Retention in care of newly diagnosed HIV patients. Similarities and differences among Italian health system and mobile-TARV strategy in Morrumbene, Mozambique

Despite the progress in HIV care, adherence remains critical. The aim of this study was to assess similarities and differences in LTFU (loss to follow up) rates among new HIV diagnosis in the Italian and Mozambican settings in order to identify possible risk factors and promote targeted interventions. A retrospective study was conducted on new HIV diagnosis in the HIV Clinic of Brescia (2015-2018) and in rural communities in Mozambique (2017-2018). A lack of contact of >12 months in Brescia and of >2 months in Morrumbene defined LTFU patients. Demographic characteristics, risk factors, pregnancy status, WHO clinical stage and immuno-virological parameters were recorded. 7.4% of new diagnosis in HIV clinic in Brescia were LTFU. Young people, females and Africans are more likely to be lost (p<.05). In Morrumbene the LTFU rate was 25.6% and being young and pregnant was significantly associated with HIV care attrition (p<.05). Most LTFU patients dropped out during the first month after diagnosis, 60% in Brescia and 67.7% in Morroumbene. Considering all patients together WHO stage 0-1, postponed cART and CD4+ cells count > 200/μl were significantly associated with failed retention in care. Retention in care of HIV patients represents a difficult step of HIV care. Educational projects focusing on fragile populations, counselling after HIV diagnosis and rapid cART initiation seem to be essential to guarantee a long-lasting adherence to HIV care.