Factors blocking the good care of people living with HIV in madagascar

This study consists of identifying the problems of care for people living with HIV (PLHIV). This is a cross-sectional, descriptive and retrospective study including all referring doctors. The median age was 51 years with a sex ratio of 1. The median year of specific HIV training was 10 years. Each doctor takes care of an average of 34.7 PLHIV [range: 0-320], 94% of the 903 PLHIV followed were on first-line treatment. Stock-outs of first-line molecules were the most frequent cause of change in treatment regimen by 50% of physicians. The other causes were the occurrence of side effects (42%), confirmed (30.8%) or suspected (23%) resistance. The lack of means of virological and immune monitoring was found in 84.5% of physicians. The problems in the management of the main opportunistic infections apart from tuberculosis were the lack of means of biological diagnostics (84.5%), the difficulties of access to imaging (57.5%) and the absence of reference drugs in more than 70% of cases. The training of referring physicians is not regular. They encounter a lot of difficulties and their training by experts and the sharing of experiences between them would be a solution to help them improve the care of PLHIV.