title: Predictors of poor retention on antiretroviral therapy as a major HIV drug resistance early warning indicator in Cameroon: results from a nationwide systematic random sampling.
abstract: BACKGROUND
  Retention on lifelong antiretroviral therapy (ART) is essential in sustaining treatment success while preventing HIV drug resistance (HIVDR), especially in resource-limited settings (RLS). In an era of rising numbers of patients on ART, mastering patients in care is becoming more strategic for programmatic interventions. Due to lapses and uncertainty with the current WHO sampling approach in Cameroon, we thus aimed to ascertain the national performance of, and determinants in, retention on ART at 12 months.
  
  
  METHODS
  Using a systematic random sampling, a survey was conducted in the ten regions (56 sites) of Cameroon, within the "reporting period" of October 2013-November 2014, enrolling 5005 eligible adults and children. Performance in retention on ART at 12 months was interpreted following the definition of HIVDR early warning indicator: excellent (>85%), fair (85-75%), poor (<75); and factors with p-value < 0.01 were considered statistically significant.
  
  
  RESULTS
  Majority (74.4%) of patients were in urban settings, and 50.9% were managed in reference treatment centres. Nationwide, retention on ART at 12 months was 60.4% (2023/3349); only six sites and one region achieved acceptable performances. Retention performance varied in reference treatment centres (54.2%) vs. management units (66.8%), p < 0.0001; male (57.1%) vs. women (62.0%), p = 0.007; and with WHO clinical stage I (63.3%) vs. other stages (55.6%), p = 0.007; but neither for age (adults [60.3%] vs. children [58.8%], p = 0.730) nor for immune status (CD4351-500[65.9%] vs. other CD4-staging [59.86%], p = 0.077).
  
  
  CONCLUSIONS
  Poor retention in care, within 12 months of ART initiation, urges active search for lost-to-follow-up targeting preferentially male and symptomatic patients, especially within reference ART clinics. Such sampling strategy could be further strengthened for informed ART monitoring and HIVDR prevention perspectives.
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.|National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Serge Clotaire
authors.initials: SC
authors.lastname: Billong
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon. josephfokam@gmail.com.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon. josephfokam@gmail.com.|Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon. josephfokam@gmail.com.|Department of Experimental Medicine and Surgery, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy. josephfokam@gmail.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Fokam
authors.affiliation: Faculty of Medicine and Pharmaceutical sciences (FMSP), University of Douala, Douala, Cameroon.|Laquintinie Hospital of Douala, Douala, Cameroon.
authors.forename: Calixte Ida
authors.initials: CI
authors.lastname: Penda
authors.affiliation: National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Salmon
authors.initials: S
authors.lastname: Amadou
authors.affiliation: National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: David Same
authors.initials: DS
authors.lastname: Kob
authors.affiliation: Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar.
authors.forename: Edson-Joan
authors.initials: EJ
authors.lastname: Billong
authors.affiliation: Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon.|UNESCO Biotechnology Multidisciplinary Board, and Department of Biology and Pathology, Faculty of Sciences, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colizzi
authors.affiliation: Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.|Chantal BIYA International Reference Centre (CIRCB) for research on HIV/AIDS prevention and management, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ndjolo
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.|Faculty of Medicine and Biomedical Sciences (FMBS), University of Yaoundé 1, Yaoundé, Cameroon.|Division of Operational Health Research, Ministry of Public Health, Yaounde, Cameroon.
authors.forename: Anne-Cecile Zoung-Kani
authors.initials: AZ
authors.lastname: Bisseck
authors.affiliation: National HIV drug resistance surveillance and prevention Working Group (HIVDR-WG), Ministry of Public Health, Yaoundé, Cameroon.|National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.
authors.forename: Jean-Bosco Nfetam
authors.initials: JN
authors.lastname: Elat
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002163:Cameroon; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000187:drug effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Cameroon; HIV drug resistance early warning indicator; Random sampling; Retention in care