Tracking linkage to care in an anonymous HIV testing context: A field assessment in Mozambique

J Eval Clin Pract. 2020 Jun;26(3):1005-1012. doi: 10.1111/jep.13262. Epub 2019 Aug 14.

Abstract

Rationale: Effective human immunodeficiency virus (HIV) prevention requires a coordinated continuum of services to foster early diagnosis and treatment. Early linkage to care (LTC) is critical, yet programmes differ in strategies to monitor LTC.

Methods: In 2014, we visited 23 HIV testing and care service delivery points in Mozambique to assess programme strategies for monitoring LTC. We interviewed key informants, reviewed forms, and matched records across service points to identify successful models and challenges.

Results: Forms most useful for tracking LTC included individual identifiers, eg, patient name, unique identifier (ie, National Health Identification Number [NID]), sex, and date of birth. The majority (67%) of records matched occurred in the presence of a unique NID. Key informants described challenges related to processes, staffing, and communication between service delivery points to confirm LTC.

Conclusions: While tracking clients from HIV testing to care is possible, programmes with insufficient tracking procedures are likely to underreport LTC. Adoption of additional patient identifiers in testing registers and standardized protocols may improve LTC programme monitoring and reduce underreporting.

Keywords: HIV/AIDS; diagnosis; evaluation; health policy; linkage to care; public health.

MeSH terms

  • Delivery of Health Care
  • Early Diagnosis
  • HIV Infections* / diagnosis
  • HIV Infections* / epidemiology
  • HIV Testing*
  • Humans
  • Mozambique / epidemiology