Uncovering Inequalities and Major Gaps in Care Provision to People Living with HIV and Hypertension in Southern Mozambique
1
Instututo Nacional de Saúde, Marracuene, Mozambique
2
Ministério da Saúde, Direcção Provincial de Saúde de Maputo, Matola, Mozambique
3
Ministério da Saúde, Direcção de Saúde da Cidade de Maputo, Maputo, Mozambique
4
Department of Global Health, University of Washington, Seattle, United States
5
Departamento de Medicina, Hospital Central do Maputo, Maputo, Mozambique
6
Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Integration of services improves quality and continuity of care for chronic diseases. In Mozambique differentiated care models have been in place for people living with HIV (PLHIV), but the screening, diagnosis and management of hypertension (HTN) is not standardized.
OBJECTIVE:
We assessed the patterns of hypertension care for PLHIV, comparing highly urbanized to periurban/rural settings.
METHODS:
Between July2021/August2022 service delivery assessment tools were used to assess HIV clinics (>1,500 patients) in 16 urban and rural settings. Direct observation, health information system documentation and standardized questionnaires applied to frontline workforce and leadership of health centres (HC) were used to describe patterns of care for HIV and HTN. Results and
DISCUSSION:
A total 112,913 PLHIV used diverse models of care, of which only 12.5% had their blood pressure measured. High caseload was found (mean 30 PLHIV/clinician/day), being worse in the rural areas. Clinicians corresponded to 28% of workforce in HIV care (urban areas) versus 16% in preurban/rural areas. The ratio provider to PLHIV was 1:842 in urban areas compared to 1:971 in periurban/rural settings. HIV screening, diagnosis and management was free of charge, used guidelines and clinical protocols, supply chain, electronic health information system and point-of-care testing were highly supported by international partners, while were unavailable for HTN. Unclear and non-standardized pathways for screening, diagnosis and referral were found HTN, requiring out-of-pocket costs. Each patient with both conditions had two identification cards/medical files, and consultations were done by the same professional in only 4 (25%) health facilities.
CONCLUSIONS:
Major inequalities in care for with comorbid hypertension and HIV were uncovered within public health facilities in Grande Maputo. Rural health facilities had larger gaps for HTN diagnosis and care, highlighting the need for efforts towards equitable distribution of resources, and integration of HIV and hypertension screening, diagnosis and management in Mozambique.
Integration of services improves quality and continuity of care for chronic diseases. In Mozambique differentiated care models have been in place for people living with HIV (PLHIV), but the screening, diagnosis and management of hypertension (HTN) is not standardized.
OBJECTIVE:
We assessed the patterns of hypertension care for PLHIV, comparing highly urbanized to periurban/rural settings.
METHODS:
Between July2021/August2022 service delivery assessment tools were used to assess HIV clinics (>1,500 patients) in 16 urban and rural settings. Direct observation, health information system documentation and standardized questionnaires applied to frontline workforce and leadership of health centres (HC) were used to describe patterns of care for HIV and HTN. Results and
DISCUSSION:
A total 112,913 PLHIV used diverse models of care, of which only 12.5% had their blood pressure measured. High caseload was found (mean 30 PLHIV/clinician/day), being worse in the rural areas. Clinicians corresponded to 28% of workforce in HIV care (urban areas) versus 16% in preurban/rural areas. The ratio provider to PLHIV was 1:842 in urban areas compared to 1:971 in periurban/rural settings. HIV screening, diagnosis and management was free of charge, used guidelines and clinical protocols, supply chain, electronic health information system and point-of-care testing were highly supported by international partners, while were unavailable for HTN. Unclear and non-standardized pathways for screening, diagnosis and referral were found HTN, requiring out-of-pocket costs. Each patient with both conditions had two identification cards/medical files, and consultations were done by the same professional in only 4 (25%) health facilities.
CONCLUSIONS:
Major inequalities in care for with comorbid hypertension and HIV were uncovered within public health facilities in Grande Maputo. Rural health facilities had larger gaps for HTN diagnosis and care, highlighting the need for efforts towards equitable distribution of resources, and integration of HIV and hypertension screening, diagnosis and management in Mozambique.
| eISSN: | 2654-1459 |
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