Qualitative Assessment of Health and Care-Seeking Behaviors among Hiv-Infected Adults and Health Care Providers in Mozambique.

Background: From 2009 to 2014, the prevalence of HIV among adults in Mozambique increased from 11.5% to 13.2%. To reduce disease progression and prevent transmission, HIV-infected persons must have access to timely, continuous, high-quality HIV care and treatment services. This study aim to identify the barriers to early diagnosis, access to medical care, ART initiation and adherence. Methods: In-depth interviews were conducted with newly diagnosed HIV-positive patients and health providers in Maputo City and Zambézia Province. Participants were recruited into the study at the time of HIV testing. Interviews were obtained at least 45 days after HIV diagnosis and were conducted in the community where the patients resided. Interviews were recorded, transcribed and translated into Portuguese prior to analysis. A framework approach was used for analysis using NVivo 10.0. Results: Ninety patients and twelve providers were interviewed. Twenty-nine patients (32%) stated that they were motivated to get tested for HIV because they felt they had an unspecified health problem. Among pregnant women, nineteen (44%) were motivated to enroll in care and initiate ART by nurses during their first prenatal visit. Of the 90 newly diagnosed patients, 80% sought care and treatment for HIV after being diagnosed in a health facility. Conclusions: Test-seeking behaviour for persons newly diagnosed with HIV in this study was often influenced by their health status, both for patients accessing voluntarily counselling and testing and for patients who tested in antenatal care settings. Initiation of ART was also strongly influenced by provider recommendation.