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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.
Univariable and multivariable Cox regression models were used to screen for factors associated with the outcomes. Telephone calls were made to trace patients LTFU. Of these, were aged 15 and above and were included in our analysis. The overall mortality rate was The mortality rates steadily rose to a peak of The LTFU rate increased sharply from Two- thirds Interventions to address factors associated with high mortality and LTFU should be implemented for optimal results in patient care.
At the end of , an estimated A total of 5. Loss of patients to follow-up and care LTFU is, however, an important problem in resource-limited settings. A systematic review and meta-analysis of studies tracing patients lost to follow-up found that these patients experience high mortality compared to patients remaining in care [ 5 ]. The successful treatment of individual patients and the monitoring and evaluation of ART programmes both depend on regular and complete patient follow-up.
Cameroon with an estimated population of The ART coverage increased from Late presentation and or late ART initiation [ 12 ], TB co-infection [ 13 ] and long travels to clinic [ 14 ] were the other important factors for treatment interruption reported by different authors. These studies were mostly conducted before during an era of very constrained access to ARV, and in urban settings. Since several changes have been instituted: ARVs are dispensed free of charge to patients, many treatment centres have been established nationwide, treatment has been decentralised, ART initiation cut off has been increased from to and the more toxic stavudine D4T -based regimen has been gradually phased out since in accordance with the World Health Organisation WHO recommendations [ 15 ].
These changes were instituted to improve access to HIV care. Consequently, an increased number of patients are receiving ART [ 16 , 17 ] but the outcomes of these patients before and after these interventions are not known in terms of morbidity and mortality. The rates and determinants of which vary by health facility [ 18 ] and as such each setting needs to determine theirs and institute improvement programs. It is a 2nd level reference public health facility with a catchment area of over , inhabitants.