Abstract:

Despite considerable progress in the scale-up of antiretroviral therapy programs in Cameroon, disparities persist between urban and rural settings. Understanding the characteristics of rural populations is crucial for designing effective, context-specific interventions that address barriers to early HIV care engagement. A retrospective cohort study was conducted of all HIV infected adults who initiated ART at 10 rural ART clinics in the Centre Region of Cameroon between June 2020 and May 2021. Patients’ medical records were reviewed for data collection. Of the 2 591 HIV infected adults included in the analysis, 983 (37.9%) were males and 1 608 (62.1%) females. Mean age at initiation was 38.91 ± 11.41 years with statistically significant difference between genders (p = 0.0002). A higher percentage of females (34.8%) initiated care in the 21-30 years age group than males (18.6%) (χ² = 87.163, p < 0.0001). More females initiating ART had no formal education (10.3%) or primary education (42.3%) compared to their male counterparts (8.1% and 40.7%, respectively) (χ² = 13.213, p=0.021).  Females (56.7%) were more likely not to disclose their HIV status to their partners than males (53.2%) (χ² = 9.380, p = 0.009*). Moreover, more females (71.1%) compared to males (41.1%) initiated ART with TDF/3TC/DTG (χ² = 35.509, p < 0.0001*). The findings from the study show the complexity of demographic, behavioural and clinical factors influencing ART engagement emphasising the importance of tailored interventions to address the unique challenges faced by both males and females during this critical phase of care.

References:

[1] UNAIDS Data, 2023, Geneva: Joint United Nations Programme on HIV/AIDS. https://thepath.unaids.org/.

[2] HIV/AIDS Key facts. 2023, https://www.who.int/news-room/fact-sheets/detail/hiv-aids.

[3] Ministry of Public Health. Cameroon Country Operational Plan COP 2022: Strategic Direction Summary, Yaoundé. https://www.state.gov/wp-content/uploads/2022/09/Cameroon-COP22-SDS.pdf.

[4] Cameroon Population-based HIV Impact Assessment (CAMPHIA), 2017, a household-based national survey, conducted between July 2017 and February 2018 in order to measure the status of Cameroon’s national HIV response. https://phia.icap.columbia.edu/wp-content/uploads/2021/04/53059-CAMPHIA-Report_EN_Web_V4.pdf.

[5] Hudelson, C., Cluver, L., 2015, Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care, 27(7), 805-816. https://www.tandfonline.com/doi/abs/10.1080/09540121.2015.1011073.

[6] Makambo, M. T., Schuster, R. C., Allies, E., Decroo, T., Ford, N., Luong, D. H., Nhan, P., Van Damme, W., 2017, Falling through the cracks: a qualitative study of HIV risks among women who use drugs and alcohol in Northeast India. BMC Int Health Hum Rights, 17(1), 10. https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/1472-698x-13-9.

[7] Heckman, T. G., Somlai, A. M., Peters, J., Walker, J., Otto-Salaj, L., Galdabini, C. A., & Kelly, J. A., 1998, Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS care, 10(3), 365-375. https://www.tandfonline.com/doi/abs/10.1080/713612410.

[8] World Health Organization (WHO)., 2015, Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. World Health Organization. https://i-base.info/htb/28949.

[9] Boyer, S., Protopopescu, C., Marcellin, F., Carrieri, M. P., Koulla-Shiro, S., Moatti, J. P., Spire, B., 2018, Performance of HIV care decentralization from the patient's perspective: health-related quality of life and perceived quality of services in Cameroon. Health Policy Plann, 33(3), 314–324. https://academic.oup.com/heapol/article/27/4/301/604418?login=false.

[10] Julien, A., Anthierens, S., Van Rie, A., West, R., Maritze, M., Twine, R., Kahn, K., Lippman, S. A., Pettifor, A., & Leslie, H. H., 2021, Health Care Providers' Challenges to High-Quality HIV Care and Antiretroviral Treatment Retention in Rural South Africa. Qualitative Health Research, 31(4), 722–735. https://pubmed.ncbi.nlm.nih.gov/33570470/.

[11] CNLS., 2016, Annual report. Assessed on 12th June 2023. Available at: http://wwwcnlscm.

[12] World Health Organization (WHO)., 2019, Consolidated guidelines on HIV testing services. Geneva. https://www.who.int/publications/i/item/978-92-4-155058-1.

[13] Bassett, I. V., Regan, S., Mbonambi, H., Blossom, J., Bogan, S., Bearnot, B., et al., 2019, Finding HIV in hard-to-reach populations: mobile HIV testing and geospatial mapping in Umlazi township, Durban, South Africa. AIDS Behav, 23(7), 1874-1882. https://link.springer.com/article/10.1007/s10461-015-1012-3.

[14] Sharma, M., Ying, R., Tarr, G., Barnabas, R., 2015, Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature, 528(7580), S77-S85. https://www.nature.com/articles/nature16044.

[15] Ng’ang’a, A., Waruiru, W., Ngare, C., Ssempijja, V., Gachuki, T., Njoroge, I., et al., 2014, The status of HIV testing and counseling in Kenya: results from a nationally representative population-based survey. J Acquir Immune Defic Syndr, 66, S27-S36. https://journals.lww.com/jaids/Fulltext/2014/05011/The_Status_of_HIV_Testing_and_Counseling_in_Kenya_.4.aspx.

[16] Wouters, E., van Loon, F., van Rensburg, D., Meulemans, H., 2012, Community support and disclosure of HIV serostatus to family members by public-sector antiretroviral treatment patients in the Free State Province of South Africa. AIDS Patient Care STDs, 26(4), 241-248. https://www.liebertpub.com/doi/abs/10.1089/apc.2008.0201.

[17] Loubiere, S., Peretti-Watel, P., Boyer, S., Blanche, J., Abega, S. C., Spire, B., 2013, HIV disclosure and unsafe sex among HIV-infected women in Cameroon: results from the ANRS-EVAL study. Soc Sci Med, 97, 29-35. https://www.sciencedirect.com/science/article/abs/pii/S0277953609003414.

[18] DHS, 2018, Demographic and Health Survey, Cameroon. https://dhsprogram.com/pubs/pdf/SR266/SR266.pdf.

[19] Mills, E. J., Beyrer, C., Birungi, J., Dybul, M. R., Geng, E., Hogg, R. S., et al., 2019, Engaging men in prevention and care for HIV/AIDS in Africa. PLoS Med, 16(2), e1002751. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001167.

[20] Lines, M., & Suleman, F., 2017, Patients’ perceptions of a rural decentralised anti-retroviral therapy management and its impact on direct out-of-pocket spending. African Health Sciences, 17(3), 746-752. https://www.ajol.info/index.php/ahs/article/view/161249.

[21] Ndawinz, J. D., Chaix, B., Koulla-Shiro, S., Delaporte, E., Okouda, B., Abanda, A., ... & Supervie, V., 2013, Factors associated with late antiretroviral therapy initiation in Cameroon: a representative multilevel analysis. Journal of Antimicrobial Chemotherapy, 68(6), 1388-1399. https://academic.oup.com/jac/article/68/6/1388/761464?login=false.

[22] Lockwood, N. M., Lypen, K., Shalabi, F., Kumar, M., Ngugi, E., & Harper, G. W., 2019, 'Know that You are not Alone.' Influences of Social Support on Youth Newly Diagnosed with HIV in Kibera, Kenya: A Qualitative Study Informing Intervention Development. International Journal of Environmental Research and Public Health, 16(5), 775. https://www.mdpi.com/1660-4601/16/5/775.

[23] Nachega, J. B., Uthman, O. A., Peltzer, K., Richardson, L. A., Mills, E. J., Amekudzi, K., et al., 2012, Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis. Bull World Health Organ, 90(1), 73-82. https://wrap.warwick.ac.uk/65653/.

[24] White, C., Lentin, P., & Farnworth, L., 2013, An investigation into the role and meaning of occupation for people living with on‐going health conditions. Australian Occupational Therapy Journal, 60(1), 20-29. https://onlinelibrary.wiley.com/doi/abs/10.1111/1440-1630.12023.

[25]  Mbuagbaw, L., Thabane, L., Ongolo-Zogo, P., Lester, R. T., 2014, The Cameroon mobile phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PLoS One, 9(2), e89658. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046909.

[26] Medley, A., Garcia-Moreno, C., McGill, S., Maman, S., 2004, Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ, 82(4), 299-307. https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/bwho/v82n4/v82n4a13.pdf

[27] Li, X. M., Yuan, X. Q., Rasooly, A., Bussell, S., Wang, J. J., & Zhang, W. Y., 2018, An evaluation of impact of social support and care-giving on medication adherence of people living with HIV/AIDS: A nonrandomized community intervention study. Medicine, 97(28), e11488. https://pubmed.ncbi.nlm.nih.gov/29995812/.

Deribe, K., Woldemichael, K., Wondafrash, M., Haile, A., Amberbir, A., Njau, B. J., 2008, Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users. SAHARA J, 5(4), 176-185. https://www.ajol.info/index.php/saharaj/article/view/67720.