By Marina Martinez Prieto, Mozambique Ministry of Health (MISAU), Mozambique
In 2020, MISAU adopted the six-month antiretroviral therapy dispensing (6MMD) model for all eligible people living with HIV. In 2024, it expanded the use of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) for contraceptive care to include self-injection (SI).
A quarter of women of reproductive age in Mozambique use a modern contraceptive method, particularly injectables, and 26% have an unmet need for family planning (FP); 87% of women living with HIV are on antiretroviral treatment (ART). This provides a high-volume and sustainable platform for integrated delivery of DMPA-SC SI and other modern contraceptive methods.
National guidelines for integration of FP and HIV services, launched in 2015, have not been updated to accommodate the rollout of DSD models for HIV. Some integration of FP services occurs at ART consultations, but it often only includes giving a starter pack of pills or DMPA-SC. The result is that women on ART have to receive their comprehensive FP services – including counselling, contraceptive methods continuation and follow up – separately from HIV services.
To address these challenges, Mozambique developed an integrated package of care for women of reproductive age living with HIV who are enrolled in the 6MMD model that provides a combined ART-FP clinical consultation and scripting. This package comprises routine FP counselling in each clinical HIV review/ART refill and integrated DSD counselling. It offers a range of contraceptive methods – including DMPA-SC SI demonstration, implant insertion and coordinated referral for IUD insertion at FP services – and synchronized refill schedules for ART and FP.
Initial implementation will be in 80 health facilities across five provinces over two years, phased to gather evidence and best practices, refine the approach and demonstrate viability before national scale up. This integration pathway will be supported by training of ART providers on integration and FP care (including DMPA-SC SI and implant insertion, reinforced via WhatsApp-based microlearning) and updating of the digital data system now in use for HIV services to provide integrated HIV-FP client-level data.
In this way, Mozambique will test whether embedding DMPA-SC SI and other methods suitable for integrated DSD care within ART routine consultations accelerates uptake and improves continuation. It will establish a DSD model that enhances client empowerment, promoting self-care practices. The aim is also to strengthen health system efficiency and sustainability through synchronized service delivery, integrated data systems and reduced duplication of visits for HIV and FP services.
