Objective: We studied the transition to dolutegravir-containing antiretroviral therapy (ART) at HIV treatment clinics within the International epidemiology Databases to Evaluate AIDS (IeDEA). Design: Site-level survey conducted in 2020–2021 among HIV clinics in low- and middle-income countries (LMICs). Methods: We assessed the status of dolutegravir rollout and viral load and drug resistance testing practices for persons on ART switching to dolutegravir-based regimens. We used generalized estimating equations to assess associations between clinic rollout of both first- and second-line dolutegravir-based ART regimens (dual rollout) and site-level factors. Results: Of 179 surveyed clinics, 175 (98%) participated; 137 (78%) from Africa, 30 (17%) from the Asia-Pacific, and 8 (5%) from Latin America. Most clinics (80%) were in low- or lower-middle-income countries, and there were a mix of primary-, secondary- and tertiary-level clinics. Ninety percent reported rollout of first-line dolutegravir, 59% of second-line, 94% of first- or second-line and 55% of dual rollout. The adjusted odds of dual rollout were higher among tertiary-level [adjusted odds ratio (aOR) 4.00; 95% confidence interval (CI) 1.39–11.47] and secondary-level clinics (aOR 3.66; 95% CI 2.19–6.11) than in primary-level clinics. Over half (59%) of clinics that introduced first- or second-line dolutegravir-based ART required recent viral load testing before switching to dolutegravir, and 15% performed genotypic resistance testing at switch. Conclusions: Dolutegravir-based ART was rolled out at nearly all IeDEA clinics in LMICs, yet many switched persons to dolutegravir without recent viral load testing and drug resistance testing was rarely performed. Without such testing, drug resistance among persons switching to dolutegravir may go undetected.
Abstract Hypertension is a global public health challenge, but awareness, treatment, and control rates remain low. May Measurement Month (MMM) creates a platform for awareness creation and opportunistic screening which can identify significant numbers with raised blood pressure (BP). We present results of the 2018 edition of MMM in Cameroon. A cross-sectional survey of self-selected volunteers aged ≥18 years was conducted in May 2018. The definition of hypertension and statistical analyses followed the standard protocol. Data were collected from 28 public (indoors and outdoors) and private locations which were assigned unique site identification numbers, over a 30-day period. Of the 8883 participants screened, 53.8% were male and the median age was 35 (interquartile range 21) years, and 30.0% reported not having a previous BP measurement. After imputation, 1867 (21.0%) were hypertensive, 645 (34.5%) were aware of their diagnosis, and 507 (27.2%) were on antihypertensive medication, among whom 242 (47.8%) had controlled BP. In linear regression models adjusting for age, sex, and the use of antihypertensive medication, systolic and diastolic BP were significantly higher in participants aware of their diagnosis, those on antihypertensive medication, and who reported alcohol intake of 1–3 times per month and, one or more times per week. Hypertension prevalence is the lowest, and awareness, treatments, and control rates the highest reported in epidemiological studies in Cameroon in the last two decades. Further surveys will be useful in evaluating the impact, if any, of the MMM campaign on the burden of hypertension in the Cameroon.
Research is a vital component for the development of any country. In Cameroon, HIV Operational research is rapidly growing, however, it faces some intractable problems which can only be solved through an urgent, strategic, efficient, and collaborative approach involving key stakeholders. The Kribi meeting (09 and 10th December 2020) brought together under the auspices of the Ministry of Public Health leading HIV research organisations and connected HIV researchers and actors from different sectors. These actors disseminated and discussed recent research findings and worked out mechanisms to advance HIV research development, developed new ideas and identified priority research areas, with emphasis on translational research. The official launching and consolidation of Cam-HERO was a critical step and it is hoped that these synergistic efforts will catalyse attainment of the 95-95-95 goals in Cameroon.
Abstract Background The association between HIV infection and increased cardiometabolic risk, attributed to chronic inflammation in people living with HIV (PLWH) and/or antiretroviral therapy (ART) effects, has been inconsistent. In this study, we aimed to assess the associations of HIV-related factors with hypertension (HTN) and type-2 diabetes mellitus (T2DM), and the potential mediation effects of body mass index (BMI) in the associations between ART use and HTN or T2DM in PLWH in Cameroon. Methods A cross-sectional study was conducted with 14,119 adult PLWH from Cameroon enrolled in the International epidemiology Databases to Evaluate AIDS (IeDEA) between 2016 and 2021. HTN was defined as systolic/diastolic blood pressure ≥ 140/90 mmHg and/or current use of antihypertensive medication, while T2DM was defined as fasting blood sugar ≥ 126 mg/dL and/or use of antidiabetic medications. Univariable and multivariable multinomial logistic regression analyses examined the associations of factors with HTN alone, T2DM alone, and both (HTN + T2DM). Mediation analyses were conducted to assess the potential mediation roles of BMI, while controlling for age, sex, and smoking. Results Of the 14,119 participants, 9177 (65%) were women, with a median age of 42 (25 th –75th percentiles: 35–51) years. Age > 50 years was associated with HTN alone, T2DM alone, and HTN + T2DM compared to the age group 19–29 years. Men had higher odds of having HTN + T2DM. Overweight and obesity were predictors of HTN alone compared to being underweight. WHO stages II and III HIV disease were inversely associated with HTN alone compared to stage I. The odds of diabetes alone were lower with ART use. BMI partially mediated the association between ART use and hypertension, with a proportion of mediation effect of 49.6% (all p < 0.02). However, BMI did not mediate the relationship between ART use and diabetes. Conclusions Traditional cardiovascular risk factors were strongly associated with hypertension among PLWH, while HIV-related exposures had smaller associations. BMI partially mediated the association between ART use and hypertension. This study emphasizes the importance of screening, monitoring, and managing HTN and T2DM in older, male, and overweight/obese PLWH. Further research on the associations of HIV disease stage and ART use with HTN and T2DM is warranted.
Intimate partner violence (IPV) has been associated with poor mental health among people with HIV (PWH) globally. Social support may be a strategy to foster mental health among PWH. Little is known about whether the relationship between IPV and mental health differs by IPV type or level of social support. Interviews were conducted with 426 PWH initiating HIV care in Cameroon. Log binomial regression analyses were used to estimate the association between four types of IPV (controlling behavior and emotional, physical, and sexual IPV) and symptoms of depression or hazardous alcohol use, separately by IPV type and level of social support. Over half (54.8%) of respondents experienced moderate/high levels of controlling behavior, 42.0% experienced emotional IPV, 28.2% experienced physical IPV and 23.7% experienced sexual IPV. Controlling behavior was associated with greater prevalence of depressive symptoms. This relationship did not vary meaningfully by level of social support (low: aPR 2.4 [95% CI 1.2, 4.9]; high: 1.7 [95% CI 1.0, 2.7]). Emotional and physical IPV were associated with greater prevalence of depressive symptoms among those with low social support (emotional IPV: aPR 1.9 [95% CI 1.0, 3.4]; physical IPV: aPR 1.8 [95% CI 1.2, 2.8]), but not among those with high social support (emotional IPV: aPR 1.0 [95% CI 0.7, 1.6]; physical IPV: aPR 1.0 [95% CI 0.6, 1.6]). Controlling behavior, emotional IPV, and physical IPV were associated with a greater prevalence of hazardous alcohol use, with moderately larger effect estimates among those with high compared to low social support. Sexual IPV was not associated with depressive symptoms or hazardous alcohol use. Services to screen and care for people experiencing IPV are urgently needed among PWH in Cameroon. Future research to identify barriers, feasibility, acceptability, and organizational readiness to integrate IPV and mental health services into HIV care settings is needed.
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