1. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Barrot H. Lambdin, PhD, MPH Director of Implementation Science Pangaea Global AIDS Foundation Integration of HIV Treatment in Primary Health Care Centers Impacts Attrition from HIV Treatment Programs in Central Mozambique Advancing the health and well-being of people most affected by AIDS

2. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content 53% Coverage 31% In RLS Patients History of ART Scale-up in Mozambique 3,314 7,456 18,956 44,100 88,211 128,330 170,198 218,991

3. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content 53% Coverage 31% In RLS ClinicsPatients National ART Program ART Integrated with PHC Clinics History of ART Scale-up in Mozambique

4. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Study Design, Setting and Population Retrospective cohort study of patients initiating ART in the national ART program (Jan 06–Jun 08) Exclusion Criteria: <15 years of age Transfer in Pregnancy Post Historical Events–Flooding & Temporary Closure 18 HIV care and treatment clinics managed by MOH in Manica or Sofala Province Standardized approach for care delivery, patient tracing and data recording Routine Clinic Databases

5. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Methods Outcomes Time until Attrition: Lost to Follow-up or Mortality Concern for Differential Misclassification Analysis: Cox proportional hazards models Accounted for clinic-level clustering (robust variances) Pre-ART CD4 Count Pre-ART WHO Stage Age Sex Education Year of Initiation Pharmacy Staff Burden Clinic Model: Vertical vs. Integrated Clinic Location: Urban vs. Rural Clinic Experience: 1 st 6-months vs. After CovariatesExposures

6. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Results: Study Population Initiated Treatment: 15,232 N (%) Delivery Model Vertical 3 (17%) Integrated 16 (89%) Location Urban 10 (55%) Rural 8 (45%) 9,120 person-years Attrition Rate: 39.22 per 100 py

7. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Results: Demographic Characteristics 36% In RLS

8. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Results: Clinical Characteristics 36% In RLS

9. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Results: Clinic Factors and Attrition HR (95% CI)p-value Clinic Model Integrated [Ref] 1.00 Vertical 0.84 (0.73 – 0.97)0.015 Clinic Location Rural 1.00 Urban 0.86 (0.61 – 1.22)0.389 Clinic Experience First 6-Months 1.00 Post First 6-Months 0.72 (0.51-1.02)0.065 *adjusted for pre-ART CD4 count, WHO stage, age (with quadratic term), education, year of initiation and pharmacy staff burden

10. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Results: Clinic Factors and Attrition Vertical Integrated Urban Rural Post 1 st 6 Months 1 st 6 Months

11. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Strengths & Limitations Strengths Standardization of Protocols Care delivery Patient tracing Data Recording High quality data Limitations Observational Study Unable to adjust for all patient and clinic characteristics Generalizeability

12. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Conclusions Integrating HIV services into PHC dramatically expanded coverage However, patients attending integrated clinics have a higher risk of attrition Need to address the obstacles patients face in the integrated setting Qualitative Study Theme: Dissatisfaction with Pharmacy in Integrated setting Lower quality of service Lack of Privacy

13. Slide Title Body copy for the slide; level one content Level 1 content Level 2 content Level 3 content Acknowledgements Juvenol Amos Luis Francisco Fernando Baloi Pedro Tenete Mark Micek James Pfeiffer Pablo Montoya Kenny Sherr Alejandro Soto Stephen Gloyd