Factors influencing the initiation of antiretroviral therapy in HIV infected patients attending the Bamenda and the Bertoua regional treatment centers in Cameroon

Abstract

Background: In sub-Saharan Africa, access to antiretroviral drugs (ARVs) remains low due to various obstacles. Encouraging progress in the availability of these drugs in Cameroon has been noted leading to an increase number of treatment centers and an increase number of patients under ARVs. The present study aimed at determining the factors influencing the initiation of ARV therapy in HIV infected patients attending the Bamenda and the Bertoua regional treatment centers in Cameroon (RTC). Methods: A cross sectional study involving 460 files of HIV infected adult patients attending the Bamenda and the Bertoua RTC was carried out from January to April 2011. Socio-demographic, biological and clinical characteristics including the antiretroviral treatment were compared between these RTC. Data were analysed using the Chi-Squared and the Ficher, and statistical significance was set at p < 0.05. Results: Out of the 460 files, 53.9% were from Bamenda and 46.1% from Bertoua RTC. The median age of patients was 36 years in Bamenda and 35 years in Bertoua. There were more female patients in both the Bamenda (69, 0%) and the Bertoua (61, 8%) RTC (p = 0.11). The majority of patients in Bertoua discovered their HIV status through voluntary testing as compared to those in Bamenda (41 vs 22; p = 0.008). HIV type 1 and 2 viruses were more frequent in Bamenda than in Bertoua (15 vs 3; p = 0.011). The median CD4 count was 133 cells/mm3 in Bamenda and 175 cell/mm3 in Bertoua (p = 0.008). Standard first line ARV drugs were the most used protocols [Bamenda (93.1%) and Bertoua (98.1)]. Zidovudine, Nevirapine and Lopinavir were more frequently used in Bamenda (p = 0.000), while Tenofovir and Effavirenz were more used in Bertoua (p = 0.017). Conclusion: This study highlights the fact that socio-demographic, biological and clinical management of patients differ from one RTC to the other in Cameroon, even when both have a high HIV prevalence. We therefore recommend the standardization of treatment strategies according to national HIV treatment guidelines. In addition to education programs for behaviour change towards HIV/AIDS, future studies should focus in the comparison of the management options for HIV infection in the different treatment centers throughout Cameroon.