Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind
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IMPLEMENTATION SCIENCE (E GENG, SECTION EDITOR)
Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind Anna Grimsrud 1,2 & Lynne Wilkinson 1,3 & Ingrid Eshun-Wilson 4 & Charles Holmes 5 & Izukanji Sikazwe 6 & Ingrid T. Katz 7,8,9,10
# The Author(s) 2020
Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support reengagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management. Keywords Engagement . Re-engagement . Retention . HIV . Client-centred . Differentiated service delivery
Introduction Set in 2014, the UNAIDS Fast-Track targets for accelerating the HIV response to reach the 90-90-90 goals of 90% of people knowing their status, 90% of those being on treatment and 90%
of those on treatment being virally suppressed are due at the end of this year (2020) [1]. At the time these goals were set, less than 40% (13.6 million) of the 25 million people living with HIV were accessing antiretroviral therapy. By the end of 2018, global estimates were 79-78-86, highlighting the significant
This article is part of the Topical Collection on Implementation Science * Anna Grimsrud [email protected]
4
School of Medicine, Washington University, St Louis, MO, USA
5
Center for Innovation in Global Health, Georgetown University, Washington, DC, USA
Ingrid Eshun-Wilson [email protected]
1
2
3
6
Ingrid T. Katz [email protected]
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
7
International AIDS Society, 3 Doris Road, Claremont, Cape Town 7708, South Africa
Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
8
Harvard Medical School, Boston, MA, USA
Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
9
Massachusetts General Hospit
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