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Landry Tsague, Sinata S Koulla, Alain Kenfak, Charles Kouanfack, Mathurin Tejiokem, Therese Abong, Madeleine Mbangue, Yacouba Njankouo Mapoure, Claudine Essomba, Jembia Mosoko, Regis Pouillot, Louis Menyeng, Helene Epee, Carno Tchuani, Anne Cecile Zoung-Kanyi, Lucienne Assumpta Bella, Leopold Zekeng. Determinants of retention in care in an antiretroviral therapy (ART) program in urban Cameroon, 2003-2005. The Pan African Medical Journal. 2008;1:2 Key words: HIV, HAART, low income country, retention in care, loss to follow-up, cohort studies, Cameroon, sub-Sahara Africa Permanent link: http://www.panafrican-med-journal.com/content/article/1/2/full Received: 01/03/2008 - Accepted: 01/07/2008 - Published: 04/07/2008 © Landry Tsague et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Determinants of retention in care in an antiretroviral therapy (ART) program in urban Cameroon, 2003-2005
Landry Tsague1&, Sinata S Koulla2,3,4, Alain Kenfak3, Charles Kouanfack3, Mathurin Tejiokem5, Therese Abong3, Madeleine Mbangue6, Yacouba Njankouo Mapoure6, Claudine Essomba2,3, Jembia Mosoko4, Regis Pouillot5, Louis Menyeng4, Helene Epee6, Carno Tchuani4, Anne Cecile Zoung-Kanyi1,2, Lucienne Assumpta Bella1,2, Leopold Zekeng4
1Directorate for Disease Control, Ministry of Public Health, Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon; 3Yaounde Central Hospital; 4National AIDS Control Program; 5Centre Pasteur du Cameroun, Yaoundé; 6Douala Laquintinie Hospital;
&Corresponding author
Landry Tsague, MD, MPH, International Center for HIV/AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University. Country Office: Kigali, Rwanda, Po Box 1524.
Retention in long-term antiretroviral therapy (ART) program remains a major challenge for effective management of HIV infected people in sub-Saharan Africa. Highly Active Antiretroviral Therapy (ART) discontinuation raises concerns about drug resistance and could negate much of the benefit sought by ART programs.
Methods
Based on existing patient records, we assessed determinants of retention in HIV care among HIV patients enrolled in an urban ART at two urban hospitals in Cameroon. Extended Cox regression procedures were used to identify significant predictors of retention in HIV care.
Results
Of 455 patients, 314 (69%) were women, median (IQR) age and baseline CD4 cell count were respectively 36 years (30 43) and 110 cells/µL (39 177). Forty patients (9%) had active tuberculosis (TB) at enrollment. After a median (IQR) follow-up of 18 months (1018), 346 (75%) were still in care, 8 (2%) were known dead, and 101 (22%) were lost to follow-up (LFU). Severe immunosuppression (CD4 cell count ≤ 50 cells/µL) at baseline (aHR 2.3; 95% CI 1.4 - 3.7) and active tuberculosis upon enrollment (aHR 1.8; 95% CI 1.0 - 3.6) were independent predictors of cohort losses to follow-up within the first 6 months after HAART initiation.
Conclusion
These data suggest that three-quarter of HIV patients initiated on HAART remained in care and on HAART by 18 months; however, those with compromised immunologic status at treatment initiation, and those co-infected with TB were at increased risk for being lost to follow-up within the first 6 months on treatment.
