Factors predictive of successful retention in care among HIV-infected men in a universal test-and-treat setting in Uganda and Kenya: A mixed methods analysis

• Published in: PloS one 2019-01, Vol.14 (1), p.e0210126-e0210126
• Main Authors: Brown, Lillian B, Getahun, Monica, Ayieko, James, Kwarisiima, Dalsone, Owaraganise, Asiphas, Atukunda, Mucunguzi, Olilo, Winter, Clark, Tamara, Bukusi, Elizabeth A, Cohen, Craig R, Kamya, Moses R, Petersen, Maya L, Charlebois, Edwin D, Havlir, Diane V, Camlin, Carol S
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; AIDS; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Care and treatment; CD4 antigen; CD4 Lymphocyte Count; Collaboration; Data analysis; Data processing; Disease prevention; Gynecology; Hazards; Health; Health behavior; Health care; Health sciences; HIV; HIV infections; HIV Infections - blood; HIV Infections - drug therapy; HIV patients; Human immunodeficiency virus; Humans; Infectious diseases; Intervention; Kenya; Longitudinal Studies; Male; Masculinity; Medical research; Medical screening; Medical tests; Medicine and Health Sciences; Men; Methods; Middle Aged; Mixed methods research; Norms; Obstetrics; Partnerships; Patient Acceptance of Health Care - statistics & numerical data; Patients; People and Places; Qualitative analysis; Regression analysis; Research and Analysis Methods; Retention; Retention in Care - statistics & numerical data; Rural Population - statistics & numerical data; Searching; Sex discrimination; Social interactions; Social Sciences; Society; Studies; Uganda; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210126

Previous research indicates clinical outcomes among HIV-infected men in sub-Saharan Africa are sub-optimal. The SEARCH test and treat trial (NCT01864603) intervention included antiretroviral care delivery designed to address known barriers to HIV-care among men by decreasing clinic visit frequency and providing flexible, patient-centered care with retention support. We sought to understand facilitators and barriers to retention in care in this universal treatment setting through quantitative and qualitative data analysis. We used a convergent mixed methods study design to evaluate retention in HIV care among adults (age > = 15) during the first year of the SEARCH (NCT01864603) test and treat trial. Cox proportional hazards regression was used to evaluate predictors of retention in care. Longitudinal qualitative data from n = 190 in-depth interviews with HIV-positive individuals and health care providers were analyzed to identify facilitators and barriers to HIV care engagement. There were 1,863 men and 3,820 women who linked to care following baseline testing. Retention in care was 89.7% (95% CI 87.0-91.8%) among men and 89.0% (86.8-90.9%) among women at one year. In both men and women older age was associated with higher rates of retention in care at one year. Additionally, among men higher CD4+ at ART initiation and decreased time between testing and ART initiation was associated with higher rates of retention. Maintaining physical health, a patient-centered treatment environment, supportive partnerships, few negative consequences to disclosure, and the ability to seek care in facilities outside of their community of residence were found to promote retention in care. Features of the ART delivery system in the SEARCH intervention and social and structural advantages emerged as facilitators to retention in HIV care among men. Messaging around the health benefits of early ART start, decreasing logistical barriers to HIV care, support of flexible treatment environments, and accelerated linkage to care, are important to men's success in ART treatment programs. Men already benefit from increased social support following disclosure of their HIV-status. Future efforts to shift gender norms towards greater equity are a potential strategy to support high levels of engagement in care for both men and women.