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Billong SC, Fokam J, Penda CI, Mvilongo EA, Fodjo R, Messeh A, Anoubissie JDD, Kegne C, Nguekam G, Batamack YA, Billong EJ, Moutapam PR, Ndjolo A, Bonono L, Elat JB, Bissek ACZK. [National profile of early warning indicators of HIV pharmaco-resistance in Cameroon]. Pan Afr Med J 2020; 37:374. [PMID: 33796187 PMCID: PMC7992409 DOI: 10.11604/pamj.2020.37.374.17649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Serge Clotaire Billong
- Département de Santé Publique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
- Groupe de Travail National pour la Prévention et la Surveillance de la Pharmaco-résistance du VIH, Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Joseph Fokam
- Département de Santé Publique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Groupe de Travail National pour la Prévention et la Surveillance de la Pharmaco-résistance du VIH, Ministère de la Santé Publique, Yaoundé, Cameroun
- Centre International de Référence Chantal BIYA pour la Recherche sur la Prévention et la Prise en Charge du VIH/SIDA, Yaoundé, Cameroun
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Calixte Ida Penda
- Hôpital de Jour, Hôpital Laquintinie de Douala, Douala, Cameroun
- Faculté de Médecine et des Sciences Pharmaceutiques, Université de Douala, Douala, Cameroun
| | - Ernest Anaba Mvilongo
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Raoul Fodjo
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Arlette Messeh
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | | | - Cyprien Kegne
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Gildas Nguekam
- Division de la Recherche Opérationnelle en Santé, Ministère de la Santé Publique, Yaoundé, Cameroun
| | - Yannick Aimé Batamack
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Edson Joan Billong
- Faculté de Médecine, Université d’Antananarivo, Antananarivo, Madagascar
| | - Pamela Reine Moutapam
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Alexis Ndjolo
- Département de Santé Publique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Centre International de Référence Chantal BIYA pour la Recherche sur la Prévention et la Prise en Charge du VIH/SIDA, Yaoundé, Cameroun
| | - Leonard Bonono
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
| | - Jean Bosco Elat
- Groupe Technique Central, Comité Nationale de Lutte Contre le SIDA, Yaoundé, Cameroun
- George Town University, Yaoundé, Cameroun
| | - Anne Cécilé Zoung-Kanyi Bissek
- Département de Santé Publique, Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Yaoundé, Cameroun
- Groupe de Travail National pour la Prévention et la Surveillance de la Pharmaco-résistance du VIH, Ministère de la Santé Publique, Yaoundé, Cameroun
- Division de la Recherche Opérationnelle en Santé, Ministère de la Santé Publique, Yaoundé, Cameroun
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Melku M, Abebe G, Teketel A, Asrie F, Yalew A, Biadgo B, Kassa E, Damtie D, Anlay DZ. Immunological status and virological suppression among HIV-infected adults on highly active antiretroviral therapy. Environ Health Prev Med 2020; 25:43. [PMID: 32838734 PMCID: PMC7444678 DOI: 10.1186/s12199-020-00881-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) recommends that viral load ([VL) is a primary tool that clinicians and researchers have used to monitor patients on antiretroviral therapy (ART), an antiviral drug against retroviruses. Whereas, CD4 cell counts can only be used to monitor clinical response to ART in the absence of VL testing service. Therefore, this study is aimed to assess the level of immunological status and virological suppression, and identify associated factors among human immunodeficiency virus ([HIV)-infected adults who were taking antiretroviral drugs of combination regimen know as highly active antiretroviral therapy (HAART). METHODS A hospital-based cross-sectional study was conducted at the University of Gondar comprehensive specialized referral hospital from February to April 2018. A total of 323 adult participants on HAART were selected using a systematic random sampling technique and enrolled into the study. Blood samples for viral load determination and CD4 cell count were collected. Binary logistic regression analysis was used to determine factors associated with immunologic status and virological suppression in HIV patients on HAART. Odds ratio with 95% CI was used to measure the strength of association. RESULTS Virological suppression (VL level < 1000 copies/ml) was found in 82% (95% CI 77.7, 86.1) of study participants, and it has been associated with CD4 cell count between 350 and 499 cells/mm3 (adjusted odds ratio (AOR) = 2.56; 95% CI 1.14, 5.75) and > 499 cells/mm3 (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 45 years old (AOR = 5.99; 95% CI 2.12, 16.91). Similarly, favorable immunological status (≥ 400 cells/mm3 for male and ≥ 466 cells/mm3 for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm3, age at enrollment of 26 through 40 years old, and urban residence were significantly associated with favorable immunological status. CONCLUSION Though the majority of HIV-infected adults who were on HAART had shown viral suppression, the rate of suppression was sub-optimal according to the UNAIDS 90-90-90 target to help end the AIDS pandemic by 2020. Nonetheless, the rate of immunological recovery in the study cohort was low. Hence, early initiation of HAART should be strengthened to achieve good virological suppression and immunological recovery.
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Affiliation(s)
- Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Gizachew Abebe
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanuel Teketel
- School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikir Asrie
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aregawi Yalew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyuel Kassa
- University of Gondar comprehensive specialize referral Hospital, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Debasu Damtie
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Food Animal Health Research Program, CFAES, Ohio Agricultural Research and Development Center, Department of Veterinary Preventive Medicine, The Ohio State University, Wooster, OH, 44691, USA.,Global One Health Initiative, Eastern African Regional Office, The Ohio State University, Addis Ababa, Ethiopia
| | - Degefaye Zelalem Anlay
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fokam J, Nangmo A, Wandum C, Takou D, Santoro MM, Nlend AEN, Ateba FN, Ndombo PK, Kamgaing N, Kamta C, Essiane A, Lambo V, Fokunang C, Mbanya D, Colizzi V, Perno CF, Ndjolo A. Programme quality indicators of HIV drug resistance among adolescents in urban versus rural settings of the centre region of Cameroon. AIDS Res Ther 2020; 17:14. [PMID: 32398107 PMCID: PMC7216382 DOI: 10.1186/s12981-020-00270-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The high rate of mortality among HIV-vertically infected adolescents might be favoured by HIV drug resistance (HIVDR) emergence, which calls for timeous actions in this underserved population. We thus sought to evaluate program quality indicators (PQIs) of HIVDR among HIV-vertically infected adolescents on antiretroviral therapy (ART). METHODS A study was conducted in the Centre region of Cameroon among adolescents (10-19 years) receiving ART in two urban (The Mother-Child Centre of the Chantal BIYA Foundation, the National Social Welfare Hospital) and three rural (Mfou District Hospital, Mbalmayo District Hospital and Nkomo Medical Center) health facilities. Following an exhaustive sampling from ART registers, patient medical files and pharmacy records, data was abstracted for seven PQIs: on-time drug pick-up; retention in care; pharmacy stock outs; dispensing practices; viral load coverage; viral suppression and adequate switch to second-line. Performance in PQIs was interpreted following the WHO-recommended thresholds (desirable, fair and/or poor); with p < 0.05 considered significant. RESULTS Among 967 adolescents (888 urban versus 79 rural) registered in the study sites, validated data was available for 633 (554 in urban and 79 in rural). Performance in the urban vs. rural settings was respectively: on-time drug pick-up was significantly poorer in rural (79% vs. 46%, p = 0.00000006); retention in care was fair in urban (80% vs. 72%, p = 0.17); pharmacy stock outs was significantly higher in urban settings (92% vs. 50%, p = 0.004); dispensing practices was desirable (100% vs. 100%, p = 1.000); viral load coverage was desirable only in urban sites (84% vs. 37%, p < 0.0001); viral suppression was poor (33% vs. 53%, p = 0.08); adequate switch to second-line varied (38.1% vs. 100%, p = 0.384). CONCLUSION Among adolescents on ART in Cameroon, dispensing practices are appropriate, while adherence to ART program and viral load coverage are better in urban settings. However, in both urban and rural settings, pharmacy stock outs, poor viral suppression and inadequate switch to second-line among adolescents require corrective public-health actions to limit HIVDR and to improve transition towards adult care in countries sharing similar programmatic features.
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HIV drug resistance early warning indicators in Ethiopia: Variability at regional and health facility levels and trend over time. Int J Infect Dis 2020; 95:90-97. [PMID: 32088338 DOI: 10.1016/j.ijid.2020.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess status of early warning indicators (EWIs) for HIV drug resistance in Ethiopia. METHODS A retrospective cohort study was conducted among 90 health facilities (HFs) in 2015. Data were abstracted for 'on time pill pickup' (EWI-I), 'Retention in care' (EWI-II), 'drug supply continuity'(EWI-III) and 'dispensing practices' (EWI-IV). Data analysis was conducted using WHO Excel tool and SPSS V20. RESULTS EWI-IV was excellent across all of the six rounds of EWI surveys conducted between 2008 and 2015. There were improvements in EWI-II over time from 55.6% to 81%. However, EWI-I and EWI-III declined from 86.7% to 31% and 100% to 41%, respectively. During 2015, half of the HFs in Gambella, Amhara and Southern Nation, Nationalities and people regional (SNNPR) states achieved excellent performance for EWI-I. Similarly, all HFs in Afar, Amhara, Dire Dawa, Harari and Tigray regions achieved excellent performance for EWI-II. There were also differences by level of HFs for EWI-III; 62% of hospitals and 28% of health centers were out of stock of one or more ARV drugs by 2015. CONCLUSION Excellent performance of EWI-IV and improvement of EWI-II over time shall be maintained. The program shall further work to ensure medication adherence and supply continuity.
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Lertpiriyasuwat C, Teeraratkul A, Suchonwanich Y, Chatharojwong N, Phokasawad K, Yuktanon P, Pattarapayoon N, Bhakeecheep S, Bertagnolio S, Roels TH, Thanprasertsuk S. Monitoring HIV Drug Resistance: Early Warning Indicators to Assess Performance of Thailand's Antiretroviral Treatment Program. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2017; 100:944-952. [PMID: 29861515 PMCID: PMC5978419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe trends in Thailand's antiretroviral treatment (ART) program performance assessed by HIV drug resistance early warning indicators (EWIs), as recommended by WHO, between 2009 and 2013. MATERIAL AND METHOD Seven EWIs were monitored, viral load (VL) testing coverage, VL suppression, retention in ART, lost to follow-up (LTFU), antiretrovirals (ARVs) dispensing practices, on-time pill pick-up, and pharmacy stock-outs. Data from ART adult patients in National Health Security Office Scheme were analyzed except for pharmacy stock-outs, which were reported from hospitals. Aggregated averages were calculated for each EWI. Chi-square for trend was applied to measure significant changes. RESULTS By September 2013, 174,284 adults were receiving ART at 929 hospitals. Over time, improvement in VL testing coverage (53.8% in 2009 to 79.8% in 2013) was observed. VL suppression and on-time pill pick up rates were well above 90%. Rates of retention in ART declined from 84.0 to 82.9%, whereas LTFU rates increased from 8.3 to 9.2% (p<0.001). Prescriptions with inappropriate ARVs decreased from 0.32 to 0.10% (p<0.001). Of reporting hospitals, 96.1%, 96.3%, and 96.2% observed no ARVs stock-out between 2011 and 2013. CONCLUSION EWI is a useful tool to monitor ART program performance and to identify area where improvement is needed.
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Affiliation(s)
- Cheewanan Lertpiriyasuwat
- Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Achara Teeraratkul
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand
| | | | - Nartlada Chatharojwong
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand
| | - Kunjanakorn Phokasawad
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand
| | - Porntip Yuktanon
- Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | - Naparat Pattarapayoon
- Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
| | | | | | - Thierry H Roels
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand
| | - Sombat Thanprasertsuk
- Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand
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Billong SC, Fokam J, Penda CI, Amadou S, Kob DS, Billong EJ, Colizzi V, Ndjolo A, Bisseck ACZK, Elat JBN. 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. BMC Infect Dis 2016; 16:678. [PMID: 27846809 PMCID: PMC5111226 DOI: 10.1186/s12879-016-1991-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/29/2016] [Indexed: 01/09/2023] Open
Abstract
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. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1991-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Serge Clotaire Billong
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.,National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Joseph Fokam
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon. .,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon. .,Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon. .,Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Calixte Ida Penda
- Faculty of Medicine and Pharmaceutical sciences (FMSP), University of Douala, Douala, Cameroon.,Laquintinie Hospital of Douala, Douala, Cameroon
| | - Salmon Amadou
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - David Same Kob
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Edson-Joan Billong
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | - Vittorio Colizzi
- Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon.,UNESCO Biotechnology Multidisciplinary Board, and Department of Biology and Pathology, Faculty of Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Alexis Ndjolo
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.,Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon
| | - Anne-Cecile Zoung-Kani Bisseck
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.,Division of Operational Health Research, Ministry of Public Health, Yaounde, Cameroon
| | - Jean-Bosco Nfetam Elat
- National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.,National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
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Mungati M, Mhangara M, Dzangare J, Mugurungi O, Apollo T, Gonese E, Kilmarx PH, Chakanyuka-Musanhu CC, Shambira G, Tshimanga M. Results from implementing updated 2012 World Health Organization Guidance on early-warning indicators of HIV drug resistance in Zimbabwe. ACTA ACUST UNITED AC 2016; 2:85-91. [PMID: 29862318 DOI: 10.5430/jer.v2n2p85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective This study evaluated the performance of sentinel sites in preventing the emergence of HIVDR using Early Warning Indicators (HIVDR EWI) survey. Methods Adult and paediatric patient data on: On time pill pick up, Retention in care, Pharmacy stock-outs, and Dispensing practices was collected. Information from pharmacy registers was verified using facility-held cards. This was a cross-sectional analysis of retrospectively collected data from 72 sites providing both adult and paediatric ART as well as two providing adult ART only. All data were entered into and analysed using a WHO EWI data abstraction electronic tool. Results Twenty-one percent of sites providing adult and 4.2% of sites providing paediatric ART managed to meet the target for on time pill pick up. Retention in care indicator was met by 48.7% (95% CI: 36.9-60.6) of sites. ARV stock-outs occurred in 81.1% (95% CI: 70-89.3) adult sites and 63.9% (95% CI: 50-78.6) paediatric sites. ARVs were appropriately dispensed by 86.5% (95% CI: 75.6-93.3) of adult sites and 84.7% (95% CI: 74.3-92.1) of paediatric sites. Conclusions Most sites had low performance in many indicators in this survey and failed to meet the recommended targets. Some policies such as the current buffer stock and storage outside Harare should be revised in order to improve site access to ARVs. The country should prioritize the provision of viral load testing services in all provinces. The electronic patient management system should be rolled out to all ART sites to improve patient tracking and monitoring by sites.
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Affiliation(s)
- More Mungati
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe.,Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mutsa Mhangara
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Janet Dzangare
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Peter H Kilmarx
- Centers for Disease Control and Prevention, Harare, Zimbabwe
| | | | - Gerald Shambira
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe
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Fokam J, Elat JBN, Billong SC, Kembou E, Nkwescheu AS, Obam NM, Essiane A, Torimiro JN, Ekanmian GK, Ndjolo A, Shiro KS, Bissek ACZK. Monitoring HIV Drug Resistance Early Warning Indicators in Cameroon: A Study Following the Revised World Health Organization Recommendations. PLoS One 2015; 10:e0129210. [PMID: 26083364 PMCID: PMC4471113 DOI: 10.1371/journal.pone.0129210] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background The majority (>95%) of new HIV infection occurs in resource-limited settings, and Cameroon is still experiencing a generalized epidemic with ~122,638 patients receiving antiretroviral therapy (ART). A detrimental outcome in scaling-up ART is the emergence HIV drug resistance (HIVDR), suggesting the need for pragmatic approaches in sustaining a successful ART performance. Methods A survey was conducted in 15 ART sites of the Centre and Littoral regions of Cameroon in 2013 (10 urban versus 05 rural settings; 8 at tertiary/secondary versus 7 at primary healthcare levels), evaluating HIVDR-early warning indicators (EWIs) as-per the 2012 revised World Health Organization’s guidelines: EWI1 (on-time pill pick-up), EWI2 (retention in care), EWI3 (no pharmacy stock-outs), EWI4 (dispensing practices), EWI5 (virological suppression). Poor performance was interpreted as potential HIVDR. Results Only 33.3% (4/12) of sites reached the desirable performance for “on-time pill pick-up” (57.1% urban versus 0% rural; p<0.0001) besides 25% (3/12) with fair performance. 69.2% (9/13) reached the desirable performance for “retention in care” (77.8% urban versus 50% rural; p=0.01) beside 7.7% (1/13) with fair performance. Only 14.4% (2/13) reached the desirable performance of “no pharmacy stock-outs” (11.1% urban versus 25% rural; p=0.02). All 15 sites reached the desirable performance of 0% “dispensing mono- or dual-therapy”. Data were unavailable to evaluate “virological suppression” due to limited access to viral load testing (min-max: <1%-15%). Potential HIVDR was higher in rural (57.9%) compared to urban (27.8%) settings, p=0.02; and at primary (57.9%) compared to secondary/tertiary (33.3%) healthcare levels, p=0.09. Conclusions Delayed pill pick-up and pharmacy stock-outs are major factors favoring HIVDR emergence, with higher risks in rural settings and at primary healthcare. Retention in care appears acceptable in general while ART dispensing practices are standard. There is need to support patient-adherence to pharmacy appointments while reinforcing the national drug supply system.
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Affiliation(s)
- Joseph Fokam
- Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- University of Rome Tor Vergata, Department of Experimental Medicine and Surgery, Rome, Italy
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- * E-mail:
| | - Jean-Bosco N. Elat
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Serge C. Billong
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Etienne Kembou
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- World Health Organization (WHO), Afro, Country Office, Yaoundé, Cameroon
| | - Armand S. Nkwescheu
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- Division of Operational Health Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Nicolas M. Obam
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- Division of Operational Health Research, Ministry of Public Health, Yaoundé, Cameroon
| | - André Essiane
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
| | - Judith N. Torimiro
- Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
| | - Koulla S. Shiro
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- General Secretariat, Ministry of Public Health, Yaoundé, Cameroon
- Agence National de Recherche sur le SIDA et les hépatites virales (ANRS), Yaoundé, Cameroon
| | - Anne C. Z-K. Bissek
- Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé I, Yaoundé, Cameroon
- National HIV Drug Resistance Surveillance and Prevention Working Group, Ministry of Public Health, Yaoundé, Cameroon
- Division of Operational Health Research, Ministry of Public Health, Yaoundé, Cameroon
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Mouafo LCM, Péré H, Ndjoyi-Mbiguino A, Koyalta D, Longo JDD, Mbopi-Kéou FX, Kane CT, Bélec L. LETTER TO THE EDITOR Performance of the ViroSeq® HIV-1 Genotyping System v2.0 in Central Africa. Open AIDS J 2015; 9:9-13. [PMID: 25767633 PMCID: PMC4353127 DOI: 10.2174/1874613601509010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 11/22/2022] Open
Abstract
Resistance genotypes in pol gene of HIV-1 were obtained by the ViroSeq® HIV-1 Genotyping System v2.0 (Celera Diagnostics, Alameda, CA, USA) in 138 of 145 (95%) antiretroviral treatment-experienced adults in virological failure living in Central Africa (Cameroon, Central African Republic, Chad, Gabon). HIV-1 group M exhibited broad genetic diversity. Performance of the 7 ViroSeq® sequencing primers showed high failure rate, from 3% to 76% (D: 76%; F: 17%; A and H: 15%; G and B: 4%; C: 3%). These findings emphasize the need of updating the ViroSeq® HIV-1 genotyping system for non-B subtypes HIV-1.
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Affiliation(s)
- Linda Chapdeleine Mekue Mouafo
- University of Dschang, Dschang, Cameroon ; Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Hélène Péré
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; Faculté de Médecine Paris Descartes, Université Paris Descartes (Paris V), Sorbonne Paris Cité, Paris, France
| | | | | | - Jean De Dieu Longo
- Centre National de Référence des Maladies Sexuellement Transmissibles, et de la Thérapie Antirétrovirale, and Unité de Recherches et d'Intervention sur les Maladies Sexuellement Transmissibles et le SIDA, Département de Santé Publique, Faculté des Sciences de la Santé de Bangui, Bangui, Central African Republic
| | - François-Xavier Mbopi-Kéou
- Laboratoire National de Santé Hygiène Mobile, Ministry of Public Health, and Université de Yaoundé I, Yaoundé, Cameroon
| | - Coumba Toure Kane
- Laboratoire de Bactériologie-virologie, CHU Aristide Le Dantec, Dakar, Senegal
| | - Laurent Bélec
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France ; Faculté de Médecine Paris Descartes, Université Paris Descartes (Paris V), Sorbonne Paris Cité, Paris, France
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10
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Jonas A, Sumbi V, Mwinga S, DeKlerk M, Tjituka F, Penney S, Jordan MR, Desta T, Tang AM, Hong SY. HIV drug resistance early warning indicators in namibia with updated World Health Organization guidance. PLoS One 2014; 9:e100539. [PMID: 24988387 PMCID: PMC4079656 DOI: 10.1371/journal.pone.0100539] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/25/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In response to concerns about the emergence of HIV drug resistance (HIVDR), the World Health Organization (WHO) has developed a comprehensive set of early warning indicators (EWIs) to monitor HIV drug resistance and good programme practice at antiretroviral therapy (ART) sites. METHODS In 2012, Namibia utilized the updated WHO EWI guidance and abstracted data from adult and pediatric patients from 50 ART sites for the following EWIs: 1. On-time Pill Pick-up, 2. Retention in Care, 3. Pharmacy Stock-outs, 4. Dispensing Practices, and 5. Virological Suppression. RESULTS Data for EWIs one through four were abstracted and validated. EWI 5--Virological Suppression was not included due to poor data entry at many sites. On-time Pill Pick-up national estimate was 87.9% (87.2-88.7) of patients picking up pills on time for adults and 90.0% (88.9-90.9) picking up pills on time for pediatrics. Retention in Care national estimate was 82% of patients retained on ART after 12 months for adults and 83% for pediatrics. Pharmacy Stock-outs national estimate was 99% of months without a stock-out for adults and 97% for pediatrics. Dispensing Practices national estimate was 0.01% (0.003-0.064) of patients dispensed mono- or dual-therapy for adults and 0.25% (0.092-0.653) for pediatrics. CONCLUSIONS The successful 2012 EWI exercise provides Namibia a solid evidence base, which can be used to make national statements about programmatic functioning and possible HIVDR. This evidence base will serve to contextualize results from Namibia's surveys of HIVDR, which involves genotype testing. EWI abstraction has prompted the national program and its counterparts to engage sites in dialogue regarding the need to strengthen adherence and retention of patients on ART. The EWI collection process and EWI results will serve to optimize patient care and support Namibia in making evidence-based recommendations and take action to minimize the emergence of preventable HIVDR.
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Affiliation(s)
- Anna Jonas
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Victor Sumbi
- Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia
| | - Samson Mwinga
- Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia
| | - Michael DeKlerk
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Francina Tjituka
- Strengthening Pharmaceutical Systems, Management Sciences for Health, Windhoek, Namibia
| | - Scott Penney
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Michael R. Jordan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Tiruneh Desta
- World Health Organization Namibia, Klein Windhoek, Namibia
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Steven Y. Hong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
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Taieb F, Aghokeng AF, Eymard-Duvernay S, Chia JE, Einterz E, Mpoudi-Ngole E, Peeters M, Molina JM, Delaporte E. Challenges of antiretroviral treatment monitoring in rural and remote-access regions in Africa. AIDS Res Hum Retroviruses 2014; 30:623-5. [PMID: 24645979 DOI: 10.1089/aid.2014.0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabien Taieb
- Hôpital Saint-Louis, Service de Maladies Infectieuses et Tropicales, Paris, France
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
| | - Avelin F. Aghokeng
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
- Virology Laboratory CREMER/IMPM/IRD, Yaoundé, Cameroon
| | - Sabrina Eymard-Duvernay
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
| | | | | | | | - Martine Peeters
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
| | - Jean-Michel Molina
- Hôpital Saint-Louis, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Eric Delaporte
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
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12
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Juma JM, Tiberio JK, Abuya MI, Kilama BK, Somi GR, Sambu V, Banda R, Jullu BS, Ramadhani AA. Monitoring prevention or emergence of HIV drug resistance: results of a population-based foundational survey of early warning indicators in mainland Tanzania. BMC Infect Dis 2014; 14:196. [PMID: 24725750 PMCID: PMC3999848 DOI: 10.1186/1471-2334-14-196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Tanzania, routine individual-level testing for HIV drug resistance (HIVDR) using laboratory genotyping and phenotyping is not feasible due to resource constraints. To monitor the prevention or emergence of HIVDR at a population level, WHO developed generic strategies to be adapted by countries, which include a set of early warning indicators (EWIs). METHODS To establish a baseline of EWIs, we conducted a retrospective longitudinal survey of 35 purposively sampled care and treatment clinics in 17 regions of mainland Tanzania. We extracted data relevant for four EWIs (ART prescribing practices, patients lost to follow-up 12 months after ART initiation, retention on first-line ART at 12 months, and ART clinic appointment keeping in the first 12 months) from the patient monitoring system on patients who initiated ART at each respective facility in 2010. We uploaded patient information into WHO HIVResNet excel-based tool to compute national and facility averages of the EWIs and tested for associations between various programmatic factors and EWI performance using Fisher's Exact Test. RESULTS All sampled facilities met the WHO EWI target (100%) for ART prescribing practices. However, the national averages for patients lost to follow-up 12 months after ART initiation, retention on first-line ART at 12 months, and ART clinic appointment keeping in the first 12 months fell short, at 26%, 54% and 38%, respectively, compared to the WHO targets ≤ 20%, ≥ 70%, and ≥ 80%. Clinics with fewer patients lost to follow-up 12 months after ART initiation and more patients retained on first-line-ART at 12 months were more likely to have their patients spend the longest time in the facility (including wait-time and time with providers), (p = 0.011 and 0.007, respectively). CONCLUSION Tanzania performed very well in EWI 1a, ART prescribing practices. However, its performance in other three EWIs was far below the WHO targets. This study provides a baseline for future monitoring of EWIs in Tanzania and highlights areas for improvement in the management of ART patients in order not only to prevent emergence of HIVDR due to programmatic factors, but also to improve the quality of life for ART patients.
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Affiliation(s)
- James M Juma
- Ministry of Health and Social Welfare, The National AIDS Control Programme (NACP), P,O, Box 11857, Dar es Salaam, Tanzania.
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TB and HIV in the Central African region: current knowledge and knowledge gaps. Infection 2013; 42:281-94. [PMID: 24311148 DOI: 10.1007/s15010-013-0568-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/27/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE Reliable and comprehensive data on the HIV/AIDS and TB co-pandemics from Central Africa remain scarce. This systematic review provides a comprehensive overview on current and past research activities in the region and provides a basis for future research work to close knowledge gaps. METHODS The scientific literature was searched for publications meeting the following search terms: "tuberculosis" or "HIV" or "acquired immunodeficiency syndrome", combined with "Central Africa", or the names of individual countries within the region. Original studies, reviews and case series were included, and a selection of relevant articles was made. RESULTS Most research in the field of HIV and TB has been conducted in Cameroon, where the epidemics have been described fairly well. The Democratic Republic of Congo ranked second on the amount of publications, despite the civil wars over the past several decades. Very little has been published on HIV and TB in the other countries, possibly due to the poor infrastructure of health care systems, lack of scientific capacity building or shortage of laboratory equipment. CONCLUSIONS Despite the relatively high burden of HIV and TB in the Central African region, the amount of research activities on these topics is limited. A better understanding of the co-epidemics in this region is urgently needed. The occurrence of opportunistic infections, treatment complications and drug resistance in TB and HIV need to be better described; the failure of public health systems needs to be understood, and research infrastructure needs to be developed. Only then will it be possible to turn the tide against the HIV and TB epidemics in this region.
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Bekolo CE, Webster J, Batenganya M, Sume GE, Kollo B. Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon. BMC Res Notes 2013; 6:512. [PMID: 24308609 PMCID: PMC3937159 DOI: 10.1186/1756-0500-6-512] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/03/2013] [Indexed: 12/24/2022] Open
Abstract
Background Access to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges. Methods A retrospective review of point of care data from HIV patients was conducted in June 2012 at Nkongsamba Regional Hospital in Cameroon to establish mortality and LTFU rates. Univariable and multivariable Cox regression models were used to screen for factors associated with the outcomes. Telephone calls were made to trace patients LTFU. Results Between June 2005 and December 2010, 2388 HIV infected patients were admitted. Of these, 1858 were aged 15 and above and were included in our analysis. Their median age was 36 years (IQR: 30–44) and they were followed up over a total risk period of 3647.3 person-years (pyrs). The overall mortality rate was 34.6 deaths per 1000 pyrs (95% CI: 29.0-41.1) while the overall LTFU rate was 94.6 per 1000 pyrs (95%CI: 85.1-105.1).The mortality rates steadily rose to a peak of 69.6 deaths per 1000 pyrs in 2009 and then fell drastically to 20.6 per 1000 pyrs in 2010. The LTFU rate increased sharply from 29.7 in 2006 to 138.2 in 2007 and remained virtually stable until 2010. The factors associated with mortality were: being male (aHR = 2.25, 95% CI: 1.58-3.19), clinical disease progression (aHR = 2.0, 95% CI: 1.58-2.53), CD4 count <200 cells/μl (aHR = 3.14, 95% CI: 1.27-7.73), haemoglobin level <10 g/dl (aHR = 2.50, 95% CI: 1.69-3.69). Major factors associated with high LTFU rate were: distance to clinic of over 5 km (aHR = 1.25, 95% CI: 1.00-1.55), being single, having partners with unknown HIV status or taking no treatment and with CD4 count >500 cells/μl. Two- thirds (66.7%) of traced LTFU patients were dead. Conclusion Mortality and LTFU rates in our cohort were high but there is evidence that patients’ outcomes are improving. Interventions to address factors associated with high mortality and LTFU should be implemented for optimal results in patient care.
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Affiliation(s)
- Cavin Epie Bekolo
- Centre Medical d'Arrondissement de Bare, PO Box 628, Nkongsamba, Cameroon.
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15
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Billong SC, Fokam J, Aghokeng AF, Milenge P, Kembou E, Abessouguie I, Meva’a-Onglene FB, Bissek ACZK, Colizzi V, Mpoudi EN, Elat JBN, Shiro KS. Population-based monitoring of emerging HIV-1 drug resistance on antiretroviral therapy and associated factors in a sentinel site in Cameroon: low levels of resistance but poor programmatic performance. PLoS One 2013; 8:e72680. [PMID: 23991142 PMCID: PMC3753336 DOI: 10.1371/journal.pone.0072680] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 07/18/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Scale-up of antiretroviral therapy (ART) in resource-limited settings has drastically reduced HIV-related morbidity and mortality. However, challenges in long-term ART, adherence and HIV drug resistance (HIVDR) itself, require monitoring to limit HIVDR emergence among ART-experienced populations, in order to ensure regimen efficacy. METHODS A longitudinal study was conducted from 2009-2011 in a cohort of 141 HIV-infected adult patients (aged >21) at the national social insurance centre hospital in Yaounde, Cameroon. As per-WHO HIVDR protocol, HIV-1 protease-reverse transcriptase genotyping was performed at baseline and at endpoint (12 months) on first-line ART using ViroSeq™ Genotyping kit. RESULTS At baseline, a prevalence of 3.6% (5/139) HIVDR was observed [protease inhibitors M46I (1/5), G73A (1/5), L90LM (1/5); nucleoside reverse transcriptase inhibitors: M184V (1/5), T215F (1/5); non-nucleoside reverse transcriptase inhibitors: K103N (1/5), Y181Y/C (2/5), M230ML (1/5)]. At endpoint, 54.0% (76) patients were followed-up, 9.2% (13) died, and 3.5% (5) transferred, 38.5% (47) lost to follow-up (LTFU). 69.7% (53/76) of those followed-up had viremia <40 copies/ml and 90.8% (69/76) <1000 copies/ml. 4/7 patients with viremia ≥1000 copies/ml harbored HIVDR (prevalence: 5.3%; 4/76), with M184V/I (4/4) and K103K/N (3/4) being the most prevalent mutations. LTFU was favored by costs for consultation/laboratory tests, drug shortages, workload (physician/patient ratio: 1/180) and community disengagement. CONCLUSIONS Low levels of HIVDR at baseline and at endpoint suggest a probable effectiveness of ART regimens used in Cameroon. However the possible high rate of HIVDR among LTFUs limited the strengths of our findings. Evaluating HIVDR among LTFU, improving adherence, task shifting, subsidizing/harmonizing costs for routine follow-up, are urgent measures to ensure an improved success of the country ART performance.
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Affiliation(s)
- Serge C. Billong
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- National AIDS Control Committee, Central Technical Group, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences of the University of Yaounde 1, Yaounde, Cameroon
- * E-mail: (JF); (SCB)
| | - Joseph Fokam
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences of the University of Yaounde 1, Yaounde, Cameroon
- CIRCB: Chantal BIYA International Reference Centre for Research on HIV/AIDS prevention and management, Molecular Biology Laboratory, Sequencing unit, Yaounde, Cameroon
- * E-mail: (JF); (SCB)
| | - Avelin F. Aghokeng
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- Centre de Recherche en Maladies Emergentes et Ré-émergentes (CREMER)/IMPM/IRD, Virology Laboratory, Yaounde, Cameroon
- Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMI 233 TransVIHMI, Montpellier, France
| | - Pascal Milenge
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- World Health Organisation (WHO), Afro, HIV/AIDS, Yaounde, Cameroon
| | - Etienne Kembou
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- World Health Organisation (WHO), Afro, HIV/AIDS, Yaounde, Cameroon
| | - Ibile Abessouguie
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- National AIDS Control Committee, Central Technical Group, Yaounde, Cameroon
| | | | - Anne C. Zoung-Kanyi. Bissek
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Vittorio Colizzi
- CIRCB: Chantal BIYA International Reference Centre for Research on HIV/AIDS prevention and management, Molecular Biology Laboratory, Sequencing unit, Yaounde, Cameroon
- University of Rome Tor Vergata, Laboratory of Immunology and Molecular Pathology, Department of Biology, Faculty of Sciences, Rome, Italy
| | - Eitel N. Mpoudi
- Centre de Recherche en Maladies Emergentes et Ré-émergentes (CREMER)/IMPM/IRD, Virology Laboratory, Yaounde, Cameroon
| | - Jean-Bosco N. Elat
- National HIV Drug Resistance Prevention and Surveillance Working Group, Yaounde, Cameroon
- National AIDS Control Committee, Central Technical Group, Yaounde, Cameroon
| | - Koulla S. Shiro
- Faculty of Medicine and Biomedical Sciences of the University of Yaounde 1, Yaounde, Cameroon
- Yaounde Central Hospital, Infectiology service, Yaounde, Cameroon
- Division of Operational Health Research, Ministry of Public Health, Yaounde, Cameroon
- General Secretariat, Ministry of Public Health, Yaounde, Cameroon
- Agence Nationale pour la Recherche sur le Sida et les hépatites virales (ANRS)-Sud, Yaounde, Cameroon
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Jonas A, Gweshe J, Siboleka M, DeKlerk M, Gawanab M, Badi A, Sumbi V, Pereko D, Blom A, Mwinga S, Jordan MR, Jerger L, Lau K, Hong SY. HIV drug resistance early warning indicators in Namibia for public health action. PLoS One 2013; 8:e65653. [PMID: 23762406 PMCID: PMC3676318 DOI: 10.1371/journal.pone.0065653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/25/2013] [Indexed: 11/26/2022] Open
Abstract
Background HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings, therefore antiretroviral therapy (ART) program and site factors known to be associated with emergence of HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR. Methods In 2010, Namibia selected five World Health Organization Early Warning Indicators (EWIs) and scaled-up monitoring from 9 to 33 ART sites: ART prescribing practices, Patients lost to follow-up (LTFU) at 12 months, Patients switched to a second-line regimen at 12 months, On-time antiretroviral (ARV) drug pick-up, and ARV drug-supply continuity. Results Records allowed reporting on three of the five selected EWIs. 22 of 33 (67%) sites met the target of 100% initiated on appropriate first-line regimens. 17 of 33 (52%) sites met the target of ≤20% LTFU. 15 of 33 (45%) sites met the target of 0% switched to a second-line regimen. Conclusions EWI monitoring directly resulted in public health action which will optimize the quality of care, specifically the strengthening of ART record systems, engagement of ART sites, and operational research for improved adherence assessment and ART patient defaulter tracing.
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Affiliation(s)
- Anna Jonas
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Justice Gweshe
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Milner Siboleka
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Michael DeKlerk
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Michael Gawanab
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Alfons Badi
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | - Victor Sumbi
- Management Sciences for Health, Windhoek, Namibia
| | - Dawn Pereko
- Strengthening Health Outcomes through the Private Sector, Abt Associate Inc, Windhoek, Namibia
| | - Abraham Blom
- Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia
| | | | - Michael R. Jordan
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
| | - Logan Jerger
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Kiger Lau
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Steven Y. Hong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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Yebra G, de Mulder M, Holguín Á. Description of HIV-1 group M molecular epidemiology and drug resistance prevalence in Equatorial Guinea from migrants in Spain. PLoS One 2013; 8:e64293. [PMID: 23717585 PMCID: PMC3661467 DOI: 10.1371/journal.pone.0064293] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background The HIV epidemic is increasing in Equatorial Guinea (GQ), West Central Africa, but few studies have reported its HIV molecular epidemiology. We aimed to describe the HIV-1 group M (HIV-1M) variants and drug-resistance mutations in GQ using sequences sampled in this country and in Spain, a frequent destination of Equatoguinean migrants. Methods We collected 195 HIV-1M pol sequences from Equatoguinean subjects attending Spanish clinics during 1997-2011, and 83 additional sequences sampled in GQ in 1997 and 2008 from GenBank. All (n = 278) were re-classified using phylogeny and tested for drug-resistance mutations. To evaluate the origin of CRF02_AG in GQ, we analyzed 2,562 CRF02_AG sequences and applied Bayesian MCMC inference (BEAST program). Results Most Equatoguinean patients recruited in Spain were women (61.1%) or heterosexuals (87.7%). In the 278 sequences, the variants found were CRF02_AG (47.8%), A (13.7%), B (7.2%), C (5.8%), G (5.4%) and others (20.1%). We found 6 CRF02_AG clusters emerged from 1983.9 to 2002.5 with origin in GQ (5.5 sequences/cluster). Transmitted drug-resistance (TDR) rate among naïve patients attended in Spain (n = 144) was 4.7%: 3.4% for PI (all with M46IL), 1.8% for NRTI (all with M184V) and 0.9% for NNRTI (Y188L). Among pre-treated patients, 9/31 (29%) presented any resistance, mainly affecting NNRTI (27.8%). Conclusions We report a low (<5%) TDR rate among naïve, with PI as the most affected class. Pre-treated patients also showed a low drug-resistance prevalence (29%) maybe related to the insufficient treatment coverage in GQ. CRF02_AG was the prevalent HIV-1M variant and entered GQ through independent introductions at least since the early 1980s.
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Affiliation(s)
- Gonzalo Yebra
- HIV-1 Molecular Epidemiology Laboratory, Dept. of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain
| | - Miguel de Mulder
- HIV-1 Molecular Epidemiology Laboratory, Dept. of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Dept. of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain
- * E-mail:
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