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Evaluating the Impact of the Universal Test and Treat Strategy on the Survival of Patients in the Northwest Region of Cameroon

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World Journal of AIDS 2024年第3期14卷 45-60页

作者： Emmanuel mboh Nshom Bereynuy Jude Cholong Kum Kang Walter khan eveline mboh Keng Vitalis Noela F. Ijang Gwendoline Nkenu Nsom Mirabel Mbueh Vifeme Esther Bonje Kuni Monju Johnson Vishi Gladys Enih Fosah Pius Muffih Tih AIDS Care and Prevention Program Cameroon Baptist Convention Health Services Bamenda Cameroon Regional Technical Group for the Fight against HIV and AID Northwest Region Cameroon

Introduction: The main outcome of efficiently implemented universal test and treat (UTT) program is improved survival. UTT implementation has been ongoing in Cameroon since 2016 but evaluation data are scarce. This study aims to assess the survival of antiretroviral therapy (ART) patients initiated under UTT in Northwest region of Cameroon. Methods: This retrospective cohort study included HIV-positive patients initiated in 2016 at 27 purposefully selected sites and followed until 2021. Data was anonymously abstracted from ART registers and patients’ charts. Kaplan-Meier survival estimates and Cox model were used to compare the survival of patients initiated under UTT with those initiated otherwise, using stata version 14.0. Results: In total, 2490 HIV-positive patients (median age 42.7 years, 94.7% adults, and 69.0% female) participated in the study. Of 1389 patients with viral load (VL) test results, 55% were initiated on ART late. The VL suppression rate of patients initiated late and those initiated early were similar. During follow-up, 1020 (40.9%) participants censored. The survival curves of patients initiated early on ART and those initiated late were similar during the first 2.5 years of follow-up but significantly (p Conclusions: This study confirms the expected impact of UTT. Programs only need to close existing implementation gaps along the critical pathways (diagnosis and treatment) of UTT, focusing more on males.

关键词： Universal Test and Treat Viral Load Survival Northwest Cameroon

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Outcome Evaluation of Early Implementation of Option B+ in Cameroon: A Prospective Cohort Observational Survey in the Northwest and Southwest Regions

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World Journal of AIDS 2018年第3期8卷 90-104页

作者： Pius Tih Muffih Edouard Katayi Tshimwanga Andrew Abutu Lem Edith Abongwa Jacques Chirac Awa Pascal Nji Atanga Felix Desembuin eveline mboh khan Kuni Esther Bonje Nshom Emmanuel Ebeny Francois Temgbait Chimoun Thomas Welty Gladys Tayong Fosah Jennifer Lim Dana Duncan Leah Petit Gilbert Tene Jembia Mosoko Omotayo Bolu AIDS Care and Prevention Program Cameroon Baptist Convention Health Services Bamenda Cameroon United States Centers for Disease Control and Prevention (CDC) Atlanta USA Ministry of Public Health National AIDs Control Committee Northwest Region Technical Group Bamenda Cameroon Association of Schools and Programs of Public Health/Allan Rosenfield Global Health Fellowship Washington DC USA United States Centers for Disease Control and Prevention (CDC) Yaoundé Cameroon Elizabeth Glazer Pediatric AIDS Foundation (EGPAF) Washington DC USA QED Group LLC Washington DC USA

Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.

关键词： Option B+ Implementation Research Prevention of Mother to Child HIV Transmission HIV Exposed Infants

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