Revista mocambicana de ciencias de saude最新文献

Introduction: Advanced HIV Disease (AHD) is a remaining hurdle in the care and treatment cascade in Mozambique and has the potential to delay Mozambique's progress towards the UNAIDS 95-95-95 goals for 2025. An improved understanding of the prevalence and demographics of people with AHD is critical to address this important condition.

Methods: Data were reviewed from October to December 2023 from the 79 health facilities at a national level implementing the AHD diagnosis and treatment package at the national level.

Results: Overall, 36% (7.811/21.452) of people living with HIV new initiated or reinitiated on antiviral treatment had a CD4 test, of which 1.986 were diagnosed with AHD (25%). Most of the diagnosed cases were in people living with HIV that were newly initiated (1.814) versus those being reinitiated (179).

Conclusion: The low coverage of CD4 testing in eligible patients is an obstacle to the early identification of AHD patients and the reduction of mortality, and consequently a barrier to HIV elimination in Mozambique.

Introduction: Mozambique implements the prevention of mother-to-child transmission (PMTCT) of HIV as part of the national program since 2022. Despite the gains, vertical transmission rates continue high, estimated at 9% in 2023. We describe the progress of PMTCT in health facilities (HF) with PEPFAR support.

Methods: We analyzed routine data of 656 HF with PEPFAR support, during the 2017 - 2023 fiscal years (October-September). We calculated the following proportions: pregnant women (PW) at first antenatal care consultation (ANC1) that knew their HIV status; HIV positive PW at ANC; PW on antiretroviral treatment (ART); PW on ART with a documented viral load (VL); PW with suppressed VL (VLS, defined as <1.000 copies/ml); HIV exposed children (HEI) tested up to 12 months, with a HIV positive result; HEI positive in ART. Data were analyzed by fiscal year (October - September).

Results: During 2017-2023, the proportion of PW knowing their HIV status at ANC1 increased from 90,4% (863.181/954.933) to 99,9% (1.047.870/1.049.225); the proportion of PW on ART remained above 99%; the proportion of PW with VL test increased from 24,5% (9.862/40.293) to 74,9% (46.292/61.818); and the VLS increased from 51,4% (5.073/9.862) to 88,5% (40.950/46.292). During 2017-2023, HEI testing increased from 76,5% (64.322/84.038) to 96,0% (82.689/86.132), and testing positivity decreased from 8,5% (5.487/64.322) to 2,5% (2.075/82.689); during 2018-2023, the proportion of HIV positive HEI on ART increased from 82,7% (3.521/4.256) to 93,3% (1.936/2.075).

Conclusions: Health facilities with PEPFAR support achieved progress in PMTCT. Continued implementation of sound interventions to improve ART initiation and retention, VLS and ART linkage of HEI testing HIV positive can lead to additional reduction of vertical transmission and its elimination as a public health problem in the country.

Introduction: Data quality improvements have aimed to align national reporting systems for Ministry of Health (MISAU) and PEPFAR. For example, in 2019 the patient Master Card improved systematic data collection process and sites were selected for intensified support including data quality activities (AJUDA). This study aims to compare reported data between MISAU and PEPFAR to understand data alignment trends.

Methods: The annual number of PLHIV on ART, newly initiating ART and HIV status in first ANC visit as reported by MISAU and PEPFAR were compared for 2017-2023. The absolute difference was calculated as MISAU-reported number minus PEPFAR-reported number; proportional absolute difference as the absolute difference over the MISAU-reported number and assessed the slope of the difference over time.

Results: During 2017-2023, median absolute difference for PLHIV on ART was 104. 940 (range = 154. 901 [2018] to 1. 598 [2020]), and median proportional difference was 5, 0% (range = 0, 1% [2020] to 12,8% [2018]), with a trend towards improved concordance. A similar trend was found in positive HIV status at first ANC (10,4% [2017] to 0,0% [2023]), as well as with newly initiated on ART (2,7% [2017] to 0.3% [2023]).

Conclusion: In the three indicators analyzed, there were improvements in data alignment between the years of 2017 and 2023, with increased alignment in different years and for different reasons. Continued improvements will support programming and increase certainty for tracking progress toward the UNAIDS 95-95-95 goals to end HIV.