Access to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges.

Breast cancer (breast Ca) is recognised as a major public health problem in the world. Data on reproductive factors associated with breast Ca in the Central African Republic (CAR) is very limited. This study aimed to identify reproductive variables as risk factors for breast Ca in CAR women. A case–control study was conducted among 174 cases of breast Ca confirmed at the Pathology Unit of the National Laboratory in Bangui between 2003 and 2015 and 348 age-matched controls. Data collection tools included a questionnaire, interviews and a review of medical records of patients. Data were analysed using SPSS software version 20. Odd ratios and 95% confidence intervals (CI) for the likelihood of developing breast Ca were obtained using unconditional logistic regression. In total, 522 women with a mean age of 45.8 (SD = 13.4) years were enrolled. Women with breast Ca were more likely to have attained little or no education (AOR = 11.23, CI: 4.65–27.14 and AOR = 2.40, CI: 1.15–4.99), to be married (AOR = 2.09, CI: 1.18–3.71), to have had an abortion (AOR = 5.41, CI: 3.47–8.44), and to be nulliparous (AOR = 1.98, CI: 1.12–3.49). Decreased odds of breast Ca were associated with being employed (AOR = 0.32, CI: 0.19–0.56), living in urban areas (AOR = 0.16, CI: 0.07–0.37), late menarche (AOR = 0.18, CI: 0.07–0.44), regular menstrual cycles (AOR = 0.44, CI: 0.23–0.81), term pregnancy (AOR = 0.26, CI: 0.13–0.50) and hormonal contraceptive use (AOR = 0.62, CI: 0.41–0.93). Breast Ca risk factors in CAR did not appear to be significantly different from that observed in other populations. This study highlighted the risk factors of breast Ca in women living in Bangui to inform appropriate control measures.

Long term use of antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLWHIV) is associated with disturbances in blood lipids which should be monitored. More data on such disturbances are needed in Cameroon to persuade the country program to institute their routine monitoring. We then sought to determine the prevalence and timing of dyslipidaemia in PLWHIV and receiving ART in a predominantly rural Cameroonian setting.

The outbreak of the Ebola virus disease (EVD) in 2014 led to massive dropouts in HIV care in Guinea. Meanwhile, Médecins Sans Frontières (MSF) was implementing a six-monthly appointment spacing approach adapted locally as Rendez-vous de Six Mois (R6M) with an objective to improve retention in care. We sought to evaluate this innovative model of ART delivery in circumstances where access to healthcare is restricted. A retrospective cohort study in 2014 of the outcome of a group of stable patients (viral load ≤1000 copies/μl) enrolled voluntarily in R6M compared with a group of stable patients continuing standard one to three monthly visits in Conakry. Log-rank test and Cox proportional hazards model were used to compare rates of attrition (deaths and defaulters) from care between the two groups. A linear regression analysis was used to describe the trend or pattern in the number of clinical visits over time. Included were 1957 adults of 15 years old and above of whom 1166 (59.6%) were enrolled in the R6M group and 791 (40.4%) in the standard care group. The proportion remaining in care at 18 months and beyond was 90% in the R6M group; significantly higher than the 75% observed in the control group (p < 0.0001). After adjusting for duration on ART and tuberculosis co-infection as covariates, the R6M strategy was associated with a 60% reduction in the rate of attrition from care compared with standard care (adjusted Hazard Ratio = 0.40, 95%CI: 0.27–0.59, p < 0.001). There was a negative secular trend in the number of monthly clinical visits for 24 months as the predicted caseload reduced on average by just below 50 visits per month (β = −48.6, R2 = 0.82, p < 0.0001). R6M was likely to reduce staff workload and to mitigate attrition from ART care for stable patients in Conakry despite restricted access to healthcare caused by the devastating EVD on the health system in Guinea. R6M could be rolled out as the model of care for stable patients where and when feasible as a strategy likely to improve retention in HIV care.

Background: HIV remains an epidemic of major public health importance in Cameroon but a decline in HIV prevalence has been observed according to population-based surveys conducted in 2004, 2011 and 2018. We sought to review current evidence for declining HIV prevalence despite increasing survival owing to ‘universal test and treat’ and to explore the reason for the decrease, particularly the role of behavioural change. Methods: We conducted a secondary analysis using HIV prevalence, behavioural and social determinants data of the Demographic and Health Survey Program databases. Trend lines were fitted to data that were available for a minimum of three points in time during the 1991–2018 period. Regression coefficients associated p-values and 95% confidence intervals were obtained using Microsoft Excel software. Results: Overall adult HIV prevalence decreased significantly from 5.4% (95%CI: 4.8-6.0) in 2004 to 4.3% (95%CI: 3.8–4.8) in 2011 and further down to 2.7% (95%CI: 2.3–3.1) in 2018 at a rate of about 1.4% every septennium (β = -1.4, R² = 0.98, p = 0.03). Yet, the number of persons surviving with HIV increased from about 0.05 million in 1991 to 0.5 million in 2018 corresponding to an increase in access to antiretroviral therapy from less than 10% to universal coverage of 80% respectively. Concurrent reductions in risky sexual behaviours were observed: a delayed sexual debut by one year, decreased sexual violence by 7%, decreased polygamous unions by 16%, decreased multiple sexual partners by 15.3% and increased condom use by 26.3%. Conclusion: The observed decline in HIV prevalence is statistically valid and reflects the observed decline in risky sexual behaviour that need to be sustained by the National HIV programme. Though universal access to ART has increased the number of persons surviving with HIV, this has not led to an increased prevalence of HIV in a setting with a rising population.

Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0–7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9–58.5) and 41.0 (38.8–44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include new-born screening programs and strategies to prevent chronic complications.