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

Autor:	Beres LK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Schwartz S; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Simbeza S; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., McGready J; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Eshun-Wilson I; Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO., Mwamba C; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Sikombe K; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Topp SM; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia., Somwe P; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Mody A; Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO., Mukamba N; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Ehrenkranz PD; The Bill & Melinda Gates Foundation, Seattle, WA., Padian N; Division of Epidemiology, University of California Berkeley, Berkeley, CA; and., Pry J; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO., Moore CB; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL., Holmes CB; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.; Department of Medicine, Georgetown University, Washington, DC., Sikazwe I; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Denison JA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Geng E; Division of Infectious Diseases, Washington University School of Medicine, University of Washington, St. Louis, St. Louis, MO.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2021 Mar 01; Vol. 86 (3), pp. 313-322.
DOI:	10.1097/QAI.0000000000002554
Abstrakt:	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. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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