Author/Authors :
Kob Ye Same III, David Anouar Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Billong, Serge C Ministry of Public Health - National AIDS Control Committee - Central Technical Group, National HIV Drug Resistance Prevention and Surveillance Working Group, Cameroon , Billong, Serge C Université de Yaoundé 1 - Faculté de Médicine et des Sciences Biomédicales (FMSB), Cameroun , Fokam, Joseph Ministry of Public Health - Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management - National HIV Drug Resistance Prevention and Surveillance Working Group, Cameroon , Fokam, Joseph Université de Yaoundé 1 - Faculté de Médicine et des Sciences Biomédicales (FMSB), Cameroun , Fokam, Joseph University of Rome Tor Vergata - Faculty of Medicine and Surgery - Department of Experimental Medicine and Surgery, Italy , Momo, Pavel Tsamo Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Amadou, Salmon Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Ngo Nemb, Marinette Ministry of Public Health, Yaoundé - National AIDS Control Committee - Central Technical Group, Cameroon , Ekali, Gabriel Loni Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Lontchi, Eric Frenzy University of Yaoundé 1 - Faculty of Medicine and Biomedical Sciences, Cameroon , Ngufor, Rita University of Yaoundé 1 - Faculty of Medicine and Biomedical Sciences, Cameroon , Nkomom, Floribert Mabouli Ministry of Public Health - Division of Disease, Endemics and Pandemics Control, Cameroon , Kamga, Yannick Ministry of Public Health - Division of Disease, Endemics and Pandemics Control, Cameroon , Bimila, Glory Clinton Health Access Initiative, Cameroon , Oumbe, Josée Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Ampuolia, Nadia Ministry of Public Health - Division of Family Health, Cameroon , Bosco Elat Nfetam, J. Ministry of Public Health - National AIDS Control Committee - Central Technical Group, Cameroon , Zoung- Kanyi Bissek, AC University of Yaoundé 1 - Faculty of Medicine and Biomedical Sciences, Cameroon , Zoung- Kanyi Bissek, AC Ministry of Public Health - Division of Operational Health Research, Cameroon
Abstract :
Objectives: With increasing antiretroviral therapy (ART) coverage in Cameroon (from 28,000 patients in 2008 to 122,000 by end 2012) following the World health organisation (WHO) criteria of CD4≤350 cells/mm3, there are increasing risks of poor programmatic outcomes and HIV drug resistance (HIVDR) emergence. We aimed to determine survival rates and associated factors among patients enrolled on ART following the national guidelines in Cameroon. Methods: A longitudinal study was conducted in 2013 among patients initiating ART in rural (Mfou District Hospital) and urban (Yaoundé Central Hospital) settings of the Centre region of Cameroon. Socio-demographic, clinical, laboratory and mortality data were analysed with EPI INFO v.3.5.3 and SPSS v.20, using Cox model and Wilcoxon test for survival analysis. Results: A total of 350 patients initiating ART (median age 37 years; 71% female) were enrolled, with an overall delayed ART initiation (median CD4: 171 cells/mm3 and 59.9% at WHO-clinical stages 3 and 4). Survival rates at 6 and 12 months were 93.9% and 91.3% respectively, without significant disparity between the rural and urban setting (p=0.21). Retention in care at 6 and 12 months after ART initiation was 78.6% and 69.1% respectively, suggesting increasing lost to follow-up. Mortality was predominantly associated with initial events of anaemia (p=0.00001), opportunistic infections (p=0.002), CD4 count 200 cells/mm3 (p=0.004). Conclusions: There are decreasing rates of survivals within 12 months of ART initiation, while retention in care drops below minimal target of 70%. An improved life expectancy on ART requires close monitoring for anaemia, preventing clinical events while ensuring earlier initiation on ART in both rural and urban resource-limited settings.
