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

Abstract

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1991-3) contains supplementary material, which is available to authorized users.

Outcome Evaluation of Early Implementation of Option B+ in Cameroon: A Prospective Cohort Observational Survey in the Northwest and Southwest Regions

“…In this evaluation, early retention at 6 months after ART initiation was high at 90% and then declined at 12 months after ART initiation to 79%. The 12 months ART retention rate was high when compared to 60% from a nationwide survey of Cameroon's adult ART program in 2014 [16]. Among women in Option B+ programs, the 6 months retention rate in Cameroon was higher than the rate seen in Uganda and the Democratic Republic of Congo (DRC), while the 12 months retention was similar to data from Malawi Option B+ program [14] [17] [18].…”

<p>HIV Treatment Outcomes Among Patients Initiated on Antiretroviral Therapy Pre and Post-Universal Test and Treat Guidelines in South Africa</p>

“…By 12 months, approximately 80% and 82% of UTT initiates (≤500 vs >500 cells/mm 3 ) were still alive and in care compared to 90% of pre-UTT initiates. 16,[26][27][28][29][30][31] The newly implemented treatment policy has resulted in patients initiating ART at increasingly better health status (moderately higher CD4 cell count in this study). These patients may not fully perceive the direct benefits of treatment, particularly in the context of travel time and transport costs to the clinic, long queues and waiting times.…”

Retention and adherence

“…Failure to optimally diagnose, retain and treat adolescents and young adults living with HIV (AYALHIV) has broad implications for the global epidemic. Viral suppression is critical to preventing onward transmission and reducing morbidity and mortality [21][22][23][24]. The UNAIDS "90-90-90" goal that 90% of persons living with HIV are diagnosed, 90% on treatment, and 90% virally suppressed in order to end the AIDS epidemic, cannot be achieved without a sustained and targeted effort to improve AYA outcomes [25,26].…”