Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 1;86(3):313-322.
doi: 10.1097/QAI.0000000000002554.

Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort

Laura K Beres  1 , Sheree Schwartz  2 , Sandra Simbeza  3 , John McGready  4 , Ingrid Eshun-Wilson  5 , Chanda Mwamba  3 , Kombatende Sikombe  3 , Stephanie M Topp  6 , Paul Somwe  3 , Aaloke Mody  5 , Njekwa Mukamba  3 , Peter D Ehrenkranz  7 , Nancy Padian  8 , Jake Pry  3   5 , Carolyn Bolton Moore  3   9 , Charles B Holmes  1   10 , Izukanji Sikazwe  3 , Julie A Denison  1 , Elvin Geng  5
Affiliations

Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort

Laura K Beres et al. J Acquir Immune Defic Syndr. .

Abstract

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 the cumulative incidence of return and the 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% confidence interval (CI): 61.0 to 83.8] returned to HIV care. The median follow-up time from disengagement was 32.3 months (interquartile range: 23.6-38.9). The rate of return decreased with time postdisengagement. Independent predictors of incident return included a previous gap in care [adjusted Hazard Ratio (aHR): 1.95, 95% CI: 1.23 to 3.09] and confronting a stigmatizer once in the past year (aHR: 2.14, 95% CI: 1.25 to 3.65). Compared with a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95% CI: 0.48 to 0.96) or hospital (aHR: 0.52, 95% CI: 0.33 to 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.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
A, Cumulative incidence of re-engagement in care (n = 556). B, Hazard for returning to care based on time since disengagement.
See this image and copyright information in PMC

References

    1. Kranzer K, Govindasamy D, Ford N, et al. Quantifying and addressing losses along the continuum of care for people living with HIV infection in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2012;15:17383. - PMC - PubMed
    1. Mugavero MJ, Amico KR, Horn T, et al. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57:1164–1171. - PubMed
    1. Lee H, Wu XK, Genberg BL, et al. Beyond binary retention in HIV care: predictors of the dynamic processes of patient engagement, disengagement, and re-entry into care in a US clinical cohort. AIDS (London, England). 2018;32:2217–2225. - PMC - PubMed
    1. Lee H, Hogan JW, Genberg BL, et al. A state transition framework for patient-level modeling of engagement and retention in HIV care using longitudinal cohort data. Stat Med. 2018;37:302–319. - PMC - PubMed
    1. Hallett TB, Eaton JW. A side door into care cascade for HIV-infected patients? J Acquir Immune Defic Syndr 2013;63(suppl 2):S228–S232. - PubMed

Publication types

Substances