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Title
Favorable outcomes of Option B+ strategy despite COVID-19 restrictions: retrospective cohort study in Zambézia Province, Mozambique (2019-2021)
Presenter
Caroline De Schacht
Authors
C. De Schacht1, Z. Yu2, M. Bravo1, E. Graves3, K. Tibana4, C. Cugara5, C. Verísssimo5, C. Belo1, G. Amorim2, J. Tique1, A. Couto4, C.W. Wester6
Institutions
1Friends in Global Health, Maputo, Mozambique, 2Vanderbilt University Medical Center (VUMC), Department of Biostatistics, Nashville, United States, 3Vanderbilt University Medical Center (VUMC), Vanderbilt Institute of Global Health (VIGH), Nashville, United States, 4Ministry of Health, National Directorate of Public Health, Maputo, Mozambique, 5Provincial Health Directorate Zambézia, Quelimane, Mozambique, 6Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, United States

BACKGROUND: In response to the COVID-19 pandemic, the Ministry of Health of Mozambique installed mitigation measures in April 2020, including expansion of differentiated models of care (DMC). Quarterly dispensation (QD) for pregnant women (PW) was implemented April-August 2020. We herein describe trends of pre-pandemic (April2019-March2020) and within-pandemic (April2020-March2021) maternal and infant HIV outcomes.
METHODS: Aggregated routine data from 173 health facilities in Zambézia Province for PW initiating ART and their HIV-exposed infants (HEI) were used. Outcomes included: proportion of PW retained in care 3- and 6-months post-ART initiation, early infant diagnosis (EID) coverage, and proportion of positive tests among HEI by 9 months of age. Generalized linear mixed-effect models were used to compare trends pre- and within-COVID-19.
RESULTS: The odds of PW being retained at 3-months decreased significantly to 56.6% in April 2020 (OR 0.57 [95%CI:0.44–0.74], p<0.001). During COVID-19 period, the odds of being retained at 3-months increased ~3.9% per month (OR 0.57 [95%CI:1.06-1.10], p<0.001). The odds of PW being retained at 6-months increased (OR 2.16 [95%CI:1.50–3.10], p<0.001) within-pandemic. Although the odds decreased within-pandemic (OR 0.91 [95%CI:0.88–0.93], p<0.001), 6-month retention proportion remained higher than the pre-pandemic period. EID coverage experienced an increase immediately after April 2020 (OR 1.94 [95%CI:1.26-2.98], p=0.003) and had a sustained effect, with odds of HEI undergoing EID increasing ~4.7% per month. There were no significant differences in proportion of HEI testing positive, decreasing 2.7% per month, over time regardless of period (Figure).


CONCLUSIONS: In Zambézia Province, the pandemic and associated restrictions did not adversely impact maternal retention in care, EID coverage or EID positivity rates among PW and their HEI. Despite transient reductions in early retention, rapid expansion of DMC including QD for PW, introduced in response to COVID-19 pandemic, appeared to have a favorable impact on mother and child outcomes.

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