Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis.

Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. Achieving the third 95 (viral load suppression) is the most desirable target in HIV care. We aimed to evaluate the effectiveness of this novel approach on access to viral load testing (VLT), viral suppression (VLS), and viral load rebound (VLR). A retrospective cohort study was conducted at The Nkongsamba Regional Hospital to compare VLT outcomes between the pre-UTT (2002 to 2015) and the post-UTT (2016 to 2020) periods. We used a data extraction form to collect routine data on adult patients living with HIV. We measured uptake levels of the first and serial VLT and compared the incidence rates of VLS (VL<1000 copies/ml) and viral load rebound (VLR) before and after introducing the UTT approach using Kaplan Meier plots and log-rank tests. Cox regression was used to screen for factors independently associated with VLS and VLR events between the guideline periods. Access to initial VLT increased significantly from 6.11% to 25.56% at 6 months and from 12.00% to 73.75% at 12 months before and after introducing the UTT guidelines respectively. After a total observation time at risk of 17001.63 person-months, the UTT group achieved an incidence rate of 90.36 VLS per 1000 person-months, four-fold higher than the 21.71 VLS per 1000 person-months observed in the pre-UTT group (p<0.0001). After adjusting for confounding, the VLS rate was about 6-fold higher in the UTT group than in the pre-UTT group (adjusted Hazard Rate (aHR) = 5.81 (95% confidence interval (95%CI): 4.43-7.60). The incidence of VLR increased from 12.60 (95%CI: 9.50-16.72) to 19.11 (95%CI: 14.22-25.67) per 1000 person-months before and after the introduction of UTT guidelines respectively. After adjusting, VLR was more than twice as high in the UTT group than in the pre-UTT group (aHR = 2.32, 95%CI: 1.30-4.13). Increased access to initial VLT and higher rates of VLS have been observed but there are concerns that the suppressed viral load may not be durable since the introduction of the UTT policy in this setting.

The declining trend in HIV prevalence from population-based surveys in Cameroon between 2004 and 2018: myth or reality in the universal test and treat era?

BACKGROUND: HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to 'universal test and treat' and to explore the reason for the decrease, particularly the role of behavioural change. METHODS: We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991-2018 period. Regression coefficients associated p-values and 95% confidence intervals were obtained using Microsoft Excel software. RESULTS: Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8-4.8) in 2011 and further down to 2.7% (95%CI: 2.3-3.1) in 2018 at a rate of about 1.4% every septennium (ß = -1.4, R² = 0.98, p = 0.03). Yet, the number of persons surviving with HIV increased from about 0.05 million in 1991 to 0.5 million in 2018 corresponding to an increase in access to antiretroviral therapy from less than 10% to universal coverage of 80% respectively. Concurrent reductions in risky sexual behaviours were observed: a delayed sexual debut by one year, decreased sexual violence by 7%, decreased polygamous unions by 16%, decreased multiple sexual partners by 15.3% and increased condom use by 26.3%. CONCLUSION: The observed decline in HIV prevalence is statistically valid and reflects the observed decline in risky sexual behaviour that need to be sustained by the National HIV programme. Though universal access to ART has increased the number of persons surviving with HIV, this has not led to an increased prevalence of HIV in a setting with a rising population.

The effect of the Universal Test and Treat policy uptake on CD4 count testing and incidence of opportunistic infections among people living with HIV infection in Cameroon: a retrospective analysis of routine data.

Background: Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. UTT has shown inconsistent results elsewhere and has not yet been assessed in Cameroon. We aimed to evaluate the effectiveness of this novel approach on the quality of care and health outcomes of people living with HIV (PLHIV). Methods: A retrospective cohort design was conducted at The Nkongsamba Regional Hospital, using routine clinical service delivery data to measure uptake levels of UTT and CD4 testing, and to compare the incidence of opportunistic infections (OI) between PLHIV initiated on ART based on the "Universal Test and Treat" strategy and those initiated on ART based on the standard deferred approach between 2002 and 2020. Kaplan Meier plots and log-rank tests were used to compare OI events between the pre-UTT and post-UTT eras. The Cox regression model was used to screen for factors independently associated with the risk of acquisition of OI. Results: The uptake of UTT ranged from 39.1% to 92.8% while baseline CD4 count testing reduced drastically from 89.4% to 0.4% between 2016 to 2020 respectively. The median delay in ART initiation declined significantly from 21 days (IQR: 9 - 113) in the pre-UTT era to the same day of diagnosis (IQR: 0 - 2) in the UTT era (p < 0.001). The incidence of all OI events reported was over five times higher during the UTT era than in the pre-UTT era [aHR = 5.55 (95% CI: 3.18 - 9.69), p < 0.001]. Conclusion: The UTT policy has been effectively rolled out and has contributed to improved access to rapid and immediate ART initiation, but a higher incidence of OIs was observed with a rollback of baseline CD4 testing. We advocate for a return to routine baseline CD4 measurement to identify PLHIV who should benefit from interventions to prevent OIs for optimal outcomes under the UTT approach.

Environmental exposure to carcinogens in northwestern Cameroon.

BACKGROUND: In developing countries, 6% of deaths are due to cancer but cancer prevention is not practiced. Humans can prevent themselves from a number of workplace and environmental carcinogens. OBJECTIVES: To assess exposure to carcinogens, risky behaviours and associated preventive methods. METHODS: A structured questionnaire was used to collect information on carcinogen exposure in the workplace and environment through trained field staff from volunteers after gaining informed consent. Data was analysed using SPSS. RESULTS: Participants were exposed to recognized carcinogens and environmental hazards. Thirty-five (83.3%) [95% CI: 72.0- 94.6] participants knew the carcinogen names they were exposed to. Common hygienic practices such as taking a bath and washing work dresses at the workplace, use of detergents to wash hands, and no smoking or eating at the workplace were poor. Twenty-nine (69.0%) [95% CI: 47.0 - 75.0] participants could smell the carcinogenic chemicals they use. Thirty (71.4%) [95% CI: 65.0 - 77.0] participants had been instructed in the use of protective equipment against carcinogens. Participants used preventive devices like hand gloves, laboratory coats, boots, face masks, goggles, ear plugs and respirators. CONCLUSIONS: Exposure to carcinogens is common necessitating case-control and cohort studies in this locality on cancer prevalence and incidence.

HIV-1/HIV-2 co-infection among voluntary counselling and testing subjects at a regional hospital in Cameroon.

BACKGROUND: HIV/AIDS is a major public health problem in Cameroon which had a prevalence of 5.1% in 2010 with 141 new infections per day. The fear of voluntary counseling and testing (VCT) is an obstacle to HIV prevention. OBJECTIVES: To determine the prevalence of HIV-1, HIV-2 and HIV-1/HIV-2 co-infection among people attending a health facility for VCT. METHODS: Venous blood was collected from participants using aseptic techniques in a descriptive observational cross-sectional study. DETERMINE HIV-1/2 and SD BIOLINE HIV-1/2 3.0 qualitative tests were used for the detection of HIV-1 and HIV-2 in their sera. Range and consistency checks were carried out on the data and analysed using Epi-Info. RESULTS: Of 290 individuals tested, 78(26.9%) were positive for HIV-1 and HIV-2. Among the 78 HIV positive individuals, 62 (79.5%) had HIV-1, 1(1.3%) had HIV-2 and 15(19.2%) had concurrent HIV-1/ HIV-2. Among those infected, 57(73.1%) were females including 21(26.9%) males. CONCLUSION: HIV-1 is the major cause of AIDS and VCT is well accepted. Co-infection with HIV-1/HIV-2 may lead to anti-retroviral drug resistance. VCT should be encouraged so that positive cases can initiate therapy on time to stay ahead of anti-retroviral drug resistance.

The incidence of feco-oral parasites in street-food vendors in Buea, south-west region Cameroon.

BACKGROUND: The street-food industry lacks legal recognition, it operates in unstable and precarious conditions, involving women and men with minimal or no knowledge of hygienic food handling practices. Infective eggs, bacteria, toxins and cysts of faecal orally transmissible parasites are common agents responsible for food contamination in developing countries. OBJECTIVE: To determine the incidence of digestive faecal-oral parasites among street-food vendors in Buea, South-west region of Cameroon, METHODS: From March to May 2009, physical and laboratory analysis of stool samples of 150 randomly selected street-food vendors, residing in four different zones in the municipality were carried out. Information on environmental and personal hygiene was also collected. RESULTS: Results revealed that 56.7% of the sampled population was infected with faecal-oral parasites. The major faecal-oral parasites detected in stool samples were: Entamoeba coli (14.0%), Entamoeba histolytica (12.67%), Ascaris lumbricoides (11.33%), Ankylostoma duodenalis (10.67%). Childcare activities, lack of deworming, poor personal hygiene, poor sanitary and toilet facilities, were factors promoting the spread of faecal-oral infections. CONCLUSION: Food vendors should be educated on personal hygiene and safe food handling measures. Regulatory procedures on environmental hygiene and regular medical and paramedical follow up of food vendors should be enforced.

A critical review on HIV/AIDS and wound care

Wound infections in AIDS patients increase discomfort; prolong hospital stay; render an additional burden upon an already debilitated patient and weaken the immune system further. Treatment must relate to the aetiology of the wound and take into account the patients underlying health problems. The treatment of wounds in HIV-AIDS patients is not different from the standard treatment. There are wound -related criteria for selecting the appropriate types of dressing. The best dressing for postoperative wound healing by secondary intention is unknown. Continuing wound evaluation and the appraisal of what dressing is useful for the type of wound and stage of healing is the basis of optimum wound care Optimum wound care; emotional support; health education will enhance both the emotional and physical wellbeing of the HIV-AIDS patient

Epidemiological studies on proteeae isolates from clinical specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine; 264 blood; 243 CSF and 195 wounds and burns; 1136 (33.3) yielded a positive bacterial growth; of which 230 (20.2) were Gram positive and 906 (79.7) were Gram negative. 164 (14.4) isolates were identified as members of Proteeae of which 110 (67.1) were from urine; 37( 22.6) from wounds and burns; 10(6.1) from blood and 7( 4.3) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7) were Proteus mirabilis; 21(12.8) Proteus vulgaris; 11 (6.7) Providencia alcalifaciens; 6 (3.6) Providencia stuartii; 4 (2.4) Morganella morganii and 5 (3.0) Proteus penneri and Providencia rettgeri. There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p0.05). Most Proteeae isolates where susceptible to imipemen; ceftazidine; chloramphenicol; gentamicin; nalidixic acid; ofloxacin and amikacin. These findings have significant clinical and epidemiological implications

Schistosomiasis in Cameroon: an assessment of community knowledge pattern.

OBJECTIVE: Schistosomiasis is one of the most widespread of all human parasitic diseases and is a serious health problem in Cameroon despite tremendous efforts by health authorities. The purpose of this study was to determine community knowledge of the infection in order to evaluate control programmes put in place. METHODS: A random sampling method was used to administer questionnaires to 3200 individuals in 80 communities throughout the ten regions of the country. RESULTS: Globally the percentage of persons with good knowledge of schistosomiasis was low (28.8%). Of the 2586 who responded 1311 (50.7%) were females and 1275 (49.3%) were males. There was a statistically significant difference in the community knowledge pattern by gender (chi2 = 157.28, P < 0.05), and persons with good knowledge were more frequent among males than females (61.8% vs. 38.2% P < 0.05). The percentage of people who had good knowledge about the disease was highest in the Far North region (35.4), followed by the North (33.8) and the Southwest (31.1) regions. There was a statistically significant difference in community knowledge pattern of Schistosomiasis by region and gender (chi2 = 1265.648 P < 0.001). Also, there was a statistically significant difference in community knowledge pattern of by setting (chi2 = 38.538 P = 0.001) and the percentage of people who had a good knowledge of the disease was higher in rural areas than in urban areas (72.5% vs. 3.1% P < 0.05). CONCLUSION: was a low community knowledge pattern of schistosomiasis, mostly among the female population and among people living in urban areas. We advocated that health education should be adopted as one of the control strategies by the

Seroprevalence of Toxoplasma Gondii Infection among Pregnant Women in Cameroon

Toxoplasmosis is caused by an intracellular protozoan; Toxoplasma gondii; which has a wide geographical distribution. The congenital form results in a gestational form that can present a temporary parasiteamia that will infect the fetus. For this reason early diagnosis in pregnancy is highly desirable; allowing prompt intervention in cases of infection. The aim of this study was to determine the seroprevalence of Toxoplasma gondii antibodies among pregnant women attending the Douala General Hospital. The study was carried out between March and July 2009; whereby 110 pregnant women were tested for IgG and IgM antibodies and information about eating habits and hygienic conditions was collected using a questionnaire. These women's ages ranged from 20-44 years old with an average of 29.9 years; the overall IgG and IgM seroprevalence was 70and 2.73respectively. Seroprevalence was significantly high amongst women who ate raw vegetables (76.39; P0.05) and there was a significant trend towards a higher seroprevalence in women who did not have a good source of water (75.58; P0.05). This research showed that consumption raw vegetables and poor quality drinking water are two risk factors associated with Toxoplasma gondii infection amongst pregnant women attending the Douala General Hospital in Cameroon

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey.

BACKGROUND: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold. OBJECTIVE: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. METHODS: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. RESULTS: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. CONCLUSION: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey.

BACKGROUND: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold. OBJECTIVE: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. METHODS: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. RESULTS: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991. From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. CONCLUSION: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Childhood Leprosy in Essimbiland of Cameroon: Results of Chart Review and School Survey

Background: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT; endemic pools still exist in some countries that have attained the national elimination threshold. Objective: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. Methods: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. Results: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review; 42 (23.3) new leprosy cases from 1961-1967 and 35 (12.2) from 1982-1998 were from the Mbingo leprosarium. 31(39.7) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998; 24(68.6) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools; 6(1.3) new leprosy cases were identified giving a prevalence of 131 per 10;000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16(3.5) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. Conclusion: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-tohouse search for new cases

Hippurate hydrolysis and Christie, Atkins, Munch-Peterson tests as epidemiological diagnostic tools for Streptococcus agalactiae carriage in pregnancy.

OBJECTIVE: To evaluate the Christie, Atkins, Munch-Peterson (CAMP) and hippurate hydrolysis reactions as diagnostic tools for Streptococcus agalactiae carriage in pregnancy. DESIGN: Observational, analytical case-control study. SETTING: Hospital-based study in a primary and a tertiary health care institution. PATIENTS: One hundred and six pregnant and 56 non-pregnant (controls) women were included in the study. The participants were of different socio-economic status. A volunteer sample was used. About 800 subjects were contacted and 162 participated in the study. RESULTS: The sensitivity of the screening test varied from 25% for the CAMP test to 77.78% for the hippurate hydrolysis reaction. The specificity was the same for both tests at (50%). A significant difference in positivity between the CAMP and hippurate hydrolysis reactions (95% confidence limit, P < 0.05) was observed. The predictive values of the positive test were 66.6% (CAMP) and 87.55% (hippurate hydrolysis) while the negative test were 14.29% (CAMP) and 33.30% (hippurate hydrolysis). Pregnant women had 0.33 chances of being GBS carriers with the CAMP compared to 3.5 with the hippurate hydrolysis. CONCLUSION: The hippurate hydrolysis test is highly recommended since the reagents are easily available and the organism was easily isolated using this method. The presence of GBS in the anorectum and endocervix is likely to induce systemic and local immunity in the female genital tract. This can contribute to the development of a mucosal vaccine for GBS diseases.