Assessment of linkages from HIV testing to enrolment and retention in HIV care in Central Mozambique.

Autor: Inguane CA; Department of Anthropology, University of Washington, Seattle, WA, USA.; Health Alliance International, Seattle, WA, USA; celsoi@uw.edu., Gloyd S; Health Alliance International, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA., Manuel JL; Centro de Investigação Operacional de Beira (CIOB), Ministry of Health, Beira, Mozambique., Brown C; Office of HIV/AIDS, USA, Agency for International Development, Washington, DC, USA., Wong V; Office of HIV/AIDS, USA, Agency for International Development, Washington, DC, USA., Augusto O; Health Alliance International, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA.; Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.; Manhiça Research Center (CISM), Manhiça, Mozambique., Hassan WM; Health Alliance International, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA., Vieira L; Centro de Investigação Operacional de Beira (CIOB), Ministry of Health, Beira, Mozambique., Afonso P; Health Alliance International, Seattle, WA, USA., Jamnadás M; Centro de Investigação Operacional de Beira (CIOB), Ministry of Health, Beira, Mozambique., Bernard JJ; Health Alliance International, Seattle, WA, USA., Cowan J; Health Alliance International, Seattle, WA, USA., Kalibala S; HIVCore/Population Council, Washington, DC, USA., Pfeiffer J; Health Alliance International, Seattle, WA, USA.; Department of Global Health, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2016 Jul 20; Vol. 19 (5 Suppl 4), pp. 20846. Date of Electronic Publication: 2016 Jul 20 (Print Publication: 2016).
DOI: 10.7448/IAS.19.5.20846
Abstrakt: Introduction: Effectiveness 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.
Methods: We 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.
Results: Overall, 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.
Conclusions: Efforts 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.
Databáze: MEDLINE
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