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Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention
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INTRODUCTION: Context-specific improvements in the continuum of
HIV care are needed in order to achieve the UNAIDS target of
90-90-90. This study aimed to assess the linkage to and
retention in HIV care according to different testing modalities
in rural southern Mozambique. METHODS: Adults newly diagnosed
with HIV from voluntary counseling and testing (VCT),
provider-initiated (PICT) and home-based HIV testing (HBT)
services were prospectively enrolled between 2014- 2015 at the
Manhica District. Patients were passively followed-up through
chart examination .Tracing was performed at 12-months to
ascertain causes of loss to follow-up. Fine and Grey competing
risk analysis was performed to determine factors associated with
the each step of the cascade. RESULTS: Overall linkage to care
as defined by having a CD4 count at 3 months, was 43.7% (95CI%
40.8-46.6) and 25.2% of all participants initiated ART. Factors
associated with increased linkage in multivariable analysis
included testing at VCT, older age, having been previously
tested for HIV, owning a cell phone, presenting with WHO
clinical stages III/IV, self-reported illness-associated
disability in the previous month , and later calendar month of
participant recruitment. Ascertaining deaths and transfers
allowed adjustment of the rate of 12-month retention in
treatment from 75.6% (95% CI 70.2-80.5) to 84.2% (95% CI
79.2-88.5). CONCLUSIONS: HBT reached a socio-demographically
distinct population from that of clinic based testing modalities
but low linkage to care points to a need for facilitated linkage
interventions. Distinguishing between true treatment defaulting
and other causes of loss-to-follow-up can significantly change
indicators of retention in care.
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LÓPEZ VARELA, Elisa, et al. Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 2018. Vol. 78, num. 5, pags. 527-535. ISSN 1525-4135. [consulted: 17 of June of 2026]. Available at: https://hdl.handle.net/2445/128568