Abstract
IntroductionEffectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care. However, the measurement of both has been challenging in these settings. This study aimed to assess enrolment and retention in HIV care (pre-ART and ART) among HIV-positive adults in Central Mozambique, including identification of barriers and facilitators.MethodsWe assessed linkages to and retention in HIV care using a mixed quantitative and qualitative approach in six districts of Manica and Sofala provinces. We analyzed routine district and health facility monthly reports and HIV care registries from April 2012 to March 2013 and used single imputation and trimmed means to adjust for missing values. In eight health facilities in the same districts and period, we assessed retention in HIV care among 795 randomly selected adult patient charts (15 years and older). We also conducted 25 focus group discussions and 53 in-depth interviews with HIV-positive adults, healthcare providers and community members to identify facilitators and barriers to enrolment and retention in HIV care.ResultsOverall, 46% of the monthly HIV testing reports expected at the district level were missing, compared to 6.4% of the pre-ART registry reports. After adjustment for missing values, we estimated that the aggregate numbers of adults registered in pre-ART was 75% of the number of persons tested HIV-positive in the six districts. In the eight health facilities, 40% of the patient charts for adults enrolled in pre-ART and 44% in ART were missing. Of those on ART for whom charts were found, retention in treatment within 90 and 60 days prior to the study team visit was 34 and 25%, respectively. Combining these multiple data sources, the overall estimated retention was 18% in our sample. Individual-level factors were perceived to be key influences to enrolment in HIV care, while health facility and structural-level factors were perceived to be key influences of retention.ConclusionsEfforts to increase linkages to and retention in HIV care should address individual, health facility, and structural-level factors in Central Mozambique. However, their outcomes cannot be reliably assessed without improving the quality of routine health information systems.
Highlights
Effectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care
The Mozambique Ministry of Health reported in 2015 that ART coverage was only 59% of the estimated treatment needs [9], and, as in other countries in the region, the proportion of those retained in pre-ART care and ART in Mozambique tends to decrease over time [8Á10]
We analyzed all available reports from the 87 facilities providing HIV testing and the 34 facilities providing ART
Summary
Effectiveness of the rapid expansion of antiretroviral therapy (ART) throughout sub-Saharan Africa is highly dependent on adequate enrolment and retention in HIV care. Conclusions: Efforts to increase linkages to and retention in HIV care should address individual, health facility, and structurallevel factors in Central Mozambique Their outcomes cannot be reliably assessed without improving the quality of routine health information systems. The Mozambique Ministry of Health reported in 2015 that ART coverage was only 59% of the estimated treatment needs [9], and, as in other countries in the region, the proportion of those retained in pre-ART care and ART in Mozambique tends to decrease over time [8Á10]. This poses challenges to reaching the ambitious 90-90-90 goals of the. Poor HIV data quality from both routine sources and international implementing partners [9,15] remains a challenge to understanding the cascade
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