Integrating Cervical Cancer Screening with HIV Care in Cameroon: Comparative Risk Analysis of Cervical Disease in HIV-Infected Women Receiving Antiretroviral Therapy to Women in the General Population.

BACKGROUND: While the effect of highly active antiretroviral therapy (HAART) on natural history of cervical lesions remains controversial, resource limited countries need to understand the relevance of their own data to their settings. We compared the risk of cervical disease in HAART-experienced women with that in women in the general population of Cameroon. METHODS: A retrospective cross sectional survey of women aged 35 years and above, attending a voluntary screening campaign for cervical cancer at the Nkongsamba Regional Hospital in Cameroon between February and May 2014. Squamous intraepithelial lesions (SIL) were determined by Pap smear. Multiple logistic regression was used to compare the odds of SIL in women on HAART to women from the community with unknown HIV status. RESULTS: Included were 302 women of whom 131(43.4%) were HIV-infected and receiving HAART on the site while 171 (56.6%) were women from the community. Cervical disease was observed in 51(16.9%) persons of whom 15 (11.5%) cases in the HAART group and 36 (21.1%) cases in the general group (p = 0.027). After controlling for age and other covariates, women in the HAART group had a 67% reduction in the odds of cervical lesions compared with the community group [adjusted odd ratio (aOR) = 0.33, 95%CI: 0.15-0.73, p = 0.006). CONCLUSION: HIV-infected women receiving HAART have a lower risk of cancer than women in the general population. This finding may not be attributed to HAART alone but to all the health benefits derived from receiving a comprehensive HIV care.

[Immunization programme in urban areas in Cameroon: a case study of the Djoungolo Health District]. / L'offre des services de vaccination en milieu urbain, au Cameroun: étude de cas du District de Santé de Djoungolo.

INTRODUCTION: Cameroon's cities have a growing concentration of target children not adequately covered by routine immunization programmes. METHODS: We conducted a descriptive cross-sectional study, based on exhaustive sampling of legal health care facilities offering routine immunization services in the health district of Djoungolo (city of Yaoundé). The evaluation of the immunization programmes was based on the "Reaching Every District" approach. RESULTS: Out of the 70 health care facilities that participated in the study, 3 (4.3%) had an updated microplan for routine immunization. Out of the 63 (89.4%) health care facilities with functional refrigerator, 12 (19.0%) vaccinated employing a fixed strategy on daily basis. Fifty-seven (81.0%) health care facilities did not conduct immunization sessions employing advanced strategy. Community participation in routine immunization programs was effective in 1 out of 12 districts health areas. A steadily updated vaccine tracking curve was available in 6 (8.5%) health facilities. CONCLUSION: The "Reaching Every District" approach implemented in Djoungolo health care district doesn't provide adequate coverage of a maximum rate of targeted children. The effectiveness of realistic microplanning, the regularity of vaccination sessions employing fixed and advanced strategies, action-oriented data monitoring, community revitalization plan to promote immunization are ways to improve the provision of vaccination services in this district.

Evaluating the utility of early laboratory monitoring of antiretroviral-induced haematological and hepatic toxicity in HIV-infected persons in Cameroon.

BACKGROUND: The antiretroviral therapy (ART) program of Cameroon recommends routine laboratory monitoring of haematological toxicity if a regimen contains zidovudine (AZT) and of hepatotoxicity for NVP-containing regimens on the 15th day after ART initiation. This study aimed to assess the relevance of this repeated laboratory measurements considered to be precocious, inaccessible and unavailable in a resource limited setting. METHODS: A retrospective cohort of HIV-infected patients of age 15 years and above enrolled for first line ART at The Regional Hospital of Nkongsamba in Cameroon. We monitored liver transaminases and blood cell indices after two weeks of ART initiation for any significant change from baseline. Factors associated with abnormal changes were examined using a multivariable logistic regression model with random effects. RESULTS: Enrolled were 154 patients of whom 105 (68.2%) were females. The mean ALAT (alanine aminotransferase) level at baseline was 17.87 ± 20.48 U/L increasing to 19.25 ± 12.01 U/L at two weeks of follow-up (p = 0.53) while the mean ASAT (aspartate aminotransferase) level increased from 17.32 ± 11.87 U/L at baseline to 21.02 ± 14.12 U/L at two weeks of follow-up (p = 0.02). We observed a drop in the mean haemoglobin concentration from 10.86 ± 2.63 g/dL at baseline to 10.36 ± 1.92 g/dL at the second week of follow-up (p = 0.02). The prevalence of elevated liver enzymes and anaemia after two weeks of treatment were 7.5% and 39.2% respectively. Stavudine containing regimens were most likely to induce hepatotoxicity [adjusted Odd Ratio (aOR) = 36.52, 95% CI: 1.44-924.38, p=0.029]. Baseline anaemia (aOR=60.08, 95% CI: 13.36-270.20, p < 0.0001) and body weight ≥ 60kg (aOR=0.28, 95% CI: 0.09-0.83, p = 0.02) were associated with anaemia at follow-up. CONCLUSION: There was no significant rise in the mean level of transaminases and thus scheduling their routine monitoring at the end of the second week could be skipped. Conversely, the drop in mean haemoglobin level had little clinical importance but the high prevalence of anaemia after a fortnight on treatment suggests a targeted instead of a routine monitoring; focusing on the high risk population with baseline anaemia and low body weight.

The lipid profile of HIV-infected patients receiving antiretroviral therapy in a rural Cameroonian population.

BACKGROUND: Long term use of antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLWHIV) is associated with disturbances in blood lipids which should be monitored. More data on such disturbances are needed in Cameroon to persuade the country program to institute their routine monitoring. We then sought to determine the prevalence and timing of dyslipidaemia in PLWHIV and receiving ART in a predominantly rural Cameroonian setting. METHODS: A cross-sectional study conducted between August and October 2012 in HIV-infected persons aged 15 years or more and receiving first-line ART for at least six months at The Nkongsamba Regional Hospital in Cameroon. Lipid assays were carried out by enzymatic-linked colorimetric methods. A multiple logistic regression model was used to assess for factors related to dyslipidaemia. RESULTS: Included were 114 participants of whom 83 (72.8%) were females. Their median age was 43 years (IQR: 36-51) and their median CD4 count was 436 cells/µl (IQR: 275-585) after a median duration on ART of 36 months (IQR: 12-60). The prevalence of dyslipidaemia was 70.2%. Hypercholesterolaemia was observed in 34 (29.8%) patients. One-third of them had a high LDL-cholesterol level (LDL-c≥130 mg/dl). Hypertriglyceridaemia (TG≥150 mg/dl) was present in 59 (51.8%) cases. The proportion of patients with a low HDL-cholesterol (HDL-c<40 mg/dl) was 18.4% while those with a ratio of TC/HDL-c≥5 were about 16.7%. A duration of 2-4 years on ART (adjusted Odd Ratio, aOR=5.22, 95% CI: 1.43-19.06, p=0.01), current smokers (aOR=15.94, 95% CI: 1.13-225.61, p=0.04) and a concurrent metabolic disease (aOR=12.54, 95% CI: 1.02-153.86, p=0.48) were independently associated with pro-atherogenic LDL-c values. Alcohol users had a more friendly LDL-c profile (aOR=0.24, 95% CI: 0.07-0.74, p=0.01). CONCLUSION: The study has demonstrated a high prevalence of dyslipidaemia in HIV-patients receiving first-line ART in a predominantly rural setting of Cameroon. There is a need for the country HIV program to institute laboratory monitoring of blood lipids in patients over two years on first line ART with a focus on smokers.

Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon.

BACKGROUND: Access to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges. METHODS: A retrospective review of point of care data from HIV patients was conducted in June 2012 at Nkongsamba Regional Hospital in Cameroon to establish mortality and LTFU rates. Univariable and multivariable Cox regression models were used to screen for factors associated with the outcomes. Telephone calls were made to trace patients LTFU. RESULTS: Between June 2005 and December 2010, 2388 HIV infected patients were admitted. Of these, 1858 were aged 15 and above and were included in our analysis. Their median age was 36 years (IQR: 30-44) and they were followed up over a total risk period of 3647.3 person-years (pyrs). The overall mortality rate was 34.6 deaths per 1000 pyrs (95% CI: 29.0-41.1) while the overall LTFU rate was 94.6 per 1000 pyrs (95%CI: 85.1-105.1).The mortality rates steadily rose to a peak of 69.6 deaths per 1000 pyrs in 2009 and then fell drastically to 20.6 per 1000 pyrs in 2010. The LTFU rate increased sharply from 29.7 in 2006 to 138.2 in 2007 and remained virtually stable until 2010. The factors associated with mortality were: being male (aHR=2.25, 95% CI: 1.58-3.19), clinical disease progression (aHR=2.0, 95% CI: 1.58-2.53), CD4 count<200 cells/µl (aHR=3.14, 95% CI: 1.27-7.73), haemoglobin level<10 g/dl (aHR=2.50, 95% CI: 1.69-3.69). Major factors associated with high LTFU rate were: distance to clinic of over 5 km (aHR=1.25, 95% CI: 1.00-1.55), being single, having partners with unknown HIV status or taking no treatment and with CD4 count>500 cells/µl. Two- thirds (66.7%) of traced LTFU patients were dead. CONCLUSION: Mortality and LTFU rates in our cohort were high but there is evidence that patients' outcomes are improving. Interventions to address factors associated with high mortality and LTFU should be implemented for optimal results in patient care.

[Risky Sexual Behavior And Prevalence Of HIV In Sex Workers In Douala In 2011]. / Comportements Sexuels A Risque Et Seroprevalence Du VIH Chez Des Travailleuses De Sexe De Douala En 2011.

BACKGROUND: With an HIV seroprevalence of 14%, sex workers in Douala remain a population at high risk of viral infection. Many campaigns have been carried out with the objective of informing and helping to prevent the spread of infections. This study aims to identify the reoccurring and new risky sexual behaviors and to make recommendations concerning the observations. MATERIALS AND METHODS: A cross sectional study was carried out in the city of Douala. Screening tests were carried out and a questionnaire looked at information concerning different variables. The associations between these variables were evaluated by calculating odds ratios rough-and their confidence intervals at 95%. RESULTS: A seroprevalence of 12.5% was recorded. The average years worked were 25±3. We noted 89% of participants were on HIV medicine (P= 0.001). There was no significant correlation between the sex worker's age and her HIV status (P= 0.458), and no significant correlation between their age and educational level (P= 0.502). 89% of the participants reported using condoms during their paid sexual relations, among them 9% were HIV positive (P=0.04). 87.5% of HIV positive participants reported engaging in anal sex (P=0.007). CONCLUSION: Seroprevalence remains high in sex workers in Douala. They continue to engage in risky sexual behaviors, endangering themselves and their partners. We therefore suggest to increase informational campaigns to increase awareness in this at-risk population.

INTRODUCTION: Avec une séroprévalence au VIH estimée à 14%, les travailleuses du sexe constituent un groupe à risque élevé dans la ville de Douala. Afin de réduire les risques de contamination et de transmission au sein de cette frange de la population, de nombreuses campagnes de sensibilisation et de prévention ont été organisées à cet effet. La présente étude compte répertorier les comportements sexuels à risque résiduels et /ou nouveaux observés au cours leurs activités quotidiennes et d'en faire de recommandations. MATÉRIELS ET MÉTHODES: Une étude transversale a été menée pour cela dans la ville de Douala. Des tests de dépistage ont été effectués et un questionnaire prétexté renseignait sur différentes variables. Le test du khi carré a été utilisé pour la mesure des associations entre les variables. Le seuil de significativité était de 5%. RÉSULTATS: La séroprévalence était de 12,5%. L'âge moyen de travail était de 25±3 ans. On comptait 89% des consommatrices de drogue séropositives (P= 0,001). On ne notait pas d'association significative entre l'âge des sujets et leur statut sérologique (p= 0,458), encore moins avec leur niveau d'instruction (p= 0,502). Dans cette étude, 89% de sujets disaient utiliser des préservatifs pendant les rapports sexuels payant et parmi elles, 9% étaient séropositives (P=0,04). On comptait 87,5% de séropositives qui avaient des rapports anaux (P=0,007). CONCLUSION: La séroprévalence demeure importante chez les travailleuses de sexe à Douala. Elles pratiquent toujours des comportements sexuels à risque susceptibles de les exposer ainsi que leurs partenaires. Des efforts de sensibilisation sont donc recommander au profit de cette population à risque.

Improved measles surveillance in Cameroon reveals two major dynamic patterns of incidence.

OBJECTIVE: To characterize the province-specific incidence patterns of measles in Cameroon and determine if an increase in measles incidence during the period January 2000-June 2001 is consistent with coincident epidemics in several regions with different inter-epidemic periods. METHOD: Periodic behavior of the monthly measles incidence time-series from each province of Cameroon was analyzed using time-series analysis and cluster techniques. Cumulative incidence in each province of Cameroon over a five-year period was associated with birth rates, and vaccination coverage. RESULTS: Distinct patterns of measles incidence were found in two different areas of Cameroon. The three northern-most provinces experience major epidemics every year. Seven southern provinces show evidence of experiencing major epidemics every third year. In January 2000, Cameroon experienced coincident peaks in these two cycles and thus an increase in measles incidence countrywide over the previous year. Higher cumulative province-specific incidence rates were associated with higher birth rates and lower routine vaccination coverage rates. CONCLUSION: Within one country, two dramatically different dynamic patterns of measles incidence were observed. Long-term surveillance data is crucial to the evaluation of measles immunization campaigns. The availability of a five-year record of measles incidence in Cameroon reveals an interesting dynamic pattern of measles incidence that accounts for the increase in countrywide incidence in 2000-2001.