Delayed first consultation after diagnosis of HIV infection in Cameroon

Objectives: To study the impact of both decentralization of HIV care and individual factors on delayed first consultation (>= 6 months) after HIV diagnosis in Cameroon, in the context of the national antiretroviral treatment scale-up program. Design: The national cross-sectional multicenter survey EVAL (ANRS 12-116) was conducted from September 2006 to March 2007 in 27 HIV centers in Cameroon. Methods: Logistic regression was used to characterize patients with delayed first consultation among 3151 HIV-infected adults. Results: Fifteen percent of patients reported a delay of at least 6 months before their first consultation after HIV diagnosis. In the multivariate analysis adjusted for the frequency of visits to the HIV center, independent correlates of reporting a delay of at least 6 months before consulting included the characteristics of the HIV centers (created before 2005 and located in small or medium-size hospitals) and the following individual patient characteristics: sex and matrimonial status (women living in a couple), the circumstances of the HIV diagnosis (test not performed in the hospital providing HIV care, test performed during a voluntary screening campaign) and patient's negative perception of antiretroviral treatment toxicity. Conclusion: Delays before first consultation for HIV care in Cameroon have been reduced, thanks to the full implementation of the national program of decentralization. Results underline the importance of coordinating diagnosis with treatment activities and the need to develop counseling actions, focusing on the balance between antiretroviral treatment effectiveness and its potential side effects. Counseling should also be part of patients' follow-up after diagnosis during voluntary screening campaigns. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins