Introduction: Antiretroviral Treatment (ART) outcomes remain poor in Cameroon despite the rapid increase of individuals on ART following the Test and Treat strategy since 2016. We sought to assess the effect of early missed refill appointments on treatment attrition, Viral Load (VL) uptake and Viral Suppression (VS) 12 months after treatment initiation in a large cohort of HIV-positive adults in the West region of Cameroon.
Methods: A retrospective cross-sectional analysis of existing data using medical records for adults >20 years old who started ART between October 2019 and September 2020 in the 25 HIV treatment centres in the West Region. Cox proportional hazards and logistic regressions were used to assess the effect of early missed appointment on attrition, VL uptake and VS.
Results: The 2,064 participants had as mean age 36.9 (SD= 13.3) with 36.4% males. Clients who experienced early missed appointments had a higher cumulative risk of death (4.3% vs 2.6%; p = 0.002), loss to follow-up (18.2% vs 2.2%; p< 0.001) and stop treatment (2.8% vs 0.8%; p= 0.02). They were also more likely to experience treatment attrition (Adjusted HR: AHR= 6.5; 95%CI: 4.5-9.3). There was no significant difference in VL uptake and VS rate between the early missed appointment clients and non-early missed appointment clients. In the group of clients not on Tenofovir, Lamivudine, and Dolutegravir (TLD), early missed appointment was associated with low risk of VS (AO = 0.2; 95%CI: 0.1-0.6).
Conclusions: Early missed appointments for ART refill is associated with treatment attrition, death and lost to follow-up and low risk of VS in clients not on TLD. Robust prospective and intervention studies are needed to inform improved performance in ART programs.