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.

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 (CD4 [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.