Pfeiffer, James TInguane, Celso Azarias2019-02-222019-02-222018Inguane_washington_0250O_19368.pdfhttp://hdl.handle.net/1773/43245Thesis (Master's)--University of Washington, 2018Introduction: Following international recommendations and guidelines, in 2016, Mozambique started implementing the ‘test and treat’ approach to meet the ambitious HIV treatment targets by 2020, and ‘end AIDS’ by 2030. Mozambique took a staggered and conservative implementation approach that suggested local reservations about meeting the international targets and is consistent with the slow improvements in epidemiologic and data quality indicators, despite more than a decade of international investment in the response to HIV/AIDS. This thesis describes challenges to achieving the third HIV treatment target at a public health facility receiving technical and logistical assistance from an international nongovernmental organization (NGO) in Maputo, Mozambique. Methods: I reviewed medical data on all patients whose sample for viral load had been collected between September 1-November 30, 2016, conducted participant observation and ethnographic interviewing between September 2016-February 2017. I conducted thematic analysis using Atlas.ti, version 7.5 (Scientific Software Development GmbH), and descriptive and inferential analysis (reporting 95% confidence intervals where appropriate) using Stata 13 (StataCorp, 2013) and graphing in R3.5 (Core Team, 2018). The study was approved by the Ministry of Health and the National Bioethics Committee for Health (CNBS) of Mozambique and the University of Washington Institutional Review Board (IRB). Results and discussion: Between September-November 2016, 362 samples were sent for viral load testing at the reference laboratory. However, they had availability and data quality issues: 43.6% received results by February 2017, 16.9% were available in the NGO electronic-based patient tracking system (e-PTS); 2.8% and 2.2% had missing and duplicate patient ID’s, 2.2% had duplicate names, patient IDs (15.7%) and names (5.0%) in the public health system’s paper-based laboratory registry did not match with the e-PTS. These challenges occurred in a three-fold context that shaped facility unreadiness to manage viral load. Recoding protocols were implemented before receiving registries from the national level (structural), disconnections between paper-based and electronic registries remained at the facility (process), and new staff at the facility laboratory had not developed the capacity to manage viral load registry and communications (individual). These findings resonate with the low readiness for the ambitious treatment goals and chronic routine HIV data quality issues nationally. They help question the reasonableness of trying to meet internationally-defined targets, that has defined the ending AIDS agenda, without making appropriate investments in public health information system infrastructures that can provide information for timely clinical decision-making and monitoring of progress towards the very targets the international agenda defined.application/pdfen-USnoneHealth facility readinessHIVMozambiqueViral loadHealth sciencesGlobal HealthThesis