Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factorsJournal articleSylvie Boyer, Isabelle Clerc, Cécile-Renée Bonono, Fabienne Marcellin, Paule-Christiane Bilé and Bruno Ventelou, Social Science & Medicine, Volume 72, Issue 8, pp. 1383-1392, 2011

In low-income countries, health system deficiencies may undermine treatment continuity and adherence to antiretroviral therapy (ART) that are crucial for the success of large-scale public ART programs. In addition to examining the effects of individual characteristics, on non-adherence to ART and treatment interruption behaviors - i.e. treatment interruption for more than 2 consecutive days during the previous 4 weeks, this study aims to extend our knowledge on the role played by healthcare supply-related characteristics in shaping these two treatment outcomes. These effects are examined using multilevel logistic models applied to a sub-sample of 2381 ART-treated patients followed-up in 27 treatment centers in Cameroon (ANRS-EVAL survey, 2006-2007). Multivariate models show that factors common to both non-adherence and treatment interruption include binge drinking (at the individual-level) and large hospital size (at the healthcare supply-level). Among the individual factors, financial difficulties of paying for HIV-care are the major correlates of treatment interruption [Adjusted Odds Ratio (AOR) 95% confidence interval (CI)Â =Â 11.73(7.24-19.00)]. By contrast, individual factors associated with an increased risk of non-adherence include: having a main partner but not living in a couple compared to patients living in a couple [AOR(95%CI)Â =Â 1.51(1.14-2.01)]; experience of discrimination in the family environment [AOR(95%CI)Â =Â 1.74(1.14-2.65)]; a lack of regular meals [AOR(95%CI)Â =Â 1.93(1.44-2.57)], and switching antiretroviral drugs (ARV) regimen [AOR(95%CI)Â =Â 1.36(1.08-1.70)]. At healthcare facility-level, the main correlate of ART interruption was antiretroviral stock-outs [AOR(95%CI)Â =Â 1.76(1.01-3.32)] whereas the lack of psychosocial support from specialized staff and lack of task-shifting to nurses in medical follow-up were both associated with a higher-risk of non-adherence [respective AOR (95%CI)Â =Â 2.81(1.13-6.95) and 1.51(1.00-3.40)

Does HIV services decentralization protect against the risk of catastrophic health expenditures?: some lessons from Cameroon.Journal articleSylvie Boyer, Mohammad Abu-Zaineh, Jérôme Blanche, Sandrine Loubiere, Cécile-Renée Bonono, Jean-Paul Moatti and Bruno Ventelou, Health services research, Volume 46, Issue 6pt2, pp. 2029-2056, 2011

OBJECTIVE: Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection. DATA SOURCE AND STUDY DESIGN: We use primary data from the cross-sectional EVAL-ANRS

Individual and Structural Factors Associated With HIV Status Disclosure to Main Partner in Cameroon: ANRS 12-116 EVAL Survey, 2006-2007Journal articleMarie Suzan-Monti, Jérôme Blanche, Paule Bilé, Sinata Koulla-Shiro, Mohammad Abu-Zaineh, Fabienne Marcellin, Sylvie Boyer, Maria Patrizia Carrieri and Bruno Spire, JAIDS Journal of Acquired Immune Deficiency Syndromes, Volume 57, Issue Suppl. 1, pp. s22-s26, 2011

Encouraging HIV-positive people to disclose their serostatus to their main partner is considered as a key component of secondary prevention. The purpose of this study was to identify individual and structural factors associated with HIV serostatus disclosure to one's steady partner in Cameroon, a...

HIV disclosure and unsafe sex among HIV-infected women in Cameroon: Results from the ANRS-EVAL studyJournal articleSandrine Loubiere, Patrick Peretti-Watel, Sylvie Boyer, Jérôme Blanche, Séverin-Cécile Abega and Bruno Spire, Social Science & Medicine, Volume 69, Issue 6, pp. 885-891, 2009

Encouraging seropositive people to voluntarily disclose their serostatus has been promoted as a key component of HIV prevention. Among other reasons, HIV disclosure to one's main partner is believed to be an incentive for serodiscordant couples to practice safe sex. The present article investigated this issue by conducting a cross-sectional survey of a large sample of HIV-infected women attending HIV care centers in Cameroon (NÂ =Â 1014). Overall, 86.3% of these women had disclosed their serostatus to their main partner. With respect to sexual activity with their main partner during the previous three months, 35.0% had practiced abstinence and 47.4% only safe sex, whereas 17.6% had engaged in unsafe sex at least once. HIV disclosure to one's main partner was related to safe sexual practices in multivariate analysis. Some of the factors associated with disclosure and safe sex were illustrative of the positive roles of improved access to care and women's empowerment. On the contrary, beliefs overestimating the effectiveness of antiretroviral therapies were quite widespread among respondents and predictive of both concealment of HIV status and unsafe sex.