Abstract
In Mozambique, the evaluation of retention in HIV care and ART programmes is limited. To assess rate and predictors of attrition (no retention in care) and HAART effectiveness in HIV-1 infected patients who pay for medication and laboratory testing in Mozambique, we conducted a multicenter survey of HIV-1-infected patients who started HAART during 2002–2006. Cox proportional hazard models were used to assess risk of attrition and of therapy failure. Overall, 142 patients from 16 healthcare centers located in the capital city Maputo were followed-up for 22.2 months (12.1–46.7). The retention rate was 75%, 48% and 37% after one, two and three years, respectively. Risk of attrition was lower in patients with higher baseline CD4 count (P = 0.022) and attending healthcare center 1 (HCC1) (P = 0.013). The proportion of individuals with CD4 count ≤200 cells/µL was 55% (78/142) at baseline and decreased to 6% (3/52) at 36 months. Among the patients with available VL, 86% (64/74) achieved undetectable VL levels. The rate of immunologic failure was 17.2% (95% CI: 12.6–22.9) per 100 person-years. Risk of failure was associated to higher baseline CD4 count (P = 0.002), likely reflecting low adherence levels, and decreased with baseline VL ≥10,000 copies/mL (P = 0.033). These results suggest that HAART can be effective in HIV-1 infected patients from Mozambique that pay for their medication and laboratory testing. Further studies are required to identify the causes for low retention rates in patients with low CD4 counts and to better understand the association between healthcare setting and attrition rate.
Highlights
Mozambique suffers from one of the highest HIV/AIDS burdens in the world, with HIV-1 prevalence of 21% in the southern regions where the capital city Maputo is located [1]
Among patients who achieved undetectable VL, 8 experienced a rebound after a median time on highly active antiretroviral therapy (HAART) of 16.5 months (11.2–19.2). One of those had mutations conferring intermediate-to-high resistance to zidovudine and lamivudine (D69N, K70R, M184V). This is the first study evaluating the predictors of attrition after initiation of HAART as well as HAART effectiveness in a population paying for antiretrovirals and laboratory testing in Mozambique
In Maputo, a recent study reported a high lost to follow-up rate (40%) in patients eligible for antiretroviral therapy (ART) undergoing counselling before treatment [9]
Summary
Mozambique suffers from one of the highest HIV/AIDS burdens in the world, with HIV-1 prevalence of 21% in the southern regions where the capital city Maputo is located [1]. In Kenya and Uganda, treatment interruption and drug resistance levels are higher among HIV patients that pay for their own medication and laboratory testing compared to patients on free-ART programs suggesting that new strategies may be needed to improve treatment outcomes in this population [2,3]. At this time, no studies have evaluated the response to ART among this particular population of patients who attend the pay-for-care setting in Mozambique. The current study was conducted to evaluate the determinants of attrition (no retention in care) after the initiation of ART in HIV-1-infected patients undergoing selfpaid medication and laboratory testing in Maputo, Mozambique, and to assess the effectiveness of ART and the predictors of immunologic failure in this population
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