Joseph FOKAM1 , Carlson WANDUM2*, Desire TAKOU1, Maria-Mercedes SANTORO3, Armanda NANGMO2, Cedric KAMTA4, Andre ESSIANE5, Chanceline LAMBO6 , Charles FOKUNANG7, Vittorio COLIZZI3 , Carlo-Fedrico PERNO8 , Alexis NDJOLO1
1Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management 2Faculty of Health Sciences, University of Bamenda ; 3University of Rome Tor Vergata,Rome,Italy ; 4Mfou District Hospital ;5Mbalmayo District Hospital ; 6Nkomo Healthcare Centre; 7Faculty of Medicine and Biomedical Sciences ; 8University of Milan,Italy
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OAU037
Background: Prolonged exposure to antiretrovirals following perinatal infection predisposes to HIV drug resistance (HIVDR) emergence at adolescence. Considering challenges faced by adolescents in rural settings, identifying risk factors for HIVDR emergence among this population is essential for public health actions toward a long-term survival and effective transition to adult care.
Objectif: To evaluate quality indicators of HIVDR emergence among perinatally infected adolescents on antiretroviral therapy (ART) in the rural settings of the Centre region of Cameroon.
Methodology: Using a retrospective review of clinical data in the EDCTP READY-Study, 79 adolescents (10-19 years) receiving ART in three clinics in rural settings of the centre region of Cameroon (Mfou District Hospital [MFDH], Mbalmayo District Hospital [MBDH], and Nkomo Healthcare Centre [NHC]) were monitored based on seven HIVDR quality indicators: (1) "on-time drug pick-up" (2) "retention in care" (3) "drug supply continuity" (4) "pharmacy dispensing practices" (5) "viral load coverage" (6) "viral suppression" and (7) "adequate switch to second-line". HIVDR determinants were identified following the thresholds of WHO-recommended quality indicators (desirable, fair, or poor performance), with p <0.05 considered significant.
Results : Performance at MFDH, MBDH and NHC were respectively: "on-time drug pick-up" was poor in all the sites (31.3%, 37.5% and 50.6%, p=0.180); "retention in care" was varied consistently between sites (83.3%, 51.6% and 86.7%, p=0.010); "drug supply continuity" was poor per site (50%, 41.7% and 58.3%, p=0.913); "pharmacy dispensing practices" was desirable as per the national guidelines (100%, 100% and 100%, p=1.000); "viral load coverage" was poor per site (27.8%, 22.3% and 56.7%, p=0.015); "viral suppression" was also poor (66.7%, 75% and 41.7%, p=0.546), and "adequate switch to second-line" was desirable in the evaluated site (NA, NA and 100%).
Conclusion/Recommandation :In spite of the good dispensing practices (triple ART), adolescents in rural settings are at high risk of acquiring HIVDR due to delayed drug pick-up, poor viral monitoring and poor viral suppression; which are likely favoured by events of drug stock outs. Therefore, successful transition of adolescents toward adult care in rural settings requires tracing for defaulters, increasing access to viral load, intensifying ART compliance for viral suppression, while ensuring a regular drug supply machinery.
Key Words: HIV drug resistance quality indicators, adolescents.