“ProTeggiMI”: Adherence to HIV Vertical Transmission Prevention Pathway in Remote Communities in Mozambique

Background. Mother-to-child transmission of HIV (MTCT) has, in Mozambique, one of the highest rates (9%). Women living with HIV (WLWH) in remote areas have poor access to health services, including to antiretroviral treatment. On an experimental basis, services to prevent MTCT (PMTCT) are offered in mobile health clinics (Brigadas Móveis, BM) in the Inhambane province. The study aims to evaluate the effectiveness of this innovative strategy in the cascade of care for these patients. Methods. We collected demographic and clinical data on WLWH, as well as HIV-exposed children, reached at least once by BM strategy, over a 24-month period from 2021 to 2023. We performed a statistical analysis to assess adherence to the care pathway and identify risk factors for HIV infection in children. Results. Two hundred and forty WLWH and 252 children were included in the study. About 40% of the women received a new HIV diagnosis and for 85% of them the BM offered the first PMTCT visit. A beneficial effect on earlier entry into the PMTCT cascade-of-care was observed, with the median gestational age at entry decreasing from 24 weeks in the first year to 20 weeks in the second. Adherence to scheduled visits was lower for women with a recent HIV diagnosis and for women living in communities not reached monthly. A vertical transmission rate of 11% was estimated for exposed infants born from pregnant women. Conclusions. HIV vertical transmission is still a major challenge in Mozambique, especially for women from remote communities. Decentralization of services is a key strategy for protecting HIV-exposed children. A recent diagnosis and irregular service delivery are significant risk factors for adherence to the PMTCT course.