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Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis.
Rosen, Joseph G; Nakyanjo, Neema; Ddaaki, William G; Zhao, Tongying; Van Vo, Anh; Nakubulwa, Rosette; Ssekyewa, Charles; Isabirye, Dauda; Katono, Ruth L; Nabakka, Proscovia; Ssemwanga, Richard J; Kigozi, Grace; Odiya, Silas; Nakigozi, Gertrude; Nalugoda, Fred; Kigozi, Godfrey; Kagaayi, Joseph; Grabowski, M Kate; Kennedy, Caitlin E.
Afiliación
  • Rosen JG; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: jrosen72@jhu.edu.
  • Nakyanjo N; Rakai Health Sciences Program, Entebbe, Uganda.
  • Ddaaki WG; Rakai Health Sciences Program, Entebbe, Uganda.
  • Zhao T; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
  • Van Vo A; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
  • Nakubulwa R; Rakai Health Sciences Program, Entebbe, Uganda.
  • Ssekyewa C; Rakai Health Sciences Program, Entebbe, Uganda.
  • Isabirye D; Rakai Health Sciences Program, Entebbe, Uganda.
  • Katono RL; Rakai Health Sciences Program, Entebbe, Uganda.
  • Nabakka P; Rakai Health Sciences Program, Entebbe, Uganda.
  • Ssemwanga RJ; Rakai Health Sciences Program, Entebbe, Uganda.
  • Kigozi G; Rakai Health Sciences Program, Entebbe, Uganda.
  • Odiya S; Rakai Health Sciences Program, Entebbe, Uganda.
  • Nakigozi G; Rakai Health Sciences Program, Entebbe, Uganda.
  • Nalugoda F; Rakai Health Sciences Program, Entebbe, Uganda.
  • Kigozi G; Rakai Health Sciences Program, Entebbe, Uganda.
  • Kagaayi J; Rakai Health Sciences Program, Entebbe, Uganda.
  • Grabowski MK; Rakai Health Sciences Program, Entebbe, Uganda; Division of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
  • Kennedy CE; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda.
Soc Sci Med ; 339: 116386, 2023 12.
Article en En | MEDLINE | ID: mdl-37984182
ABSTRACT

BACKGROUND:

There 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.

METHODS:

In 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.

RESULTS:

Thirty-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.

CONCLUSIONS:

Identified 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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Límite: Adult / Female / Humans / Male País/Región como asunto: Africa Idioma: En Revista: Soc Sci Med Año: 2023 Tipo del documento: Article Pais de publicación: ENGLAND / ESCOCIA / GB / GREAT BRITAIN / INGLATERRA / REINO UNIDO / SCOTLAND / UK / UNITED KINGDOM

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Fármacos Anti-VIH Límite: Adult / Female / Humans / Male País/Región como asunto: Africa Idioma: En Revista: Soc Sci Med Año: 2023 Tipo del documento: Article Pais de publicación: ENGLAND / ESCOCIA / GB / GREAT BRITAIN / INGLATERRA / REINO UNIDO / SCOTLAND / UK / UNITED KINGDOM