@article{fdi:010075681,
  title = {{T}he case-area targeted rapid response strategy to control cholera in {H}aiti : a four-year implementation study},
  author = {{R}ebaudet, {S}. and {B}ulit, {G}. and {G}audart, {J}. and {M}ichel, {E}. and {G}azin, {P}ierre and {E}vers, {C}. and {B}eaulieu, {S}. and {A}bedi, {A}. {A}. and {O}sei, {L}. and {B}arrais, {R}. and {P}ierre, {K}. and {M}oore, {S}. and {B}oncy, {J}. and {A}drien, {P}. and {G}uillaume, {F}. {D}. and {B}eigbeder, {E}. and {P}iarroux, {R}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {I}n {O}ctober 2010, {H}aiti was struck by a large-scale cholera epidemic. {T}he {H}aitian government, {UNICEF} and other international partners launched an unprecedented nationwide alert-response strategy in {J}uly 2013. {C}oordinated {NGO}s recruited local rapid response mobile teams to conduct case-area targeted interventions ({CATI}s), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. {A}n innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. {O}ur study aimed to describe and evaluate the exhaustiveness, intensity and quality of the {CATI}s in response to cholera alerts in {H}aiti between {J}uly 2013 and {J}une 2017. {M}ethodology/principal findings {W}e analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified {CATI}s. {T}he odds of {CATI} response during the same week (exhaustiveness) and the number of complete {CATI}s in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. {CATI}s were carried out significantly more often in response to red alerts (adjusted odds ratio (a{OR}) [95%-confidence interval, 95%-{CI}], 2.52 [2.22-2.87]) compared with orange alerts. {S}ignificantly more complete {CATI}s were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (a{IR}), 1.85 [1.73-1.99]). {O}ver the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (a{OR}, 1.43 [1.38-1.48] per semester) as well as the intensity and quality (a{IR}, 1.23 [1.2-1.25] per semester) of {CATI} responses, independently of funds available for the strategy. {T}he odds of launching a {CATI} response significantly decreased with increased rainfall (a{OR}, 0.99 [0.97-1] per each accumulated cm). {R}esponse interventions were significantly heterogeneous between {NGO}s, communes and departments. {C}onclusions/significance {T}he implementation of a nationwide case-area targeted rapid response strategy to control cholera in {H}aiti was feasible albeit with certain obstacles. {S}uch feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in {H}aiti and in other affected countries. {A}uthor summary {C}holera is a potentially deadly diarrheal disease caused by toxin-secreting strains of {V}ibrio cholerae. {T}he bacterium can trigger severe epidemics in countries with limited access to potable water and sanitation. {H}ygiene promotion, proper sanitation and improved access to safe drinking water are essential to control cholera. {H}owever, very few reports have described and evaluated the implementation of such activities in the field. {S}ince {O}ctober 2010, {H}aiti has been affected by one of the most severe cholera epidemics of the past few decades. {I}n this report, we describe and evaluate the implementation of the original nationwide case-area targeted interventions ({CATI}s) response strategy, which was launched in {J}uly 2013 after years of insufficient response coordination and diminishing efforts to control cholera outbreaks in affected communities. {R}apid implementation of education sessions, household decontamination, soap distribution and water chlorination in affected communities proved challenging but possible, even in a mountainous and decentralized country such as {H}aiti with tens of thousands of suspected cholera cases per year. {E}valuation of the impact of the {CATI}-based strategy on the cholera epidemic is underway. {T}ogether with other components of a multi-sectoral approach, this rapid response strategy appears to be critical to eventually eliminate cholera in {H}aiti.},
  keywords = {{HAITI}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {13},
  numero = {4},
  pages = {art. e0007263 [18]},
  ISSN = {1935-2735},
  year = {2019},
  DOI = {10.1371/journal.pntd.0007263},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075681},
}