Retention in Care and Virological Failure among Adult HIV-Positive Patients on First-Line Antiretroviral Treatment in Maputo, Mozambique

Abstract

Introduction: Access to antiretroviral treatment (ART) is increasingly available worldwide; however, the number of patients lost to follow-up and number of treatment failures continue to challenge most African countries.

Objectives: To analyse the retention in clinical care and the virological response and their associated factors of HIV-1 patients from the Maputo Military Hospital (MMH).

Methods: A cross-sectional observational study was conducted to analyse data from patients who started ART between 2016 and 2018 in the MMH.

Results: At the end of 12 months, 75.1% of 1247 patients were active on clinical follow-up and 16.8% had suspected virologic failure (VL > 1000 copies/mm³). Patients younger than 40 years old were more likely to be lost to follow-up when compared to those aged >50 years old, as well as patients who were unemployed and patients with a CD4 count < 350 cells/mm³. Patients with haemoglobin levels lower than 10 g/dL and with a CD4 count < 350 cells/mm³ were more likely to have virological failure.

Conclusions: We have identified clinical and sociodemographic determinants of loss to follow-up and in the development of virological failure for HIV-positive patients in clinical care in the MMH. Therefore, HIV programs must consider these factors to increase the screening of patients at high risk of poor outcomes and particularly to strengthen adherence counselling programs.

Keywords: HIV-1; Mozambique; retention on care; virological response.

Figure 1

Flowchart of identification and selection of study patients, as well as their characterization in relation to retention at 12 months and viral load at 6 months.