HAI’s Option B+ study showed low-cost inputs and systems adjustments can meaningfully improve retention of HIV-positive mothers in antiretroviral treatment (ART), especially when combined with much needed resource investment.

In 2013, the Mozambique Ministry of Health rolled out Option B+, a treatment regimen for pregnant women living with HIV that mandates universal lifelong ART from diagnosis. Given that retention and adherence are pervasive challenges in the administration of lifelong ART, HAI undertook a study to 1) determine bottlenecks in Mozambique’s HIV care system that contribute to poor retention and adherence; and 2) develop and pilot an intervention in response.

Through a combination of routine health system data analysis, flow mapping, and health worker interviews, HAI’s Option B+ study identified two types of major barriers to retention: those that require significant resource investment in the public system, and those which could be addressed through systems improvements within existing and available health system resources.

Focusing on the latter to ensure scalability, the study team designed and piloted an intervention package that addressed both facility-based workflow (role clarification, task shifting, supervisory job aids) and active patient tracking (data review, SMS outreach, home visits).

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