ArticleSocial science & medicine (1982)2023
Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis.
Article in Social science & medicine (1982), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 17 citations in OpenAlex.
- Predicting ART initiation through intertemporal preferences: development and validation of a decision-making preferences scale for ART initiation.BMC public health · 2026Article
- Tracing the journey: Patient engagement in long-term antiretroviral therapy care in Malawi.PloS one · 2026Article
- Gender, mental health symptoms, loss to clinic, and viral non-suppression 6 months after HIV care initiation among a cohort of people with HIV in Cameroon.BMC public health · 2025Article
- Retention in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention.Journal of the International AIDS Society · 2025Article
- An Enhanced Retention Strategy to Prevent the Vertical Transmission of HIV in Uganda: A Budget Impact Analysis.PharmacoEconomics - open · 2025Article
- Trajectories and predictors of HIV care retention among individuals receiving ART in rural South Africa: a group-based trajectory modelling analysis.Journal of global health · 2025Article
- Clinico-radiological characteristics and lethality of HIV-tuberculosis coinfection in the Infectiology ward of the Libreville University Hospital, Gabon.Southern African journal of infectious diseases · 2025Article
- Article
- The potential promise and pitfalls of point-of-care viral load monitoring to expedite HIV treatment decision-making in rural Uganda: a qualitative study.BMC health services research · 2024Article
- 'Not taking medications and taking medication, it was the same thing:' perspectives of antiretroviral therapy among people hospitalised with advanced HIV disease.BMC infectious diseases · 2024Article
- Factors influencing the implementation of a guideline for re-engagement in HIV care in primary care settings in Johannesburg, South Africa: A qualitative study.PLOS global public health · 2024Article
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Authors and funding
19 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundThere is limited study of persons deemed "harder to reach" by HIV treatment services, including those discontinuing or never initiating antiretroviral therapy (ART). We conducted narrative research in southern Uganda with virologically unsuppressed persons identified through population-based sampling to discern longitudinal patterns in HIV service engagement and identify factors shaping treatment persistence.
methodsIn mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by "re-storying" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data.
resultsThirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations.
conclusionsIdentified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.
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