'University Library System, University of Pittsburgh'
Abstract
Retention in HIV care is an important public health issue as it improves survival and quality of life among people living with HIV (PLWH) and reduces the risk of infection spread to others. In order to increase retention in care and maintain a care continuum, it is essential to understand the factors and reasons that lead to non-retention in care. The effects of reported loss-to-care reasons on reengagement in care among a Southwestern Pennsylvania HIV program-based population of 920 individuals was examined in the present study. Participants reported 17 single primary reasons and 9 categories of multiple reasons; the most commonly reported single reasons were denial/avoidance, substance abuse, incarceration, unstable locations and mental health issues while the most reported multiple reason category was mental health and substance abuse. Multinomial regression was conducted to explore loss to care reason categories and factors associated with reengagement in care. In multinomial analysis, adjusted for race, HIV contact risk, insurance and use of antiretroviral medication, persons with single reasons related to finance and stigma were 2.5 (95% CI; 1.2, 5.5) and 3.5 (95% CI; 1.2, 10.1) times, respectively, as likely as those with multiple reasons to be reengaged in care. Enrollment in insurance and taking antiretroviral medications were also found to be strong independent predictors of reengagement in care. Participants who reported multiple reasons were less likely to be reengaged in care and those with injective drug use risk were 50% less likely to be reengaged in care compared to those with heterosexual contact risk. Success in reengagement was lower among PLWH with higher risk reasons such as mental health issues and substance abuse; hence, while intervention approaches may be effective for those with fewer and less complicated reasons, other PLWH may benefit from program modifications in the attempt to reengage them
