Mobile health service for HIV screening and care in resource-constrained setting

Objective: This review paper aims at demonstrating that mobile health services for HIV infection in resource-constrained countries may be particularly useful for HIV screening and treatment of HIV disease and associated co-morbidities, especially for people who have limited access to fixed health facilities, including remote or nomadic populations and socially marginalised people.Data source: PubMed database was used to retrieve appropriate literature related to the following MeSH terms: HIV, testing, counselling, mobile counselling and testing, routine offer of counselling and testing, provider-initiated testing and counselling,home-based counselling and testing, decentralisation.Study selection: All articles that met these inclusion criteria and described work conducted in sub-Saharan Africa were considered. Articles were reviewed for information pertaining to mobile health facilities in the field of HIV infection. Wealso reviewed available articles describing alternative approaches to HIV screening and care delivery in resource-limited settings without time period restrictions up to December 2015.Data synthesis: Data collected were analysed and the results related to the aim of the study.Conclusions: The development of mobile services has benefitted from the  simplification of laboratory tests, including reliable rapid diagnostic tests for HIV, and “point of care” (“POC”) tests for CD4 enumeration. The mobile strategy aims to reach more patients,particularly those living in remote areas, to reduce loss-to-follow-up, and to improve patient outcomes. With a reduction in HIV-related stigma and associated discrimination by using these services, the mobile strategy may assist decentralisation of programs devoted to HIV screening, anti-retroviral treatment and HIV care

Evaluation of treatment response, drug resistance and HIV-1 variability among adolescents on first- And second-line antiretroviral therapy: A study protocol for a prospective observational study in the centre region of Cameroon (EDCTP READY-study)

BackgroundSub-Saharan Africa (SSA) alone has nine out of every 10 children living with HIV globally and monitoring in this setting remains suboptimal, even as these children grow older. With scalability of antiretroviral therapy (ART), several HIV-infected children are growing towards adolescence (over 2.1 million), with the potentials to reach adulthood. However, despite an overall reduction in HIV-related mortality, there are increasing deaths among adolescents living with HIV (ADLHIV), with limited evidence for improved policy-making. Of note, strategies for adolescent transition from pediatrics to adult-healthcare are critical to ensure successful treatment response and longer life expectancy. Interestingly, with uptakes in prevention of mother-to-child transmission, challenges in ART programs, and high viremia among children in SSA, the success rate of paediatric ART might be quickly jeopardised, with possible HIV-1 drug-resistance (HIVDR) emergence, especially after years of paediatric ART exposure. Therefore, monitoring ART response in adolescents and evaluating HIVDR patterns might limit disease progression and guide on subsequent ART options for SSA ADLHIV.ObjectivesAmong Cameroonian ADLHIV receiving ART, we shall evaluate the rate of immunovirologic failure, acquired HIVDR-associated mutations, HIV-1 subtype distribution, genetic variability in circulating (plasma) versus archived (cellular) viral strains, and HIVDR early warning indicators (EWIs) at different time-points.MethodsA prospective and observational study will be conducted among 250 ADLHIV (10-19years old) receiving ART in the centre region of Cameroon, and followed-up at 6 and 12months after enrollment. Following consecutive sampling at enrolment, plasma viral load and CD4/CD8 count will be measured, and genotypic resistance testing (GRT) will be performed both in plasma and in buffy coat for participants experiencing virological failure (two consecutive viremia >=1000 copies/ml). Plasma viral load and CD4/CD8 will be monitored for all participants at 6 and 12months after enrolment. HIVDR-EWIs will be monitored and survival analysis performed during the 12months follow-up. Primary outcomes are rates of virological failure, acquired-HIVDR, and mortality.DiscussionOur findings will provide evidence-based recommendations to ensure successful transition from paediatrics to adult ART regimens and highlight further needs of active ART combinations, for reduced morbidity and mortality in populations of ADLHIV within SSA

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: Adolescents at high risk of virological failure in the era of "test and treat"

Background: After the launching of the "Test & Treat" strategy and the wider accessibility to viral load (VL), evaluating virological success (VS) would help in meeting the UNAIDS targets by 2020 in Cameroon.Setting and methods: Cross-sectional study conducted in the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaounde, Cameroon; data generated between October 2016 and August 2017 amongst adults, adolescents and children at 12, 24, 36 and >= 48 months on ART. VS was defined as < 1000 copies/mL of blood plasma and controlled viremia as VL < 50 copies/mL. Data were analysed by SPSS; p < 0.05 considered as significant.Results: 1946 patients (70% female) were enrolled (1800 adults, 105 adolescents, 41 children); 1841 were on NNRTI-based and 105 on PI-based therapy; with 346 patients at M12, 270 at M24, 205 at M36 and 1125 at >= M48. The median (IQR) duration on was 48 months (24-48). Overall, VS was 79.4% (95% CI 77.6-81.2) and 67.1% (95% CI 64.9-69.1) had controlled viral replication. On NNRTI-based, VS was 79.9% vs. 71.4% on PIs-based, p = 0.003. By ART duration, VS was 84.1% (M12), 85.9% (M24), 75.1% (M36) and 77.2% (>= M48), p = 0.001. By age, VS was 75.6% (children), 53.3% (adolescents) and 81.1% (adults), p < 0.001.Conclusions: In this sub-population of patients receiving ART in Cameroon, about 80% might be experiencing VS, with declining performance at adolescence, with NNRTI-based regimens, and as from 36 months on ART. Thus, improving VS may require an adapted adherence support mechanism, especially for adolescents with long-term treatment in resource-limited settings

Les &#946-thalassemies de lfenfant camerounais : Etude de la symptomatologie en fonction des differentes formes biologiques

L'association ƒÀ-thalassemie et trait drepanocytaire donne lieu a des phenotypes varies. Elle peut engendrer des crises douloureuses vaso-occlusives. Nous avons observe dans notre pratique quotidienne des phenotypes S-ƒÀ-thalassemiques ou des sujets souffraient des crisesdouloureuses, tandis que dfautres en etaient indemnes. Notre objectif a ete de contribuer a une meilleure comprehension de lfexpression clinique de lfassociation des traits S et ƒÀ-thalassemique. Sur les 65 sujets inclus dans notre etude nous avions identifie neuf phenotypes de  ƒÀ-thalassemie, dont 29 (44,62%) HbSF, 20 (30,77%) HbA2SF, 2 (3,08%) HbA2S, 1 (1,54%) HbA1A2SF, 3 (4,62%) HbA1A2S et 2 (3,08%) HbA1SF, 1 (1,54%) HbA1A2, 6 (9,23%) HbA1A2F, 1 (1,54%) HbA2. Six de ces phenotypes regroupant 57 (87,69%) sujets etaient associes au trait drepanocytaire : les phenotypes HbSF, HbA2SF, HbA2S,HbA1A2SF ont ete constamment symptomatiques, tandis que la symptomatologie etait variable dfun sujet a lfautre au sein des phenotypes HbA1A2S et HbA1SF

HIV-1 drug resistance testing is essential for heavily-treated patients switching from first- to second-line regimens in resource-limited settings: Evidence from routine clinical practice in Cameroon

BackgroundWith the phase-out of stavudine (d4T), change to first-line regimens with zidovudine (AZT) or tenofovir (TDF) in resource-limited settings (RLS) might increase risks of cross-resistance to nucleos(t) ide reverse transcriptase inhibitors (NRTI). This would restrict the scope of switching to the World Health Organisation (WHO)-recommended standard second-line combinations (SLC) without HIV drug resistance (HIVDR)-testing in routine clinical practice.MethodsAn observational study was conducted among 101 Cameroonian patients (55.4% male, median [IQR] age 34 [10-41] years) failing first-line antiretroviral therapy (ART) in 2016, and stratified into three groups according to NRTIs exposure: exposure to both thymidine analogues AZT and D4T (group-A, n=55); exposure to both TDF and AZT or D4T (group-B, n=22); exposure solely to D4T (group-C, n=24). Protease-reverse transcriptase HIVDR was interpreted using the HIVdb penalty scores (60: high-resistance; 20-59: intermediate-resistance; <20: susceptible). The acceptable threshold for potential-efficacy was set at 80%.ResultsThe median [IQR] CD4, viral RNA, and time on ART, were respectively 129 [29-466] cells/l, 71,630 [19,041-368,000] copies/ml, and 4 [2-5] years. Overall HIVDR-level was 89.11% (90/101), with 83.2% harbouring M184V (high-level 3TC/FTC-resistance) and only 1.98% (2/101) major HIVDR-mutations to ritonavir-boosted protease-inhibitors (PI/r). Thymidine-analogue mutations (TAMs)-1 [T215FY (46.53%), M41L (22.77%), L210W (8.91%)], with cross-resistance to AZT and TDF, were higher compared to TAMs-2 [D67N (21.78%), K70R (19.80%), K219QE (18.81%)]. As expected, K65R was related with TDF-exposure: 0% (0/55) in group-A, 22.72% (5/22) group-B, 4.17% (1/24) group-C (p=0.0013). The potential-efficacy of AZT vs. TDF was respectively 43.64% (24/55) vs. 70.91% (39/55) in group-A (p=0.0038); 63.64% (14/22) vs. 68.28% (15/22) in group-B (p=1.0000); and 37.50% (9/24) vs. 83.33% (20/24) in group-C (p=0.0032). CRF02_AG was the prevailing subtype (63.40%), followed by CRF11.cpx (8.91%), A(1) (7.92%), G (5.94%); without any significant effect of the subtype-distribution on HIVDR (92.2% in CRF02_AG vs. 83.8% in non-AG; p=0.204).ConclusionFirst-line ART-failure exhibits high-level NRTI-resistance, with potential lower-efficacy of AZT compared to TDF. Significantly, using our 80% efficacy-threshold, only patients without NRTI-substitution on first-line could effectively switch to SLC following the WHO-approach. Patients with multiple NRTI-substitutions (exposed to both thymidine-analogues and TDF) on first-line ART would require HIVDR-testing to select active NRTIs for SLC