Relatório da avaliação conjunta do plano estratégico e operacional, do programa nacional de controlo da tuberculose 2014-2018, do plano estratégico nacional de resposta ao hiv e sida 2016-2020 e do estabelecimento da linha de base das hepatites virais em moçambique / Report of the joint evaluation of the strategic and operational plan, the national tuberculosis control program 2014-2018, the national strategic plan for the response to hiv and aids 2016-2020 and the establishment of the viral hepatitis baseline in mozambique

O MISAU e o CNCS encomendaram uma revisão externa conjunta dos planos estratégicos dos programas nacionais de contro de ITS/HIV/SIDA e da Tuberculose (TB) bem como o estabelecimento da linha de base da resposta as hepatites virais em Moçambique. Esta avaliação foi liderada pela Organização Mundial da Saúde (OMS) em coordenação com o Ministério da Saúde (MISAU) e o Conselho Nacional de Combate ao SIDA (CNCS) e com apoio financeiro do CDC. O principal objectivo desta revisão externa, era de avaliar a Resposta Nacional às epidemias de HIV e da TB bem como o estado da resposta as hepatites virais, em direcção as metas de 2020. Com foco no Plano Estratégico de resposta ao HIV/SIDA 2016-2020 (PEN IV) e no Plano Estratégico e Operacional do Programa Nacional de Controlo da Tuberculose (PNCT) 2014-2018, foram avaliados os progressos alcançados, identificados os desafios, e destacadas as boas práticas. A Revisão recomendou estratégias e abordagens operacionais para um maior e estável progresso, melhoria da qualidade e aumento da relação custo-benefício dos principais serviços de HIV, TB e hepatites virais.

Advanced disease at enrollment in HIV care in four sub-Saharan African countries: change from 2006 to 2011 and multilevel predictors in 2011.

OBJECTIVES: To examine changes between 2006 and 2011 in the proportion of HIV-positive patients newly enrolled in HIV care with advanced disease and the median CD4 cell count at enrollment; and identify patient, facility, and contextual-level factors associated with late enrollment in care in 2011. DESIGN: Cross-sectional over time. METHODS: For time-trends analyses, routinely collected patient-level data (307 110 adults newly enrolled in 138 HIV clinical care facilities) in Kenya, Mozambique, Rwanda and Tanzania; and for analyses of correlates, patient-level data (46 201 in 195 facilities), and facility and population-level survey data were used. Late enrollment was defined as CD4 cell count 350 cells/µl or less and/or WHO clinical stage 3/4. RESULTS: Late enrollment declined from 69.9 to 57.2% (P < 0.0001); median CD4 cell count increased from 242 to 292 cells/µl (Ptrend < 0.0001). In 2011, risk of late enrollment was significantly higher for men and nonpregnant women vs. pregnant women; patients aged above 25 vs. 15-25 years; nonmarried vs. married; and those entering from sites other than prevention of mother-to-child transmission. More extensive HIV testing coverage in the region of a facility was significantly associated with lower risk of late enrollment. CONCLUSIONS: Despite improvement, in 2011, 57% of patients entered HIV care who were already antiretroviral therapy-eligible. The lower risk of late enrollment among those referred from prevention of mother-to-child transmission and in regions where HIV testing coverage was higher suggests that innovative approaches to rapidly increase testing uptake among people living with HIV prior to the development of symptoms have the potential to reduce late enrollment in care.