Journey towards universal viral load monitoring in Maputo, Mozambique: many gaps, but encouraging signs

Sarah Swannet, Tom Decroo, Sheila M T L de Castro, Caroline Rose, Ruggero Giuliani, Lucas Molfino, Ana W Torrens, Walter S E D Macueia, Sharon Perry, Tony Reid

Research output: Contribution to journalA1: Web of Science-article

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 languageEnglish
JournalInternational Health
Volume9
Issue number4
Pages (from-to)206-214
Number of pages9
ISSN1876-3413
DOIs
Publication statusPublished - 2017
Externally publishedYes

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

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