HIV treatment in mobile clinics or health centers

Introduction

Access to HIV care and retention in care is one of the challenges in rural Subsaharan-Africa. Continuous decentralization efforts to smaller health facilities are ongoing with good results. Mobile Clinics (MC) represent another one of the strategies to increase access to care for HIV patients living in rural areas. Nevertheless there is scarce evidence regarding its effectiveness. Our objective was to compare retention in care, lost-to-follow-up (LTFU) and mortality of patients starting antiretroviral treatment (ART) at the MC or at health centres (HC) in the secluded district of Ancuabe, province of Cabo Delgado, Mozambique.

The district of Ancuabe comprises 6 primary health care centres serving 125,000 inhabitants through 48 health care providers and two doctors, of which two health centres offer in-patient care and HIV services permanently. Between June 2011 and May 2013, a MC offered HIV care on a weekly basis in on of the remote health centres.

Materials and methods

Prospective cohort study involving all patients started on ART during the study period. LTFU was defined as not showing up for ≥60 days of the next appointment. A patient was only considered dead after confirmation by patient tracing. Retained in care was defined as alive and active on ART. A survival analysis with the Kaplan-Meier (KM) method was done. A multivariable analysis with a Cox proportional hazards regression model was also performed, the forward stepwise method was used. The SolidarMed ART Database has the ethical approval of the Mozambican National Committee of Bioethics.

Results

Patients: A total of 711 patients were started on ART during the study period; 586 patients at a HC and 125 at the MC. Mean age was 32.14 years; 61.3% were women. Total follow-up was 1051.57 person-years.

Conclusion

This analysis confirms the value of Mobile Clinics in expanding access to HIV treatment and care to remote areas. Patients started on ART at MC showed equal outcomes as those at the HCs’ clinics in terms of lost to follow-up, deaths and retention in care. (SolidarMed AIDS 2014)