Advanced disease programming brings much needed attention and improvements to inpatient paediatric HIV care in Mozambique

With the publication of guidelines for the management of advanced HIV disease (AHD) by the World Health Organization (WHO) in 2017, an opportunity to reengage with referral hospitals emerged with the recognition that despite massive scale-up of prevention and treatment services nationally, there were still gaps in the quality of care for the sickest patients, many of whom require inpatient care. Hospital pharmacy management was problematic with local medication stock-outs during periods of adequate provincial supply including one hospital not having any paediatric ART formulations and 3/11 reporting recent interruptions in the availability of paediatric TB medications. [...]with the exception of one hospital which is newer and still has not yet established its paediatric HIV treatment programme, all other hospitals had in stock the paediatric formulations necessary to provide optimized dolutegravir-based paediatric ART, cotrimoxazole preventive therapy and TB preventive treatment, and had active outpatient ART clinics for post-discharge care of patients. Table 1 Evolution of key selected indicators for inpatient paediatric HIV and TB care, aggregate results for central and provincial hospitals in Mozambique, 2020–2023 Baseline assessment before AHD launch, 2020 (n = 11 hospitals) Follow-up assessment after AHD launch, 2022–2023 (n = 11 hospitals) Dedicated HIV counsellors for inpatient paediatric PITC (#/% of hospitals) 5 (45%) 10 (91%) % of sampled inpatient charts with documentation of PITC results (mean, range) 76% (13–100%) 94% (58–100%) Access to timely EID testing (#/% of hospitals) 4 (36%) 9 (82%) Availability of CD4 testing for hospitalized children (#/% of hospitals) 4 (36%) 11 (100%) Both sputum induction and gastric lavage available for inpatient TB testing (#/% of hospitals) 4 (36%) 6 (54%) % of sampled inpatient charts for HIV-positive children with documentation of correctly dosed ART (mean, range) 42% (0–100%) 61% (13–100%) Recent stock out of paediatric first-line ART (#/% of hospitals) 5 (45%) 1 (9%) Updated MoH paediatric HIV and TB job aids available on the ward (#/% of hospitals) 5 (45%) 10 (91%) Abbreviations: ART, antiretroviral therapy; MoH, Ministry of Health; PITC, provider-initiated HIV testing and counselling; PoC EID, point-of-care early infant diagnosis. The renewed attention to paediatric inpatient care as part of AHD programming aligns well with recently updated advice from WHO on the provision of care to people with AHD who