Patient experiences and preferences for advanced HIV disease testing services: A qualitative study in Beira, Mozambique

The decline in HIV/AIDS deaths has been slower than expected, and advanced HIV disease (AHD) remains common. Despite expanded diagnostic services, patient preferences around AHD testing are understudied. This qualitative study explored the experiences and preferences of people living with HIV and healthcare workers to inform patient-centred approaches. In February 2024, purposive sampling identified people living with HIV who underwent testing at three health facilities in poor-urban Beira, Mozambique. We conducted 18 in-depth interviews and 2 focus group discussions (FGDs) with patients, plus 3 FGDs with healthcare professionals. Interviews were recorded, transcribed, translated and analysed using grounded theory. Patient understanding of AHD varied; most reported limited knowledge despite explanations. Healthcare workers noted that some patients struggle with the term "AHD" but view it less stigmatizing than AIDS. Seventy-five per cent of patients disliked the month-long wait for CD4 results and repeated clinic visits, which disrupted their routines and economic activities. Patients strongly preferred decentralized community-based AHD screening. Health professionals perceived community screening with simplified lateral flow tests as highly feasible and likely to improve patient satisfaction and convenience. Our findings suggest that empowering patients and decentralizing AHD screening with rapid tests can enhance uptake, reduce burden and improve care experiences.