Abstract
Retention in antiretroviral therapy (ART) services is critical to achieving positive health outcomes for individuals living with HIV, but accumulating evidence indicates that individuals are likely to miss ART appointments over time. Thus, it is important to understand why individuals miss appointments and how they re-engage in HIV care. We used in-depth interviews with 44 ART clients in Malawi who recently missed an ART appointment (> 14 days) but eventually re-engaged in care (within 60 days) to explore reasons for missed appointments and barriers and facilitators to re-engagement. We found that most individuals missed ART appointments due to unexpected life events such as funerals, work, and illness for both clients and their treatment guardians who were also unable to attend facilities. Several reasons differed by gender—work-related travel was common for men, while caring for sick family members was common for women. Barriers to re-engagement included continued travel, illness, and restricted clinic schedules and/or staff shortages that led to repeat facility visits before being able to re-engage in care. Strong internal motivation combined with social support and reminders from community health workers facilitated re-engagement in HIV care.
Highlights
Antiretroviral therapy (ART) initiation has increased dramatically in sub-Saharan Africa since the introduction of Universal Treatment policies in 2016, with ~ 83% of those diagnosed with HIV in the region on treatment in 2019 [1]—a remarkable success
A recent study from the region shows that 73% of those who missed an HIV care appointment returned to care, most within one year, suggesting that cycles of disengagement and re-engagement may be central to the ART experience [9]
We examine the challenges and successes of People living with HIV (PLWH) who effectively re-engage with HIV care after missing routine ART appointments in Malawi
Summary
Antiretroviral therapy (ART) initiation has increased dramatically in sub-Saharan Africa since the introduction of Universal Treatment policies in 2016, with ~ 83% of those diagnosed with HIV in the region on treatment in 2019 [1]—a remarkable success. Successfully engaging in HIV care over time is complicated—involving frequent visits to the health facility and daily ART adherence amidst other life priorities and familial demands [2, 3]. These challenges are reflected in high rates of default from ART programs in sub-Saharan. A recent study from the region shows that 73% of those who missed an HIV care appointment returned to care, most within one year, suggesting that cycles of disengagement and re-engagement may be central to the ART experience [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
