@article{PAR00004153,
  title = {{D}ecentralization of {HIV} care in {C}ameroon : increased access to antiretroviral treatment and associated persistent barriers},
  author = {{L}oubi{\`e}re, {S}. and {B}oyer, {S}. and {P}rotopopescu, {C}. and {B}onono, {C}. {R}. and {A}bega, {S}. {C}. and {S}pire, {B}. and {M}oatti, {J}ean-{P}aul},
  editor = {},
  language = {{ENG}},
  abstract = {{C}ontext: {T}he national antiretroviral treatment ({ART}) program in {C}ameroon has reached one of the highest rate of coverage in {W}estern and {C}entral {A}frica (58% of the estimated eligible {HIV}-infected population in {J}une 2008). {O}bjectives: {T}o assess the extent to which decentralized delivery of {HIV} care at the district level has contributed to increased access to {ART}. {M}ethods: {C}omparison of {ART}-treated and non-{ART}-treated ill the sub-sample of medically eligible {HIV}-positive patients (n = 2566) in the cross-sectional {ANRS}-{EVAL} survey was carried out among patients seeking {HIV} care in 14 hospitals at central level ({Y}aounde, {D}ouala and capitals of 8 provinces) and 13 at district levels. {L}ogistic regressions and multivariate analysis were carried out to identify factors related to non-access to {ART} at both levels of care. {R}esults: {O}nly 7% of eligible patients did not have access to {ART}. {A}fter adjustment for time since initial {HIV} diagnosis and {CD}4 counts (at initiation of treatment for those {ART}-treated and at time of survey for those who were not), younger and male patients. as well as those who only had a primary level education were less likely to be {ART}-treated at central but not at district level, whereas those who were unemployed were less likely to be treated at both levels. {P}atients were less likely to be treated in central hospitals with higher workload per medical staff member and absence of task shifting policy. and ill district hospitals with non-availability of equipment for {CD}4 counts and larger size (150 beds or more). {C}onclusion: {M}ain persisting barriers in access to {ART} in {C}ameroon are rather due to insufficient access to {HIV} testing and difficulties in patients' referral to {ART} delivery centers after {HIV} diagnosis, since the overwhelming majority of eligible patients already seeking {HIV} care had effective access. {H}owever, health systems strengthening ({HSS}) is still needed to overcome some remaining barriers in access to {ART} and to guarantee its long-term sustainability.},
  keywords = {{HIV}/{AIDS} ; {D}ecentralization ; {C}ameroon ; {A}ntiretroviral treatment ; {H}ealth ; services},
  booktitle = {},
  journal = {{H}ealth {P}olicy},
  volume = {92},
  numero = {2-3},
  pages = {165--173},
  ISSN = {0168-8510},
  year = {2009},
  DOI = {10.1016/j.healthpol.2009.03.006},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00004153},
}