Conference abstract
Effect of missed appointment for early Antiretroviral (ARVs) refill on treatment attrition, viral load uptake, and suppression 12 months after treatment initiation in the test and treat context: experience from Cameroon
Pan African Medical Journal - Conference Proceedings. 2023:18(160).03
Oct 2023.
doi: 10.11604/pamj-cp.2023.18.160.2277
Archived on: 03 Oct 2023
Contact the corresponding author
Keywords: Antiretroviral refill, missed appointment, early
Oral presentation
Effect of missed appointment for early Antiretroviral (ARVs) refill on treatment attrition, viral load uptake, and suppression 12 months after treatment initiation in the test and treat context: experience from Cameroon
Djouma Nembot Fabrice1,&, Agbornkwai Nyenty2, Ismaila Esa3, Mboh Eveline Asongwe2, Jerome Ateudjieu1
1Department of Public Health University of Dschang, Dschang, Cameroon, 2Family Health International, Cameroon, 3Cameroon Baptist Convention Health Services, Cameroon
&Corresponding author
Introduction: antiretroviral Treatment (ART) outcomes remain poor in Cameroon despite the rapid increase in the number of individuals placed on ART following the implementation of the Test and Treat strategy in 2016. This study aimed to assess the effect of early missed ART refill appointments on treatment attrition, Viral Load (VL) uptake, and Viral Suppression (VS) 12 months after treatment initiation in a large cohort of adult HIV-positive clients in the western region of Cameroon.
Methods: a retrospective cross-sectional analysis was done on existing data in the medical records on-site for adults >20 years living with HIV who started ART between October 2019 and September 2020 in 25 HIV treatment centres in the West Region of Cameroon. Cox proportional hazards and logistic regression were used to assess the effect of early missed appointments on attrition, VL uptake, and VL suppression.
Results: the mean age of the 2,064 participants included in the study was 36.9 (SD= ±13.3) and 36.4% of them were males. Clients who experienced early missed appointments (compared to those who did not miss any initial appointment) had a higher cumulative risk of death (4.3% vs 2.6%; p = 0.002), loss to follow-up (18.2% vs 2.2%; p< 0.001) and stop treatment (2.8% vs 0.8%; p= 0.02). They also were more likely to experience attrition from care (Adjusted HR: AHR= 6.5; 95%CI: 4.5-9.3). There was no significant difference in VL uptake and VS rate between the early missed appointment clients and non-early missed appointment clients. In the group of clients not on Tenofovir, Lamivudine, and Dolutegravir (TLD), early missed appointment status was associated with a higher odd of unsuppressed VL (AO = 0.2; 95%CI: 0.1-0.6).
Conclusion: this study found that early missed appointments for ART refill within the first three months of treatment were associated with eventual treatment attrition, death, and loss of follow-up and also with higher odds of unsuppressed VL not on TLD. Findings from robust prospective, interventional, and qualitative studies are needed to understand and mitigate some of the factors associated with early missed appointments for improved performance in ART programs.
Effect of missed appointment for early Antiretroviral (ARVs) refill on treatment attrition, viral load uptake, and suppression 12 months after treatment initiation in the test and treat context: experience from Cameroon
Djouma Nembot Fabrice1,&, Agbornkwai Nyenty2, Ismaila Esa3, Mboh Eveline Asongwe2, Jerome Ateudjieu1
1Department of Public Health University of Dschang, Dschang, Cameroon, 2Family Health International, Cameroon, 3Cameroon Baptist Convention Health Services, Cameroon
&Corresponding author
Introduction: antiretroviral Treatment (ART) outcomes remain poor in Cameroon despite the rapid increase in the number of individuals placed on ART following the implementation of the Test and Treat strategy in 2016. This study aimed to assess the effect of early missed ART refill appointments on treatment attrition, Viral Load (VL) uptake, and Viral Suppression (VS) 12 months after treatment initiation in a large cohort of adult HIV-positive clients in the western region of Cameroon.
Methods: a retrospective cross-sectional analysis was done on existing data in the medical records on-site for adults >20 years living with HIV who started ART between October 2019 and September 2020 in 25 HIV treatment centres in the West Region of Cameroon. Cox proportional hazards and logistic regression were used to assess the effect of early missed appointments on attrition, VL uptake, and VL suppression.
Results: the mean age of the 2,064 participants included in the study was 36.9 (SD= ±13.3) and 36.4% of them were males. Clients who experienced early missed appointments (compared to those who did not miss any initial appointment) had a higher cumulative risk of death (4.3% vs 2.6%; p = 0.002), loss to follow-up (18.2% vs 2.2%; p< 0.001) and stop treatment (2.8% vs 0.8%; p= 0.02). They also were more likely to experience attrition from care (Adjusted HR: AHR= 6.5; 95%CI: 4.5-9.3). There was no significant difference in VL uptake and VS rate between the early missed appointment clients and non-early missed appointment clients. In the group of clients not on Tenofovir, Lamivudine, and Dolutegravir (TLD), early missed appointment status was associated with a higher odd of unsuppressed VL (AO = 0.2; 95%CI: 0.1-0.6).
Conclusion: this study found that early missed appointments for ART refill within the first three months of treatment were associated with eventual treatment attrition, death, and loss of follow-up and also with higher odds of unsuppressed VL not on TLD. Findings from robust prospective, interventional, and qualitative studies are needed to understand and mitigate some of the factors associated with early missed appointments for improved performance in ART programs.
