[National profile of early warning indicators of HIV pharmaco-resistance in Cameroon]. / Profil national des indicateurs d'alerte précoce de la pharmaco-résistance du VIH au Cameroun.

INTRODUCTION: since the launch of the "Treatment for All in Cameroon" strategy in 2015, an acceleration plan for antiretroviral (ARV) therapy in Cameroon was implemented, with remarkable progresses. These efforts were accompanied by the risk of developing HIV drug resistance. Then, the World Health Organization (WHO) proposed surveillance of early warning indicators (IAP) for HIV drug resistance. The purpose of this study was to assess the national HIV Drug Resistance Early Warning Indicators (EWI) in Cameroon. METHODS: we conducted a retrospective study in the ten regions of Cameroon in December 2017 to evaluate the six EWIs recommended by the WHO in 68 randomly selected HIV care sites. The reporting period ranged from July 2016 to June 2017. RESULTS: national scores were: drug withdrawal within the estimated time frame (EWI1): 66%; retention on antiretroviral therapy 12 months after treatment initiation (EWI2): 66%; stock-out of antiretroviral drugs over a 12-month period (EWI3): 53%; viral load testing coverage (CV) (EWI4): 10%; coverage suppression after 12 months of antiretroviral therapy (EWI5): 73% and practices for ARV drug delivery (EWI6): (100%). Regional scores were similar. CONCLUSION: the evaluation of EWI in Cameroon is limited and requires urgent interventions, primarily viral load testing coverage, optimal ARVs management and patient´s adherence.

Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.

BACKGROUND: 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. METHODS: 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. RESULTS: Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, 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 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%. CONCLUSIONS: 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.

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.

BACKGROUND: 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 12 months. METHODS: 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 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. RESULTS: Majority (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). CONCLUSIONS: Poor 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.