Delayed initiation of antiretroviral therapy (ART) and some socioeconomic factors contribute to disengagement from HIV care, suggests a study in the Philippines.
“Hence, rapid ART initiation, education-sensitive counselling, and person-centred models for working clients, [including] flexible clinic hours and multi-month ART dispensing, are necessary,” said lead author Dr Rodenie Arnaiz Olete, Sustained Health Initiatives of the Philippines, Mandaluyong City, Philippines.
Disengagement poses a challenge to treatment continuity and sustained viral suppression, according to Olete and his team.
“Although social and clinical determinants of retention have been described, few studies in low-to-middle-income settings have examined predictors of both disengagement and re-engagement using longitudinal survival models,” wrote Olete and colleagues.
To address this gap, a retrospective cohort analysis was conducted at four Save And Improve Lives (SAIL) community-led clinics between 2021 and 2025. The study sought to determine which factors influence “transitions into and out of HIV care as critical insight in designing targeted retention and re-engagement strategies in community-based programmes in the Philippines.”
Olete and his team fitted cause-specific Cox proportional hazards models to assess time to first short disengagement (28‒89 days late from scheduled clinic visit), time to first long disengagement (≥90 days late), and time to first re-engagement following disengagement. They also stratified these models by clinic and clustered by individual.
Covariates were as follows: age at diagnosis, time to ART initiation (≤7 vs 7 days), educational attainment, employment status, advanced HIV disease at diagnosis, tuberculosis, hepatis B/C virus (HBV/HCV) acquisition, and behavioural risk indicators.
Disengagement
Of the 1,990 people living with HIV (PLHIV) who completed the test-to-treatment process, 1,806 were included in the final regression analyses following the exclusion of observations with missing covariates. [AIDS 2026, abstract THPEC234]
Delayed ART initiation correlated with a 29-percent increased risk of short disengagement (adjusted hazard ratio [aHR], 1.29, 95 percent confidence interval [CI], 1.05‒1.58) and a 41-percent higher risk of long disengagement (aHR, 1.41, 95 percent CI, 1.09‒1.84).
Similarly, lower education (aHR, 1.45, 95 percent CI, 1.19‒1.75) and being employed (aHR, 1.33, 95 percent CI, 1.11‒1.59) both contributed to short disengagement.
Furthermore, HCV acquisition appeared to increase the risk of long disengagement (aHR, 3.16, 95 percent CI, 1.02‒9.81), whereas HBV acquisition contributed to a greater chance of re-engagement (aHR, 4.76, 95 percent CI, 1.72‒8.36).
PLHIV with previous long disengagement were significantly less likely to re-engage HIV care (aHR, 0.14, 95 percent CI, 0.10‒0.19). On the other hand, behavioural factors showed no significant association with disengagements or re-engagement.
“Given the reduced likelihood of re-engagement after prolonged disengagement, early tracing, peer navigation, and data-driven re-engagement systems should be prioritized and well-established to prevent extended interruptions in care,” Olete and colleagues said.
“Clinical co-management of viral hepatitis may anchor sustained follow-up and re-entry into HIV care in community-led treatment programmes,” they added.