HIV Antiretroviral Therapy Scale-Up in Mozambique and Estimated Averted HIV Infections and Related Deaths, 2004-2023

IntroductionMozambique is a HIV high-burden country. In 2004, Mozambique had an estimated HIV prevalence of 15.6% and 1.5 million people living with HIV (PLHIV). During same year the country started antiretroviral therapy (ART) scale-up supported by the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR). We describe the ART scale-up and estimate averted HIV infections and HIV-related deaths. MethodsWe analyzed PEPFAR Monitoring, Evaluation, and Reporting program data from fiscal year 2004 to 2023. Before October 2018, PLHIV on ART were defined as clients with [&le;]90 days since last missed visit; in October 2018, this changed to [&le;]28 days. Viral load suppression (VLS) rate was calculated as PLHIV at PEPFAR-supported sites with VLS (<1,000 viral copies/mL) among those tested in previous 12 months. We used the 2024 United Nations Programme on HIV/AIDS (UNAIDS) Spectrum AIDS Impact Model and Goals Age Structured Model (ASM) to estimate HIV infections and HIV-related deaths averted. ResultsBy September 2023, 2.1 million PLHIV in Mozambique were receiving PEPFAR-supported ART (1.4 million women [66%]; 1.9 million aged [&ge;]15 years [95%]), a 650-fold increase from 3,226 in March 2004. The VLS rate increased from 62% (78,808/126,212) in 2017 to 94% (1,235,626/1,318,544) in 2023. During 2004-2023, ART scale-up helped avert an estimated 1.6 million HIV infections, including over 350,000 infections among HIV-exposed infants, and 1,070,295 HIV-related deaths. ConclusionThe over 20 years of Mozambiques scaled up ART effort has greatly expanded effective treatment and averted many new infections and HIV-related deaths. While progress has been impressive, gaps remain toward ending HIV as a public health threat.