Measuring adherence to ARVs among HIV-positive adolescents in Cameroon: a comparative assessment of self-report and medication possession ratio methods.

INTRODUCTION: adherence to ARV medications has been shown to improve treatment outcomes in HIV positive patients. Given that ARV treatment is lifelong, adherence has become a critical issue as it may reduce over time. Measuring adherence is therefore imperative in programming. There are different methods of measuring adherence each with its advantages and disadvantages, depending on the context and the time. This study therefore compares two widely used adherence measurement scales in Cameroon, namely, the self-report and the medication possession ration (MPR) methods. METHODS: the study was done in some selected health facilities of the North West and South West regions of Cameroon among adolescents on ARV. The study was designed as an analytical cross-sectional study with a record review component and systematic random sampling was used to select the participants. Adherence was measured through self-report and the medication possession ratio. Adolescents with adherence levels of at least 95% were considered adherent. Viral load suppression was considered as having the most recent viral load suppression results of less than 1000 copies per ml. The kappa statistics of inter-rate agreement was used to ascertain the difference between adherence as measured by self-report and MPR. The difference in adherence between the two scales was also compared using Fischer´s exact test and p-values were reported. RESULTS: the study shows that adherence level using the self-report technique is 82.9% while that of MPR was 73.4%. When compared using the using Kappa statistics, there was substantial agreement between the two scales of 66% (p=0.54). The results of both self-report adherence and MPR were also compared with viral load suppression and the difference between viral load suppression and MPR was significant (p<0.01). The difference in adherence between viral load suppression and the self-report measure also showed to be significant (p<0.01). CONCLUSION: adherence from the self-report measure was higher than from MPR, but there was substantial agreement between the scales. Although there is no gold standard for adherence measurement, self-report or medication possession ratio could be used and complemented with laboratory markers like viral load counts.

Level of adherence and associated factors among HIV-positive adolescents on antiretroviral therapy in Cameroon.

Aim: Globally, there were over 250 000 new HIV infections among adolescents in 2017, with a higher proportion of these in sub-Saharan Africa. In Cameroon, UNICEF estimated over 4 200 new HIV infections in adolescents in 2015; by 2016, there were over 40 000 adolescents who had HIV. Given that the number of adolescents living with HIV in Cameroon is on the increase, there is a need to better understand the factors influencing adherence to treatment. The objective of this study was to assess the factors associated with adherence among adolescents in Cameroon. Methods: A cross-sectional study was conducted. A total of 460 HIV+ adolescents who were receiving antiretroviral therapy were sampled randomly from nine health facilities. Questionnaires and data extraction forms were used to collect data. Descriptive (frequencies and proportions) and inferential (chi-square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p = 0.05 and 95% confidence level. Results: The level of adherence to antiretroviral therapy among the adolescents was 83%. Twelve out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In the multivariable logistic regression analyses, however, only two variables significantly predicted adherence - experiencing side effects (AOR = 2.63; 95% CI = 1.14, 6.09; p = 0.02), and internalized stigma (AOR = 2.51; 95% CI = 1.04, 6.04; p = 0.04). Conclusion: Adherence to treatment among adolescents in Cameroon was found to be suboptimal. There is a need for more individualized, targeted medication counselling for adolescents and their guardians as well as strategies to reduce internalized stigma and improve adherence to antiretroviral treatment.

Abortion practices among women in Buea: a socio-legal investigation.

INTRODUCTION: there are controversies surrounding the practice of abortion especially in developing countries of Africa. Cameroon is not an exception to this and hence this study aims at assessing knowledge on the awareness of abortion laws, the factors that determine abortion and people's perceptions on the legality of abortion in Cameroon. METHODS: the study is cross-sectional in its design. A total of 224 women were randomly sampled. Data for the study were collected through the use of questionnaires from the sampled women of child bearing age. These were used to assess knowledge on the awareness of abortion laws and the determinants of abortion. The data were analysed using STATA 15. RESULTS: the prevalence of induced abortion was 21%. The major determinants of abortion among these women were; desire to stay in school (28%), fear of parents (24%) and shame of being pregnant out of wedlock (26%). Furthermore, many women are not aware of the situations where abortion is allowed and hence some still undertake illegal abortions even when they find themselves in situations deserving a legal abortion. CONCLUSION: induced abortion is still common in Buea, Cameroon despite the fact that it is illegal. Cameroon's legal and health system needs to work in harmony in order to lessen the legal processes of having a legal abortion.