Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

Abstract Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises estimate that key populations (KPs) and their partners account for about one third of all new infections due to their sexual and drug use behaviors. The Fast Track Targets monitor key indicators along the treatment cascade. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique in order to assess HIV service uptake and progress though the HIV treatment cascade among men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID). Unweighted pooled estimates were calculated for each key population group. Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. All key population groups fell below the global targets of the HIV treatment cascade. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade and should include viral load testing to guarantee a more complete picture of the treatment cascade.