HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique

Abstract

Objective: Evaluate the effect of three multimonth dispensing (3MMD) of antiretroviral therapy (ART) on HIV care retention in southern Mozambique. Design: Retrospective cohort study. Methods: We analyzed routine health data from people with HIV (PWH) aged 10 years old and older who started ART between January 2018 and March 2021. Individuals were followed until December 2021. Cox proportional-hazards models were used to compare attrition (lost to follow-up, death, and transfer out) between 3MMD and monthly ART dispensing. Results were stratified by time on ART before 3MMD enrolment: ‘early enrollers’ (<6 months on ART) and ‘established enrollers’ (≥6 months on ART), and age groups: adolescents and youth (AYLHIV) (10–24 years) and adults (≥25 years). Results: We included 7378 PWH (25% AYLHIV, 75% adults), with 59% and 62% enrolled in 3MMD, respectively. Median follow-up time was 11.3 [interquartile range (IQR): 5.7–21.6] months for AYLHIV and 10.2 (IQR: 4.8–20.9) for adults. Attrition was lower in PWH enrolled in 3MMD compared with monthly ART dispensing, in both established (aHR AYLHIV = 0.65; 95% CI: 0.54–0.78 and aHR adults = 0.50; 95% confidence interval (CI): 0.44–0.56) and early enrollers (aHR AYLHIV = 0.70; 95% CI: 0.58–0.85 and aHR adults = 0.63; 95% CI: 0.57–0.70). Among individuals in 3MMD, male gender (aHR = 1.30; 95% CI: 1.18–1.44) and receiving care in a medium-volume/low-volume healthcare facility (aHR = 1.18; 95% CI: 1.03–1.34) increased attrition risk. Conversely, longer ART time before 3MMD enrolment (aHR = 0.93; 95% CI: 0.92–0.94 per 1 month increase) and age at least 45 years (aHR = 0.77, 95% CI: 0.67–0.89) reduced risk of attrition. Conclusion: 3MMD improves retention in care compared with monthly dispensing among established and early enrollers, although to a lesser extent among the latter.