Real-world data on HIV drug resistance (HIVDR) after transitioning to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) are limited. We assessed HIVDR rates and patterns in clients with virological failure (VF) after switching from an NNRTI-based regimen to TLD. A cross-sectional study was conducted in Gaza, Mozambique (August 2021–February 2022), including adults on first-line ART for ≥12 months who transitioned to TLD and had unsuppressed viral load (VL) ≥ 1000 copies/mL six months post-transition. After three adherence counseling sessions, participants with VF underwent genotyping for drug resistance mutations (DRMs) using the Stanford HIVdb Program. Of 717 participants (median age 39.2 years, 70.7% female), 217 (30.2%) had VF, 193 (88.9%) underwent genotyping, with 183 (94.8%) successfully genotyped. Intermediate–high dolutegravir (DTG) resistance was found in 19.6% (36/183). Unsuppressed VL before DTG transition was independently associated with VF (aOR: 2.14). Resistance patterns included 33.3% (12/36; 95% CI: 14.6–46.3) to all three TLD drugs, 55.6% (20/36; 95% CI: 39.3–71.9) to DTG and 3TC, and 11% (4/36; 95% CI: 0.8–21.3) to DTG only. Major drug resistance mutations to DTG included G118R (9.3%), R263K (6.6%), and Q148H/R/K (4.4%). This study highlights the need to consider virologic status before transitioning PLHIV to TLD and suggests that adherence counseling may not prevent resistance in those with unknown or prior VF.

Background: In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings. Objectives: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV. Method: We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors. Results: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63–0.80]) and a recorded weight (AOR = 55.58 [33.88–91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03–1.34]) and previous VLS (AOR = 2.27 [1.27–4.06]). Conclusion: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.

With the increase in uptake of multi-month antiretroviral therapy dispensing (MMD) for children, little is known about consistency of MMD receipt over time and its association with virological outcomes. This analysis aims to assess the uptake of 3-month MMD among children, consistent receipt of MMD after uptake, and clinical outcomes following transition to MMD in 16 health facilities in Gaza and Inhambane Provinces. This is a secondary analysis involving children <15 years living with HIV with clinical visits during the period from September 2019 to August 2020. Of 4383 children, 82% ever received MMD (at least one pickup of a 3-month MMD supply) during the study period but only 40% received it consistently (defined as MMD at every visit during the study period). Consistent MMD was most common among older children and children without indications of clinical instability. Overall viral load (VL) coverage was 40% (733/1851). Consistent MMD was significantly associated with lower odds of having a VL (0.78, 95% CI: 0.64–0.95). In conclusion, while receipt of a multi-month supply was common particularly during the early days of the COVID-19 pandemic, only a minority of children received consistent MMD; however, there is a need to ensure children with fewer visits still receive timely VL monitoring.

Malaria remains a major public health concern worldwide. Malaria is endemic in Mozambique, with seasonal fluctuations throughout the country. Although the number of malaria cases in Mozambique have dropped by 11% from 2020 to 2021, there are still hotspots in the country with persistent high incidence and low insecticide-treated bed net usage. The aim of this study is to evaluate the factors associated with the use of long-lasting insecticidal nets by pregnant women and women with children under 5 years old in two hotspot districts in the Gaza province, Mozambique. A descriptive, qualitative cross-sectional study was conducted between June 15th and 21st 2022. An in-depth interview process was conducted with pregnant women and mothers with children under five years old, exploring their beliefs, experiences, and perception of messages conveyed by health professionals when long-lasting insecticidal nets were being supplied. A total of 48 women participated (24 pregnant women and 24 women with children under 5 years). Most participants recognized the protective effects of long-lasting insecticidal nets in preventing malaria, and understood that women and children were high risk groups. The nets were reported to cause side effects and difficulty breathing by 100% of pregnant women, while 54.2% of mothers with children under 5 reported no side effects. The majority of women in both groups reported that their health professionals did not educate them about how to use or handle the nets properly. Only 16.7% of mothers with children under 5 received correct handling instructions. Providing clear, culturally sensitive, and practical information on the correct use of LLINs, as well as regular monitoring of their proper use, would be a great step forward for Mozambique’s national malaria program.

Background: Malaria remains a major public health problem in Mozambique, disproportionately affecting children under five years of age and pregnant women. Despite wide distribution of long-lasting insecticide-treated nets (LLINs), their use remains inconsistent in several regions. The study aims to analyze the sociocultural, behavioral, and institutional factors influencing LLIN use among mothers of children under five years of age in Bilene District, Gaza Province. Methods: A cross-sectional qualitative study was conducted at the Macia Health Center between November and December 2022, involving 35 mothers of children under five selected through purposive sampling. Data were collected through semi-structured interviews, transcribed verbatim, and analyzed using content analysis with the support of MAXQDA software. Analytical categories included knowledge and perceptions of malaria, LLIN use practices, barriers, facilitators, and institutional factors. Results: Among the 35 mothers, most were aged 18–28 years, cohabiting, housewives, with primary education, living near the health center, and identified as Christian. Most participants were aware of malaria transmission and recognized LLINs as an important preventive measure. However, net use was often selective and seasonal, prioritizing children and influenced by factors such as heat, discomfort, insecticide odor, net deterioration, and insufficient nets per household. Health services played a central role in net distribution and health education, although gaps in coverage and replacement persisted. Sociocultural practices and alternative uses of nets further limited their availability for prevention. Conclusion: LLIN use is shaped by the interaction of individual, sociocultural, and institutional factors. Malaria control strategies should adopt integrated approaches that combine equitable distribution, context-sensitive health education, and continuous community follow-up to reduce the gap between knowledge and practice and strengthen malaria prevention among children under five.

Background Malaria Mass Drug Administration (MDA) is recommended to reduce malaria in low transmission settings, with a target coverage of ≥80%. This study assesses the feasibility of a programmatic MDA (pMDA) pilot implementation in southern Mozambique. Methods The National Malaria Control Programme implemented pMDA in Chidenguele (Gaza Province), where the estimated population is 59,271. Two rounds of door-to-door distribution (using satellite maps with previously enumerated households (Reveal® platform)) with fixed points were conducted between December 2022 and February 2023. Household coverage was estimated with both district census data and satellite number of expected households. All eligible individuals ≥6 months received a full therapeutic 3-day-course of dihydroartemisinin-piperaquine. Individual data collection was conducted during round 1 (R1), which was changed to aggregated data at the household level in round 2 (R2). Community engagement and human resources were also strengthened between the two rounds. The target number of households to be reached by team/day was 25/30 in R1 and 15 in R2. Results When using census data, household coverage (households reached over targeted) increased from 59.4% (8799/14818) in R1 to 94.3% (13972/14818) in R2, while with the satellite estimates, it increased from 62.5% (8799/14075) to 99.3% (13972/14075). Population programmatic coverage (individuals treated over total population) increased from 40.9% (24237/59271) to 69.8% (41347/59271). Treatment rate among present individuals (operational coverage) decreased from 91.3% (24237/26541) to 85.1% (41347/48588). Conclusion Collecting aggregated data, decreasing the household target per day per team and using fixed-points at the end as a recovery strategy helped improve operational performance. However, reaching an 80% programmatic coverage is challenging even with high rates of household visitation and operational coverage, mainly due to absences and exclusions. Funding: This project is funded by the EDCTP2 Programme.