AIDS and Behavior

, Volume 19, Issue 4, pp 666–678 | Cite as

Patient Loss to Follow-Up Before Antiretroviral Therapy Initiation in Rural Mozambique

  • Monica da Silva
  • Meridith Blevins
  • C. William Wester
  • José Manjolo
  • Eurico José
  • Lazaro C. Gonzalez
  • Bryan E. Shepherd
  • Troy D. Moon
  • Lara M. E. Vaz
Original Paper

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.

Keywords

HIV/AIDS Southern Africa Mozambique Retention Pre-ART loss to follow-up 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Monica da Silva
    • 1
  • Meridith Blevins
    • 1
    • 2
  • C. William Wester
    • 1
    • 3
    • 6
  • José Manjolo
    • 6
  • Eurico José
    • 6
  • Lazaro C. Gonzalez
    • 6
  • Bryan E. Shepherd
    • 1
    • 2
  • Troy D. Moon
    • 1
    • 4
    • 6
  • Lara M. E. Vaz
    • 1
    • 5
    • 6
    • 7
  1. 1.Vanderbilt Institute for Global Health (VIGH)NashvilleUSA
  2. 2.Department of BiostatisticsVanderbilt University School of MedicineNashvilleUSA
  3. 3.Department of MedicineVanderbilt University School of MedicineNashvilleUSA
  4. 4.Department of PediatricsVanderbilt University School of MedicineNashvilleUSA
  5. 5.Department of Preventive MedicineVanderbilt University School of MedicineNashvilleUSA
  6. 6.Friends in Global HealthQuelimane and MaputoMozambique
  7. 7.Save the ChildrenWashingtonUSA

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