Background: Early Identification for timely management of clients with AHD remains a challenge especially for OIs other than TB. Between Jan to March 2022, AHD accounted for approximately 60% of reported deaths amongst PLWHIV in the Atteindre95 PEPFAR Funded project in the littoral and south regions of Cameroon. In order to improve identification of PLHIV with AHD, we assessed the use of a novel screening tool improve early diagnosis of AHD.
Method: A quasi-experimental designed comparing AHD cases identified, during the before period defined from October 15, 2021, to April 1st, 2022, and after period from April 15, 2022, to September 2022, all clients coming for ARV pick-up during these periods were eligible for AHD Screening. A multistage sampling method was used to select 09 (05 in Littoral and 04 in the south) intervention sites. The intervention package consisted of tool design, training and mentorship, setting up of documentation processes. Frequencies and proportions were used for continuous variables, p-value set at <0.05.
Results: Sixty-three percent-63% (11698/18708) and 66% (12693/19342) of clients seen were screened during the pre and post phases respectively. A total of 183 clients were identified with AHD with a median age of 40yrs (IQR=30-49yrs) amongst which 15 were children <5yrs. Median duration on ART to time of AHD Diagnosis was 0yrs (IQR=0-4yrs), 32% vs 42% of Clients with AHD were in therapeutic failure in the pre and post phases respectively. The case detection rate during the before and after period was 5.6‰ and 9.3‰ respectively. This represented a 1.7-fold increase in the case detection rate during the intervention phase (RR=1.67, p=0.0001).
Conclusion:
The use of the integrated AHD Screening tool has shown to improve identification of clients with AHD, and can be an option to consider while trying to close the existing gap in AHD Screening and diagnosis