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

# metadata.dc.description.abstract[].value
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.

# metadata.dc.relation.ispartof[].value
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 2018, vol. 78, num. 5, p. 527-535

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention