Declining trends in early warning indicators for HIV drug resistance in Cameroon from 2008–2010: lessons and challenges for low-resource settings

BMC Public Health

Jean BN Elat⁹  Vittorio Colizzi^1,10  Peter M Ndumbe⁹  Grace D Ngute⁶  Avelin F Aghokeng¹  Zephirin Tsomo⁸  Armand S Nkwescheu⁴  Ibile Abessouguie⁷  Pascal Milenge⁵  Etienne Kembou⁵  Anne C ZK Bissek³  Serge C Billong²  Joseph Fokam⁹ 

[1] Virology Laboratory, Centre de Recherche en Maladies Emergentes et Ré-émergentes (CREMER)/IMPM/IRD, Yaounde, Cameroon;Central Technical Group (CTG), National AIDS Control Committee (NACC), Yaounde, Cameroon;Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon;Division of Operational Health Research (DROS), Ministry of Public Health, Yaounde, Cameroon;World Health Organisation (WHO) Afro, National Office, Yaounde, Cameroon;Approved Treatment Centre (ATC), Yaounde General Hospital, Yaounde, Cameroon;Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Yaounde, Cameroon;Approved Treatment Centre, Yaoundé Central Hospital, Yaounde, Cameroon;Faculty of Medicine and Biomedical Sciences (FMBS) of the University of Yaounde 1, Yaounde, Cameroon;UNESCO Biotechnology Chair, Department of Biological Sciences, University of Rome “Tor Vergata”, Rome, Italy

关键词: Cameroon;    Surveillance and prevention;    HIV drug resistance;    Early warning indicator;   

Others  :  1162373
DOI  :  10.1186/1471-2458-13-308

 received in 2012-11-16, accepted in 2013-04-03,  发布年份 2013

【 摘 要 】

Background

Rapid scale-up of antiretroviral therapy (ART) and limited access to genotyping assays in low-resource settings (LRS) are inevitably accompanied by an increasing risk of HIV drug resistance (HIVDR). The current study aims to evaluate early warning indicators (EWI) as an efficient strategy to limit the development and spread of preventable HIVDR in these settings, in order to sustain the performance of national antiretroviral therapy (ART) rollout programmes.

Methods

Surveys were conducted in 2008, 2009 and 2010 within 10 Cameroonian ART clinics, based on five HIVDR EWIs: (1) Good prescribing practices; (2) Patient lost to follow-up; (3) Patient retention on first line ART; (4) On-time drug pick-up; (5) Continuous drug supply. Analysis was performed as per the World Health Organisation (WHO) protocol.

Results

An overall decreasing performance of the national ART programme was observed from 2008 to 2010: EWI₁ (100% to 70%); EWI₂ (40% to 20%); EWI₃ (70% to 0%); EWI₄ (0% throughout); EWI₅ (90% to 40%). Thus, prescribing practices (EWI₁) were in conformity with national guidelines, while patient adherence (EWI₂, EWI₃, and EWI₄) and drug supply (EWI₅) were lower overtime; with a heavy workload (median ratio ≈1/64 staff/patients) and community disengagement observed all over the study sites.

Conclusions

In order to limit risks of HIVDR emergence in poor settings like Cameroon, continuous drug supply, community empowerment to support adherence, and probably a reduction in workload by task shifting, are the potential urgent measures to be undertaken. Such evidence-based interventions, rapidly generated and less costly, would be relevant in limiting the spread of preventable HIVDR and in sustaining the performance of ART programmes in LRS.

【 授权许可】

   
2013 Fokam et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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