Linking home-based care to facility-based HIV testing and ART services in central Mozambique

Issues:

In Manica and Sofala Provinces of Mozambique, home based care has been managed through community-based organizations. In 2006, after two years of national ART scale-up, linkages between HBC and the public ART services remained ill-defined. Few HBC patients were tested for HIV or referred for ART. Lack of formal linkages led to major missed opportunities for testing and treatment in the HBC population.

Description:

With partner support, the two provincial health directorates initiated programs in 2006 to better integrate HBC groups with public ART services. About 6045 HBC clients per month are served by 14 organizations; 950 HBC staff were trained by the health system for HIV testing and ART referrals at 67 facilities. Point contacts among heath staff were trained at each facility as liaisons to HBC groups to facilitate referrals.

Lessons Learned:

The proportion of HBC clients enrolled in facility HIV care rose from less than 20% in 2006 to 77% by December 2008; the proportion on ART rose from less than 10% to 57%. Regular supervision visits and refresher courses are required to maintain close coordination. Joint meetings to analyze indicators and troubleshoot problems make substantial improvements in HBC group performance .

Recommendations:

Formal linkages between HBC organizations and health services can significantly improve patient referrals and follow-up. Links can be created through training of HBC workers and health facility staff as liaisons. This approach can improve testing, referrals, and adherence by mitigating the lack of human resources in the health system for community-based patient follow-up.