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

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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.

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Acknowledgments

We thank Marcia Souza, Robert Burny, Deidra Parrish, Cameron Ingram and the volunteer community AIDS activists in Maganja da Costa for their assistance. We also thank Candace Miller and Sydney Rosen for sharing the data collection instruments from their study.

Conflict of interest

This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Department of Health and Human Services, Centers for Disease Control and Prevention under the terms of Cooperative Agreement #U2GPS000631. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

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Author notes

  1. Lara M. E. Vaz

    Present address: Save the Children, Washington, DC, USA

Authors and Affiliations

  1. Vanderbilt Institute for Global Health (VIGH), 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA

    Monica da Silva, Meridith Blevins, C. William Wester, Bryan E. Shepherd, Troy D. Moon & Lara M. E. Vaz

  2. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Meridith Blevins & Bryan E. Shepherd

  3. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    C. William Wester

  4. Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA

    Troy D. Moon

  5. Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Lara M. E. Vaz

  6. Friends in Global Health, Quelimane and Maputo, Mozambique

    C. William Wester, José Manjolo, Eurico José, Lazaro C. Gonzalez, Troy D. Moon & Lara M. E. Vaz

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  1. Monica da Silva
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Correspondence to Meridith Blevins.

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da Silva, M., Blevins, M., Wester, C.W. et al. Patient Loss to Follow-Up Before Antiretroviral Therapy Initiation in Rural Mozambique. AIDS Behav 19, 666–678 (2015). https://doi.org/10.1007/s10461-014-0874-0

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