title: Patient loss to follow-up before antiretroviral therapy initiation in rural Mozambique.
abstract: Within Mozambique's current HIV care system, there are numerous opportunities for a person to become lost to follow-up (LTFU) prior to initiating antiretroviral therapy (pre-ART). We explored pre-ART LTFU in Zambézia province utilizing quantitative and qualitative methods. Patients were deemed LTFU if they were more than 60 days late for either a scheduled appointment or a CD4+ cell count blood draw, according to national guidelines. Among 13,968 adult patients registered for care, 211 (1.8 %) died, one transferred, 2,196 (15.7 %) initiated ART, and 9,195 (65.8 %) were LTFU during the first year. Being male, younger, less educated, and/or having no home electricity were associated with LTFU. Qualitative interviews revealed that poor clinical care, logistics and competing priorities contribute to attrition. In addition, many expressed fears of stigma and/or rejection by family or community members because they were HIV-infected. At 66 %, pre-ART LTFU in Zambézia, Mozambique is a significant problem. This study highlights characteristics of lost patients and discusses barriers requiring consideration to improve retention.
authors.affiliation: Vanderbilt Institute for Global Health (VIGH), 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA, monica.l.da.silva@vanderbilt.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: da Silva
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.forename: José
authors.initials: J
authors.lastname: Manjolo
authors.forename: Eurico
authors.initials: E
authors.lastname: José
authors.forename: Lazaro C
authors.initials: LC
authors.lastname: Gonzalez
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Troy D
authors.initials: TD
authors.lastname: Moon
authors.forename: Lara M E
authors.initials: LM
authors.lastname: Vaz
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D009073:Mozambique; D012929:Psychological Distance; D036301:Qualitative Research; D012424:Rural Population; D012737:Sex Factors; D057545:Social Stigma; D055815:Young Adult