Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

Laura Fuente-Soro, Carlos Iniesta, Elisa López-Varela, Mauro Cuna, Rui Guilaze, Maria Maixenchs, Edson Luis Bernardo, Orvalho Augusto, Raquel Gonzalez, Aleny Couto, Khatia Munguambe and Denise Naniche

PLOS ONE, 2019, vol. 14, issue 9, 1-16

Abstract: Background: The implementation of quality HIV control programs is crucial for the achievement of the UNAIDS 90-90-90 targets and to motivate people living with HIV (PLWHIV) to link and remain in HIV-care. The aim of this mixed method cross-sectional study was to estimate the linkage and long-term retention in care of PLWHIV and to identify factors potentially interfering along the HIV-care continuum in southern Mozambique. Methods: A home-based semi-structured interview was conducted in 2015 to explore barriers and facilitators to the HIV-care cascade among individuals that had been newly HIV-diagnosed in community testing campaigns in 2010 or 2012. Linkage and long-term retention were estimated retrospectively through client self-reports and clinical records. Cohen's Kappa coefficient was calculated to measure the agreement between participant self-reported and documented cascade outcomes. Results: Among the 112 interviewed participants, 24 (21.4%) did not disclose their HIV-positive serostatus to the interviewer. While 84 (75.0%) self-reported having enrolled in care, only 69 (61.6%) reported still being in-care 3–5 years after diagnosis of which 17.4% reported having disengaged and re-engaged. An important factor affecting optimal continuum in HIV-care was the impact of the fear-based authoritarian relationship between the health system and the patient that could act as both driver and barrier. Conclusion: Special attention should be given to quantify and understand repeated cycles of patient disengagement and re-engagement in HIV-care. Strategies to improve the relationship between the health system and patients are still needed in order to optimally engage PLWHIV for long-term periods.

Date: 2019
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0222028

DOI: 10.1371/journal.pone.0222028

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