Community-led interventions to re-engage people living with HIV into care in Pakistan.

BACKGROUND

By 2021, Pakistan had an estimated 210 000 people living with HIV (PLHIV), and 27% of those initiated into treatment in 2020 had disengaged from care within one year.

AIM: We assessed the effectiveness of an intervention to re-engage PLHIV lost to follow-up into care in Pakistan.

METHODS

Between September 2020 and May 2021, the Association of People Living with HIV (APLHIV) implemented a search and rescue intervention for PLHIV lost to follow-up in 2 large treatment centres in Pakistan. The centre staff reviewed records to identify those not in care for > 6 months and from September 2020 to May 2021, the APLHIV tracked them through telephone calls and home visits to re-engage them into care. We used SAS version 9.4 to analyse the data and univariate logistic regression to identify factors associated with disengagement and becoming untraceable.

RESULTS

Among the 4184 PLHIV registered (74% male), 36% (1517) (83.9% male, 15.4% female, 0.7% transgender) had disengaged from care. APLHIV members tracked 696 (46%) of them; 295 (42%) were deceased and 325 (47%) were re-engaged into care. Reasons for disengagement were long distance from the ART centre or lack of resources (45%), injecting drug use (19%), adverse effects of antiretroviral therapy (9%), disinformation (9%), no male family member to accompany them to treatment centre after the death of husband (3%), and no reason given (15%). Injecting drug users and males were more likely to be lost to follow-up, and males were more likely to be untraceable.

CONCLUSION

This community-led intervention successfully re-engaged many PLHIV into care. The community-led re-engagement intervention should be upscaled to reduce loss to care and follow-up in Pakistan, especially among injecting drug users and male PLHIV.