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Billong S.C.,National HIV Drug Resistance Surveillance and Prevention Working Group HIVDR WG | Billong S.C.,Central Technical Group CTG | Billong S.C.,University of Yaounde I | Fokam J.,National HIV Drug Resistance Surveillance and Prevention Working Group HIVDR WG | And 21 more authors.
PLoS ONE | Year: 2012

Background: Rapid scale-up of antiretroviral therapy (ART) in resource-limited settings is accompanied with an increasing risk of HIV drug resistance (HIVDR), which in turn could compromise the performance of national ART rollout programme. In order to sustain the effectiveness of ART in a resource-limited country like Cameroon, HIVDR early warning indicators (EWI) may provide relevant corrective measures to support the control and therapeutic management of AIDS. Methods: A retrospective study was conducted in 2010 among 40 ART sites (12 Approved Treatment Centers and 28 Management Units) distributed over the 10 regions of Cameroon. Five standardized EWIs were selected for the evaluation using data from January through December, among which: (1) Good ARV prescribing practices: target = 100%; (2) Patient lost to follow-up: target ≤20%; (3) Patient retention on first line ART: target ≥70%; (4) On-time drug pick-up: target ≥90%; (5) ARV drug supply continuity: target = 100%. Analysis was performed using a Data Quality Assessment tool, following WHO protocol. Results: The number of sites attaining the required performance are: 90% (36/40) for EWI1, 20% (8/40) for EWI2; 20% (8/40) for EWI3; 0% (0/37) for EWI4; and 45% (17/38) for EWI 5. ARV prescribing practices were in conformity with the national guidelines in almost all the sites, whereas patient adherence to ART (EWI2, EWI3, and EWI4) was very low. A high rate of patients was lost-to-follow-up and others failing first line ART before 12 months of initiation. Discontinuity in drug supply observed in about half of the sites may negatively impact ARV prescription and patient adherence. These poor ART performances may also be due to low number of trained staff and community disengagement. Conclusions: The poor performance of the national ART programme, due to patient non-adherence and drug stock outs, requires corrective measures to limit risks of HIVDR emergence in Cameroon. © 2012 Billong et al.

PubMed | Centers for Disease Control and Prevention, University of Antananarivo, Central Technical Group, National HIV drug resistance surveillance and prevention Working Group HIVDR WG and 2 more.
Type: Journal Article | Journal: BMC infectious diseases | Year: 2017

In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs.A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard.Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (493% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 812%, ranging from 588% (South region) to 100% (West region); thus implying that 188% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 993%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 444% (16/36) of evaluated laboratories reached the quality target of 80%.The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes.

PubMed | University of Douala, University of Antananarivo, University of Yaounde I, Chantal International Reference Center for research on HIV AIDS prevention and management and 2 more.
Type: Journal Article | Journal: BMC infectious diseases | Year: 2016

Retention on lifelong antiretroviral therapy (ART) is essential in sustaining treatment success while preventing HIV drug resistance (HIVDR), especially in resource-limited settings (RLS). In an era of rising numbers of patients on ART, mastering patients in care is becoming more strategic for programmatic interventions. Due to lapses and uncertainty with the current WHO sampling approach in Cameroon, we thus aimed to ascertain the national performance of, and determinants in, retention on ART at 12months.Using a systematic random sampling, a survey was conducted in the ten regions (56 sites) of Cameroon, within the reporting period of October 2013-November 2014, enrolling 5005 eligible adults and children. Performance in retention on ART at 12months was interpreted following the definition of HIVDR early warning indicator: excellent (>85%), fair (85-75%), poor (<75); and factors with p-value<0.01 were considered statistically significant.Majority (74.4%) of patients were in urban settings, and 50.9% were managed in reference treatment centres. Nationwide, retention on ART at 12months was 60.4% (2023/3349); only six sites and one region achieved acceptable performances. Retention performance varied in reference treatment centres (54.2%) vs. management units (66.8%), p<0.0001; male (57.1%) vs. women (62.0%), p=0.007; and with WHO clinical stage I (63.3%) vs. other stages (55.6%), p=0.007; but neither for age (adults [60.3%] vs. children [58.8%], p=0.730) nor for immune status (CD4Poor retention in care, within 12months of ART initiation, urges active search for lost-to-follow-up targeting preferentially male and symptomatic patients, especially within reference ART clinics. Such sampling strategy could be further strengthened for informed ART monitoring and HIVDR prevention perspectives.

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