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MSF in Cameroon, 2011
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In Cameroon, there are significant obstacles to providing high-quality treatment for patients with HIV, particularly those who are developing resistance to medication.
Tens of thousands of people living with HIV in Cameroon are on antiretroviral (ARV) drugs thanks to the government’s commitment to promote universal access to ARV treatment and the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
However, close to 10 percent of patients develop resistance to first-line drugs, usually after several years of treatment, sometimes because of problems with adhering to the medication. Drug-resistant strains of the virus can also be transmitted from person to person. Patients with drug-resistant forms of HIV need to move on to second-line treatment, which is far more expensive for both the government and patients.
Addressing HIV drug resistance
In Nylon district hospital, in the economic capital Douala, Doctors Without Borders/Médecins Sans Frontières (MSF) medical teams have introduced an improved first-line treatment, which includes the medicine tenofovir (TDF), for more than 1,500 HIV patients. TDF has fewer side effects, and staff are hoping that the new medication, together with better patient follow-up, will encourage adherence and reduce the risk of developing resistance.
MSF successfully lobbied the Ministry of Health and international donors to follow suit and change the national standard first-line medical protocol from a combination of drugs including stavudine (d4T) – which often causes side effects – to TDF-based combinations. The TDF-based regime has been validated for first-line treatment and the drugs are available in pharmacies.
Fifty-four HIV patients in Douala were switched to second-line treatment.
In the town of Akonolinga, central Cameroon, MSF treated 160 patients with Buruli ulcer. Although not normally life-threatening, Buruli ulcer is extremely incapacitating and painful. Related to leprosy, it can cause irreversible deformities, which can restrict movement and lead to secondary infections and long-term disability. Skin lesions can also result in social stigma and exclusion.
Early treatment is crucial – the later someone seeks medical attention, the longer treatment and recovery take – but it is not easy to implement. The disease is prevalent mainly among poor, rural communities, in places where health services are not able to provide the complex and expensive treatment Buruli ulcer requires. Investment in research is necessary so that prevention, diagnosis and treatment can be improved. The mode of transmission of the disease is still not known.
An MSF team helped the Ministry of Health tackle two cholera epidemics. The main symptom of cholera is profuse, watery diarrhea, which can quickly lead to severe dehydration. An outbreak was declared in Yaoundé, the capital city, on March 20. MSF set up a 300-bed cholera treatment centre (CTC), where some 1,350 patients received treatment.
Douala was hit by cholera in November. MSF staff set up and operated a 130-bed CTC next to the central hospital of Laquintinie for nine weeks. On the first day alone, 56 patients were admitted. In total, more than 1,000 patients were treated for the disease.
At the end of 2011, MSF had 83 staff in Cameroon. MSF has been working in the country since 1984.