title: Adult HIV care resources, management practices and patient characteristics in the Phase 1 IeDEA Central Africa cohort.
abstract: BACKGROUND
  Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts' characteristics in the Central Africa region are sparse.
  
  
  METHODS
  A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site).
  
  
  RESULTS
  Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%).
  
  
  CONCLUSIONS
  Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort's site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa.
authors.affiliation: Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, North Carolina, USA.
authors.forename: Kimon
authors.initials: K
authors.lastname: Divaris
authors.forename: Jamie
authors.initials: J
authors.lastname: Newman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway-Foday
authors.forename: Wilfred
authors.initials: W
authors.lastname: Akam
authors.forename: Ashu
authors.initials: A
authors.lastname: Balimba
authors.forename: Cyrille
authors.initials: C
authors.lastname: Dusengamungu
authors.forename: Lucien
authors.initials: L
authors.lastname: Kalenga
authors.forename: Marcel
authors.initials: M
authors.lastname: Mbaya
authors.forename: Brigitte Mfangam
authors.initials: BM
authors.lastname: Molu
authors.forename: Veronicah
authors.initials: V
authors.lastname: Mugisha
authors.forename: Henri
authors.initials: H
authors.lastname: Mukumbi
authors.forename: Jules
authors.initials: J
authors.lastname: Mushingantahe
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.forename: Théodore
authors.initials: T
authors.lastname: Niyongabo
authors.forename: Joseph
authors.initials: J
authors.lastname: Atibu
authors.forename: Innocent
authors.initials: I
authors.lastname: Azinyue
authors.forename: Modeste
authors.initials: M
authors.lastname: Kiumbu
authors.forename: Godfrey
authors.initials: G
authors.lastname: Woelk
mesh_terms: D000328:Adult; D000350:Africa, Central / Q000453:epidemiology; D000351:Africa, Eastern / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003695:Delivery of Health Care; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male
chemical_list: D019380:Anti-HIV Agents