunter M. Keys, Gregory S. Noland, Madsen Beau De Rochars, Stephen Blount and Manuel Gonzales.
The island of Hispaniola, shared by Haiti and the Dominican Republic (DR), is the only remaining malaria-endemic island in the Caribbean and accounts for 95% of the lymphatic filariasis (LF) burden in the Americas. Both countries aim to eliminate the diseases by 2020. Migration from Haiti, where both diseases are more prevalent, may promote transmission in the DR. Historically, Haitian migrant labourers live in rural Dominican agricultural ‘company towns’ called bateyes, many of which received mass drug administration (MDA) for LF elimination. This study sought to determine the prevalence of malaria and LF in bateyes of the DR and to describe related risk factors for disease.

Oct. 29, 2018
"Wherever Doctors Cannot Reach, the Sunshine Can:" Overcoming Potential Barriers to Malaria Elimination Interventions in Haiti (PDF)
Published by Malaria Journal.
Authors: Thomas Druetz, Katherine Andrinopoulos, Louis-Marie Boulos, Michaelle Boulos, Gregory S Noland, Luccene Desir, Jean Frantz Lemoine, Thomas P Eisele.
The goal of this study was to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies that could be considered by the Haitian Ministry of Health and its partners. The specific objectives were to assess community perceptions about malaria, including its relative importance and its risk factors, and describe perceptions and acceptability of potential malaria elimination interventions.

June 2018
Building Trust through Lymphatic Filariasis Elimination: A Platform to Address Social Exclusion and Human Rights in the Dominican Republic
Published by Health and Human Rights Journal, Volume 20, Issue 1, June 2018.
Authors: Hunter Keys, Manuel Gonzales, Madsen Beau de Rochars, Stephen Blount, and Gregory S. Noland.
Hispaniola, the Caribbean island that includes the countries of Haiti and the Dominican Republic (DR), accounts for 90% of lymphatic filariasis (LF) in the Americas. Both countries have committed to LF elimination by 2020. In the DR, LF occurs mainly in bateyes, or company towns that historically hosted migrant laborers from Haiti. A legacy of anti-Haitian discrimination as well as the 2013 Sentencia, which stripped generations of Haitian-descended Dominicans of their citizenship, ensure that this population remains legally, economically, and socially marginalized. Despite this context, the country’s LF elimination program (PELF) has worked in bateyes to eliminate LF through health education and annual drug treatment to interrupt parasite transmission.

Oct. 26, 2015
Post-MDA Transmission Assessment Survey for the Elimination of Lymphatic Filariasis in La Ciénaga, Dominican Republic (PDF)
Published by the American Journal of Hygiene and Tropical Medicine.
Authors: Gregory S. Noland, Stephen Blount, and Manuel Gonzalez. The Dominican Republic is one of four remaining countries in the Americas with lymphatic filariasis (LF). Annual mass drug administration (MDA) with albendazole and diethylcarbamazine was conducted in La Ciénaga, an impoverished urban barrio in Santo Domingo from 2004 to 2006. Eight years after the last MDA, a transmission assessment survey (TAS) was conducted in November–December 2014 to determine if LF transmission remains absent.

Jan. 3, 2013
Disease Eradication
Published by New England Journal of Medicine, Vol 368 No. 1.pp. 53-64. Doi:10.1056/NEJMra1200391
Author: Donald R. Hopkins.
Since the last case of naturally occurring smallpox in 1977, there have been three major international conferences devoted to the concept of disease eradication. Several other diseases have been considered as potential candidates for eradication, but the World Health Organization (WHO) has targeted only two other diseases for global eradication after smallpox. In 1986, WHO's policy-making body, the World Health Assembly, adopted the elimination of dracunculiasis (Guinea worm disease) as a global goal, and it declared eradication of poliomyelitis a global goal in 1988. Although both diseases now appear to be close to eradication, the fact that neither goal has been achieved after more than two decades — and several years beyond the initial target dates for their eradication — underscores the daunting challenge of such efforts, as does the failure of previous attempts to eradicate malaria, hookworm, yaws, and other diseases. "Disease Eradication" was published as part one of "A Global View of Health – An Unfolding Series." Read the overview of the series >