Sustaining success in HIV care: Long-term outcomes of a 6MMD model in Mozambique (Sept 2024)

By Jabulani Chacha, Julio Pacca, Alexa Smith-Rommel and the ECHO project team

In Mozambique, the six-month multi-month dispensing (6MMD) model has shown strong potential for maintaining high levels of care while reducing burdens on clients and healthcare providers. The 6MMD model allows “stable” clients to receive a six-month supply of antiretrovirals and visit the health facility twice a year. This reduces the need for frequent and burdensome trips to health centres, which are often difficult to access, while alleviating strains on health facilities themselves.

The model was rolled out in 24 facilities across four provinces in Mozambique and then evaluated by the PEPFAR-funded USAID Efficiencies for Clinical HIV Outcomes (ECHO) project. ECHO’s study, presented at AIDS 2024, showed that retention in care remained exceptionally high during 6MMD enrolment, with 98% of clients continuing their treatment. Viral load (VL) suppression was also strong, matching retention at 98%, while VL coverage reached 82%. Extended dispensing intervals often face challenges, such as people disengaging from care during the longer periods between visits. In ECHO-supported provinces in Mozambique, patients enrolled in 6MMD experienced no discernible decline in care or outcomes.

Notably, there was a gender disparity in VL coverage, with women showing higher rates than men, though VL suppression rates were comparable across genders. This reflects common gender disparity trends in Mozambique and emphasizes the importance of considering gender-specific approaches like male engagement approaches when implementing and expanding DSD models.

The success of 6MMD in Mozambique underscores its potential as a scalable solution for other regions seeking to optimize ART outcomes while easing operational and resource burdens on health systems. 6MMD has demonstrably maintained strong retention and viral suppression rates with less frequent client visits, positioning it as a desirable DSD strategy in worldwide efforts to achieve the second and third UNAIDS 95-95-95 targets.