title: Susceptibility to transmitting HIV in patients initiating antiretroviral therapy in rural district hospitals in Cameroon (Stratall ANRS 12110/ESTHER Trial).
abstract: Using cohort data nested in a randomized trial conducted in Cameroon, this study aimed to investigate time trends and predictors of the susceptibility to transmitting HIV during the first 24 months of treatment.
  
  
  
  The outcome, susceptibility to transmitting HIV, was defined as reporting inconsistent condom use and experiencing incomplete virological suppression. Mixed logistic regressions were performed to identify predictors of this outcome among 250 patients reporting to have had sexual relationships either with HIV-negative or unknown HIV status partner(s).
  
  
  
  Despite an initial decrease from 76% at M0 to 50% at M6, the rate of inconsistent condom use significantly increased from M12 (59%) to M24 (66%) (p = 0.017). However, the proportion of patients susceptible to transmitting HIV significantly decreased over follow-up from 76% at M0, to 50% at M6, 31% at M12 and 27% at M24 (p<0.001). After controlling for age, gender and intervention group, we found that perceiving healthcare staff's readiness to listen as poor (adjusted odds ratios (AOR) [95% Confidence Interval (CI)] = 1.87 [1.01-3.46]), reporting to have sexual relationships more than once per week (AOR [95%CI] = 2.52 [1.29-4.93]), having more than one sexual partner (AOR [95%CI] = 2.53 [1.21-5.30]) and desiring a/another child (AOR [95%CI] = 2.07 [1.10-3.87]) were all associated with a higher risk of being susceptible to transmitting HIV. Conversely, time since ART initiation (AOR [95%CI] = 0.66 [0.53-0.83] for an extra 6 months and ART adherence (AOR [95%CI] = 0.33 [0.15-0.72]) were significantly associated with a lower risk of being susceptible to transmitting HIV.
  
  
  
  The decrease observed in the susceptibility to transmitting HIV suggests that fear of behavioural disinhibition should not be a barrier to universal access to ART. However, developing adequate preventive interventions matching patients' expectations -like the desire to have children- and strengthening healthcare staff's counselling skills are urgently needed to maximize the impact of ART in slowing the HIV epidemic.
authors: INSERM, UMR912, SESSTIM, Marseille, France.
authors: Gilbert
authors: G
authors: Ndziessi
authors: Julien
authors: J
authors: Cohen
authors: Charles
authors: C
authors: Kouanfack
authors: Fabienne
authors: F
authors: Marcellin
authors: Maria Patrizia
authors: MP
authors: Carrieri
authors: Maria Patrizia
authors: MP
authors: Carierri
authors: Gabrièle
authors: G
authors: Laborde-Balen
authors: Camélia
authors: C
authors: Protopopescu
authors: Avelin Fobang
authors: AF
authors: Aghokeng
authors: Jean-Paul
authors: JP
authors: Moatti
authors: Bruno
authors: B
authors: Spire
authors: Eric
authors: E
authors: Delaporte
authors: Christian
authors: C
authors: Laurent
authors: Sylvie
authors: S
authors: Boyer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D017280:Condoms; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000472:pathogenicity*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission*; D006767:Hospitals, District; D006801:Humans; D008297:Male; D012307:Risk Factors; D021841:Safe Sex / Q000187:drug effects; D012747:Sexual Partners
chemical_list: D044966:Anti-Retroviral Agents
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