Impact of Patient Volume on Loss to Follow-up and Mortality in Antiretroviral Therapy Programs in Mozambique

The Mozambican Ministry of Health (MOH) in 2004 initiated a national scale-up of anti-retroviral therapy (ART) using primarily a vertical model of day hospitals within high population centers. In order to expand ART coverage, the MOH initiated ART-delivery within primary health care clinics in 2006. Despite efforts of scaling up services to meet the growing population of ART-recipients, concern remains that high patient volume at clinics is overburdening the health system. We therefore conducted a study to examine the relationship of patient volume with loss to follow-up and mortality among patients on ART.

Data were aggregated for 24 HIV treatment clinics in Manica and Sofala provinces. Linear regression models with robust standard errors were used to assess the relationship of patient volume with loss to follow-up and mortality. Survival analyses will be used to analyze patient-level, time-until-event data.

Of the 24 HIV treatment clinics, the median patient population size is 557 with a range from 100 to 5,468 patients per clinic. Patient volume is significantly associated with the percent loss to follow-up (p=0.001) with higher patient volumes tending to have more loss to follow-up. The estimated percent loss to follow-up is 7.56% in a HIV treatment clinic with 500 patients and is 20.95% in a clinic with 5,000 patients. Patient volume is not significantly associated with mortality.

As ART-delivery continues to be scaled-up, strategies to relieve the patient burden on clinics need to be considered. Addressing these barriers will lead to better retention and more efficient delivery of HIV treatment.