Re-engagement and retention in HIV care after preventive default tracking in a cohort of HIV-infected patients in rural Malawi: A mixed-methods study.

Autor:	Suffrin JCD; Partners In Health, Neno, Malawi., Rosenthal A; Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel., Kamtsendero L; Partners In Health, Neno, Malawi., Kachimanga C; Partners In Health, Neno, Malawi., Munyaneza F; Partners In Health, Neno, Malawi., Kalua J; Ministry of Health, Neno District Hospital, Donda, Malawi., Ndarama E; Ministry of Health, Neno District Hospital, Donda, Malawi., Trapence C; Partners In Health, Neno, Malawi., Aron MB; Partners In Health, Neno, Malawi.; Research Group Snake Bite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany., Connolly E; Partners In Health, Neno, Malawi.; Division of Pediatrics, College of Medicine University of Cincinnati, Cincinnati, Ohio, United States of America.; Division of Hospital Medicine, Cincinnati Children Hospital Medical Center, Cincinnati, Ohio, United States of America., Dullie LW; Partners In Health, Neno, Malawi.; Department of Family Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Feb 21; Vol. 4 (2), pp. e0002437. Date of Electronic Publication: 2024 Feb 21 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0002437
Abstrakt:	Loss-to-follow-up (LTFU) in the era of test-and-treat remains a universal challenge, especially in rural areas. To mitigate LTFU, the HIV program in Neno District, Malawi, utilizes a preventive default tracking strategy named Tracking for Retention and Client Enrollment (TRACE). We utilized a mixed-methods descriptive study of the TRACE program on patient's re-engagement and retention in care (RiC). In the quantitative arm, we utilized secondary data of HIV-infected patients in the TRACE program from January 2018 to June 2019 and analyzed patients' outcomes at 6-, 12-, and 24-months post-tracking. In the qualitative arm, we analyzed primary data from 25 semi-structured interviews. For the study period, 1028 patients were eligible with median age was 30 years, and 52% were women. We found that after tracking, 982 (96%) of patients with a 6-week missed appointment returned to care. After returning to care, 906 (88%), 864 (84%), and 839 (82%) were retained in care respectively at 6-,12-, and 24-months. In the multivariate analysis, which included all the covariates from the univariate analysis (including gender, BMI, age, and the timing of ART initiation), the results showed that RiC at 6 months was linked to WHO stage IV at the start of treatment (with an adjusted odds ratio (aOR) of 0.18; 95% confidence interval (CI) of 0.06-0.54) and commencing ART after the test-and-treat recommendation (aOR of 0.08; 95% CI: 0.06-0.18). RiC after 12 months was associated with age between 15 and 29 years (aOR = 0.18; 95%CI: 0.03-0.88), WHO stage IV (aOR = 0.12; 95%CI: 0.04-0.16) and initiating ART after test-and-treat recommendations (aOR = 0.08; 95%CI: 0.04-0.16). RiC at 24 months post-tracking was associated with being male (aOR = 0.61; 95%CI: 0.40-0.92) and initiating ART after test-and-treat recommendations (aOR = 0.16; 95%CI:0.10-0.25). The qualitative analysis revealed that clarity of the visit's purpose, TRACE's caring approach changed patient's mindset, enhanced sense of responsibility and motivated patients to resume care. We recommend integrating tracking programs in HIV care as it led to increase patient follow up and patient behavior change. Competing Interests: I have read the journal’s policy and the following authors of this manuscript have the following competing interests: Anat Rosenthal is an editorial board member of PLOS Global Public Health. The other Authors have no other conflicts of interests. (Copyright: © 2024 Suffrin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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