Evaluating differentiated service delivery across the HIV care continuum: from testing to treatment monitoring in Mozambique

[eng] INTRODUCTION: Eastern and southern Africa (ESA), which accounts for 53% of all people living with HIV (PLHIV) worldwide, has yet to achieve the UNAIDS 95-95-95 targets for 2025: 95% of PLHIV know their status, 95% of those are on antiretroviral therapy (ART), and 95% of those achieve viral suppression. To meet these goals, ESA must diagnose an additional 630,000 PLHIV, retain 1.47 million more in treatment, and ensure an extra 1.89 million achieve viral suppression. Key challenges include addressing disparities in care among adolescents and young adults, reducing high disengagement rates within six months of ART initiation, and expanding viral load (VL) monitoring for all PLHIV on ART. Differentiated HIV service delivery (DSD) models, defined as “a responsive, person-centred approach that simplifies and adapts HIV services across the HIV care continuum to reflect the preferences, expectations and needs of people living with and vulnerable to HIV, while reducing unnecessary burdens on the healthcare system”, have been widely implemented in ESA to help meet the UNAIDS targets. Thorough monitoring and evaluation of DSD implementation are essential to improve model design and identify scale-up barriers. Additionally, interferon gamma-induced protein 10 (IP-10), a chemokine correlated with increased HIV VL, shows promise as a biomarker for ART monitoring in settings with limited access to universal VL testing. HYPOTHESIS: The implementation of DSD interventions across the HIV care continuum in Mozambique will significantly improve HIV diagnosis, retention in care, and ART monitoring, ultimately enhancing viral suppression. OBJECTIVE: The general objective of this thesis is to evaluate three DSD interventions across the HIV care continuum for adolescents and adults living with HIV in Mozambique: i) a Ministry of Health training module on targeted provider-initiated HIV testing and counselling (PITC), focusing on testing individuals at higher risk of HIV, ii) three multi-month dispensing (MMD) of ART, and iii) a novel IP-10-based point-of-care (POC) test for targeted VL-based ART monitoring.