Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnosis, treatment guidelines, and well-defined cascades of care. Mozambique bears a significant burden of the global pediatric HIV and TB burden. The present study evaluates the results of Mozambique’s pediatric TB-HIV care cascade and seeks to identify strengths and weaknesses in its adherence to national guidelines.
An analysis with descriptive statistics was performed using retrospective, aggregate TB/HIV indicators for pediatric patients 0-14 years of age for the year 2016. Data for years 2012-2015 was also used to analyze trends over time. Variables such as province, site type, site experience, and patient volume were analyzed with respect to specific TB and HIV care cascade performance indicators.
The TB sector achieved near optimal performance in routine HIV testing (99.4%) and cotrimoxazole initiation (95.7%). ART initiation was lower (87.2%), but has steadily improved from 2012. Data from the HIV sector showed 82.2% of HIV-infected children were screened for TB at their last consultation, and only 42.0% of newly enrolled children received isoniazid preventative therapy (IPT) or other TB treatment. In a multivariable regression analysis using 2014 data, both patient volume and being a newer ART site were significantly associated with ART initiation for patients in the TB sector.
Care cascade in the TB sector is strong, with high percentages for the number of patients tested and for initiation of treatment. There are missed opportunities for TB prevention in the HIV sector, and prioritizing IPT may reduce TB morbidity and mortality in HIV-infected children. Next steps in the research will be an update to the regional regression analysis using 2016 data, which is expected to be completed in the next few weeks.