The development of an accurate, practical, and affordable diagnostic test is essential to improve the management of visceral leishmaniasis (VL) in remote health centers. We evaluated the Formol Gel test (

Objective We evaluated whether regular mobile phone text reminders improved patients’ retention in antiretroviral therapy (ART) care in Mozambique. Design SMSaúde was a randomised control trial of HIV-infected patients on ART who received regular text message reminder vs. standard of care at three public health facilities in Maputo Province, Mozambique. The primary outcome was retention in HIV care. Between November 2011 and March 2012, 830 eligible HIV-infected patients on ART were randomized 1:1 to the text reminder intervention or standard of care. Methods We used Kaplan-Meier estimators and log-rank tests to compare proportions of patients who received SMS reminders who were retained in HIV care compared to the control group which received standard of care. Post-hoc analyses were done using Cox proportional-hazards models stratified by urban/rural facility and when initiated ART (<3-months vs. >3-months). Hazard ratios and confidence intervals are reported. Analysis was with intention to treat. Results Patients who received text messages had lower attrition from HIV care at 12-months, though the difference was non-significant (RR=0.68, 95%CI=0.41–1.13). Among urban patients, text messages improved retention in HIV care (RR=0.54, 95% CI=0.31–0.95). Intervention patients newly initiated on ART (<3-months) had lower attrition compared to control patients (HR=0.54; 95% CI=0.23–0.91), especially urban newly initiated patients (HR=0.20, 95% CI=0.06–0.64). Text messages had no effect on retention among rural patients. Conclusion Text messages did not improve retention in HIV care for all patients on ART, but improved retention in care of urban patients and those who recently started ART and received text reminders compared with standard of care. Trial Registration Clinicaltrials.gov NCT01910493

Between September 2003 and April 2004, the supply of antimonial drugs to Amudat Hospital, in north-eastern Uganda, was interrupted and all cases of visceral leishmaniasis presenting at the hospital could only be treated with amphotericin B deoxycholate (AmB). This allowed the safety and effectiveness of the AmB to be evaluated, in comparison with an historical cohort of patients treated, at the same hospital, with meglumine antimoniate (Sb(V)). Demographic and clinical data were collected before and after treatment. Adverse effects were recorded passively in all the subjects, and actively, using a standardized questionnaire, in a sub-group of the patients given AmB. The in hospital case-fatality 'rates' were 4.8% [95% confidence interval (CI) = 2.4%-8.8%] among the 210 patients treated with AmB and 3.7% (CI = 1.4%-7.9%) among the 161 patients treated with Sb(V) (P>0.20). Adverse effects requiring treatment interruption were rare in both cohorts. Treatment failures (i.e. non-responses or relapses) were observed in 2.9% (CI = 1.2%-6.4%) of the patients treated with AmB and 1.2% (CI = 0.1%-4.4%) of the patients treated with Sb(V) (P>0.20). For the treatment of visceral leishmaniasis in Uganda, AmB therefore had a similar effectiveness and safety profile to that of meglumine antimoniate.

In accordance with global HIV/AIDS goals, Mozambique is attempting to improve management of antiretroviral treatment failure (TF). We sought to determine whether the utilization of a national HIV/AIDS clinician telephone consultation service increased recognition and reporting of TF. In a retrospective analysis of routinely collected program data from telephone consultation logs and Mozambique’s national registry of second-line antiretroviral requests, we used linear mixed methods to describe the association between TF-related telephone consultations and submission of second-line requests, which required documentation of the TF diagnosis. The unit of analysis was the health facility. Available data included 1417 consultations (390 [27.5%] TF related) and 2662 second-line requests from 1011 health units (2015-2016 data). In multivariable analyses, each TF-related consultation was associated with an increase of 0.61 (95% confidence interval 0.15 to 1.06) second-line requests. In this setting, TF-related telephone consultation was positively and significantly associated with diagnosis and reporting of antiretroviral TF.

Adherence to HIV care and treatment is the main challenge in following up HIV-infected patients in Mozambique. Similarly, adherence to prevention of mother to child transmission programmes is the main challenge in eliminating paediatric AIDS. Despite various interventions to improve patient adherence in Mozambique, the number of patients defaulting from treatment is still increasing. To address this problem, Absolute Return for Kids (ARK) launched a randomized control trial in 2011 to evaluate the impact of SMS reminders on adherence to antiretroviral therapy and prevention of mother to child transmission programmes. If proven effective and cost-effective the programme could be scaled up nationally and expanded to include all pregnant women. However, many HIV-positive pregnant women and women on HIV treatment do not have cell phones or are illiterate. Research has shown that women in sub-Saharan Africa are 23% less likely to own a mobile phone than men [1]. These vulnerable groups will continue to be left out of mhealth interventions, such as SMS reminders, that can have considerable impact on their and their families' health.