Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa

Abstract

Objective Engagement in care is key to successful HIV treatment in resource-limited settings; yet little is known about the magnitude and determinants of reengagement among patients out of care. We assessed patient-reported reasons for not returning to clinic, identified latent variables underlying these reasons, and examined their influence on subsequent care reengagement. Design We used data from the East Africa International Epidemiologic Databases to Evaluate AIDS to identify a cohort of patients disengaged from care (>3 months late for last appointment, reporting no HIV care in preceding 3 months) (n = 430) who were interviewed about reasons why they stopped care. Among the 399 patients for whom follow-up data were available, 104 returned to clinic within a median observation time of 273 days (interquartile range: 165–325). Methods We conducted exploratory and confirmatory factor analyses (EFA, CFA) to identify latent variables underlying patient-reported reasons, then used these factors as predictors of time to clinic return in adjusted Cox regression models. Results EFA and CFA findings suggested a six-factor structure that lent coherence to the range of barriers and motivations underlying care disengagement, including poverty, transport costs, and interference with work responsibilities; health system ‘failures,’ including poor treatment by providers; fearing disclosure of HIV status; feeling healthy; and treatment fatigue/seeking spiritual alternatives to medicine. Factors related to poverty and poor treatment predicted higher rate of return to clinic, whereas the treatment fatigue factor was suggestive of a reduced rate of return. Conclusion Certain barriers to reengagement appear easier to overcome than factors such as treatment fatigue. Further research will be needed to identify the easiest, least expensive interventions to reengage patients lost to HIV care systems. Interpersonal interventions may continue to play an important role in addressing psychological barriers to retention.

Observational Study of the Effect of Patient Outreach on Return to Care: The Earlier the Better

“…Camlin [2016] identified a similar spectrum of factors, with poverty and transportation resources having a greater role, and fear of mistreatment by clinic staff also playing an important role. (32) Indeed, it is possible that the outreach effort was effective in part because it mitigated concerns over staff hostility or provided encouragement to patients.…”

“…(20–26) The few studies assessing re-engagement in low-income countries have focused more on descriptions of factors associated with attrition, have assessed only groups such as pregnant women, or have been qualitative in nature. (27–32) No studies however have quantitatively evaluated the success of specific strategies or their timing to maximize patient re-engagement in care after loss to care.…”

“…(33) The re-engagement of individuals lost to care is an essential and understudied stage in the HIV continuum of care. (32) In this report, we use a sampling-based method as described above to undertake a rigorous analysis of the impact and timing of patient outreach on re-engagement in care among HIV-infected patients receiving care in a large African HIV care and treatment program who have experienced gaps in care over the course of a decade.…”

Burden of fatigue among adults living with HIV/AIDS attending antiretroviral therapy in Ethiopia

“…It can also impose burden on family and community by affecting patients' job desire and productivity level [20,23,24]. Studies also found out that higher fatigue level was reported by HIV-infected patients, who were single, unemployed, and under-weight [12,20,26,27]. Similarly, the finding of the study from USA showed that having inadequate income had an association with higher fatigue intensity [28].…”

Experience of fatigue and related factors among HIV-infected adults attending ART clinic in Ethiopia; a cross-sectional study

“…The prevalence of fatigue among HIV/AIDS patients and predictors vary widely across countries and regions in the country. Several studies have reported that fatigue can negatively impact the patient's activities of daily living, quality of life, sociability, job desire, productivity, level of physical activity, psychological wellbeing, health-seeking behavior, and adherence to the HAART regimen [15,16,[18][19][20][21][22]. The cause of fatigue in HIV-infected patients is probably multifactorial.…”