Early Warning Indicators for HIV Drug Resistance in Cameroon during the Year 2010

Background: Rapid scale-up of antiretroviral therapy (ART) in resource-limited settings is accompanied with an increasing risk of HIV drug resistance (HIVDR) which in turn could compromise the performance of national ART rollout programme. In order to sustain the effectiveness of ART in a resource-limited country like Cameroon HIVDR early warning indicators (EWI) may provide relevant corrective measures to support the control and therapeutic management of AIDS. Methods: A retrospective study was conducted in 2010 among 40 ART sites (12 Approved Treatment Centers and 28 Management Units) distributed over the 10 regions of Cameroon. Five standardized EWIs were selected for the evaluation using data from January through December among which: (1) Good ARV prescribing practices: target = 100%; (2) Patient lost to follow-up: target less-than or equal to 20%; (3) Patient retention on first line ART: target greater-than or equal to 70%; (4) On-time drug pick-up: target greater-than or equal to 90%; (5) ARV drug supply continuity: target = 100%. Analysis was performed using a Data Quality Assessment tool following WHO protocol. Results: The number of sites attaining the required performance are: 90% (36/40) for EWI 1 20% (8/40) for EWI 2; 20% (8/40) for EWI 3; 0% (0/37) for EWI 4; and 45% (17/38) for EWI 5. ARV prescribing practices were in conformity with the national guidelines in almost all the sites whereas patient adherence to ART (EWI 2 EWI 3 and EWI 4) was very low. A high rate of patients was lost-to-follow-up and others failing first line ART before 12 months of initiation. Discontinuity in drug supply observed in about half of the sites may negatively impact ARV prescription and patient adherence. These poor ART performances may also be due to low number of trained staff and community disengagement. Conclusions: The poor performance of the national ART programme due to patient non-adherence and drug stock outs requires corrective measures to limit risks of HIVDR emergence in Cameroon.