The clinic-biological progress of patients on ARV under D.O.T

Context and justification

• Cameroon is a Central African country of limited resources with about 16 M inhabitants in 10 administrative regions

• Surface area: 475 000 km²

• Prevalence: 5,5% EDSIII 2004

• PNLS .... Decentralisation (CTA, CTAFF, UPEC)

• Representing about 1/4 of the total surface area of Cameroon, the East Region is under populated, with a total population of about 945 000 h. This gives a population density of about 3 per km². It has one CTA and 8 UPECS of which only 5 are functional. At 8,6% it has the second highest national prevalence rate of HIV in the Country.

• There are 14 landlocked health districts having as a distance unit, 100 km to undertake in about 4 to 6 hours depending on the season, which leads to the most recurrent reason given by patients to justify their poor observance of treatment.

• Resolution: D.O.T initiative

Objectives

• Ameliorate the observance of patients on ARV who live far from the care units and whom distance leads to poor appointment observance and follow up of ARV and O.I.D

Methods

A - Role of sites

• Massive sensibilisation and screening for the recruitment of HIV+ patients

• Choosing patients belonging to associations

• Collection of samples to be analyzed at the appropriate CTA

• Transportation of patients eligible for ARVT to the CTA for evaluation and inclusion in the study

• Weekly sharing of ARV and O.I.D

B - Role of the tutor CTA

• Receiving and analyzing samples for PTW

• Clinical evaluation of patients for eligibility and treatment of ARV according to the national directives.

• Making available Hospital Unit of ARV and MIO

• Clinical and biological follow up every 6 months

• Collection and analysis of data

• Networking the CTA and these Hospital Unit for eventual problems

Results

• All the peripheral patients on D.O.T did their two bi-annual workups expected during the period of study.

• No patient on D.O.T missed his appointment for supplies of ARV or drugs for prophylaxis of O.I

• No patient on D.O.T on ARVT had an O.I during the period of the study

• Total weight gain of patient on D.O.T was between 5 to 15 kg.

Conclusion

• The global management of PLHIV is a team and harmonious problem

• A permanent and active coaching can ameliorate the success of ARVT for the PLHIV by reducing the multiple difficulties they face, be they linked to:

• The patient himself and his surroundings

• The drugs,

• To the health personnel

Thanks

• The team of the tutor CTA involved in the study;

• Mme Bithé Veronica, Mme Sembong Valérie, Mme Nanga Aicha

• The Catholic Health Center team of Doume , more especially sister Isabella Krauss and Fr Faiseandier

• The Garoua-Boulai team (Dr Solofo and his community agents)

• The Doume DH team ( Dr Bayiha and his collaborators)

• The Doumbi Catholic Center team, especially Sister Louise SAAR.