Abstract #138  -  Decentralization of access to HIV treatment in Cameroun: impact on knowledge, practices, attitudes and working conditions among physicians involved in HIV care
Authors:   Presenting Author:   Prof Jean-Paul Moatti - INSERM U912
Additional Authors:  Mrs Sylvie Boyer, Mrs Sophie Rasson, Mrs Renée-Cécile Bonono, Mr Lionel Fugon, Mrs Sandrine Loubière, Mrs Josiane Tantchou, Mrs Fabienne Marcellin, Dr Pierre Ongolo-Zogo, Mrs Marie Préau, Mrs Maria Patrizia Carrieri, Dr Bruno Spire, Pr Jean-Paum Moatti,
Aim: In the context of large scaling-up program, delivering and sustaining antiretroviral therapy (ART) require appropriate trained, experienced and motivated human resources (HR) for health at all levels of the health care delivery (district, provincial and central). As HR drives effectiveness of health services, assessment of health care providers’ performance is a central issue. In Cameroon, the government implemented by 2005 a national program of access to ART based on the decentralization of HIV-care up to the district level. This study aimed to compare, according to the level of HIV-care decentralization, physicians’ performance in terms of knowledge and practices regarding national guidelines, attitudes towards people living with HIV and AIDS (PLWHA) and working conditions in Cameroon.
Method / Issue: The cross-sectional survey EVAL (ANRS 12-116) provided data for 97 physicians working in 27 HIV services located at the three levels of HIV-care decentralization (September 2006-March 2007). Physicians completed anonymous questionnaires assessing (i) their experience, knowledge and practices for HIV-care with respect to national guidelines, (ii) attitudes toward patients and (iii) working conditions. Selected variables in these three areas of physicians’ performance were compared between the three levels of decentralization using chi-square or Fisher tests for categorical variables and Kruskal-Wallis test for continuous ones.
Results / Comments: Physicians had a good overall knowledge of the management of ART initiation (respectively 89.4% and 81.9% had good knowledge of protocols recommended in first-line and criteria to decide ART initiation). A lower level of knowledge was observed in the management of specific situations such as HIV-positive pregnant women, children and tuberculosis co-infected patients (70% of good answers) and of ART side effects (respectively 84.0% and 58.5% of correct answers). However, no significant difference was found in knowledge according to the level of decentralization. We also found no differences regarding practices, except concerning task shifting, which was significantly more frequent at the district level than at the central level (51.2% of the physicians versus 35.1%, p=0.009). Although discriminatory attitudes were rarely reported with less than 7% of physicians declaring “HIV-patients to be responsible of their own disease” and “fear of getting a bad name by treating HIV-patients”, some negative attitudes such as perceiving PLWHA as dangerous were significantly more frequently reported by physicians working at the district level (this statement was reported by 39.4% of the physicians at the district level, 29.4% at the provincial level and 13.5% at the central level, p=0.046). Dissatisfaction regarding working conditions and especially salaries (only 25% of physicians declared to be satisfied with their current level of remuneration) was widespread.
Discussion: Our results suggest a relative homogeneity of HIV-care delivery across the different levels of decentralization in Cameroon. Interventions should be developed at all three levels of decentralization to improve knowledge regarding specific situations such as tuberculosis co-infected patients, pregnant women and children. Task shifting procedures, technical support and human resources incentives need also to be adequately planned and funded to ensure long term success of the decentralization process of HIV-care and higher coverage of patients in need.
Go Back