Youth Living with HIV in Mozambique—Reaching the Last 95: A Qualitative Study in Sofala, Manica and Niassa Provinces

Introduction
Mozambique is working to achieve sustained epidemic control through the “95-95-95” goals outlined by the Joint United Nations Programme on HIV/AIDS (UNAIDS)—that by 2030, 95 percent of people living with HIV know their diagnosis (1st 95), 95 percent of those diagnosed receive sustained antiretroviral therapy (ART) (2nd 95), and 95 percent of those on ART are virally suppressed (3rd 95). With more than 1 million people on treatment, Mozambique is making progress toward reaching these goals. However, low rates of treatment retention, especially among children (ages 0–14 years), adolescents (ages 15–19 years), and young adults (ages 20–24 years), threaten to undermine epidemic control. For example, in 2017, the 12-month rate of retention in care was only 70 percent—and only 62 percent among adolescents (PEPFAR, 2018). 

To meet their global commitments, Mozambique must continue to use data to rapidly design, refine and scale up programming to address the specific barriers faced by adolescents and young adults, building on successes so far achieved. The Government of Mozambique is rolling out various epidemic control strategies to strengthen the HIV response and better meet the needs of young people living with HIV. However, the response is hindered by a lack of input from young people living with HIV and their caregivers. 

This study was conducted by the Health Policy Plus (HP+) project, funded by the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), in collaboration with the Ministério da Saúde (Ministry of Health, Mozambique) (MISAU). It is intended to provide novel and timely data to guide policymakers and program managers in designing and refining adolescent HIV treatment strategies. HP+ also aimed to take stock of progress in rolling out new initiatives (such as viral load testing and Serviços de Amigos dos Adolescentes e Jovens (Services of Friends of Adolescents and Young People) (SAAJs), to guide government partners in their efforts to strengthen Mozambique’s HIV response. This study, conducted in mid-2018, had the following research objectives: 

• To catalogue the barriers and facilitating factors affecting retention in care and ART adherence 
• To describe any services or innovations that may improve outcomes across the clinical cascade among youth ages 15–24 years
• To document the current status of viral load monitoring among youth ages 15–24 years
• To gather perspectives on a new adolescent/youth HIV care model currently being 
developed by MISAU

Data from this study will inform the development of clinical policies and strategies to improve retention and adherence among adolescents and young adults living with HIV, with the goal of achieving sustained viral load suppression.