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High loss to follow-up and delays in HAART access for pregnant women registering for care at local treatment centers in Central Mozambique: A call for decentralization and integration

Diederike Geelhoed, MD1, Wendy Johnson, MD, MPH1, Pablo Montoya, MD, MPH1, Eduardo Matediane, MD2, and Firmino Jaqueta, MD3. (1) Health Alliance International, PO Box, Chimoio, Mozambique, 258825013600, pablom@teledata.mz, (2) Mozambican Ministry of Health, Beira Central Hospital, Beira, Mozambique, (3) Mozambique Ministry of Health, Chimoio Provincial Hospital, Chimoio, Mozambique

Background: One year after HAART introduction in Mozambique, all women testing HIV positive from pMTCT/ANC sites are referred to local HIV clinics, but less than 40% register. Those eligible for HAART (CD4 under 350 or phase 4) need five encounters before starting treatment.

Methods: Chart review of pregnant women (166) registering at the Chimoio clinic from 7/1/04 to 9/1/05 for HAART eligibility status, total visits, initial CD4, time to start HAART and demographics. Those not starting HAART pre-delivery were grouped by reason. We compared patient attributes starting HAART to non-starting eligibles using Chi-squared test and Odds Ratios in Epi Info 6.04d.

Results: HAART eligibility status could be determined for 78% (130). Of those 40% (52) met criteria. Only 24 women (46%) started HAART pre-delivery. Women starting HAART had a significantly higher number of visits than those not starting (7.8 vs. 4.4). Each social work visit increased the probability of starting HAART by 17.7 times (95% CI 4.1-75.6). Reasons for not starting HAART: 50% failed to follow-up further, 32% were clinical management failures, 18% registered too late in pregnancy.

Conclusions: Failure to start eligible pregnant women on HAART before delivery is a lost opportunity for preventing HIV transmission and improving mothers' health outcomes. With increasing HAART availability in Mozambique, new integrated care models must be developed to remove barriers faced by HAART eligible pregnant women.

Learning Objectives:

Keywords: Women and HIV/AIDS, International Health

Presenting author's disclosure statement:

Any relevant financial relationships? No

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The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA