Programme quality indicators of HIV drug resistance among adolescents in urban versus rural settings of the centre region of Cameroon

Joseph Fokam,Nelly Kamgaing,Paul Koki Ndombo,Armanda Nangmo,Charles Fokunang,Carlson Wandum,Alexis Ndjolo,Cedric Kamta,Virginie Lambo,Desire Takou,Francis Ndongo Ateba,Carlo-Federico Perno,Vittorio Colizzi,Maria Mercedes Santoro,Anne-Esther Njom Nlend,Andre Essiane,Dora Mbanya

doi:10.1186/s12981-020-00270-7

Abstract

BackgroundThe 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).MethodsA 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.ResultsAmong 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).ConclusionAmong 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.

Highlights

There is a remarkable reduction in Human immunodeficiency virus (HIV) associated mortality (1.1 million [940,000–1.3 million] in 2015, with a 45% decline since 2005 [1]) due to the roll-out of antiretroviral therapy (ART) in resource-limited settings (RLS), especially those with the highest burden of HIV [2]
Such challenges might be due to individual, program and viral factors, all contributing to ART failure, emergence of HIV drug resistance (HIVDR), limited ART options and continuous mortality of this vulnerable and underserved population [8]
There are fewer number of adolescents managed in rural health facilities, this is partly due to referral of some cases to reference centres

Summary

Introduction

There is a remarkable reduction in Human immunodeficiency virus (HIV) associated mortality (1.1 million [940,000–1.3 million] in 2015, with a 45% decline since 2005 [1]) due to the roll-out of antiretroviral therapy (ART) in resource-limited settings (RLS), especially those with the highest burden of HIV [2]. In spite of the overall decreasing mortality, AIDS remains the leading cause of death among adolescents in SSA [5] This is true for adolescents who acquire HIV as babies and survive to teen age [5]. Besides identifying the most suitable ART regimens for adolescents, understanding challenges faced by these adolescents is concerning [7, 8] Such challenges might be due to individual, program and viral factors, all contributing to ART failure, emergence of HIV drug resistance (HIVDR), limited ART options and continuous mortality of this vulnerable and underserved population [8]. We sought to evaluate program quality indicators (PQIs) of HIVDR among HIV-vertically infected adolescents on antiretroviral therapy (ART)

Methods

Results

Discussion

Conclusion