The challenges in controlling the HIV epidemic in Angola: Experience of Nossa Senhora da Paz Hospital, Cubal

Abstract

Nossa Senhora da Paz Hospital (HNSP) has 11 years of experience in HIV management. Treatment failures with second-line antiretroviral drugs (ART) and an increase in opportunistic infections represent a challenge for the future of this disease in Angola. It was done with the aim of determining the characteristics of HIV patients treated at HNSP from 01 January 2015 to 31 August 2016, as well as the characteristics of patients on ART from 01 January 2010 to 30 September 2016. To this end, a retrospective analysis of the patients enrolled in the DREAM Programme was performed, recording their age, gender, CD4 levels and stage at diagnosis, initiation of ART and their evolution. During the 20 months, 3,089 HIV tests were performed, of which 138 were positive, indicating a prevalence of 4.5%. From 1 January 2010 to date, 906 patients have received ART, of which 66.9% are women. Currently, the DREAM programme is monitoring 606 patients, of whom 505 are on ART. Of the patients on ART, 17 are on second-line ART and 7 have confirmed resistance to ART. Co-infection with Tuberculosis is 24.3%. From 1 January 2015 to 30 September 2016 128 new cases were incorporated, 11.7% died within the first 30 days of diagnosis and 6 of these have CD4 levels less than 50 with an incidence of cryptococcal meningitis of 33.3%. It is necessary to design strategies for the target population in the early diagnosis of HIV in order to make diagnosis at the early stage, reducing mortality. A verified problem is the failure of second-line ART. The incorporation of new therapeutic families is an imperative need along with addressing opportunistic infections and incorporating viral load to ensure quality HIV program in Angola.