Survival Analysis among Patients receiving Antiretroviral Therapy in Urban and Rural Settings of the Centre Region of Cameroon

Objectives: With increasing antiretroviral therapy (ART) coverage in Cameroon (from 28,000 patients in 2008 to 122,000 by end 2012) following the World health organisation (WHO) criteria of CD4≤350 cells/mm3, there are increasing risks of poor programmatic outcomes and HIV drug resistance (HIVDR) emergence. We aimed to determine survival rates and associated factors among patients enrolled on ART following the national guidelines in Cameroon. Methods: A longitudinal study was conducted in 2013 among patients initiating ART in rural (Mfou District Hospital) and urban (Yaounde Central Hospital) settings of the Centre region of Cameroon. Socio-demographic, clinical, laboratory and mortality data were analysed with EPI INFO v.3.5.3 and SPSS v.20, using Cox model and Wilcoxon test for survival analysis. Results: A total of 350 patients initiating ART (median age 37 years; 71% female) were enrolled, with an overall delayed ART initiation (median CD4: 171 cells/mm3 and 59.9% at WHO-clinical stages 3 and 4). Survival rates at 6 and 12 months were 93.9% and 91.3% respectively, without significant disparity between the rural and urban setting (p=0.21). Retention in care at 6 and 12 months after ART initiation was 78.6% and 69.1% respectively, suggesting increasing lost to follow-up. Mortality was predominantly associated with initial events of anaemia (p=0.00001), opportunistic infections (p=0.002), CD4 count<200 cells/mm3 (p=0.004). Conclusions: There are decreasing rates of survivals within 12 months of ART initiation, while retention in care drops below minimal target of 70%. An improved life expectancy on ART requires close monitoring for anaemia, preventing clinical events while ensuring earlier initiation on ART in both rural and urban resource-limited settings. RESUME Introduction : Le nombre de malades sous Traitement Anti Retroviral (TARV) au Cameroun est passe de 28000 a 122 000 de 2008 en 2012, laissant presager uneaugmentation des resistances au virus. L’objectif de notre etude etait de determiner le taux de survie des PVVIH mis sous ARV dans deux hopitaux de la region du centre au Cameroun. Materiel-Methodes Une cohorte de patients mis sous ARV en 2012 a l’Hopital Central de Yaounde et l’Hopital de District de Mfou a ete suivie. Le recueil des donnees s’est fait a partir des dossiers patients et du logiciel ESOPE. Les donnees ont ete analysees a l’aide d’EPI INFO version 3.5.3 et SPSS 20. Resultats : L’âge median des patients etait de 37 ans (71% de femmes). Ces derniers avaient un taux median de CD4 a l’initiation de 171/ mm3 ainsi qu’un stade clinique OMS avance. Les taux de survie a 6 mois et 12 mois etaient respectivement de 93,9% et 91,3%. Les taux de retention des patients aux ARV de notre cohorte etaient de 78,6 % et 69,1% respectivement a 6 et 12 mois. La survie des patients etait associee de facon significative avec la presence d’anemie et d’Infections Opportunistes a l’admission, ainsi que des niveaux de CD4 bas et un stade clinique OMS avance. Conclusion : La survie des PVVIH a 12 mois dans ces structures est dans les limites definies par l’OMS. Elle est influencee par la presence d’anemie a l’initiation, ainsi que le fait pour le patient de se presenter tardivement pour la prise de traitement.