Implementing HbA1c monitoring in sub-Saharan Africa: Lessons learnt from a pilot project in Mozambique.

Aims: We aimed to evaluate lesson learnt from a pilot project in Mozambique focused on point-of-care (POC) HbA1c testing for diabetes management in primary health care facilities. Methods: Over a three-year period, several health centers were equipped with POC HbA1c testing machines. The evaluation involved 12 months of data collection, interviews with patients and staff, and regular supervision visits. Results: The project screened over 22,000 individuals and provided HbA1c testing to 2362 diabetes patients. Among the analyzed results, 65.7 % had HbA1c levels below 7 %, 10.9 % between 7 % and 8.5 %, and 23.4 % above 8.5 %. POC testing showed advantages such as reduced costs and improved workload management. Conclusions: Limited access to HbA1c testing remains a challenge in African countries. The pilot project demonstrated the feasibility of POC HbA1c testing and highlighted the need for increased efforts to make it more widely available, leading to improved diabetes management and patient outcomes.

Enhancing retention in care in HIV-infected adolescents during COVID-19 in Mozambique: results from the DREAM program.

INTRODUCTION: Around 1,7 million adolescents aged 10-19 years worldwide are infected with HIV, 84% of them living in Sub-Saharan Africa. Mozambique is one of the countries with the highest prevalence of HIV in the world. According to UNAIDS, HIV services for adolescents should be tailored and specifically designed for them. METHODS: We aimed to evaluate a package of activities to enhance the retention of HIV-infected adolescent in Mozambique. We retrospectively reviewed routine data from 7 health centers involved in 26 months, from March 2020 to May 2022. A package of tailored interventions was implemented in all the sites. We reviewed activity data from the included centers. RESULTS: The median number of patients per center was 343 (IQR: 289-466) at the beginning of the period and 395 (IQR: 322-453) at the end. The median overall retention in care and rate of lost to follow-up at the beginning and the end of the period were respectively: 94.2% (IQR 91.9-97.3%) to 99.0% (IQR 96.8-99.5%), 1.5% (IQR 1-3.2%) to 0% (IQR 0.0-0.3%). The total number of deaths increased reaching a plateau after September 2021. All the indicators improved after the beginning of the intervention, also during COVID-19 pandemic. CONCLUSIONS: Our data support the idea that enhancing retention in care for HIV positive adolescents need tailored interventions, based on deep rooting in the specific social context. Tailored intervention can resist external shock such as COVID-19.