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Multi-month Drug Distribution Improves ART Retention and Quality of Care

When COVID-19 hit Mozambique, it aggravated demands on already overburdened health facilities. To reduce long queues, Mozambique rolled out a novel scheme. But it didn’t target patients with the novel virus.

For years, HIV-positive patients had crowded clinics when they stopped by to pick up their monthly medications. With the COVID-19 pandemic as a catalyst, the Abt-led Efficiencies for Clinical HIV Outcomes (ECHO) project, funded by the U.S. Agency for International Development, worked with the Mozambican Ministry of Health on a simple change: give people medication for three months instead of one. The policy change also cut the time that a patient must be on antiretroviral therapy (ART) before becoming eligible for this multi-month drug distribution (MMDD) program and eliminated the need for laboratory tests to verify eligibility. That cut the number of visits by HIV-positive patients by 25 percent.

A later switch to six-month supplies meant a total reduction in visits of 83 percent a year. Communities were receptive to the change. Enrollment in the six-month program in Tete skyrocketed from 172 to 17,112 in about eight months.

Fewer trips to the clinics were not the only benefit. After just a few months of implementing the changes, ART adherence shot up and the number of dropouts plummeted to record lows. In early 2020, for example, three-month retention was just 78% in Tete province and 70% in Niassa. By July 2022, that figure shot up to 99% in Tete and 96% in Niassa. Both provinces also saw steep drops in patients leaving treatment. In a single quarter, the number plunged 94 percent, from 10,210 to 632, in Tete, and 70 percent, from 2,175 to 648, in Niassa. More patients staying on treatment means more people living happy, productive, and healthy lives with a greatly reduced chance of passing HIV to others. 

The reason for these improvements: MMDD reduced the time and financial burden for patients of monthly trips to a clinic, which often were at a considerable distance. In Tete, for example, nearly 30 percent of residents cross borders for work, so coming back monthly is a huge burden. “Patients have always asked for more medicine so they wouldn’t interrupt their lives to pick up treatment,” says Sofia Amoda, a general medical technician. “I always told them it was impossible. Now, I can give them six months of medicine, and patients are happier.”

Healthcare providers benefit, too. With daily patient traffic more manageable, providers note that the quality of care they can provide has improved. A recent ECHO study found that even though MMDD decreased patients’ doctor visits, the decline didn’t worsen clinical outcomes. It helps that the program requires that patients be virally suppressed to be eligible to enroll. That’s why Dias Afonso, a patient in Tete province on his second round of ART with the six-month model, is dedicated to taking his medication correctly.

With the success of MMDD in Tete and Niassa as well as Manica and Sofala provinces, the ECHO project plans to continue supporting the Mozambican government in scaling up the new approach. That could make HIV treatment easy and accessible for everyone who needs it in Mozambique.

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