ArticleBMC infectious diseases2026
Retention and predictors of loss-to-follow-up among patients on antiretroviral therapy in the Test-and-Treat Era: evidence from a retrospective cohort study in Maputo, Mozambique.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRetention in antiretroviral therapy (ART) is critical for HIV treatment success. Evidence on the impact of Test-and-Treat (TT) strategy in high-burden urban settings remains limited. We evaluated TT implementation effect on ART patients’ retention and identified predictors of loss-to-follow-up (LTFU) in Maputo, Mozambique.
methodsA retrospective cohort study (2013–2020) was conducted among ART patients aged 15–49 years using data from 12 health facilities (HFs). Patients were grouped into pre-Test-and-Treat (BTT, 2013–2016) and post-Test-and-Treat (ATT, 2017–2020) cohorts for comparative purposes. Retention probabilities were estimated using Kaplan–Meier methods, and predictors of loss to follow-up (LTFU) were assessed using Cox proportional hazards models. Population attributable fractions (PAFs) were calculated to quantify the population-level impact of Test-and-Treat implementation.
resultsAmong 16,968 patients (9,036 BTT; 7,932 ATT), 7,908 experienced LTFU over 487,958 person-months. Loss to follow-up incidence decreased from 17.3 to 15.0 per 1,000 person-years in BTT versus ATT, a 13.3% reduction. Median retention time (MRT) increased from 39.8 to 49.0 months. Test-and-treat reduced LTFU hazard by 25% (adjusted PAF 23%). Higher LTFU risk was associated with male sex, WHO stage III/IV, HIV/TB co-infection, second-line ART, and non-membership in community ART groups (CAGs).
conclusionTest-and-Treat substantially improved ART retention, particularly when combined with differentiated service delivery models (DSDMs). Targeted interventions for high-risk groups may further enhance retention. Future research should assess TT effects in specific subpopulations and account for undocumented deaths and self-transfers.
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