01 Nov 2009
Micek MA, Gimbel-Sherr K, Baptista AJ, Matediana E, Montoya P, Pfeiffer J, Melo A, Gimbel-Sherr S, Johnson W, Gloyd S (2009) Loss to follow-up of adults in public HIV care systems in central Mozambique: identifying obstacles to treatment. Journal of Acquired Immune Deficiency Syndromes. 2009;52(3):397-405.
Introduction—Access to antiretroviral treatment (ART) has expanded dramatically in resourcelimited settings. Evaluating loss to follow-up from HIV testing through post-ART care can help identify obstacles to care.
Methods—Routine data was analyzed for adults receiving services in two public HIV care systems in central Mozambique. The proportion of people passing through the following steps was determined: (1) HIV testing, (2) enrollment at an ART clinic, (3) CD4 testing, (4) starting ART if eligible, and (5) adhering to ART.
Results—During the 12-month study period (2004–2005), an estimated 23,430 adults were tested for HIV, and 7,005 (29.9%) were HIV-positive. Only 3,956 (56.5%) of those HIV-positive enrolled at an ART clinic ≤30 days after testing. CD4 testing was obtained in 77.1% ≤30 days of enrollment. Of 1,506 eligible for ART, 471 (31.3%) started ART ≤90 days after CD4 testing. Of 382 with ≥180 days of potential follow-up time on ART, 317 (83.0%) had pharmacy-based adherence rates ≥90%.
Discussion—Substantial drop-offs were observed for each step between HIV testing and treatment, but were highest for referral from HIV testing to treatment sites and for starting ART. Interventions are needed to improve follow-up and ensure that people benefit from available HIV services.