Abstract
Introduction: Viral load (VL) monitoring for people on antiretroviral therapy (ART) is extremely challenging in resource-limited settings. We assessed the VL testing scale-up in six Médecins Sans Frontières supported health centres in Maputo, Mozambique, during 2014-15.
Methods: In a retrospective cohort study, routine programme data were used to describe VL testing uptake and results, and multi-variate logistical regression to estimate predictors of VL testing uptake and suppression.
Results: Uptake of a first VL test was 40% (17 236/43 579). Uptake of a follow-up VL test for patients with a high first VL result was 35% (1095/3100). Factors associated with a higher uptake included: age below 15 years, longer time on ART and attending tailored service delivery platforms. Virological suppression was higher in pregnant/breastfeeding women and in community ART Group members. Patients with a high first VL result (18%; 3100/17 236) were mostly younger, had been on ART longer or had tuberculosis. Out of 1095 attending for a follow-up VL test, 678 (62%) had virological failure. Of those, less than one-third had started second line ART.
Conclusion: This was the first study describing the uptake and results of VL testing scale-up in Mozambique. Identified gaps show patient and programmatic challenges. Where service delivery was customized to patient needs, VL monitoring was more successful.
Original language | English |
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Journal | International Health |
Volume | 9 |
Issue number | 4 |
Pages (from-to) | 206-214 |
Number of pages | 9 |
ISSN | 1876-3413 |
DOIs | |
Publication status | Published - 2017 |
Externally published | Yes |
Keywords
- Adolescent
- Adult
- Anti-HIV Agents/therapeutic use
- Child
- Child, Preschool
- Drug Monitoring/statistics & numerical data
- Female
- HIV Infections/drug therapy
- Humans
- Male
- Mozambique
- Pregnancy
- Program Evaluation
- Retrospective Studies
- Viral Load/drug effects
- Young Adult