Loss to follow-up of adults in public HIV care systems in central Mozambique: identifying obstacles to treatment.
BACKGROUND
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%.


CONCLUSIONS
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.
Micek
Mark A
MA
Department of Global Health, University of Washington, Seattle, WA 09195, USA. mmicek@u.washington.edu
Gimbel-Sherr
Kenneth
K
Baptista
Alberto João
AJ
Matediana
Eduardo
E
Montoya
Pablo
P
Pfeiffer
James
J
Melo
Armando
A
Gimbel-Sherr
Sarah
S
Johnson
Wendy
W
Gloyd
Stephen
S
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D009073:Mozambique / Q000453:epidemiology; D009313:National Health Programs; D010349:Patient Compliance
D019380:Anti-HIV Agents