title: Decentralization of access to antiretroviral therapy in Cameroon: correlates of HIV physicians' knowledge in HIV care.
abstract: BACKGROUND
  Good knowledge in HIV care among physicians is a necessary prerequisite to effective antiretroviral therapy (ART) scaling-up in Sub-Saharan Africa.
  
  
  METHODS
  Between September 2006 and March 2007, a 27-item knowledge questionnaire was proposed to all HIV physicians working in 27 hospitals throughout six provinces of Cameroon. Physicians' responses were compared between the three levels of decentralization of the Cameroonian healthcare delivery system (χ(2) and Fisher tests). Correct responses were summed to build a knowledge score. Factors significantly associated with a higher score were identified using linear regression.
  
  
  RESULTS
  In total, 93 physicians filled in the questionnaire. Level of knowledge was globally good (median score 23), with no significant difference between the three levels of decentralization. Gaps in knowledge were observed regarding the use of cotrimoxazole and the follow-up of ART-treated patients. Main factors independently associated with a higher knowledge score included training, involvement in therapeutic committees, satisfactory collaboration with other practitioners and establishment of strong relationships between patients and patients' associations.
  
  
  CONCLUSIONS
  Overall knowledge in HIV care is good among HIV physicians working at all three levels of decentralization of healthcare in Cameroon. However, a national training policy should be set up to improve knowledge and practices in both ART follow-up and specific situations such as paediatric HIV. Collaboration between caregivers and external resources involved in HIV care should also be encouraged.
authors.affiliation: INSERM, U, Marseille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rasson
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.forename: Lionel
authors.initials: L
authors.lastname: Fugon
authors.forename: Camelia
authors.initials: C
authors.lastname: Protopopescu
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marcellin
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002163:Cameroon; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology*; D011057:Politics; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents