Predictors of poor retention on antiretroviral therapy as a major HIV drug resistance early warning indicator in Cameroon: results from a nationwide systematic random sampling

BMC Infectious Diseases

Research Article

Vittorio Colizzi¹  Alexis Ndjolo²  Calixte Ida Penda³  Edson-Joan Billong⁴  David Same Kob⁵  Salmon Amadou⁵  Joseph Fokam⁶  Anne-Cecile Zoung-Kani Bisseck⁷  Serge Clotaire Billong⁸  Jean-Bosco Nfetam Elat⁹ 

[1] Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon;UNESCO Biotechnology Multidisciplinary Board, and Department of Biology and Pathology, Faculty of Sciences, University of Rome Tor Vergata, Rome, Italy;Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon;Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon;Faculty of Medicine and Pharmaceutical sciences (FMSP), University of Douala, Douala, Cameroon;Laquintinie Hospital of Douala, Douala, Cameroon;Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar;National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon;National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon;Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon;Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon;Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy;National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon;Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon;Division of Operational Health Research, Ministry of Public Health, Yaounde, Cameroon;National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon;Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon;National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon;National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon;National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon;

关键词: Retention in care;    Antiretroviral therapy;    HIV drug resistance early warning indicator;    Cameroon;    Random sampling;   

DOI  :  10.1186/s12879-016-1991-3

 received in 2016-04-09, accepted in 2016-10-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundRetention 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 12 months.MethodsUsing 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 12 months 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.ResultsMajority (74.4%) of patients were in urban settings, and 50.9% were managed in reference treatment centres. Nationwide, retention on ART at 12 months 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 (CD4351–500 [65.9%] vs. other CD4-staging [59.86%], p = 0.077).ConclusionsPoor retention in care, within 12 months 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.

【 授权许可】

CC BY   
© The Author(s). 2016