Case study

Lessons learned during down referral of antiretroviral treatment in Tete, Mozambique

Tom Decroo¹ , Isabella Panunzi¹ , Carla das Dores² , Fernando Maldonado³ , Marc Biot³ , Nathan Ford⁴ and Kathryn Chu⁴

¹  Médecins Sans Frontières, Tete, Mozambique

²  Provincial Health Department, Tete, Mozambique

³  Médecins Sans Frontières, Maputo, Mozambique

⁴  South African Medical Unit, Médecins Sans Frontières, Johannesburg, South Africa

author email corresponding author email

Journal of the International AIDS Society 2009, 12:6doi:10.1186/1758-2652-12-6

Published:	6 May 2009

Abstract

As sub-Saharan African countries continue to scale up antiretroviral treatment, there has been an increasing emphasis on moving provision of services from hospital level to the primary health care clinic level. Delivery of antiretroviral treatment at the clinic level increases the number of entry points to care, while the greater proximity of services encourages retention in care.

In Tete City, Mozambique, patients on antiretrovirals were rapidly down referred from a provincial hospital to four urban clinics in large numbers without careful planning, resulting in a number of patients being lost to follow-up.

We outline some key lessons learned to support down referral, including the need to improve process management, clinic infrastructure, monitoring systems, and patient preparation. Down referral can be avoided by initiating patients' antiretroviral treatment at clinic level from the outset.