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A COMBINATION INTERVENTION STRATEGY FOR HIV LINKAGE AND RETENTION IN MOZAMBIQUE
Batya Elul1, Matthew R. Lamb1, Maria Lahuerta1, Fatima Abacassamo2, Laurence Ahoua3, Stephanie Kujawski1, Maria Tomo2, Ilesh Jani4
1Columbia Univ, New York, NY,2Cntr for Collab in Hlth, Maputo City, Mozambique,3ICAP at Columbia Univ, Maputo City, Mozambique,4Inst Nacional de Saude, Maputo, Mozambique
Identifying scalable interventions to strengthen linkage to and retention in HIV care is essential to ensuring individual and population benefits of ART.
Engage4Health, a cluster-randomized controlled trial implemented at 10 health facilities in Mozambique, evaluated the effectiveness of a combination intervention strategy (CIS) vs the standard of care (SOC) on the combined outcome of linkage to care within 1 month and retention in care at 12 months following HIV diagnosis. CIS included: (1) point-of-care CD4+ count at HIV testing sites; (2) accelerated ART initiation for eligible patients; and (3) SMS appointment reminders. A subset of CIS participants additionally received non-cash financial incentives (CIS+FI). Adults >18 years newly diagnosed with HIV and willing to receive HIV care at the diagnosing health facility were enrolled from 4/13-6/15 and followed for 12 months. Main analyses assessed outcomes at the diagnosing facility using medical record abstraction, while sensitivity analyses examined outcomes at any health facility using self-reports collected during follow-up interviews. Log-Poisson models were used to estimate the relative risk (RR) of outcomes in intent-to-treat analyses, with additional models adjusting for clustering within sites and patient characteristics using propensity score matching.
Among 2004 participants (N=744 CIS, 493 CIS+FI, 767 SOC), 64% were women and the mean age was 34 years (standard deviation = 10). As shown in the table, 57% receiving CIS and 55% receiving CIS+FI achieved the primary outcome versus 35% receiving SOC (RR vs SOC: 1.63 [95%CI:1.45-1.83] for CIS; 1.56 [95%CI:1.37-1.76] for CIS+FI). Participants in the CIS (94%, RR vs SOC 1.50 [95%CI:1.42-1.49]) and CIS+FI (94%, RR 1.49 vs SOC [95%CI:1.41-1.58]) groups had higher linkage to care at 1 month versus those in the SOC (63%) group; and higher 12-month retention (CIS 59%, RR vs SOC 1.31 [95%CI:1.19-1.45], and CIS+FI 55%, RR vs SOC 1.24 [95%CI:1.11-1.38]) relative to those in SOC (45%). In sensitivity analyses considering self-reported linkage and retention at any health facility, 73% in CIS, 72% in CIS+FI, and 47% in SOC achieved the primary outcome (RR vs SOC: 1.55 [95%CI: 1.35-1.77] for CIS; 1.53 [95%CI: 1.32-1.77] for CIS+FI).
The CIS offers a feasible approach for enhancing outcomes across the HIV care continuum, particularly linkage to care following diagnosis. No additional benefit of non-cash financial incentives was observed.