Beres, Laura K; Mwamba, Chanda; Bolton-Moore, Carolyn; Kennedy, Caitlin E; Simbeza, Sandra; Topp, Stephanie M; Sikombe, Kombatende; Mukamba, Njekwa; Mody, Aaloke; Schwartz, Sheree R; +4 more... Geng, Elvin; Holmes, Charles B; Sikazwe, Izukanji; Denison, Julie A; (2023) Trajectories of re-engagement: factors and mechanisms enabling patient return to HIV care in Zambia. Journal of the International AIDS Society, 26 (2). e26067-. ISSN 1758-2652 DOI: https://doi.org/10.1002/jia2.26067
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Abstract
INTRODUCTION: While disengagement from HIV care threatens the health of persons living with HIV (PLWH) and incidence-reduction targets, re-engagement is a critical step towards positive outcomes. Studies that establish a deeper understanding of successful return to clinical care among previously disengaged PLWH and the factors supporting re-engagement are essential to facilitate long-term care continuity. METHODS: We conducted narrative, patient-centred, in-depth interviews between January and June 2019 with 20 PLWH in Lusaka, Zambia, who had disengaged and then re-engaged in HIV care, identified through electronic medical records (EMRs). We applied narrative analysis techniques, and deductive and inductive thematic analysis to identify engagement patterns and enablers of return. RESULTS: We inductively identified five trajectories of care engagement, suggesting patterns in patient characteristics, experienced barriers and return facilitators that may aid intervention targeting including: (1) intermittent engagement;(2) mostly engaged; (3) delayed linkage after testing; (4) needs time to initiate antiretroviral therapy (ART); and (5) re-engagement with ART initiation. Patient-identified periods of disengagement from care did not always align with care gaps indicated in the EMR. Key, interactive re-engagement facilitators experienced by participants, with varied importance across trajectories, included a desire for physical wellness and social support manifested through verbal encouragement, facility outreach or personal facility connections and family instrumental support. The mechanisms through which facilitators led to return were: (1) the promising of living out one's life priorities; (2) feeling valued; (3) fostering interpersonal accountability; (4) re-entry navigation support; (5) facilitated care and treatment access; and (6) management of significant barriers, such as depression. CONCLUSIONS: While preliminary, the identified trajectories may guide interventions to support re-engagement, such as offering flexible ART access to patients with intermittent engagement patterns instead of stable patients only. Further, for re-engagement interventions to achieve impact, they must activate mechanisms underlying re-engagement behaviours. For example, facility outreach that reminds a patient to return to care but does not affirm a patient's value or navigate re-entry is unlikely to be effective. The demonstrated importance of positive health facility connections reinforces a growing call for patient-centred care. Additionally, interventions should consider the important role communities play in fostering treatment motivation and overcoming practical barriers.
Item Type | Article |
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Faculty and Department | Faculty of Public Health and Policy > Public Health, Environments and Society |
PubMed ID | 36840391 |
Elements ID | 199696 |
Official URL | http://dx.doi.org/10.1002/jia2.26067 |
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