Patterns and predictors of incident return to HIV care among traced, disengaged patients in Zambia

Beres, Laura, Schwartz, Sheree, Simbeza, Sandra, McGready, John, Eshun-Wilson, Ingrid, Mwamba, Chanda, Sikombe, Kombatende, Topp, Steph, Somwe, Paul, Mody, Aaloke, Mukamba, Njekwa, Ehrenkranz, Peter D., Padian, Nancy, Pry, Jake, Moore, Carolyn Bolton, Holmes, Charles, Sikazwe, Izukanji, Denison, Julie A., and Geng, Elvin (2021) Patterns and predictors of incident return to HIV care among traced, disengaged patients in Zambia. JAIDS, 86 (3). pp. 313-322.

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Background: Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement.

Methods: From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zambian health facilities, we prospectively followed disengaged HIV patients for return clinic visits. We estimated cumulative incidence of return and time to return using Kaplan Meier methods. We used univariate and multivariable Cox proportional hazards regression to conduct a risk factor analysis identifying predictors of incident return across a social ecological framework.

Results: Of the 556 disengaged patients, 73.0% (95% CI: 61.0-83.8) returned to HIV care. Median follow-up time from disengagement was 32.3 months (IQR: 23.6-38.9). The rate of return decreased with time post-disengagement. Independent predictors of incident return included a prior gap in care (aHR: 1.95, 95%CI: 1.23-3.09) and confronting a stigmatizer once in the past year (aHR: 2.14, 95%CI: 1.25-3.65). Compared to a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95%CI: 0.48-0.96) or hospital (aHR: 0.52, 95%CI: 0.33-0.82).

Conclusions: Interventions are needed to hasten re-engagement in HIV care. Early and differential interventions by time since disengagement may improve intervention effectiveness. Patients in urban and tertiary care settings may need additional support. Improving patient resilience, outreach after a care gap, and community stigma reduction may facilitate return. Future re-engagement research should include causal evaluation of identified factors.

Item ID: 65257
Item Type: Article (Research - C1)
ISSN: 1944-7884
Keywords: HIV, Zambia, retention, antiretroviral therapy
Copyright Information: © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Funders: National Institute of Mental Health of the National Institutes of Health (NIH), Bill and Melinda Gates Foundation (BMGF), Johns Hopkins University Center for AIDS Research (JHUCAR)
Projects and Grants: NIH Award no. F31MH109378, BMGF Grant number OPP1105071, JHUCAR P30AI094189
Date Deposited: 07 Dec 2020 21:16
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420321 Rural and remote health services @ 80%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 20%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 45%
92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 45%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 10%
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