Identifying Contextual Factors and Evidence-based Approaches to Promote Retention in HIV care after Re-engagement

Abstract

Research Question: 1) What are barriers to care re-engagement which may have contributed to individuals who are socioeconomically challenged to have fallen out of care, and what are individual perspectives on facilitators of care re-engagement that may improve upon re-engagement and retention in HIV care? 2) What is the available evidence in literature on the effects of financial incentives which promote care engagement, adherence, retention after re-engagement in care among people with HIV (PWH) who are returning to care?

Background and Significance: Retention in HIV care is associated with durable viral suppression and improved HIV-related health outcomes. Prior reviews have summarized studies that assessed the effects of financial incentives on HIV prevention, testing, linkage to care, treatment adherence, and virologic suppression. There is currently no review which addresses the effects of financial incentives on retention in HIV care. A systematic review of studies that addressed retention in care may be useful for informing decisions about which financial incentives, if any, to implement in efforts to retain PLWH in HIV care.

Materials and Methods: Our target population of interest are PWH who returning to HIV care after being lost or disengaged from care. Routine programmatic data from the JPS Healing Wings Clinic in Fort Worth, Texas was used to identify barriers and facilitators to sustained engagement in HIV care. The systematic review synthesized evidence from literature to assess the effect of financial incentives interventions on promoting viral suppression and retention in care. For the review, PubMed and other databases was used to queried to identify relevant papers that meet our inclusion criteria for the review. Reviews were limited to literature from previous 15 years.

Results: Information gathered about barriers to care from PWH who returned to care in the local Fort Worth Community demonstrated that behavioral barriers were reported the most by respondents at 45%, followed by financial barriers at 24%, structural barriers at 19%, knowledge barriers at 9%, and communication barriers at 3% of respondents. Results from the systematic review are still in progress, however, we expect that financial barriers will have a positive effect on retention in care with PWH.

Conclusion: The collected information on barriers to care within the local Fort Worth community provides healthcare providers a better understanding of the difficulties in retention and adherence to treatment in target population. This data can help to inform efforts to prevent further disengagement in the local Fort Worth Community. Results from the systematic review provide an evidence-based guide to the efficacy of financial incentives that can be adapted and implemented to help promote retention in HIV care.