Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention

López-Varela, Elisa; Fuente-Soro, Laura; Augusto, Orvalho; Sacoor, Charfudin; Nhacolo, Ariel; Karajeanes, Esmeralda; Naniche, Denise

doi:10.1097/qai.0000000000001720

Cited by 17 publications

(59 citation statements)

References 38 publications

(42 reference statements)

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“…Prior to the current study and in order to exclude non-eligible participants, a standard deterministic and probabilistic record-linkage [20], validated by other studies [21,22], was conducted to match individuals from the cross-sectional community-based serosurveys and the Manhiça District Hospital ePTS (MDH-ePTS) to identify individuals who were already known HIV-positive at the time of the 2010 and 2012 serosurveys.…”

Section: Methodsmentioning

confidence: 99%

Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

et al. 2019

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BackgroundThe implementation of quality HIV control programs is crucial for the achievement of the UNAIDS 90-90-90 targets and to motivate people living with HIV (PLWHIV) to link and remain in HIV-care. The aim of this mixed method cross-sectional study was to estimate the linkage and long-term retention in care of PLWHIV and to identify factors potentially interfering along the HIV-care continuum in southern Mozambique.MethodsA home-based semi-structured interview was conducted in 2015 to explore barriers and facilitators to the HIV-care cascade among individuals that had been newly HIV-diagnosed in community testing campaigns in 2010 or 2012. Linkage and long-term retention were estimated retrospectively through client self-reports and clinical records. Cohen's Kappa coefficient was calculated to measure the agreement between participant self-reported and documented cascade outcomes.ResultsAmong the 112 interviewed participants, 24 (21.4%) did not disclose their HIV-positive serostatus to the interviewer. While 84 (75.0%) self-reported having enrolled in care, only 69 (61.6%) reported still being in-care 3–5 years after diagnosis of which 17.4% reported having disengaged and re-engaged. An important factor affecting optimal continuum in HIV-care was the impact of the fear-based authoritarian relationship between the health system and the patient that could act as both driver and barrier.ConclusionSpecial attention should be given to quantify and understand repeated cycles of patient disengagement and re-engagement in HIV-care. Strategies to improve the relationship between the health system and patients are still needed in order to optimally engage PLWHIV for long-term periods.

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Section: Methodsmentioning

confidence: 99%

Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

et al. 2019

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“…Also, participants working at baseline were more likely to be retained at 6-month follow-up compared to unemployed participants, although no significant associations were found for 12-month follow-up and for those attending both follow-up appointments. Other studies have found that working is associated with higher attrition rates, probably as a result of inflexible work schedules 19 , 28 , 50 , 51 . However, some authors have found opposite results, with lack of formal employment being a barrier to retention 33 , 52 .…”

Section: Discussionmentioning

confidence: 94%

Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa

Carlos

Burgueño²,

Ndarabu

et al. 2021

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Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15–59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.

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“…The importance of providing effective linkage services is underscored by over 15 studies in sub‐Saharan Africa, including one in Mozambique, suggesting that only 18%‐51% of PLHIV diagnosed in community settings enrol early in HIV care when referral is the only linkage service [ 10 , 27 , 28 , 29 ]. Among all PLHIV aged 15 to 59 years in CHDSS, however, ART coverage increased from 65% in R1 to 88% in R5, and viral load suppression coverage increased from 52% in R1 to 78% in R5 [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Annual home‐based HIV testing in the Chókwè Health Demographic Surveillance System, Mozambique, 2014 to 2019: serial population‐based survey evaluation

et al. 2021

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Introduction: WHO recommends implementing a mix of community and facility testing strategies to diagnose 95% of persons living with HIV (PLHIV). In Mozambique, a country with an estimated 506,000 undiagnosed PLHIV, use of home-based HIV testing services (HBHTS) to help achieve the 95% target has not been evaluated. Methods: HBHTS was provided at 20,000 households in the Ch okw e Health Demographic Surveillance System (CHDSS), Mozambique, in annual rounds (R) during 2014 to 2019. Trends in prevalence of HIV infection, prior HIV diagnosis among PLHIV (diagnostic coverage), and undiagnosed HIV infection were assessed with three population-based surveys conducted in R1 ( 04/2014 to 04/2015), R3 (03/2016 to 12/2016), and R5 (04/2018 to 03/2019) of residents aged 15 to 59 years. Counts of patients aged ≥15 years tested for HIV in CHDSS healthcare facilities were obtained from routine reports. Results: During 2014 to 2019, counsellors conducted 92,512 home-based HIV tests and newly diagnosed 3711 residents aged 15 to 59 years. Prevalence of HIV infection was stable (R1, 25.1%; R3 23.6%; R5 22.9%; p-value, 0.19). After the first two rounds (44,825 home-based tests; 31,717 facility-based tests), diagnostic coverage increased from 73.8% (95% CI 70.3 to 77.2) in R1 to 93.0% (95% CI 91.3 to 94.7) in R3, and prevalence of undiagnosed HIV infection decreased from 6.6% (95% CI 5.6 to 7.5) in R1 to 1.7% (95% CI 1.2 to 2.1) in R3. After two more rounds (32,226 home-based tests; 46,003 facility-based tests), diagnostic coverage was 95.4% (95% CI 93.7 to 97.1) and prevalence of undiagnosed HIV infection was 1.1% (95% CI 0.7 to 1.5) in R5. Prevalence of having last tested at home was 12.7% (95% CI 11.3 to 14.0) in R1, 45.2% (95% CI 43.4 to 47.0) in R3, and 41.4% (95% CI 39.5 to 43.2) in R5, and prevalence of having last tested at a healthcare facility was 45.3% (95% CI 43.3 to 47.3) in R1, 40.1% (95% CI 38.4 to 41.8) in R3, and 45.2% (95% CI 43.3 to 47.0) in R5. Conclusions: HBHTS successfully augmented facility-based testing to achieve HIV diagnostic coverage in a high-burden community of Mozambique. HBHTS should be considered in sub-Saharan Africa communities striving to diagnose 95% of persons living with HIV.

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Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 17 publications

References 38 publications

Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa

Annual home‐based HIV testing in the Chókwè Health Demographic Surveillance System, Mozambique, 2014 to 2019: serial population‐based survey evaluation

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