Prevalence and determinants of being out-of-care among HIV-positive young people aged 15–24 years in Mozambique: findings from the 2021 population-based HIV impact assessment survey

Abstract

Background: Globally, young people are falling behind in the push to end the HIV epidemic. Understanding the characteristics of HIV-positive young people who are out-of-care (not on antiretroviral treatment) in Mozambique is important to effectively reach and ensure access to services for this priority population. Methods: Using data from the 2021 Mozambique Population-based HIV Impact Assessment, we conducted a sub-analysis of HIV-positive young people aged 15–24 years whose blood specimens were tested for the presence of antiretrovirals. Participants testing negative for the presence of antiretrovirals were classified as out-of-care. Weighted prevalence estimates of HIV-care status and select covariates are reported. We used multivariable logistic regression to assess factors associated with out-of-care status. Analyses were weighted and adjusted for the complex survey design. Results: Among the 245 HIV-positive young people included, 58.0% (n = 141, 95% Confidence Interval [CI] 49.9–65.7%) were out-of-care. Out-of-care young people were mostly female (75.0%) and living in a rural area (68.3%). In the multivariate model, young people who discussed HIV with a parent or guardian (20.0% of participants) (adjusted Odds Ratio [aOR]: 0.33, 95% CI: 0.17–0.66) or previously heard of pre-exposure prophylaxis (PrEP) (6.1% of participants) (aOR: 0.25, 95% CI: 0.09–0.65) were less likely to be out-of-care than those who had not. Odds of being out-of-care were greater for those from the northern compared to the central provinces (aOR: 2.37, 95% CI: 1.09–5.15) and those who had participated in prevention programs (aOR: 3.19, 95% CI: 1.37–7.41). Conclusions: Over half of young people with HIV in Mozambique met our definition for out-of-care in 2021. Our results reveal important geographic and sex gaps in HIV care. Strengthening existing programs to include components centered on creating a lasting link to health services could improve the identification of new HIV-positive young people. The important role of parents and guardians in young people’s health behaviors and decision-making presents an opportunity to engage families with interventions to strengthen needed services to this priority population in Mozambique. Clinical trial number: Not applicable.