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

Souhrn

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.

Klíčová slova:

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


Zdroje

1. UNAIDS. Ending AIDS: progress towards the 90–90–90 targets. 2017; Available: http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf

2. UNAIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic [Internet]. 2014. Available: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

3. UNAIDS. MILES TO GO CLOSING GAPS BREAKING BARRIERS RIGHTING INJUSTICES [Internet]. 2018. Available: http://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf

4. Instituto Nacional de Saúde (INS), Instituto Nacional de Estatística (INE) M. Inquérito de Indicadores de Imunização, Malária e HIV/SIDA em Moçambique (IMASIDA). 2015; Available: http://cncs.co.mz/wp-content/uploads/2015/11/IMASIDA-2015_Relatorio-de-Indicadores-Basicos-de-HIV-FINAL-for-web-no-blank-pages-1.pdf

5. República de Moçambique Conselho Nacional de Combate ao SIDA Resposta Global à SIDA Relatório do Progresso, 2016 MOÇAMBIQUE [Internet]. 2016. Available: http://www.unaids.org/sites/default/files/country/documents/MOZ_narrative_report_2016.pdf

6. Layer EH, Kennedy CE, Beckham SW, Mbwambo JK, Likindikoki S, Davis WW, et al. Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania. Chung MH, editor. PLoS One. 2014;9: e104961. doi: 10.1371/journal.pone.0104961 25119665

7. Topp SM, Mwamba C, Sharma A, Mukamba N, Beres LK, Geng E, et al. Rethinking retention: Mapping interactions between multiple factors that influence long-term engagement in HIV care. Isaakidis P, editor. PLoS One. 2018;13: e0193641. doi: 10.1371/journal.pone.0193641 29538443

8. Ayieko J, Brown L, Anthierens S, Van Rie A, Getahun M, Charlebois ED, et al. “Hurdles on the path to 90-90-90 and beyond”: Qualitative analysis of barriers to engagement in HIV care among individuals in rural East Africa in the context of test-and-treat. Costa AB, editor. PLoS One. 2018;13: e0202990. doi: 10.1371/journal.pone.0202990 30161172

9. Masa R, Chowa G, Nyirenda V. Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status. African J AIDS Res. 2017; 1–9. doi: 10.2989/16085906.2017.1308386 28639469

10. Shabalala FS, Vernooij E, Pell C, Simelane N, Masilela N, Spiegelman D, et al. Understanding reasons for discontinued antiretroviral treatment among clients in test and treat: a qualitative study in Swaziland. J Int AIDS Soc. 2018;21: e25120. doi: 10.1002/jia2.25120 30027651

11. Lifson AR, Demissie W, Tadesse A, Ketema K, May R, Yakob B, et al. Barriers to retention in care as perceived by persons living with HIV in rural Ethiopia: focus group results and recommended strategies. J Int Assoc Provid AIDS Care. 12: 32–8. doi: 10.1177/1545109712456428 22993233

12. Bassett I V., Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, et al. Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa. JAIDS J Acquir Immune Defic Syndr. 2017;74: 432–438. doi: 10.1097/QAI.0000000000001277 28060226

13. Nhacolo AQ, Nhalungo DA, Sacoor CN, Aponte JJ, Thompson R, Alonso P. Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhiça district. BMC Public Health. 2006;6: 291. doi: 10.1186/1471-2458-6-291 17137494

14. Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, et al. Profile: Manhica Health Research Centre (Manhica HDSS). Int J Epidemiol. 2013;42: 1309–1318. doi: 10.1093/ije/dyt148 24159076

15. Sacoor C, Payne B, Augusto O, Vilanculo F, Nhacolo A, Vidler M, et al. Health and socio-demographic profile of women of reproductive age in rural communities of southern Mozambique. Gebhardt S, editor. PLoS One. 2018;13: e0184249. doi: 10.1371/journal.pone.0184249 29394247

16. González R, Munguambe K, Aponte J, Bavo C, Nhalungo D, Macete E, et al. High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. doi: 10.1111/j.1468-1293.2012.01018.x

17. González R, Augusto OJ, Munguambe K, Pierrat C, Pedro EN, Sacoor C, et al. HIV Incidence and Spatial Clustering in a Rural Area of Southern Mozambique. PLoS One. 2015;10: e0132053. doi: 10.1371/journal.pone.0132053 26147473

18. Pons-Duran C, González R, Quintó L, Munguambe K, Tallada J, Naniche D, et al. Association between HIV infection and socio-economic status: evidence from a semirural area of southern Mozambique. Trop Med Int Heal. 2016;21: 1513–1521. doi: 10.1111/tmi.12789 27696629

19. Boullé A, Todd J, Xueref S, Davies MA. HIV Case Based Surveillance and Patient Tracking Systems. Results from Four Situational Assessments in High Burden, Low-Resourced Countries Members of the MeSH Routine Case-based Surveillance Working Group [Internet]. 2016. Available: www.mesh-consortium.org.uk

20. Kabudula CW, Joubert JD, Tuoane-Nkhasi M, Kahn K, Rao C, Gmez-Oliv FX, et al. Evaluation of record linkage of mortality data between a health and demographic surveillance system and national civil registration system in South Africa. Popul Health Metr. 2014;12: 23. doi: 10.1186/s12963-014-0023-z

21. Fuente-Soro L, Lopez-Varela E, Augusto O, Sacoor C, Nhacolo A, Honwana N, et al. Monitoring progress towards the first UNAIDS target: understanding the impact of people living with HIV who re-test during HIV-testing campaigns in rural Mozambique. J Int AIDS Soc. 2018;21: e25095. doi: 10.1002/jia2.25095 29652098

22. Lopez-Varela E, Fuente-Soro L, Augusto OJ, Sacoor C, Nhacolo A, Karajeanes E, et al. Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention. JAIDS J Acquir Immune Defic Syndr. 2018;78: 527–535. doi: 10.1097/QAI.0000000000001720 29771786

23. Chi BH, Yiannoutsos CT, Westfall AO, Newman JE, Zhou J, Cesar C, et al. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. Bartlett J, editor. PLoS Med. 2011;8: e1001111. doi: 10.1371/journal.pmed.1001111 22039357

24. Carl Hartung, Yaw Anokwa, Waylon Brunette, Adam Lerer, Clint Tseng GB. Open Data Kit: Tools to Build Information Services for Developing Regions. 2010; Available: http://www.gg.rhul.ac.uk/ict4d/ictd2010/papers/ICTD2010Hartungetal.pdf

25. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008;42: 377–381. doi: 10.1016/j.jbi.2008.08.010 18929686

26. Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33: 159. doi: 10.2307/2529310 843571

27. da Silva M, Blevins M, Wester CW, Manjolo J, José E, Gonzalez LC, et al. Patient loss to follow-up before antiretroviral therapy initiation in rural mozambique. AIDS Behav. 2015;19: 666–78. doi: 10.1007/s10461-014-0874-0 25096897

28. Tomori C, Kennedy CE, Brahmbhatt H, Wagman JA, Mbwambo JK, Likindikoki S, et al. Barriers and facilitators of retention in HIV care and treatment services in Iringa, Tanzania: the importance of socioeconomic and sociocultural factors. AIDS Care. 2014;26: 907–13. doi: 10.1080/09540121.2013.861574 24279762

29. Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care. AIDS. 2012;26: 2059–2067. doi: 10.1097/QAD.0b013e3283578b9b 22781227

30. Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM, Bimirew MA, Kassie DM. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia. PLoS One. 2014;9: e97353. doi: 10.1371/journal.pone.0097353 24828585

31. De Schacht C, Lucas C, Mboa C, Gill M, Macasse E, Dimande SA, et al. Access to HIV prevention and care for HIV-exposed and HIV-infected children: a qualitative study in rural and urban Mozambique. BMC Public Health. 2014;14: 1240. doi: 10.1186/1471-2458-14-1240 25467030

32. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13: 117. doi: 10.1186/1471-2288-13-117 24047204

33. Knight LC, Van Rooyen H, Humphries H, Barnabas R V, Celum C. Empowering patients to link to care and treatment: qualitative findings about the role of a home-based HIV counselling, testing and linkage intervention in South Africa. AIDS Care. 2015; 1–6. doi: 10.1080/09540121.2015.1035633 25923366

34. Hladik W, Benech I, Bateganya M, Hakim AJ. The utility of population-based surveys to describe the continuum of HIV services for key and general populations. Int J STD AIDS. 2015; doi: 10.1177/0956462415581728 25907348

35. Holtzman CW, Shea JA, Glanz K, Jacobs LM, Gross R, Hines J, et al. Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen’s Behavioral Model. AIDS Care. 2015;27: 817–28. doi: 10.1080/09540121.2015.1009362 25671515

36. Tabatabai J, Namakhoma I, Tweya H, Phiri S, Schnitzler P, Neuhann F. Understanding reasons for treatment interruption amongst patients on antiretroviral therapy—a qualitative study at the Lighthouse Clinic, Lilongwe, Malawi. Glob Health Action. 2014;7: 24795. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4185090&tool=pmcentrez&rendertype=abstract doi: 10.3402/gha.v7.24795 25280736

37. hIarlaithe MO, Grede N, de Pee S, Bloem M. Economic and Social Factors are Some of the Most Common Barriers Preventing Women from Accessing Maternal and Newborn Child Health (MNCH) and Prevention of Mother-to-Child Transmission (PMTCT) Services: A Literature Review. AIDS Behav. 2014;18: 516–530. doi: 10.1007/s10461-014-0756-5 24691921

38. Phelps BR, Ahmed S, Amzel A, Diallo MO, Jacobs T, Kellerman SE, et al. Linkage, initiation and retention of children in the antiretroviral therapy cascade: an overview. AIDS. 2013;27 Suppl 2: S207–13. doi: 10.1097/QAD.0000000000000095 24361630

39. Bogart LM, Chetty S, Giddy J, Sypek A, Sticklor L, Walensky RP, et al. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS Care. 2013;25: 843–53. doi: 10.1080/09540121.2012.729808 23061894

40. Miller CM, Ketlhapile M, Rybasack-Smith H, Rosen S. Why are antiretroviral treatment patients lost to follow-up? A qualitative study from South Africa. Trop Med Int Health. 2010;15 Suppl 1: 48–54. doi: 10.1111/j.1365-3156.2010.02514.x 20586960

41. Govindasamy D, Meghij J, Kebede Negussi E, Clare Baggaley R, Ford N, Kranzer K. Interventions to improve or facilitate linkage to or retention in pre-ART (HIV) care and initiation of ART in low- and middle-income settings—a systematic review. J Int AIDS Soc. 2014;17: 19032. Available: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4122816&tool=pmcentrez&rendertype=abstract doi: 10.7448/IAS.17.1.19032 25095831

42. Pecoraro A, Mimiaga MJ, O’Cleirigh C, Safren SA, Blokhina E, Verbitskaya E, et al. Lost-to-care and engaged-in-care HIV patients in Leningrad Oblast, Russian Federation: barriers and facilitators to medical visit retention. AIDS Care. 2014;26: 1249–57. doi: 10.1080/09540121.2014.897910 24666174

43. Marty L, Cazein F, Panjo H, Pillonel J, Costagliola D, Supervie V, et al. Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France. J Int AIDS Soc. 2018;21: e25100. doi: 10.1002/jia2.25100 29603879

44. Seeman M, Goffman E. Stigma: Notes on the Management of Spoiled Identity. Am Sociol Rev. 1964;29: 770. doi: 10.2307/2091442

45. Mayfield Arnold E, Rice E, Flannery D, Rotheram-Borus MJ. HIV disclosure among adults living with HIV. AIDS Care. 2008;20: 80–92. doi: 10.1080/09540120701449138 18278618

46. Maixenchs M, Boene H, Anselmo R, Mindu C, Alonso P, Menéndez C, et al. Post-ART Symptoms Were Not the Problem: A Qualitative Study on Adherence to ART in HIV-Infected Patients in a Mozambican Rural Hospital. 2015; doi: 10.1371/journal.pone.0137336

47. Kagoya HR, Kibuule D, Mitonga-Kabwebwe H, Ekirapa-Kiracho E, Ssempebwa JC. Awareness of, responsiveness to and practice of patients’ rights at Uganda’s national referral hospital. African J Prim Heal care Fam Med. 2013;5. doi: 10.4102/phcfm.v5i1.491 24563777

48. Abdalla SM, Mahgoub EA, Abdelgadir J, Elhassan N, Omer Z. Operationalization of patients’ rights in Sudan: Quantifying nurses’ knowledge. Nurs Ethics. 2018; 096973301878722. doi: 10.1177/0969733018787224 30322330

49. Eshun-Wilson I, Rohwer A, Hendricks L, Oliver S, Garner P. Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. Isaakidis P, editor. PLoS One. 2019;14: e0210408. doi: 10.1371/journal.pone.0210408 30629648

50. Kruk ME, Riley PL, Palma AM, Adhikari S, Ahoua L, Arnaldo C, et al. How Can the Health System Retain Women in HIV Treatment for a Lifetime? A Discrete Choice Experiment in Ethiopia and Mozambique. Roy JK, editor. PLoS One. 2016;11: e0160764. doi: 10.1371/journal.pone.0160764 27551785

51. Sando D, Kendall T, Lyatuu G, Ratcliffe H, McDonald K, Mwanyika-Sando M, et al. Disrespect and Abuse During Childbirth in Tanzania. JAIDS J Acquir Immune Defic Syndr. 2014;67: S228–S234. doi: 10.1097/QAI.0000000000000378 25436822

52. Zanolini A, Sikombe K, Sikazwe I, Eshun-Wilson I, Somwe P, Bolton Moore C, et al. Understanding preferences for HIV care and treatment in Zambia: Evidence from a discrete choice experiment among patients who have been lost to follow-up. Tsai AC, editor. PLOS Med. 2018;15: e1002636. doi: 10.1371/journal.pmed.1002636 30102693

53. Agaba PA, Genberg BL, Sagay AS, Agbaji OO, Meloni ST, Dadem NY, et al. Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria. J AIDS Clin Res. 2018;09. doi: 10.4172/2155-6113.1000756 29682399

54. Decroo T, Telfer B, Dores C Das, White RA, Santos N Dos, Mkwamba A, et al. Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study. BMJ Open. 2017;7: e016800. doi: 10.1136/bmjopen-2017-016800 28801427

55. Camlin CS, Charlebois ED, Geng E, Semitala F, Wallenta J, Getahun M, et al. Redemption of the “spoiled identity:” the role of HIV-positive individuals in HIV care cascade interventions. J Int AIDS Soc. 2017;20: e25023. doi: 10.1002/jia2.25023 29210185

56. Kiwanuka G, Kiwanuka N, Muneza F, Nabirye J, Oporia F, Odikro MA, et al. Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study. BMC Infect Dis. 2018;18: 533. doi: 10.1186/s12879-018-3450-9 30355356

57. Nhassengo P, Cataldo Id F, Magaç A, Hoffman Id RM, Nerua L, Saide M, et al. Barriers and facilitators to the uptake of Test and Treat in Mozambique: A qualitative study on patient and provider perceptions. 2018; doi: 10.1371/journal.pone.0205919

58. Inguane CA, Gloyd S, Luis Manuel J, Brown C, Wong V, Augusto O, et al. Assessment of linkages from HIV testing to enrolment and retention in HIV care in Central Mozambique. J Int AIDS Soc. 2016;19. doi: 10.7448/IAS.19.5.20846 27443273


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