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

Autoři: Laura Fuente-Soro aff001;  Carlos Iniesta aff003;  Elisa López-Varela aff001;  Mauro Cuna aff001;  Rui Guilaze aff001;  Maria Maixenchs aff001;  Edson Luis Bernardo aff001;  Orvalho Augusto aff001;  Raquel Gonzalez aff002;  Aleny Couto aff005;  Khatia Munguambe aff001;  Denise Naniche aff001
Působiště autorů: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique aff001;  ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain aff002;  Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain aff003;  Direcção Distrital em Saúde, Manhiça, Maputo, Mozambique aff004;  National STI-HIV/AIDS Program, Ministry of Health, Maputo, Mozambique aff005;  Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique aff006
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222028



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.


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.


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.


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.

Klíčová slova:

Behavioral and social aspects of health – Cross-sectional studies – HIV diagnosis and management – HIV epidemiology – Long-term care – Mozambique


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