[Factors associated with non-adherence of adults infected with HIV on antiretroviral therapy in a referral hospital in Douala]

[Association between depression and viral load in people on antiretroviral treatment followed at the Yaoundé Central Hospital in Cameroon]

INTRODUCTION

depression may be associated with poor immune and virological response, poor quality of life and high medical costs in people living with HIV. The purpose of this study is to investigate the association between depression and viral load in people living with HIV on antiretroviral treatment followed at the Yaounde Central Hospital.

METHODS

we conducted a cross-sectional study of people living with HIV who had their viral load results at the Central Hospital of Yaounde over 8 months (November 2019 to July 2020). Before starting the study, informed consent was obtained from each participant. Sociodemographic, clinical, paraclinical and lifestyle data were collected. Depression was assessed using the Hospital Anxiety and Depression scale (HAD). Consecutive and non-probability sampling was used. Statistical analysis was performed using SPSS software version 23.0. A p-value < 0.05 was considered statistically significant.

RESULTS

of the 205 participants enrolled, female sex was the most represented (n=153, 74.6%) and the mean age was 46.5 ± 1.8 years. All participants had clinical stage I HIV and most of them had undetectable viral load (n=164, 80.0%). Definite depression was found in 4.8% of cases and people living with HIV with symptoms of definite depression were more likely to have a high viral load (OR = 14.24 [3.61-56.14]; p = <0.001). Conclusion: depression could be a leading cause of high viral load.

Factors associated with non-adherence to antiretroviral therapy among HIV-infected adolescents aged 15-19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon

Introduction

non-adherence to antiretroviral therapy (ART) constitutes the main cause of therapeutic failure among HIV-infected adolescents, especially in the aged group 15 to 19 years. We aimed to determine factors associated with this non-adherence in this specific population.

Methods

we conducted a cross-sectional study at the Mother and Child Center in Yaounde from August to October 2018. Delayed clinic appointment was referred to as defaulters. Non-adherence was measured during the 3 days preceding inclusion by self-reported method following quantitative (missing dosage of ART), qualitative (ART taken with a delay of more than 2 hours) and combined measure. A threshold of non-adherence > 20% was considered high, with p<0.05 statistically significant.

Results

overall, 195 out of 251 (77.7%) eligible adolescents were included, of which 56.9% were girls (sex-ratio = 4/3). The mean age was 16.8 ± 1.5 years. The rate of defaulters was 21.0%. Following quantitative approach, 33.8% were non-adherent. Using combined approach, we had 41.0%. This non-adherence was associated with duration on ART > 5 years (adjusted Odds Ratio [aOR]: 2.33;95% Confidence Interval [CI]: 1.08-5.00; p:0.030), defaulters (aOR: 2.56;95% CI: 1.12-5.82; p:0.025) and HIV Viral Load (VL) ≥ 40 copies/ml (aOR: 0.42; 95% CI: 0.21-0.83; p:0.013).

Conclusion

at this reference pediatric center, 4 out of 10 adolescents aged 15-19 years on ART are non-adherent, driven by missing dosage of drug intake. Strategies for enhanced adherence for late age adolescents are therefore warranted, by prioritizing interventions on defaulters and duration on ART > 5 years.

[National profile of early warning indicators of HIV pharmaco-resistance in Cameroon]

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.

[Determinants of non-compliance with antiretroviral therapy in adult patients in Kinshasa]

Introduction

l´objectif de cette étude était d´identifier les déterminants de non-observance des patients vivant avec le VIH (PVVIH) au TAR (traitement antirétroviral) à Kinshasa.

Méthodes

dans une étude transversale conduite à Kinshasa du 1^ermai au 31 août 2015 chez des PVVIH âgées d´au moins 18 ans et sous traitement antirétroviral depuis au moins 3 mois. Un échantillon probabiliste de 400 patients a été pris en compte. Le CASE Adherence Index (méthode subjective) et le renouvellement d´ordonnance (méthode objective) ont évalué l´observance. Les déterminants de la non-observance ont été recherchés par régression logistique multiple.

Résultats

les 400 PVVIH avaient un âge médian de 43 ans (18-75). La fréquence de non-observance globale était de 25,5%. La fréquence de la non-observance objective était plus élevée que celle de la non-observance subjective (29% vs 21%, p = 0,01). Le paiement de la consultation (ORaj: 1,70; IC95%: 1,02-2,81; p = 0,042), les effets indésirables (ORaj: 2,23; IC95%: 1,33-3,75; p = 0,002) et le manque de perception tel que l´oubli d´une dose qui peut aggraver la maladie (ORaj: 4,16; IC95%: 1,04-16,68; p=0,045) ont émergé comme déterminants de la non-observance. La présence d´une personne de confiance était un facteur protecteur contre la non-observance (ORaj: 0,54; IC95%: 0,39-0,93; p = 0,004).

Conclusion

la fréquence de la non-observance au TAR demeure élevée à Kinshasa. La différence de fréquence entre l´appréciation objective et subjective de l´observance indique l´importance de la biologie dans le suivi des PVVIH sous antirétroviraux. La prise en compte des déterminants sera nécessaire pour définir des stratégies qui permettront l´amélioration de l´observance.

Terapia com antirretrovirais: grau de adesão e a percepção dos indivíduos com HIV/Aids

Resumo Objetivo Apreender os aspectos relacionados ao grau de adesão de pessoas vivendo com HIV/aids aos antirretrovirais. Métodos Estudo com abordagem qualitativa desenvolvido em duas unidades de internação de um hospital universitário do interior paulista. A produção dos dados ocorreu no período de outubro de 2017 a abril de 2018 com 40 participantes entrevistados, cujo material produzido foi gravado e posteriormente transcrito. A análise e o processamento dos dados foram realizados com apoio na técnica da Classificação Hierárquica Descendente e base fundamentada no Discurso do Sujeito Coletivo. Resultados Após análise e processamento, obtiveram-se cinco classes de palavras: 1. Questões sócio-econômicas como motivos fundamentais da não adesão aos antirretrovirais; 2. O apoio familiar para o enfrentamento da condição e estímulo para a adesão ao tratamento; 3. Consequências do grau de adesão aos antirretrovirais; 4. Dificuldades de adesão à terapia antirretroviral relacionadas aos efeitos adversos e apresentação medicamentosa; e 5. Possíveis mudanças para melhorar a adesão ao tratamento do HIV. Conclusão As principais dificuldades enfrentadas por pessoas vivendo com HIV/aids hospitalizadas e que estão em adesão irregular são questões sócio-econômicas, apoio familiar e efeitos adversos.

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

OBJECTIVE

The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA).

DESIGN

Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching.

METHODS

Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews.

RESULTS

After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22).

CONCLUSION

This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators.