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

Predictors of Non-Adherence to Combined Anti-Retroviral Therapy among Expectant and Breastfeeding Women Receiving Care through Test and Treat Model in Lusaka

Introduction: To achieve viral suppression and reduce vertical transmission of HIV, more than eighty percent of pregnant or breastfeeding women in Zambia have been started on combined ART using the Test and Treat model. However, Chawama First Level Hospital in Lusaka had records which showed that 32 percent of pregnant or breastfeeding women were non-adherent to combined anti-retroviral therapy (cART). Method: A mixed-method study was conducted to establish predictors of non-adherence to cART by women in the Test and Treat model of care. For the quantitative component, 92 consenting Pregnant and breastfeeding women were randomly drawn from ART defaulter register and a semi-structured questionnaire was administered. Multiple logistic regression was conducted to improve predictive power and control for confounders. Quantitative Results: The mean age was 28years. The study established that housewives were 84 percent less likely to be non-adherent [AOR 0.16;95% CI 0.12, 0.36] compared to women who were formally employed with a statistically significant P-value of 0.04. Pregnant or breastfeeding women who were several months away from home were 84.9 percent more likely to be non-adherent [AOR 15.11;95% CI 13.9, 16.4] compared to women who had travelled away from home for several days. The associated P-value was 0.03. The study also established that pregnant and breastfeeding women who were counselled in individually enclosed units were 91 percent less likely to be non-adherent compared to those who were counselled in an open space as a group [AOR 0.09;95% CI 0.02, 0.53] with an associated P-value of 0.01. Conclusion: The study established that predictors of non-adherence to cART among pregnant and breastfeeding women were: being a working-class client;being away from home or usual clinic for several months;being counselled in open spaces, and negative staff attitude. Therefore, researcher can conclusively say that predictors of non-adherence to cART can be solved by training and re-training of health workers in Patient-Centred Care Model for effective patient engagement. Women should be counselled in private rooms. Furthermore, an improvement in patient’s tracking system by the use of smart-care-cards for pregnant and breastfeeding women countrywide can reduce patient’s non-adherence to cART.

Antiretroviral therapy related adverse effects:Can sub-Saharan Africa cope with the new“test and treat”policy of the World Health Organization?

Background:Recent studies have shown that early antiretroviral therapy(ART)initiation results in significant HIV transmission reduction.This is the rationale behind the“test and treat”policy of the World Health Organization(WHO).Implementation of this policy will lead to an increased incidence of ART-related adverse effects,especially in sub-Saharan Africa(SSA).Is the region yet ready to cope with such a challenging issue?Main body:The introduction and widespread use of ART have drastically changed the natural history of HIV/AIDS,but exposure to ART leads to serious medication-related adverse effects mainly explained by mitochondrial toxicities,and the situation will get worse in the near future.Indeed,ART is associated with an increased risk of developing cardiovascular disease,lipodystrophy,prediabetes and overt diabetes,insulin resistance and hyperlactatemia/lactic acidosis.The prevalence of these disorders is already high in SSA,and the situation will be exacerbated by the implementation of the new WHO recommendations.Most SSA countries are characterized by(extreme)poverty,very weak health systems,inadequate and low quality of health services,inaccessibility to existing health facilities,lack of(qualified)health personnel,lack of adequate equipment,inaccessibility and unaffordability of medicines,and heavy workload in a context of a double burden of disease.Additionally,there is dearth of data on the incidence and predictive factors of ART-related adverse effects in SSA,to anticipate on strategies that should be put in place to prevent the occurrence of these conditions or properly estimate the upcoming burden and prepare an adequate response plan.These are required if we are to anticipate and effectively prevent this upcoming burden.Conclusion:While SSA would be the first region to experience the huge benefits of implementing the“test and treat”policy of the WHO,the region is not yet prepared to manage the consequential increased burden of ART-related toxic and metabolic complications.Urgent measures should be taken to fill the lacunae if SSA is not to become over-burdened by the consequences of the“test and treat”policy.