Contribution of community-based organizations in the improvement of Joint United Nations Program on HIV and AIDS 90-90-90: case of the Yaoundé Central Hospital.

Community-based organizations (CBOs) are one of the initiatives implemented in Cameroon to improve access to antiretroviral treatment and influence retention in treatment centers. Despite its importance in the decongestion of patients in health facilities, we do not have data to evaluate the overall impact of these organizations. We conducted a two-part observational study. The first part was a descriptive cross-sectional study, where we included patients screened and initiated on anti-retroviral treatment (ART) either by the approved Treatment center (ATC) of Yaoundé Central Hospital (YCH) or by any of our CBOs in 2020. Then, the second part was a retrospective cohort-type study including patients from the 2015 cohort followed up from 2018 to 2020 in order to assess viral load suppression. As regards the first "90", 7,234 screening tests were performed by CBOs in 2020 out of the 28,302 screening tests registered at the YCH, giving a contribution of 25.6%. From the 7,234 screening tests performed by CBOs, 314 people had an HIV-positive result and 230 (73.34%) were linked to ART through CBOs. From the 28,302 screening tests performed at YCH, 1,089 people had an HIV-positive test, and only 354 (32.50%) were linked to ART, giving a significant difference in the link to ART (P-value < 0.00). Concerning the 3rd ''90'', the viral load suppression rates were respectively in CBOs and at YCH of (95.12% vs 90.54%, RR= 0.51; P-value= 0.27 at 12 months); (95.96% vs 95.34%, relative risk (RR)= 0.85; P-value= 0.81 at 24 months); and (96.91% vs 94.15%, RR= 0.52; P-value = 0.24 at 36 months). In conclusion, we say that the follow-up of patients living with HIV in the community does not negatively affect the evolution of the disease as one might think.

Doxycycline vs Hydroxychloroquine + Azithromycin in the Management of COVID-19 Patients: An Open-Label Randomized Clinical Trial in Sub-Saharan Africa (DOXYCOV).

Objective We aimed to compare the safety and efficacy of a doxycycline-based regimen against Cameroon National Standard Guidelines (hydroxychloroquine plus azithromycin) for the treatment of mild symptomatic COVID-19. Methods We conducted an open-label, randomized, non-inferiority trial in Cameroon comparing doxycycline 100 mg, twice daily for seven days versus hydroxychloroquine 400 mg daily for five days and azithromycin 500 mg at day 1 and 250 mg from day 2 through 5 in mild COVID-19 patients. Clinical recovery, biological parameters, and adverse events were assessed. The primary outcome was the proportion of clinical recovery on days 3, 10, and 30. Non-inferiority was determined by the clinical recovery rate between protocols with a 20-percentage points margin. Results One hundred and ninety-four participants underwent randomization and were treated either with doxycycline (n = 97) or hydroxychloroquine-azithromycin (n = 97). On day 3, 74/92 (80.4%) participants on doxycycline versus 77/95 (81.1%) on hydroxychloroquine-azithromycin-based protocols were asymptomatic (p = 0.91). On day 10, 88/92 (95.7%) participants on doxycycline versus 93/95 (97.9%) on hydroxychloroquine-azithromycin were asymptomatic (p = 0.44). On day 30, all participants were asymptomatic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) polymerase chain reaction (PCR) test was negative on day 10 in 60/92 (65.2%) participants who were assigned to doxycycline and in 63/95 (66.3%) participants who were assigned to hydroxychloroquine-azithromycin. None of the participants were admitted for worsening of the disease after treatment initiation. Conclusion Doxycycline 100 mg twice daily for seven days proved to be safe and non-inferior in terms of efficacy when compared to hydroxychloroquine-azithromycin for preventing clinical worsening of mild symptomatic or asymptomatic COVID-19 and achieving virological suppression.

[Epidemiology and diagnosis of urinary lithiasis: a cross-sectional study in a Cameroonian based population]. / Epidémiologie et diagnostic de la lithiase urinaire: étude transversale dans une population camerounaise.

Introduction: urinary stone is a multifactorial disease characterized by the presence of concretions in the urinary tract. The diagnosis of urinary lithiasis is based on clinical and imaging findings. The objective of this study was to determine the profile of patients suffering from urolithiasis in the city of Yaounde. Methods: this was a descriptive observational cross-sectional study with retrospective data collection. Patients with an age > 15 years and patients diagnosed with lithiasis confirmed by medical imaging were included in our study. The variables studied were sociodemographic, clinical and paraclinical. Results: a total of 120 patients were included in our study. The mean age was 40.46±12.62 years with extremes from 19 to 74 years. Male gender was predominant at 60.8% (n=73). Renal colic was the circumstance found in 67.5% (n=81). Physical examination was normal in 55.8% (n=67). Insufficient hydration was found in 45% (n=61) of cases. Abdominal scanner was the most performed examination in our study in 50.7% (n=61). The median stone density was 731 Hounsfield units [346; 1183.5]. The stones were predominantly located in the upper tract. The left renal topography was predominant in 35% (n=42) of cases. Urine culture revealed Escherichia Coli at 60% (n=15). Blood calcium, phosphorus and uricemia were requested in 15.8% (n=19), 0.8% (n=1) and 12.5% (n=15) of cases, respectively. The results were normal. In the absence of a laboratory specialized in biochemical analysis of calculi, a minority of patients (n=3) benefited from spectrophotometry. Conclusion: urinary lithiasis is a disease of men in their forties. Renal colic is the main revealing sign. The diagnosis is revealed by the abdominal scanner in half of the cases. Metabolic assessment and constitutional analysis of the calculus are still very rarely requested.

Effect of the COVID-19 pandemic on the financial revenues of public hospitals with a care centre: case of the Yaoundé Central Hospital.

Background: In 2020, the world was confronted with COVID-19, which caused a socio-economic panic in several sectors. The use of hospitals has been affected, with an impact on their financial performance. The objective of this study was to assess the effect of the pandemic on the financial performance of a hospital with a care center. Methodology: This was a cross-sectional study targeting the Yaoundé Central Hospital over two periods : before the pandemic (March to August 2019) and during the pandemic (March to August 2020). Based on the administrative accounts, revenues from the main sources of financial inflows were recorded and compared before and during the pandemic. Results: From March to August 2019, overall revenue was 1,131,525,099 FCFA and from March to August 2020, it was 762,770,714 FCFA, representing a drop of 32.6%. Medical imaging showed a drop of 14% corresponding to a loss of 96,500,052 FCFA. The laboratory showed a 21% decrease corresponding to a loss of 80,691,347 FCFA. Hospital admissions fell by 21%, corresponding to a loss of 62,124,675 FCFA. Consultations fell by 10%, corresponding to a loss of 49,265,835 FCFA. Conclusion: The COVID-19 pandemic had a negative effect on the financial revenues of the Yaoundé Central Hospital.

Use of Trained Non-Medical Staff to Improve Access to HIV Testing Services in Africa: Implementation of the World Health Organization Opt-out Approach in Cameroon.

BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2019 estimated that 450,000 to 50,000 people in Cameroon were living with HIV, yet only 79% knew their HIV status which is far from the 90% target for 2020. To address this situation, Cameroon adopted the "Opt-out" strategy of the World Health Organization (WHO) and use of trained non-medical cadre (psychosocial agents) to reach out to more people with HIV testing services (HTS). This describes the implementation and outcomes of this strategy by reviewing the activity of a typical day in the Yaoundé Central Hospital (YCH) in Cameroon. METHODS: HTS were offered to hospitalized and ambulatory patients (including their companions) in different departments of the YCH. Following screening for recent HIV testing, those with unknown HIV status that gave consent or did not explicitly refuse testing (as per the "Opt-out Strategy"), were counseled and tested for HIV. Testing followed the "National HIV Rapid Testing Algorithm" using rapid diagnostic test kits. Results were either positive, negative or indeterminate. Patients with positive HIV results were linked to the Care and Treatment Center for treatment initiation. RESULTS: Of the 350 patients screened and offered HTS using non-medical cadre (psychosocial agents), 193 (55.1%) were hospitalized and 157 (44.9%) came for outpatient visits. The age of participants ranged from 14 to 92 years and the yield of HIV testing in the sample population was 5.1% (6.2% for hospitalized patients and 3.8% for outpatient clinics). Statistics revealed that five HIV-positive patients had never been offered HTS before the study. The study revealed that HTS acceptance rate among hospitalized patients was 69.6% and that all new positive patients started antiretroviral treatment on the same day. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: It is feasible to use trained non-medical staff for HIV testing services (HTS). Task-shifting by using trained psychosocial agents can help in case identification and linkage to HIV treatment services.

Implementation of HIV early infant diagnosis and HIV type 1 RNA viral load determination on dried blood spots in Cameroon: challenges and propositions.

The testing of dried blood spots (DBSs) for human immunodeficiency type 1 (HIV-1) proviral DNA by PCR is a technology that has proven to be particularly valuable in diagnosing exposed infants. We implemented this technology for HIV-1 early infant diagnosis (EID) and HIV-1 RNA viral load determination in infants born of HIV-1-seropositive mothers from remote areas in Cameroon. The samples were collected between December 2007 and September 2010. Fourteen thousand seven hundred and sixty-three (14,763) DBS samples from infants born of HIV-positive mothers in 108 sites nationwide were tested for HIV. Of these, 1452 were positive on first PCR analyses (PCR1), giving an overall infection rate of 12.30%. We received only 475 DBS specimen for a second PCR testing (PCR2); out of these, 145 were positive. The median HIV-1 RNA viral load for 169 infant DBS samples tested was 6.85 log copies/ml, with values ranging from 3.37 to 8 log copies/ml. The determination of the viral load on the same DBS as that used for PCR1 allowed us to bypass the PCR2. The viral load values were high and tend to decrease with age but with a weak slope. The high values of viral load among these infants call for early and effective administration of antiretroviral therapy (ART). The findings from this study indicate that the use of DBS provides a powerful tool for perinatal screening programs, improvement on the testing algorithm, and follow-up during treatment, and thus should be scaled up to the entire nation.