Niklaus Labhardt and colleagues investigate how different HIV testing and counseling strategies, based on home visits or mobile clinics, reach different populations in a rural African setting. Please see later in the article for the Editors' Summary

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Background Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in six rural programs in Southern Africa with limited access to viral load monitoring and second-line ART. Methods Patients aged ≥16 years starting ART in two programs each in Zimbabwe, Mozambique and Lesotho were included. We evaluated risk factors for no follow-up after starting ART and mortality and loss to follow-up (LTFU) over 3 years of ART, using logistic regression and competing risk models. Odds ratios and sub-distribution hazard ratios, adjusted for gender, age category, CD4 category and WHO stage at start of ART are reported. Results Among 7,725 patients, 449 (5.8%) did not return after initiation of ART. Over 9,575 person-years, 698 (9.6%) of those with at least one follow-up visit died and 1,319 (18.1%) were LTFU. At 3 years the cumulative incidence of death and LTFU were 12.5% (11.5–13.5%) and 25.4% (24.0–26.9%), respectively, with important differences between countries: in Zimbabwe 75.1% (72.8–77.3%) were alive and on ART at 3 years compared to 55.4% (52.8–58.0%) in Lesotho and 51.6% (48.0–55.2%) in Mozambique. In all settings young age and male gender predicted LTFU, whereas advanced clinical stage and low baseline CD4 counts predicted death. Conclusions In African ART programs with limited access to second-line treatment, mortality and LTFU are high in the first 3 years of ART. Low retention in care is a major threat to the sustainability of ART delivery in Southern Africa, particularly in rural sites.

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Measurements of the Coulomb breakup of 6Li have been performed in the energy range of the incident particle from 19-26 MeV. From the analysis of the deuteron component only, an almost constant B(E2) value about 55 e2 fm4 has been deduced.