Individual and healthcare supply-related HIV transmission factors in HIV-positive patients enrolled in the antiretroviral treatment access program in the Centre and Littoral regions in Cameroon (ANRS-12288 EVOLCam survey)

Abstract

Background Despite great progress in antiretroviral treatment (ART) access in recent decades, HIV incidence remains high in sub-Saharan Africa. We investigated the role of individual and healthcare supply-related factors in HIV transmission risk in HIV-positive adults enrolled in 19 HIV services in the Centre and Littoral regions of Cameroon. Methods Factors associated with HIV transmission risk (defined as both unstable aviremia and inconsistent condom use with HIV-negative or unknown status partners) were identified using a multi-level logistic regression model. Besides socio-demographic and behavioral individual variables, the following four HIV-service profiles, identified using cluster analysis, were used in regression analyses as healthcare supply-related variables: 1) district services with large numbers of patients, almost all practicing task-shifting and not experiencing antiretroviral drugs (ARV) stock-outs (n = 4); 2) experienced and well-equipped national reference services, most practicing task-shifting and not experiencing ARV stock-outs (n = 5); 3) small district services with limited resources and activities, almost all experiencing ARV stock-outs (n = 6); 4) small district services with a wide range of activities and half not experiencing ARV stock-outs (n = 4). Results Of the 1372 patients (women 67%, median age [Interquartile]: 39 [33–44] years) reporting sexual activity in the previous 12 months, 39% [min-max across HIV services: 25%-63%] were at risk of transmitting HIV. The final model showed that being a woman (adjusted Odd Ratio [95% Confidence Interval], p-value: 2.13 [1.60–2.82], p<0.001), not having an economic activity (1.34 [1.05–1.72], p = 0.019), having at least two sexual partners (2.45 [1.83–3.29], p<0.001), reporting disease symptoms at HIV diagnosis (1.38 [1.08–1.75], p = 0.011), delayed ART initiation (1.32 [1.02–1.71], p = 0.034) and not being ART treated (2.28 [1.48–3.49], p<0.001) were all associated with HIV transmission risk. Conversely, longer time since HIV diagnosis was associated with a lower risk of transmitting HIV (0.96 [0.92–0.99] per one-year increase, p = 0.024). Patients followed in the third profile had a higher risk of transmitting HIV (1.71 [1.05–2.79], p = 0.031) than those in the first profile. Conclusions Healthcare supply constraints, including limited resources and ARV supply chain deficiency may impact HIV transmission risk. To reduce HIV incidence, HIV services need adequate resources to relieve healthcare supply-related barriers and provide suitable support activities throughout the continuum of care.

Task shifting healthcare services in the post-COVID world: A scoping review

“…HRH shortage and reduced financial support [85] limit ART and pre-exposure prophylaxis (PrEP) delivery in Africa. Coulaud et al [86] reported district-level centres in Cameroon TS routine ART prescription and administration to drive better outcomes of ART uptake. In Kenya, one-stop shop (OSS) models improved PrEP delivery, uptake and continuation.…”

Task shifting healthcare services in the post-COVID world: A scoping review

“…However, increasing caseloads and social distancing measures led to transforming of one-stop shops into isolation centres and the relocation of one-stop shop operations to distant community clinics, resulting in time and productivity losses [67]. Likewise, in Cameroon, district-level centres employed TS of ART prescription and administration onto nurses to maintain ART continuation [65].…”

“…The ability to flexibly embrace TS practices underscores healthcare organisations' adaptability, particularly in the context of Human Resources for Health (HRH) shortages and financial constraints. The implementation of TS in Cameroon played a crucial role in enhancing the accessibility of Antiretroviral Therapy (ART) and helped address the HRH limitations associated with routine prescription and administration [65]. In Kenya, the introduction of One-Stop-Shop (OSS) models streamlined the delivery of PrEP but faced challenges due to pandemic-induced social distancing measures, leading to the need for increased travel between centres [67].…”