RESUMO
Objectives: The number needed to test (NNT) to identify a child infected with HIV remains high in the context of the implementation of the blanket provider-initiated testing and counselling (bPITC) strategy. This study assessed the predictors of HIV seropositivity among outpatient children/adolescents (6 weeks-19 years) in Cameroon. This information is needed to improve the yield of bPITC and reduce the current gap in pediatric and adolescent ART coverage in this country and beyond. Study design: Cross-sectional study conducted in 3 hospitals in Cameroon. Methods: Through biological parents and guardians we systematically invited children and adolescents visiting the outpatient departments for any reason to test for HIV (bPITC) in a 6-month period. Children and adolescents were tested for HIV following the national guidelines and the predictors of HIV seropositivity were assessed using multivariate logistic regression at 5% significant level. Results: A total of 2729 eligible children/adolescents were enrolled. Among these, 90.3% (2465/2729) were tested for HIV. Out of these, 1.6% (40/2465) tested HIV-positive, corresponding to a NNT of 62. In multivariate analysis, HIV seropositivity was 2.5, 3.3, and 5 times more likely to be reported among children/adolescents of the female sex [aOR â= â0.4 (0.2-0.8), p â= â0.008]; whose fathers had no formal school education [aOR â= â0.3 (0.1-0.6), p â= â0.004] and those whose mothers had died [aOR â= â0.2 (0.0-0.9), p â= â0.041], respectively. Conclusions: Focusing HIV testing among female children/adolescents, whose fathers had no education level and whose mothers had died could reduce the NNT, improve the yield of bPITC and increase the pediatric and adolescent ART coverage.
RESUMO
SETTING: Batibo District Hospital (BDH), North-West Cameroon. OBJECTIVE: To assess the outcome of the implementation of the Global Fund (GF) Grant Round 3 for tuberculosis (TB) control at the district level. DESIGN: A retrospective study for the period 2003-2008 comparing TB programme outcome indicators before (2003-2005) and after (2006-2008) the GF grant. RESULTS: During the study period 293 TB cases were enrolled on treatment. Comparing the cumulative outcome indicators for smear-positive pulmonary TB cases 3 years before and after the grant, case notification increased by >50%, case detection by almost 50% and treatment success by nearly 20% during the grant period. The case detection rate for smear-positive pulmonary TB nearly doubled, while the treatment success rate reached 100% in 2006. Default and mortality rates dropped to zero in 2006 and 2007 from maximum values of respectively 15% and 23% in 2004 and 2005. However, in 2008, there was a decline across all programme indicators, probably due to staff turnover. CONCLUSION: Outcome indicators of the TB programme in BDH increased markedly following the implementation of the GF grant. Nevertheless, if not tackled appropriately, staff turnover might impede the sustainability of this positive outcome.