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Poor retention in care is common among HIV-positive adults in sub-Saharan Africa settings and remains a key barrier to HIV management. We quantify the associations of disclosure of HIV status and referral to disclosure counseling with successful retention in care using data from three Cameroon clinics participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa cohort. Of 1646 patients newly initiating antiretroviral therapy between January 2008 and January 2011, 43% were retained in care following treatment initiation. Self-disclosure of HIV status to at least one person prior to treatment initiation was associated with a minimal increase in the likelihood of being retained in care (risk ratio [RR] = 1.14; 95% confidence interval (CI): 0.94, 1.38). However, referral to disclosure counseling was associated with a moderate increase in retention (RR = 1.37; 95% CI: 1.21, 1.55) and was not significantly modified by prior disclosure status (p = .3). Our results suggest that while self-disclosure may not significantly improve retention among patients receiving care at these Cameroon sites, counseling services may play an important role regardless of prior disclosure status.

An improved understanding of CD4 progression over time in resource-limited settings may aid in the discussion of when to initiate antiretroviral therapy (ART) and optimal timing for CD4 monitoring. We examined CD4 progression over time among 347 HIV-positive adults from 10 HIV care and treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo (DRC). We applied a mixed model using restricted maximum likelihood to describe CD4 cell count evolution over time following ART initiation and to evaluate the association between other baseline variables and CD4 response over time. Depending on the initial baseline CD4 count, increases in mean CD4 cell count ranged from 24-46 cells/mm 3 from 3 to 6 months after treatment initiation, and from 80-117 from 6 to 18 months after treatment initiation. Females had higher CD4 count at the initiation of treatment than males. Patients with higher CD4 count at ART initiation achieved a higher CD4 count in the following months. We found that higher baseline CD4 cell counts predicted higher CD4 cell counts over time among the patients eligible for this analysis. We also observed increases in mean CD4 cell count from 3 to 18 months after treatment initiation.

Antiretroviral therapy (ART)-naive patients are vulnerable to becoming lost-to-care (LTC) because they are not monitored as often as patients on treatment. We examined data from 19,461 HIV positive adults at 10 HIV clinics in Democratic Republic of Congo (DRC), Cameroon, and Burundi participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) study. Patients were LTC if they were ART-naive and did not return within 7 months of the end of data collection. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with LTC. Of 5353 ART-naive patients, 4420 (83%) were LTC and 933 (17%) were in-care. The odds of being LTC were greatest among patients from DRC (OR = 2.16, CI: 1.64-2.84, p < .0001), males (OR = 1.39, CI: 1.15-1.69, p = .0009), and ages 18-49 (OR = 1.45, CI: 1.16-1.82, p = .001). The odds of being LTC were least among patients with a WHO Clinical Stage of 1 or 2 (OR = 0.65, CI: 0.55-0.77, p < .0001) and in a perceived concordant relationship (OR = 0.61, CI: 0.43-0.87, p < .0001). LTC patients were more likely to have characteristics associated with higher risk for HIV transmission and progression. Many entered care at advanced stages and were less likely to know their partner's serostatus. Greater efforts to retain ART-naive patients may increase earlier initiation of ART.

Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site). Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/ nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%). Conclusions: Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort’s site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa. Keywords: HIV care and treatment; Central Africa; clinical cohort; resource-limited settings (Published: 21 November 2012) Divaris K et al. Journal of the International AIDS Society 2012, 15:17422 http://www.jiasociety.org/index.php/jias/article/view/17422 | http://dx.doi.org/10.7448/IAS.15.2.17422

Globally, women comprise half of all people living with HIV, but in sub-Saharan Africa, women are disproportionately affected. Data were obtained from 8419 HIV-infected women at enrollment into 10 HIV treatment programs in Cameroon, Burundi, and the Democratic Republic of the Congo as part of the Central Africa region of the International Epidemiological Database to Evaluate AIDS. We used chi-squared tests to determine if distributions between women with children differed from those without children, in regards to socio-demographic, behavioral and clinical characteristics. Logistic regression was used to determine if motherhood was associated with medication adherence. Of 8419 women, 81.7% had living children. The majority entered care through voluntary testing, and very few entered care through prevention of mother-to-child transmission programs. Women with children were older and more likely to be widowed, more likely to have no formal education and less likely to have attended university than those without children (p0.05). Women without children were more likely to live in a home with electricity and potable water (p0.05). There was no difference in adherence between these groups. However, women older than 50 years, those who reported no drug, tobacco, or alcohol use, and those with higher levels of formal education were more likely to report adherence along with those who had been on treatment for more than two years (p0.05). As women account for a substantial proportion of HIV cases in sub-Saharan Africa, a broader understanding of their characteristics will inform testing, treatment, and support services. Though we did not find differences in adherence between women with children and those without children, we were able to identify other characteristics that may affect adherence. Further inquiry into the nuances of women living with HIV in sub-Saharan Africa is necessary to further understand their needs.

Background. Very little is known about older adults accessing HIV care in sub-Saharan Africa.Materials and Methods. Data were obtained from 18,839 HIV-positive adults at 10 treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo. We compared characteristics of those aged 50+ with those aged 18–49 using chi-square tests. Logistic regression was used to determine if age was associated with medication adherence.Results. 15% of adults were 50+ years. Those aged 50+ were more evenly distributed between women and men (56% versus 44%) as compared to those aged 18–49 (71% versus 29%) and were more likely to be hypertensive (8% versus 3%) (P<0.05). Those aged 50+ were more likely to be adherent to their medications than those aged 18–49 (P<0.001). Adults who were not heavy drinkers reported better adherence as compared to those who reported drinking three or more alcoholic beverages per day (P<0.001).Conclusions. Older adults differed from their younger counterparts in terms of medication adherence, sociodemographic, behavioral, and clinical characteristics.

IntroductionDespite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts’ characteristics in the Central Africa region are sparse.MethodsA survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site).ResultsDespite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%).ConclusionsOur findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort's site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa.