Evaluating the Impact of the Universal Test and Treat Strategy on the Survival of Patients in the Northwest Region of Cameroon

Abstract

Introduction : The main outcome of efficiently implemented universal test and treat (UTT) program is improved survival. UTT implementation has been ongoing in Cameroon since 2016 but evaluation data are scarce. This study aims to assess the survival of antiretroviral therapy (ART) patients initiated under UTT in Northwest region of Cameroon. Methods : This retrospective cohort study included HIV-positive patients initiated in 2016 at 27 purposefully selected sites and followed until 2021. Data was anonymously abstracted from ART registers and patients’ charts. Kaplan-Meier survival estimates and Cox model were used to compare the survival of patients initiated under UTT with those initiated otherwise, using stata version 14.0. Results : In total, 2490 HIV-positive patients (median age 42.7 years, 94.7% adults, and 69.0% female) participated in the study. Of 1389 patients with viral load (VL) test results, 55% were initiated on ART late. The VL suppression rate of patients initiated late and those initiated early were similar. During follow-up, 1020 (40.9%) participants censored. The survival curves of patients initiated early on ART and those initiated late were similar during the first 2.5 years of follow-up but significantly (p < 0.01) differed in the subsequent 3.5 years, with patients initiated early having improved survival. Significant predictors of poor survival were initiating treatment late and being a male (AHR: 1.84 (95% CI: 1.13 - 2.99) and 2.12 (95% CI: 1.37 - 3.28)). Conclusions : This study confirms the expected impact of UTT. Programs only need to close existing implementation gaps along the critical pathways (diagnosis and treatment) of UTT, focusing more on males.