@article{fdi:010075095,
  title = {{S}caling up access to antiretroviral treatment for {HIV} infection : the impact of decentralization of healthcare delivery in {C}ameroon},
  author = {{B}oyer, {S}. and {E}boko, {F}red and {C}amara, {M}. and {A}b{\'e}, {C}. and {N}guini, {M}. {E}. {O}. and {K}oulla-{S}hiro, {S}. and {M}oatti, {J}ean-{P}aul},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {T}he independent evaluation of the {C}ameroonian antiretroviral therapy ({ART}) {P}rogramme, which reached one of the highest coverage in the eligible {HIV}-infected population (58%) in {S}ub-{S}aharan {A}frica, offered the opportunity to assess {ART} outcomes in the context of the decentralization of {HIV} care delivery. {M}aterials and methods: {A} cross-sectional survey ({EVAL}, {ANRS} 12-116, 2007) was carried out in a random sample of 3151 {HIV}-positive patients (response rate 90%) attending 27 treatment centres at the different level of the healthcare delivery (central, provincial and district), as well as in the exhaustive sample of doctors in charge of {HIV} care in these centres (response rate 92%, n = 97). {M}ultivariate two-level analyses were conducted to assess the impact of the level of healthcare delivery on {CD}4 cell gains since initiation of treatment and adherence to treatment in the subsample of patients who were {ART}-treated for 6 months or more (n = 1985). {R}esults: {D}istrict treatment centres were characterized by more limited technical and human resources but a lower workload. {ART}-treated patients followed up in these centres had significantly lower socioeconomic status. {A}fter adjustment for other explanatory factors, immunological improvement was similar in patients followed up at the central and district level, whereas adherence to {ART} was better both at provincial and district levels. {C}onclusion: {S}uccess in scaling-up access to {ART} in {C}ameroon has been facilitated by decentralization of the healthcare system. {L}ong-term sustainability urgently implies better integration of this {HIV}-targeted programme in the global healthcare reform of financing mechanisms, management of human resources and drug procurement systems.},
  keywords = {scaling-up ; decentralization ; antiretroviral treatment ; outcomes ; {S}ub-{S}aharan {A}frica},
  booktitle = {},
  journal = {{A}ids},
  volume = {24},
  numero = {{S}uppl. 1},
  pages = {{S}5--{S}15},
  ISSN = {0269-9370},
  year = {2010},
  DOI = {10.1097/01.aids.0000366078.45451.46},
  URL = {https://www.documentation.ird.fr/hor/fdi:010075095},
}