TY - JOUR
T1 - Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia
T2 - A Latent Class Analysis
AU - Mody, Aaloke
AU - Sikombe, Kombatende
AU - Beres, Laura K.
AU - Simbeza, Sandra
AU - Mukamba, Njekwa
AU - Eshun-Wilson, Ingrid
AU - Schwartz, Sheree
AU - Pry, Jake
AU - Padian, Nancy
AU - Holmes, Charles B.
AU - Bolton-Moore, Carolyn
AU - Sikazwe, Izukanji
AU - Geng, Elvin H.
N1 - Publisher Copyright:
© 2020 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Background:Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles.Methods:We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site).Results:Among 547 patients, we identified 5 profiles of care disruptions: (1) "Livelihood and Mobility"(30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) "Clinic Accessibility"(28.9%) reported challenges with attending clinic; (3) "Mobility and Family"(21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) "Doubting Need for HIV care"(10.2%) reported uncertainty around HIV status or need for clinical care, and (5) "Multidimensional Barriers to Care"(8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The "Doubting Need for HIV Care"class were mostly disengaged (97.9%), followed by the "Multidimensional Barriers to Care"(62.8%), "Clinic Accessibility"(62.4%), "Livelihood and Mobility"(43.6%), and "Mobility and Family"(23.5%) classes.Conclusion:There are distinct HIV care disruption profiles that are strongly associated with patients' current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes.
AB - Background:Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles.Methods:We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site).Results:Among 547 patients, we identified 5 profiles of care disruptions: (1) "Livelihood and Mobility"(30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) "Clinic Accessibility"(28.9%) reported challenges with attending clinic; (3) "Mobility and Family"(21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) "Doubting Need for HIV care"(10.2%) reported uncertainty around HIV status or need for clinical care, and (5) "Multidimensional Barriers to Care"(8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The "Doubting Need for HIV Care"class were mostly disengaged (97.9%), followed by the "Multidimensional Barriers to Care"(62.8%), "Clinic Accessibility"(62.4%), "Livelihood and Mobility"(43.6%), and "Mobility and Family"(23.5%) classes.Conclusion:There are distinct HIV care disruption profiles that are strongly associated with patients' current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes.
KW - barriers to care
KW - disengagement
KW - latent class analysis
KW - loss to follow-up
KW - phenotypes
KW - retention in care
KW - transfer
UR - http://www.scopus.com/inward/record.url?scp=85098471443&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000002530
DO - 10.1097/QAI.0000000000002530
M3 - Article
C2 - 33105396
AN - SCOPUS:85098471443
SN - 1525-4135
VL - 86
SP - 62
EP - 72
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -