Evaluation of the case-by-case surveillance system for the retention-in-care of people living with HIV in two urban Health Districts-Cameroon, 2019

  • Viral hepatitis and HIV
  • Public health surveillance
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In 2016, Cameroon recruited Psychosocial Agents (PSA) to improve follow-up and retention-in-care of people living with HIV/AIDS (PLWHA) on Antiretroviral Therapy (ART). PSA perform case-by-case surveillance of retention-in-care in addition to routine surveillance. Center region includes roughly 1/4 of Cameroon patients on ART. We evaluated the surveillance system of retention-in-care of PLWHA in Biyem-assi and Cite verte Health Districts (HDs) in that region.

We conducted a cross-sectional study from 2017 to 2018. We realized a multistage sampling by randomly selecting two of the thirty HDs and about half of health facilities (HFs) within each HD. We also worked at the Regional Technical Group of the National AIDS Control Committee (RTG/NACC). Respondents were PSA and all staff involved in surveillance. We assessed key system attributes with the CDC 2001 updated guidelines for evaluation of public health surveillance systems. We collected data from monthly reports of PSA and routine surveillance through District Health Information’s 2 Software (DHIS2). Analysis was done using Epi info 7.0.

Overall, 140/194 (72 %) people were surveyed in 17 HFs and the RTG/NACC. PSA accounted for 95% (133/140) of respondents and 62% (83/133) of them completed medical or psychosocial training. Definition of retention-in-care and definition of at least three operational terms were known by 74% (104/140) and 81 % (113/140) of these same respective respondents. Surveillance reports at RTG/NACC were only paper-based. Among respondents, 69% (97/140) knew when to start looking for a patient who did not attend an appointment. The surveillance detected 52% (3012/5759) of absentees reported in DHIS2 and 78% (105/135) of respondents stated that reports were available in their HF.

The surveillance system of retention-in-care of PLWHA is simple. However, its utility, reactivity, sensitivity and stability can be improved. We thus recommend analyzing reports at the RTG/NACC, recycling APS and archiving reports after on-site validation.

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