Rural Cameroon study indicates need to double HIV treatment success, monitor outcomes in west, central Africa to control epidemic

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Researchers cite critical need for stronger capacities in remote areas to find treatment resistance, failure

The numbers of people who are receiving antiretroviral treatment HIV in remote rural areas of west and central Africa for whom that treatment is succeeding is about half of what it needs to be to achieve control of the epidemic by United Nations 90-90-90 goals, researchers concluded, following a study in rural Cameroon.

The study offered free viral load monitoring and, where indicated, testing for resistance to antiretroviral medicines to patients at a district hospital in Cameroon, where access to the testing is otherwise limited to major cities, and at cost to patients. Following 407 patients who were 15 years or older and had been receiving antiretroviral treatment for at least six months, from January 2013 to January 2014, researchers found that close to a quarter of the patients had viral loads that were not suppressed by treatment, and that three quarters of them had viruses resistant to the drugs with which they were being treated. This, researchers led by Charlotte Boullé of  Université de Montpellier, France noted, meant that about 20 percent of the patients were at risk for transmitting HIV that is resistant to treatment.

The outcomes over the course of the year were in line with findings from other studies, with higher rates of treatment failure in more remote areas, and lower numbers in district hospitals in Yaoundé, Cameroon’s capital city. While noting that higher rates of treatment failure in remote areas could, in part be attributable to difficulties faced by patients, with lower incomes and literacy, including long distances to treatment, the authors also point out that a previous study of patients receiving treatment at rural hospitals showed more adherence to treatment than patients followed in Yaoundé or Douala, Cameroon’s largest city. They note that the lower rates of treatment effectiveness also could be caused by inadequately trained health workers, and insufficient staff, particularly among physicians and pharmacists, as well as by shortcomings in laboratory capacities, and of the medicines themselves.

The study, Virologic Failure and Human Immunodeficiency Virus Drug Resistance in Rural Cameroon With Regard to the UNAIDS 90-90-90 Treatment Targets, published in Open Forum Infectious Diseases, underscores a point made last year in a report from Médecins Sans Frontières that found shortfalls in policy, practices, and treatment coverage for people living with HIV in west and central Africa countries, leaving the region out of strides made in other regions to control the virus.

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