Abstract:

Prior to the release of the current HIV testing recommendation on retesting for verification (RFV), the Cameroon Baptist Convention Health Services (CBCHS) established 0.5% misdiagnosis and inappropriate ART treatment among ART clients in Northwest and Southwest regions. This study aimed at assessing adherence to HIV testing guideline and issues involved. This cross-sectional study was conducted at 27 purposefully selected sites where participants consented and anonymously completed a questionnaire containing questions on their knowledge and practice on RFV, challenges and facilitators. Records of clients who tested HIV positive in 2021 were reviewed to confirm RFV. Data was analysed for frequencies and proportions. A total of 25(93.6%) facilities had the minimum two laboratory staff, most (93.8%) had a minimum training at diploma level and had two or more years of work experience (91.7%). The staff knowledge was averagely 81% accurate on HIV testing algorithm, 79% on RFV and 63% on practice. The main facilitators of RFV were availability of rapid test kits (46%) and trained staff (10%) while bottlenecks were limited test kits (34%) and refusals (28%). Second event testing was performed for 92.5% (1525) of cases, of whom 93.4% was by another tester. Most independent testers knew the results of the first event test before conducting the second event test. Cases of documentation of second event testing without conducted it were reported. Staff were trained and knowledgeable on RFV, but the practice was low. More training and supervision are required for improvement on adherence to protocols for RFV.

References:

[1] V. A. Fonner et al., ‘Country adherence to WHO recommendations to improve the quality of HIV diagnosis: a global policy review’, BMJ Glob Health, vol. 5, no. 5, p.e001939, May 2020, doi: 10.1136/bmjgh-2019-001939.

[2] N. B. Njozing, K. E. Edin, and A.-K. Hurtig, ‘“When I get better, I will do the test”: Facilitators and barriers to HIV testing in Northwest Region of Cameroon with implications for TB and HIV/AIDS control programmes’, SAHARA-J: Journal of Social Aspects of HIV/AIDS, vol. 7, no. 4, pp. 24–32, Dec. 2010, doi: 10.1080/17290376.2010.9724974.

[3] P. Ngangue, M.-P. Gagnon, and E. Bedard, ‘Challenges in the delivery of public HIV testing and counselling (HTC) in Douala, Cameroon: providers perspectives and implications on quality of HTC services’, BMC Int Health Hum Rights, vol. 17, no. 1, p. 9, Dec. 2017, doi: 10.1186/s12914-017-0118-2.

[4] A report on the misdiagnosis of HIV status.pdf’.

[5] ‘Implementing HIV Retesting Before ART.pdf’.

[6] HIV Screening and Testing | Guidelines and Recommendations | HIV/AIDS | CDC’, Jan. 21, 2020. https://www.cdc.gov/hiv/guidelines/testing.html (accessed May 24, 2022).

[7] WHO Recommendations to Assure HIV Testing Quality’. Accessed: May 24, 2022. [Online]. Available: http://apps.who.int/iris/bitstream/handle/10665/179521/WHO_HIV_2015.15_eng.pdf?sequence=5.

[8] Operational Guidelines for the Implementation of the “Test and Treat” Strategy in Cameroon’. Accessed: May 24, 2022. [Online]. Available: https://differentiatedservicedelivery.org/Portals/0/adam/Content/4PguUuL3dU2mjDICEGsJFQ/File/Cameroon.pdf.

[9] A report on the misdiagnosis of HIV status.pdf’.

[10] N. Hsiao, A. Zerbe, T. K. Phillips, L. Myer, and E. J. Abrams, ‘Misdiagnosed HIV infection in pregnant women initiating universal ART in South Africa’, J Int AIDS Soc, vol. 20, no. Suppl 6, p. 21758, Aug. 2017, doi: 10.7448/IAS.20.7.21758.

[11] S. Khan et al., ‘Identification of misdiagnosed HIV clients in an Early Access to ART for All implementation study in Swaziland’, Journal of the International AIDS Society, vol. 20, p. 21756, Aug. 2017, doi: 10.7448/IAS.20.7.21756.

[12] B. Dupwa et al., ‘Retesting for verification of HIV diagnosis before antiretroviral therapy initiation in Harare, Zimbabwe: Is there a gap between policy and practice?’, Transactions of The Royal Society of Tropical Medicine and Hygiene, vol. 113, no. 10, pp. 610–616, Oct. 2019, doi: 10.1093/trstmh/trz047.

[13] S. C. Billong et al., ‘Decreased Inaccuracies in HIV Screening following Strengthening of Quality System: Evidence-based Interventions through the PMTCT Program in Cameroon’, vol. 20, p. 10, 2019.

[14] F.-L. Tianyi, J. N. Tochie, V. N. Agbor, and B. M. Kadia, ‘Audit of HIV counselling and testing services among primary healthcare facilities in Cameroon: a protocol for a multicentre national
cross-sectional study’, BMJ Open, vol. 8, no. 3, p. e020611, Mar. 2018, doi: 10.1136/bmjopen-2017-020611.

[15] Northwest Region (Cameroon)’, Wikipedia. Aug. 27, 2021. Accessed: Sep. 21, 2021. [Online]. Available: https://en.wikipedia.org/w/index.php?title=Northwest_Region_(Cameroon)&oldid=1040846875.

[16] DHIS 2 Pivot Tables’. https://dhis-minsante-cm.org/dhis-web-pivot/ (accessed Jan. 23, 2023).

[17] Cameroon-National-Laboratory-Policy.pdf’.

[18] E. T. Amin et al., ‘HIV Retesting for Verification: Uptake and Implementation in Some Health Facilities in the Littoral Region of Cameroon’, International Journal of Health Sciences, no. 6, 2019.

[19] A. J. Rogers et al., ‘Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study’, BMC Pregnancy Childbirth, vol. 16, no. 1, p. 151, Dec. 2016, doi: 10.1186/s12884-016-0936-6.

[20] Consolidated guidelines on HIV testing services (2015)’. https://www.who.int/publications-detail-redirect/9789241508926 (accessed Jan. 23, 2023).

[21] A. Lasry, M. B. Kalou, P. R. Young, J. Rurangirwa, B. Parekh, and S. Behel, ‘Cost implications of HIV retesting for verification in Africa’, PLoS ONE, vol. 14, no. 7, p. e0218936, Jul. 2019, doi: 10.1371/journal.pone.0218936.