Early Warning Indicators for HIV Drug Resistance in Cameroon during the Year 2010

BACKGROUND: Rapid scale-up of antiretroviral therapy (ART) in resource-limited settings is accompanied with an increasing risk of HIV drug resistance (HIVDR), which in turn could compromise the performance of national ART rollout programme. In order to sustain the effectiveness of ART in a resource-limited country like Cameroon, HIVDR early warning indicators (EWI) may provide relevant corrective measures to support the control and therapeutic management of AIDS. METHODS: A retrospective study was conducted in 2010 among 40 ART sites (12 Approved Treatment Centers and 28 Management Units) distributed over the 10 regions of Cameroon. Five standardized EWIs were selected for the evaluation using data from January through December, among which: (1) Good ARV prescribing practices: target = 100%; (2) Patient lost to follow-up: target ≤ 20%; (3) Patient retention on first line ART: target ≥ 70%; (4) On-time drug pick-up: target ≥ 90%; (5) ARV drug supply continuity: target = 100%. Analysis was performed using a Data Quality Assessment tool, following WHO protocol. RESULTS: THE NUMBER OF SITES ATTAINING THE REQUIRED PERFORMANCE ARE: 90% (36/40) for EWI(1), 20% (8/40) for EWI(2); 20% (8/40) for EWI(3); 0% (0/37) for EWI(4); and 45% (17/38) for EWI 5. ARV prescribing practices were in conformity with the national guidelines in almost all the sites, whereas patient adherence to ART (EWI(2), EWI(3), and EWI(4)) was very low. A high rate of patients was lost-to-follow-up and others failing first line ART before 12 months of initiation. Discontinuity in drug supply observed in about half of the sites may negatively impact ARV prescription and patient adherence. These poor ART performances may also be due to low number of trained staff and community disengagement. CONCLUSIONS: The poor performance of the national ART programme, due to patient non-adherence and drug stock outs, requires corrective measures to limit risks of HIVDR emergence in Cameroon

Overall national ART performance for each EWI.

<p>Overall national ART performance for each EWI.</p

Evaluation of EWIs in each of the 40 surveyed sites during the year 2010.

<p>In <i>“</i><b><i>Bold</i></b><i>”</i>: EWI reaching the required target. NV: Not Validated. NA: Not Available.</p><p><u>EWI</u>: Early Warning Indicator.</p><p><u>EWI₁</u>: Percentage of patients initiated on an appropriate first line ARV drug regimen, following national guidelines (Required target performance: 100%);</p><p><u>EWI₂</u>: Percentage of patient lost to follow-up after 12 months of enrolment to ART (Required target performance: ≤20%);</p><p><u>EWI₃</u>: Percentage of patient retained on appropriate first line ART after 12 month of treatment (Required target performance: ≥70%);</p><p><u>EWI₄</u>: Percentage of patients picking-up their ARV drugs on-time at the pharmacy of the ART site (Required target performance: ≥90%);</p><p><u>EWI₅</u>: Percentage of months without ARV drug shutdown at the pharmacy of the ART site (Required target performance: 100%).</p

Staff/Patient ratio in the overall study population.

<p>Staff/Patient ratio in the overall study population.</p