Loss to Follow-up of Adults in Public HIV Care Systems in Central Mozambique: Identifying Obstacles to Treatment

Overview

Journal J Acquir Immune Defic Syndr

Specialty Infectious Diseases

Date 2009 Jun 25

PMID 19550350

Citations 89

Authors

Mark A Micek

Kenneth Gimbel-Sherr

Alberto Joao Baptista

Eduardo Matediana

Pablo Montoya

James Pfeiffer

Armando Melo

Sarah Gimbel-Sherr

Wendy Johnson

Stephen Gloyd

Affiliations

Soon will be listed here.

Abstract

Introduction: Access to antiretroviral treatment (ART) has expanded dramatically in resource-limited settings. Evaluating loss to follow-up from HIV testing through post-ART care can help identify obstacles to care.

Methods: Routine data were analyzed for adults receiving services in 2 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 7005 (29.9%) were HIV positive. Only 3956 (56.5%) of those HIV positive enrolled at an ART clinic < or =30 days after testing. CD4 testing was obtained in 77.1% < or =30 days of enrollment. Of 1506 eligible for ART, 471 (31.3%) started ART < or =90 days after CD4 testing. Of 382 with > or =180 days of potential follow-up time on ART, 317 (83.0%) had pharmacy-based adherence rates > or =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.

Citing Articles

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