Cameroon is dedicated to controlling the HIV epidemic through a coordinated effort led by the Ministry of Public Health and its partners. The fourth edition of the Cameroon HIV Operational Research Forum (CAM-HERO) took place in Douala from December 5 - 7, 2024, under the theme "Implementation Science and Policy on HIV/AIDS". The conference brought together local and international researchers, clinicians, and regulatory authorities to: i) disseminate HIV research findings and policies; ii) foster operational research collaboration; iii) build research capacity through training in implementation science; and iv) discuss evidence-based strategies to address key challenges in the national HIV response strategy. A total of 12 oral presentations, 6 poster presentations, and 3 late-breaking abstracts were selected for presentation after a rigorous review process. Key activities included implementation of science training, presentations of selected abstracts, and awards for the best abstract and poster presentations. The conference ended with strong recommendations, including the need to include children and adolescents as participants in the next Cameroon Population-Based HIV Impact Assessment (CAMPHIA). This key recommendation arose because the ongoing CAMPHIA 2024, a cross-sectional household-based, nationally representative survey that will assess the progress of key HIV-related health indicators and describe key HIV-related risk behaviours, gaps and barriers to access HIV care and treatment services include only participants of 15 years and above. This exclusion represents a missed opportunity for HIV research in children.

Abstract The May Measurement Month (MMM) campaign was conducted in Cameroon in 2023 to raise awareness of raised blood pressure (BP). Adults aged ≥18 years were recruited through convenience sampling at multiple sites (markets, churches, homes, motor parks, workplaces, and hospitals/clinics). Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg or diastolic BP ≥90mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 2,353 were screened, with a mean age of 44.9 years and 62.7% were female. Of all participants, 933 (39.7%) had hypertension, of whom 651 (69.8%) were aware, and 607 (65.1%) were on antihypertensive medication. Of those on antihypertensive medication, 318 (52.4%) had controlled BP, and of all participants with hypertension, 34.1% had controlled BP.

INTRODUCTION:The World Health Organization's Treat All guidelines, which eliminate eligibility thresholds for initiating antiretroviral therapy (ART) among people living with HIV, have been implemented by most countries. However, how Treat All relates to the clinical progression of HIV disease across stages remains less well characterized. METHODS:We applied a target trial-inspired design to examine the association between Treat All policy implementation and HIV disease progression in the Central Africa region of the International Epidemiology Databases to Evaluate AIDS (IeDEA). The analysis included individuals enrolled in HIV care between 2013 and 2019. Using continuous-time multistate models, we estimated transition-specific hazards across four WHO clinical stages (1: asymptomatic; 2: mild; 3: advanced; 4: severe) and death. Disease progression was compared between individuals enrolling after (n = 4607) versus before (n = 4439) Treat All adoption, with hazard ratios (HRs) estimated with and without covariate adjustment. RESULTS:At enrollment, the distribution of WHO clinical stage in the Treat All cohort was 63.4% asymptomatic, 17.7% mild, 15.6% advanced, and 3.3% severe, compared with 59.1%, 18.3%, 19.0%, and 3.6%, respectively, in the pre-Treat All cohort. Treat All implementation was associated with lower hazards of disease progression for early-stage transitions. Specifically, reduced hazards were observed for transitions from stage 1 to stage 2 (adjusted HR [aHR] 0.64, 95% CI: 0.44-0.94) and from stage 1 directly to death (aHR 0.37, 95% CI: 0.17-0.81). Estimates for transitions originating from later disease stages were less precise, and no statistically significant differences were observed. CONCLUSIONS:Enrollment in HIV care following Treat All policy adoption was associated with reduced early-stage disease progression and mortality, suggesting more favorable disease-progression dynamics among individuals entering care in the Treat All era. These findings complement existing evidence on ART uptake and viral suppression and support the role of universal ART initiation in routine HIV care.

Hypertension is an increasingly common comorbidity among adults living with HIV in sub-Saharan Africa, yet data from routine HIV clinics in Cameroon remain limited. We examined factors associated with prevalent hypertension among adults receiving antiretroviral therapy (ART) at Yaoundé Central Hospital. In this cross-sectional study of 460 participants, hypertension (blood pressure ≥ 140/90 mmHg and/or current antihypertensive treatment) was present in 43.3%. Using robust Poisson regression, older age and obesity were independently associated with higher hypertension prevalence, and family history showed the strongest association (adjusted prevalence ratio 2.83). Cumulative ART duration was not independently associated after adjustment. Weekly fruit and vegetable intake was associated with lower hypertension prevalence, whereas salt/seasoning cube intake and most behavioural factors were not associated after adjustment. Restricted cubic spline analyses did not suggest non-linearity in the relationship between ART duration and hypertension. In this urban HIV care setting, hypertension clustered primarily with conventional cardiometabolic factors rather than time on ART. Integrating systematic blood pressure screening and standardised hypertension management within HIV services, alongside weight management and lifestyle counselling, may help reduce cardiovascular burden among people living with HIV.

There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasise the incorporation of novel therapies while integrating standards of care with the most up-to-date evidence to enable clinicians to optimise obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalisation in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and-most importantly-also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such 'economic adjustment' recommendations aim to guide situations when 'Resources are somewhat limited' or when 'Resources are severely limited'. Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

AIMS:Pulmonary abnormalities are commonly reported in heart failure (HF) and may have prognostic implications. Current evidence is limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden, and long-term clinical outcomes in a diverse multi-national HF cohort. METHODS AND RESULTS:In a sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle-, and low-income countries, and followed for a median 3.8 (IQR 2.1, 5.0) years. Baseline FEV1 was transformed into z-scores standardized for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths, and all-cause hospitalizations was examined. FINDINGS:The analysis included 3359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV1 z-scores, even within the normal range (z-score>-2), showed increasing burden of HF, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤ -2 was independently associated with higher risks of all-cause (HR 2.20 [95%CI 1.61-3.01]), CV mortality (HR 2.45 [1.64-3.66]), and hospitalizations (HR 1.40 [1.12-1.74]). The effect sizes were comparable to those of other major prognostic factors. The association was consistent across populations from diverse socio-economic development, HF aetiology, HF types, and airflow obstruction. CONCLUSION:In a diverse, multi-national HF cohort, reductions in FEV1 were independently associated with higher HF burden and poor health outcomes. The effect of lower FEV1 was generalizable across the HF spectrum and comparable to other major established HF prognostic factors.

Background Despite accounting for a substantial proportion of the global population and disease burden, African countries are underrepresented in randomized controlled trials (RCTs), including those informing cardiovascular (CV) care. Objectives In this study, we sought to quantify African representation in RCTs published from 2019 to 2024 in: 1) 5 leading general medical journals; and 2) 3 leading CV journals. Methods We conducted a systematic review of RCTs published from 2019 to 2024 in the British Medical Journal, the Journal of the American Medical Association, The Lancet, Nature Medicine, and the New England Journal of Medicine, and in Circulation, the European Heart Journal, and the Journal of the American College of Cardiology. Eligible studies included traditional, pragmatic, cluster, and stepped-wedge RCTs. African representation was assessed by trial scope (Africa-only vs multicontinental), country and regional participation, disease category, and African authorship. Results Among 2,138 RCTs published in leading general medical journals, only 83 (3.9%) were conducted exclusively in Africa, and 195 (9.1%) were multicontinental studies including at least 1 African site. In the CV journals, 2 out of 334 RCTs (0.6%) were conducted exclusively in Africa, and African sites were included in only 9 multicontinental trials (2.7%). South Africa accounted for the majority of Africa-based RCTs across both journal categories. Regionally, southern Africa predominated and central Africa was minimally represented. Trials published in general medical journals and conducted exclusively in Africa largely focused on infectious diseases (n = 63; 75.9%), with only 3 addressing cardiovascular disease (CVD). In contrast, Africa-including multicontinental trials more frequently investigated noncommunicable diseases, including CVD. African leadership was common in Africa-only trials but rare in multicontinental studies. Conclusions African countries are profoundly underrepresented in RCTs published in the world’s most influential medical and CV journals. Addressing this imbalance requires expanding African participation in global trials, investing in local research capacity, and promoting equitable leadership to strengthen the relevance and validity of clinical evidence. (Underrepresentation of African Countries in Randomized Controlled Trials: A Systematic Review of Leading General Medical and Cardiovascular Journals; CRD42024603157)

AIMS:Underestimated cardiovascular (CV) risk may lead to inadequate control of blood pressure (BP), LDL cholesterol, and glycated haemoglobin. This study investigated CV risk assessment and BP, LDL cholesterol, and glycated haemoglobin control among patients with hypertension in routine clinical practice. METHODS AND RESULTS:In the observational, cross-sectional, epidemiological SNAPSHOT study (conducted in Bulgaria, Croatia, Georgia, Romania, Serbia, and Spain), CV risk was assessed in adults with hypertension according to the physician clinical practices, guidelines, and the risk assessment models valid when the study was performed (SCORE1 and SCORE2/SCORE2-OP). Blood pressure, LDL cholesterol, and glycated haemoglobin control rates were also assessed. Of 9307 patients (aged 65.8 ± 10.5 years, 43.1% male), most (91.3%) had ≥1 additional CV risk factor; 7610 (81.8%) had dyslipidaemia and 3097 (33.3%) had type 2 diabetes (T2D). Compared with guideline recommendations, assessment of patient CV risk by physicians, relative to the risk obtained using SCORE1 and SCORE2/SCORE2-OP, was accurate in only 38.0 and 26.7% of patients, respectively, and was underestimated in 54.3 and 71.8% of patients. Control rates of BP, LDL cholesterol, and glycated haemoglobin were suboptimal [<25%, <12% (in those with comorbid dyslipidaemia), and <50% (in those with comorbid T2D), respectively]. CONCLUSION:Physicians from six European countries tended to overestimate control rates of BP and LDL cholesterol, while underestimating CV risk in their patients with hypertension. Overall, BP, LDL cholesterol, and glycated haemoglobin control rates were low. Better implementation of clinical guideline recommendations is needed.

Cardiovascular disease (CVD) is a leading contributor to morbidity and mortality among people living with cancer. In sub-Saharan Africa, due to the overall cost of the treatment, resource limitations, and a lack of specialized cardio-oncologists, cardio-oncology care is limited. As such, access to advanced cardiac imaging and biomarkers is often limited, making the 12-lead electrocardiogram (ECG) a pragmatic tool for early detection of chemotherapy-associated electrophysiological abnormalities. We investigated early ECG abnormalities following chemotherapy in an African cohort. We conducted a five-month prospective cohort study at the Douala General Hospital, Cameroon. Adults (≥ 19 years) with cancer initiating first-ever chemotherapy were enrolled. A 12-lead ECG was obtained at baseline (pre-chemotherapy) and 48 h after each chemotherapy cycle. A “new ECG abnormality” was defined as an abnormality present post-cycle that was absent at baseline. We described the frequency and types of ECG abnormalities and examined factors associated with a new ECG abnormality after cycle 1 using multivariable logistic regression. A total of 102 participants (74 women, 72.5

There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and – most importantly – also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such “economic adjustment” recommendations aim to guide situations when “Resources are somewhat limited” or when “Resources are severely limited”. Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

ABSTRACT Background and Aims The COVID‐19 pandemic was a global public concern and constitutes a future threat to the world population due to its indirect effect on the burden of non‐communicable diseases. The pandemic manifested disruptions in healthcare delivery and access. However, there is limited data in Sub‐Saharan Africa on the impact of COVID‐19 on cardiovascular disease (CVD) admissions and outcomes. This study aimed to compare the trends of CVD admissions and outcomes before and during the COVID‐19 pandemic in the Southwest Region of Cameroon. Methods We carried out a retrospective study of patients suffering from CVDs admitted from March 11, 2018, to March 11, 2020 (Pre‐COVID‐19 pandemic period) and from March 11, 2020, to March 11, 2022 (COVID‐19 pandemic period). A p‐value < 0.05 was considered statistically significant. Results There were 483 admissions due to CVD during the COVID‐19 pandemic and 518 during the pre‐COVID‐19 period. There was no significant difference in mean age before (57.97 ± 15.6 years) and during the pandemic (59.74 ± 16.1 years) (p = 0.44). There was also no significant change in the proportion of males and females during and before the pandemic: males (21, 4%, and 24.8%), and females (26.8% and 27%), (p = 0.28). There was a downward secular trend with random variation in the number of CVD admissions during the pandemic compared with the corresponding pre‐COVID period, which had an upward trend. Rates of admissions of Acute Myocardial Infarction decreased the most (22.2%) during the first wave of the pandemic. The in‐hospital mortality increased by 2.4% with a relative risk for Mortality of 1.18 (95% CI [0.87–1.61], p = 0.28). There was no change in median length of hospital stay (p = 0.936). Conclusion This study provides evidence of a decreasing tendency in admissions due to CVD during the COVID‐19 Pandemic at the BRH. The effects varied among the different types of CVDs. The in‐hospital mortality of CVDs did not change significantly.

Background: Wealth-related inequalities affect cardiometabolic health worldwide, but their implications for cardiometabolic care and potentially preventable cardiovascular disease remain poorly understood. Methods: We analysed harmonised, nationally representative health examination surveys from 76 countries (109 surveys) in five WHO regions. Adults aged 18 years or older with data on age, sex, wealth, and at least one cardiometabolic outcome were eligible. Disease status was defined from measured biomarkers, self-reported diagnosis, or current medication; awareness and treatment were based on self-reported information, and control on measured biomarkers. Each indicator was expressed as the proportion of all individuals with the corresponding condition. Inequality was quantified by the wealthiest–poorest quintile difference and the slope index of inequality (SII). Predicted 10-year cardiovascular risk was estimated with Globorisk, and trial-derived relative risk reductions applied to estimate achievable absolute risk reduction. Findings: Among 315 403 participants (median age 40 years [IQR 30–52]; 185 209 [58·7%] women), inequalities widened progressively across the care cascade in all regions and were most pronounced for disease control. Pooled across regions, the SII for control increased from hypertension (0·04, 95% CI 0·02–0·06) to diabetes (0·05, 0·01–0·09) and hypercholesterolaemia (0·07, 0·04–0·09). However, regional patterns varied substantially. In the Americas, disease control consistently favoured wealthier individuals (hypertension SII 0·09, 0·01–0·18), whereas in Africa coverage was uniformly low, and the largest inequality was pro-poor, particularly for hypercholesterolaemia treatment (SII −0·38, −0·50 to −0·26). Baseline cardiovascular risk was higher among the poorest (13·6% vs 12·2%), but achievable risk reduction aligned more closely with baseline risk than with treatment coverage being greatest in Europe (3·9%) and lowest in Africa (2·5%). Across all regions, achievable risk reduction was greater in men than in women (EURO 4·6% vs 3·5%), reflecting sex-specific risk functions rather than differences in access to care. Interpretation: Populations with the largest treatment gaps are not necessarily those in which expanding treatment would prevent the greatest burden of cardiovascular disease. In settings where coverage is uniformly low, expanding the supply of care matters more than redistributing access to it. Moreover, because socioeconomic inequalities widen after diagnosis, screening alone is unlikely to reduce disparities unless accompanied by sustained access to treatment. Policy should therefore define whether its primary objective is to maximise equity or overall population health gains.

Hypertension in sub-Saharan Africa is escalating, with many cases undiagnosed and poorly controlled, even among children, despite its significant contribution to cardiovascular disease. Poor blood pressure control is largely due to limited national guidelines, underfunded programs, and a shortage of trained health professionals. Simplified protocols for non-physician health workers, who deliver most of the primary care, are essential. Cultural myths and misconceptions further delay care, underscoring the need for community-based education. Early and opportunistic screening, including in schools, markets, and places of worship, is vital across the life course. Sustainable progress depends on tailored strategies, investment in equipment and training, and leveraging existing infrastructure to improve hypertension detection and management. Africa-centred hypertension guidelines are now a priority because international models fail to address the continent's unique clinical, cultural and resource realities. The African Regional Advisory Group of the International Society of Hypertension worked with the Pan African Society of Cardiology to develop simplified protocols for primary care, particularly for non-physician health care workers, by considering the special situation and condition for managing the vast majority of cases within hypertension in Africa.

Thoughts of death or self-injury and the clinical implications of such thoughts remain largely underassessed among people with HIV (PWH) in Africa. As strong predictors of suicidal ideation and death by suicide, it is paramount to understand these risk indicators, particularly in populations with heightened susceptibility to poor mental health. We aimed to characterize thoughts of death or self-injury (i.e., self-injurious thoughts) and their relationship with non-same-day (i.e., delayed) anti-retroviral treatment (ART) initiation and longitudinal disengagement from clinic in a cohort of PWH newly entering HIV care in Cameroon. We conducted structured interviews with PWH aged 21 + initiating clinical care between June 2019 and March 2020. Clinical records were used to ascertain ART initiation date and disengagement from the clinic across two years following care initiation. Log binomial regression was used to estimate the association between self-injurious thoughts at care initiation and delayed ART initiation. A Fine and Gray sub-distribution proportional hazards model was used to quantify the cumulative incidence of disengagement from the clinic (i.e., a gap in clinic visits > 183 days) and differences in these estimates across groups. Of 426 enrolled individuals, seventy-one (16.7

INTRODUCTION:The burden of cardiometabolic diseases (CMDs) is rising in people with HIV (PWH). While extensive data exist on CMD prevalence in PWH receiving antiretroviral therapy (ART), comprehensive data on ART-naïve PWH are scarce. We aimed to estimate the global prevalence of hypertension, diabetes, obesity and dyslipidaemia among ART-naïve PWH and compare estimates with those on ART and HIV-negative populations. METHODS:This systematic review and meta-analysis included a search of PubMed-MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa-Wide Information and Africa-Journals Online for original articles published up to June 2024. Cross-sectional, cohort and case-control studies providing baseline data on CMD prevalence were included. Studies had to include ART-naïve PWH aged ≥15 years. Two independent reviewers conducted studies screening, data extraction and methodological quality assessment. A random-effects meta-analysis with double arc-sine transformation was used for prevalence estimates. The study was registered with PROSPERO (CRD42021226001). RESULTS:We included 184 studies published between 2000 and 2024, involving a total of 424 629 participants. The global pooled prevalence among ART-naïve PWH was 14.2% (95% CI: 12.4-16.1) for hypertension, 3.6% (2.9-4.3) for diabetes, 11.5% (10.3-12.9) for body mass index-based obesity, 18.3% (12.7-24.6) for waist circumference-based obesity, 14.8% (12.1-17.8) for elevated total cholesterol, 17.6% (11.3-24.8) for elevated low-density lipoprotein cholesterol, 22.9% (19.3-26.7) for elevated triglycerides and 54.6% (48.2-61.0) for low high-density lipoprotein cholesterol, all with high heterogeneity. Significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia were observed according to UNAIDS regions. DISCUSSION:We found a notable prevalence of CMDs in ART-naïve PWH, with significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia. This highlights the need for targeted interventions and early screening to address the growing CMD burden among PWH. CONCLUSION:ART-naïve PWH face a considerable CMD burden, emphasizing the importance of early detection and management. Regional differences in CMD prevalence call for tailored public health strategies and integration of CMD prevention into HIV care protocols.

Hypertension is a frequent comorbidity among people living with HIV (PLHIV) in sub-Saharan Africa, but analytical data from routine HIV clinics in Cameroon remain limited. This study assessed factors associated with prevalent hypertension among adults receiving antiretroviral therapy (ART) at an urban HIV clinic in Yaounde, Cameroon. We conducted a cross-sectional study at the Day Hospital of Yaounde Central Hospital between January and March 2024. The analytical dataset included 460 adults living with HIV receiving ART. Prevalent hypertension was coded as a binary outcome. Robust Poisson regression was used to estimate prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) because hypertension was common. Sensitivity models were fitted to clarify the interpretation of cumulative ART duration in relation to current age. Among 460 participants, 199 (43.3

While non-disclosure of HIV status may protect people living with HIV (PLWH) against stigma, discrimination, and violence, disclosure may facilitate access to social support and improve treatment adherence. This study examined factors associated with non-disclosure among recently-diagnosed PLWH at IeDEA study sites in Cameroon. We conducted a cross-sectional study of adults ≥ 19 years newly enrolling in HIV care at three Cameroon hospitals from January 2016 to June 2023 with recent (< 1 year) diagnoses and no evidence of prior HIV care. We used logistic regression to identify factors associated with non-disclosure of HIV status at the time of enrolment. Among 2880 participants, the overall prevalence of HIV status non-disclosure at enrolment was 34.4

African populations have traditionally been considered at relatively low risk of cardiovascular diseases (CVD), such as chronic coronary syndrome (CCS), but this is rapidly changing in association with ageing populations, uncontrolled urbanization and lack of control of classical CV risk factors. In sub-Saharan Africa, CVD deaths have increased by more than 50% in the past three decades. For CCS care, limited availability of clinical expertise, diagnostic facilities, and access to optimal medical therapy (OMT), lack or inadequate reimbursement of healthcare costs, and scarcity of universal health coverage (UHC) are major challenges. Cardiologists from 11 African countries, meeting through the AFEX: ACT ON Angina programme, with the endorsement of the World Heart Federation, identified the need to: engage clinicians, patients, and the media to raise awareness of CCS and angina, and encourage lifestyle modification and risk factor control, as well as early referral of high-risk individuals; develop care pathways to address growing demand, including cross-border and online collaboration where local expertise is unavailable; optimize the use of treatment budgets by adapting and implementing international guidelines according to local priorities, and avoiding prescription of nonevidence-based medicines; initiate collaborative research into the nature of CCS in African countries and potential differences in risk factors, presentation, and treatment response compared with Europe and North America whose experience forms the basis of international guidelines. A roadmap is proposed to guide future developments in CCS care and support best practices across Africa.