the EVAL Study Group. Delayed first consultation after diagnosis of HIV infection in Cameroon.

the EVAL Study Group. Delayed first consultation after diagnosis of HIV infection in Cameroon.

Marcellin and colleagues set out to study the impact of both decentralization of HIV care and individual factors on delayed first consultation (>/=6 months) after HIV diagnosis in Cameroon, in the context of the national antiretroviral treatment scale-up program. The national cross-sectional multicenter survey EVAL (ANRS 12-116) was conducted from September 2006 to March 2007 in 27 HIV centres in Cameroon. Logistic regression was used to characterize patients with delayed first consultation among 3151 HIV-infected adults. Fifteen percent of patients reported a delay of at least 6 months before their first consultation after HIV diagnosis. In the multivariate analysis adjusted for the frequency of visits to the HIV centre, independent correlates of reporting a delay of at least 6 months before consulting included the characteristics of the HIV centres (created before 2005 and located in small or medium-size hospitals) and the following individual patient characteristics: sex and matrimonial status (women living in a couple), the circumstances of the HIV diagnosis (test not performed in the hospital providing HIV care, test performed during a voluntary screening campaign) and patient’s negative perception of antiretroviral treatment toxicity. Delays before first consultation for HIV care in Cameroon have been reduced, thanks to the full implementation of the national program of decentralization. Results underline the importance of coordinating diagnosis with treatment activities and the need to develop counselling actions, focusing on the balance between antiretroviral treatment effectiveness and its potential side effects. Counselling should also be part of patients’ follow-up after diagnosis during voluntary screening campaigns.

This is the first nation-wide study in sub-Saharan Africa to explore components of the causal process leading to late access to antiretroviral treatment: late HIV diagnosis versus delayed first consultation after HIV diagnosis. Decentralisation of HIV services in Cameroon has had the benefit of more prompt access to care, with 57% of patients experiencing a delay of less than 1 month between HIV diagnosis and their first medical consultation for HIV care. With many of the factors influencing delayed onset of antiretroviral treatment highlighted by this study, now programme planners and implementers can introduce modifications to reduce the delay. Their focus should be on the 15% who are not assessed for antiretroviral treatment until 6 months or more after HIV diagnosis and those who are lost to follow-up after an initial HIV diagnosis.