1. Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme
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M Ngo Tonye, R B Pallawo, Issiakou Adamou, I Wandji, P Momo, B Spire, E Mpoudi-Ngolé, N Manga, E Njom Nlend, J M Bob Oyono, E Kamto, G Touko, B Fangam Molu, D Eloundou, H Mossi, M Tsoungi Akoa, U Olinga, H Meli, G Maradan, Pierre-Julien Coulaud, Laurent Vidal, M Ndam, R Garcia, J D Ngan Bilong, A Guterrez, Boyer, Christopher Kuaban, E Delaporte, C Tong, A P Meledie Ndjong, Y Perfura, C Nouboue, A Mafuta, G Tchatchoua, J Dissongo, N Noumssi, S Omgnesseck, J J Ze, Christian Laurent, Bruno Spire, O Ossanga, F Chabrol, C Ewolo, A Ambani, S Boyer, E Belley Priso, M C Kuitcheu, M Fokoua, E Kouakam, L J G Buffeteau, H Essama Owona, Khadim Ndiaye, S Eymard-Duvernay, Sylvie Boyer, F Liégeois, C Tchimou, M Mora, J D Noah, S Beke, E Abeng Mbozo’o, L R Njock, L March, M J Gomez, J Djene, C Danwe, Camelia Protopopescu, S Ngwane, H Fokam, E Soh, C Ndjie Essaga, O Kouambo, C Laurent, G Temgoua, M T Mengue, Gwenaëlle Maradan, Maël Baudoin, A Simo Ndongo, D S.Maninzou, L Ndalle, B Taman, Ida Penda, M Mpoudi Ngole, C Biloa, Ngam Engonwei, E H Moby, J Meli, L J Bitang, M Mbangue, L Ayangma, P Thumerel, O Ndalle, B Mbatchou, M Suzan-Monti, M Mgantcha, A L Mawe, S Abia, J Hachu, H Nyemb, P J Fouda, L Sagaon-Teyssier, H Hadja, L Ngum, F Ndoumbe, Y Mapoure, H Abessolo, I Ngo, A Yeffou, C Bondze, J Lindou, A Malongue, C Kouanfack, M de Sèze, P Ateba, Z Nanga, B Takou, M Defo, E C Njitoyap Ndam, C Ejangue, A Nono Toche, I Seyep, Yoyo Ngongang, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Yaoundé I, EVOLCam Group: G Maradan, A Ambani, O Ndalle, P Momo, C Tong, S Boyer, V Boyer, L March, M Mora, L Sagaon-Teyssier, M de Sèze, B Spire, M Suzan-Monti, C Laurent, F Liégeois, E Delaporte, V Boyer, S Eymard-Duvernay, F Chabrol, E Kouakam, O Ossanga, H Essama Owona, C Biloa, M-T Mengue, E Mpoudi-Ngolé, P J Fouda, C Kouanfack, H Abessolo, N Noumssi, M Defo, H Meli, Z Nanga, Y Perfura, M Ngo Tonye, O Kouambo, U Olinga, E Soh, C Ejangue, E Njom Nlend, A Simo Ndongo, E Abeng Mbozo'o, M Mpoudi Ngole, N Manga, C Danwe, L Ayangma, B Taman, E C Njitoyap Ndam, B Fangam Molu, J Meli, H Hadja, J Lindou, J M Bob Oyono, S Beke, D Eloundou, G Touko, J J Ze, M Fokoua, L Ngum, C Ewolo, C Bondze, J D Ngan Bilong, D S Maninzou, A Nono Toche, M Tsoungi Akoa, P Ateba, S Abia, A Guterrez, R Garcia, P Thumerel, E Belley Priso, Y Mapoure, A Malongue, A P Meledie Ndjong, B Mbatchou, J Hachu, S Ngwane, J Dissongo, M Mbangue, Ida Penda, H Mossi, G Tchatchoua, Yoyo Ngongang, C Nouboue, I Wandji, L Ndalle, J Djene, M J Gomez, A Mafuta, M Mgantcha, E H Moby, M C Kuitcheu, A L Mawe, Ngam Engonwei, L J Bitang, M Ndam, R B Pallawo, Issiakou Adamou, G Temgoua, C Ndjie Essaga, C Tchimou, A Yeffou, I Ngo, H Fokam, H Nyemb, L R Njock, S Omgnesseck, E Kamto, B Takou, L J-G Buffeteau, F Ndoumbe, J-D Noah, I Seyep, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Herrada, Anthony
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Adult ,medicine.medical_specialty ,Anti-HIV Agents ,030231 tropical medicine ,HIV Infections ,Disease ,Disease cluster ,03 medical and health sciences ,0302 clinical medicine ,healthcare supply-related factors ,Interquartile range ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Cameroon ,Proportional hazards model ,business.industry ,Health Policy ,Hazard ratio ,HIV ,Hepatitis B ,medicine.disease ,3. Good health ,time to ART initiation ,Cross-Sectional Studies ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Family medicine ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Population study ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,Delivery of Health Care ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Increasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5–4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09–1.45), P = 0.002], those with disease symptoms [1.21 (1.04–1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15–4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65–0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72–1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access.
- Published
- 2021
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