Solthis Therapeutic Solidarity and Initiatives for Health

CAMEROUNFighting HIV / AIDS

Context

WHO recommends that all HIV-exposed children be screened and that those diagnosed with HIV infection begin antiretroviral (ARV) treatment immediately. However, pediatric HIV remains a neglected disease. The market for pediatric ARV drugs remains very small. Improving access to early diagnosis and treatment for children living with HIV is an urgent public health priority. 

Cameroon faces a mixed epidemic, both generalized and concentrated in certain high-risk population groups. Overall HIV prevalence among the adult population aged 15-49 years is around 2.7% according to the latest Demographic and Health Survey (2018). In 2019, children under the age of 15 accounted for 19.3% of new infections and women accounted for 2/3 of new infections among 15-49 year olds. In terms of provision of care, as of December 31, 2020, approximately 350,818 people living with HIV in Cameroon were on antiretroviral treatment, which represented about 85% of the PLHIV population in the country. The number of children under 15 years of age on ARV treatment was 11,219 and represented 35% ARV coverage in this population. 

The strategic plan evaluation conducted in 2019 identified weaknesses that explain this underperformance in the child population. The most important of these are : 

•  the insufficient decentralization of pediatric care services throughout the country  
• frequent shortages of pediatric ARVs  
• the lack of medical and paramedical personnel trained in pediatric HIV care, etc.  

To reverse this trend, the country, through the Global Fund grant, has planned several interventions, including strengthening the prevention of mother-to-child transmission of HIV (PMTCT) and optimizing pediatric HIV care. Within this framework, the focus will be on pediatric HIV research through strengthening early diagnosis, improving the availability of pediatric ARVs, strengthening the capacity of providers and sensitizing parents and/or guardians. 

Main objective of the study

he assessment of the national HIV strategic plan revealed the structural challenges facing the country with regard to pediatric HIV care. However, very little current information exists on the operational determinants of supply and demand for care services among children. In order to improve coverage of pediatric care services, it is necessary to determine the barriers to access at all levels of the health pyramid, determine the socio-cultural and economic obstacles and identify priority areas for intervention. Therefore, the study will focus on :

• Developping the collection tools and documentation for the implementation of the situational analysis 
• Analysing quantitative, qualitative and biological data 
• Writing the final report of the survey 

Mais activities

• Epidemiological analysis of the diagnostic and treatment cascade for children in Cameroon stratified by region 
• Description of the referral system between PMTCT and the treatment site for children 
•  Description of pediatric ARV stock-outs in the country 
• Analysis of existing normative documents at the national level: review of normative documents for the diagnosis and treatment of children in relation to WHO guidelines  
• Mapping of existing differentiated models: review of care models in place for children, including mother/child clinics, adolescent clubs, intensive pediatric clinics through qualitative surveys and analysis of the functioning and performance of the different models 
• Update on the transition to dolutegravir (DGT): in each region and each site, analysis of the transition to DGT in “older children” and adolescents