Thesis presented and defended publicly in order to obtain a Professional Master Degree in Epidemiology and Public Health, Department of Biomedical Sciences, Faculty of Sciences, University of Dschang

Academic year 2014-2015

Student: Goura André Pascal ¹

gouraandrpascal@yahoo.fr

Supervisor: Dr ATEUDJIEU Jérôme, MD, MPH, Ph.D ¹²³

jateudj@yahoo.fr ; Jerome.ateudjieu@masante-cm.org

Funded by :    DOVE PROJECT  ; M.A. SANTE

 Abstract

Background: Managing hiv patients is a key component to hiv/aids control strategies in Cameroon. After ART was made free access in Cameroon in 2007, management units were created to follow up diagnosed patients but not every screened patient has access to ART. Studying the therapeutic itineraries of the western Cameroon active line and associated factors could improve the overall management of this population.

Methods: We conducted a Cross-sectional study from June 2015 to February 2016 in the Cameroon West region management units. Functional health districts with management units were exhaustively sampled for the mapping of regional access to antiretroviral care. Patients from these units were randomly selected and recruited during their monthly period of receiving antiretroviral drugs. Data were collected by 04 trained surveyors using a structured questionnaire administered in a face to face interview. Proportions were estimated using Epi-info software to describe patient distribution.

Results: Four hundred and seventy-two patients were sampled. The mean age of participants was 42 (± 10) years with a sex ratio male/female of 1/3. Sixty two percent (294/472) of participants resided in the health district of their screening. Close to 1/5 (74/382) patient migrated from local health district with treatment unit to another local health district for follow up. Nearly 72% (274/382) were follow up in the diagnose health districts. Fourteen follow up units were distributed to 09 health districts (45% coverage) and 11/20 districts had no management unit. Second line treatment was available only in one public treatment unit. About 97% of patients under treatment were screened in a health facility. Discretion, displacement, stock-outs, high management cost are the main reasons for the change of management units. Conclusion: The therapeutic itineraries of western patients make difficult the comprehensive care because of poor access to ART and the weakness of the monitoring system. Computerize monitoring databases of patients and create more management units in other districts would better control the active line.

Key words: Therapeutic itineraries, PLHIV, ATC and HMU, Western-Cameroon.

1. Department of Biomedical Sciences, Faculty of Sciences, University of Dschang
2. Division of Health Operational Research, Ministry of Public Health, Cameroon
3. A. SANTE (Meilleur Accès aux Soins de Santé/ Better Access to Health Care)