HIV care retention in three multi-month ART dispensing: a retrospective cohort study in mozambique

Objective: Evaluate the effect of three multi-month dispensing (3MMD) of antiretroviral therapy (ART) on HIV care retention in southern Mozambique. Design: Retrospective cohort study Methods: We analysed routine health data from people living with HIV (PLHIV) ≥10 years old who started ART between January 2018 and March 2021. Individuals were followed until December 2021. Cox proportional-hazards models were used to compare attrition (lost to follow-up, death, and transfer out) between 3MMD and monthly ART dispensing. Results were stratified by time on ART before 3MMD enrolment: “early enrollers” (<6 months on ART) and “established enrollers” (≥6 months on ART), and age groups: adolescents and youth (AYLHIV) (10–24 years) and adults (≥25 years). Results: We included 7,378 PLHIV (25% AYLHIV, 75% adults), with 59% and 62% enrolled in 3MMD, respectively. Median follow-up time was 11.3 (IQR: 5.7–21.6) months for AYLHIV and 10.2 (IQR: 4.8–20.9) for adults. Attrition was lower in PLHIV enrolled in 3MMD compared to monthly ART dispensing, in both established (aHR AYLHIV = 0.65; 95%CI: 0.54–0.78 and aHR adults = 0.50; 95%CI: 0.44–0.56) and early enrollers (aHR AYLHIV = 0.70; 95%CI: 0.58–0.85 and aHR adults = 0.63; 95%CI: 0.57–0.70). Among individuals in 3MMD, male gender (aHR = 1.30; 95%CI: 1.18–1.44) and receiving care in a medium/low-volume healthcare facility (aHR = 1.18; 95%CI: 1.03–1.34) increased attrition risk. Conversely, longer ART time before 3MMD enrolment (aHR = 0.93; 95% CI: 0.92–0.94 per one-month increase) and age ≥45 years (aHR = 0.77, 95%CI: 0.67–0.89) reduced risk of attrition. Conclusions: 3MMD improves retention in care compared to monthly dispensing among established and early enrollers, although to a lesser extent among the latter.