Joseph FOKAM1 , Armanda NANGMO2* , Desire TAKOU1, Maria Mercedes SANTORO3, Carlson WANDUM2 , Anne Esther NJOMNLEND4, Francis NDONGO ATEBA, Francis KOKI NDOMBO5, Dora MBANYA2, Alexis NDJOLO1, Carlo Frederico PERNO3, Vittorio COLLIZI3
1Chantal BIYA's Reference Center for HIV/AIDS research and management; 2University of Bamenda; 3University of Rome Tor Vergata ,Rome ; 4National Social Welfare Hospital; 5Mother-Child Center of the Chantal BIYA's foundation
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OSEP053
Background: The high mortality rate among HIV vertically infected adolescents might be favoured by HIV drug resistance (HIVDR) emergence, which prompts the need for identifying indicators of HIVDR, in order to implement corrective measures. Based on extensive PMTCT-exposure and long-term treatment experience, risks of acquiring HIVDR is higher in urban settings
Objectif: We therefore sought to evaluate determinants of HIVDR among vertically infected adolescents living in an urban setting, using program quality indicators.
Methodology: As baseline assessment of the EDCTP READY-Study, a survey was conducted among adolescents (10-19 years) receiving antiretroviral therapy (ART) in two reference paediatric centres of the Centre region: The Chantal BIYA Foundation's Mother-Child Centre (MCC) and the National Social Welfare Hospital (NSWH) in Yaoundé. Using ART registers, patient files and pharmacy records, data were abstracted for seven quality-indicators: "on-time drug pick-up" "retention in care" "drug supply continuity" "dispensing practices" "viral load coverage" "viral suppression" and "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: Among 888 adolescents registered in both clinics, data were available for 554 (323 in MCC and 231 in NSWH). Performance in the MCC and NSWH were respectively: "on-time drug pick-up" varied significantly (81.7% and 65%, p=0.001); "retention in care" was fairly acceptable in both sites (80% and 80%, p=1.000); "drug supply continuity" was poor in both sites (17% and 0%, p=0.13); "dispensing practices" was desirable (100% and 100%, p=1.000); "viral load coverage" was fairly acceptable (80% and 87%, p=0.18); "viral suppression" was poor and significantly different (25.8% and 42.4%, p=0.01); "adequate switch to second-line" was 35.3% and 42.1%, p=0.68.
Conclusion/Recommandation: In these reference paediatric centres, dispensing practices were standard following national guidelines (triple ART). Secondly, patient retention in care and viral load coverage were encouraging in both study sites. However, delayed drug pick-up (in NSWH), pharmacy stock outs and poor viral suppression (remarkably in the MCC), are major factors of HIVDR-emergence. Thus, limiting HIVDR among adolescents require improved drug supply machinery and timely switch to second-line driven by a close viral load monitoring.
Key Words: Quality indicators, HIV drug resistance