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

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.

journal_name

Int Health

journal_title

International health

authors

Swannet S,Decroo T,de Castro SMTL,Rose C,Giuliani R,Molfino L,Torrens AW,Macueia WSED,Perry S,Reid T

doi

10.1093/inthealth/ihx021

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

206-214

issue

4

eissn

1876-3413

issn

1876-3405

pii

4079389

journal_volume

9

pub_type

杂志文章

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