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Re-Engagement into HIV Care: A Systematic Review


Identifying evidence-based interventions that can optimize the re-engagement into care of people living with HIV is necessary to achieve and sustain HIV epidemic control. We conducted a systematic review of interventions for re-engagement into HIV care to examine the accumulated evidence and to identify similarities and differences across studies. Between January and March 2020, we searched MEDLINE, Embase, CINAHL, and PsycINFO databases for publications from 1996 to 2020. We screened 765 references and selected 125 publications for full-text review. For the nine included studies, the intervention centered on (1) integration of clinic and HIV surveillance data; (2) additional or different levels of support provided by healthcare workers; or (3) multi-component intervention. Irrespective of the interventions, mixed results were found for re-engagement into care or ART re-initiation. None of the studies led to an improvement in viral suppression. Re-engagement in HIV care is critical for longitudinal HIV and national program success. Standardizing definitions for out-of-care and re-engagement would facilitate the comparison of interventions. Rigorous study designs to assess strategies to enhance HIV re-engagement are warranted.

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  1. The Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372(9635):293–9.

    Article  Google Scholar 

  2. Johnson LF, Mossong J, Dorrington RE, Schomaker M, Hoffmann CJ, Keiser O, et al. Life expectancies of South African adults starting antiretroviral treatment: collaborative analysis of cohort studies. PLoS Med. 2013;10(4):e1001418.

    Article  Google Scholar 

  3. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.

    Article  CAS  Google Scholar 

  5. World Health Organization, UNAIDS, UNICEF. Global HIV/AIDS response: epidemic update and health sector progress toward Universal Access [Internet]. 2011. Available from: Accessed 1 Feb 2021.

  6. Lundberg BE, Davidson AJ, Burman WJ. Epidemiology of pneumocystis carinii pneumonia in an era of effective prophylaxis: The relative contribution of non-adherence and drug failure. AIDS. 2000;14(16):2559–66.

    Article  CAS  Google Scholar 

  7. Van Beckhoven D, Florence E, De Wit S, Wyndham-Thomas C, Sasse A, Van Oyen H, et al. Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort. HIV Med. 2020;21(9):557–66.

    Article  Google Scholar 

  8. Grimsrud A, Wilkinson L, Eshun-Wilson I, Holmes C, Sikazwe I, Katz IT. Understanding engagement in HIV programmes: how health services can adapt to ensure no one is left behind. Curr HIV/AIDS Rep. 2020;17(5):458–66.

    Article  Google Scholar 

  9. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.

    Article  Google Scholar 

  10. Centers for Disease Control and Prevention. Understanding the HIV care continuum [Internet]. 2019. Available from: Accessed 1 Feb 2021.

  11. Mocroft A, Kirk O, Aldins P, Chies A, Blaxhult A, Chentsova N, et al. Loss to follow-up in an international, multicentre observational study. HIV Med. 2008;9(5):261–9.

    Article  CAS  Google Scholar 

  12. Fox MP, Rosen S. Retention of adult patients on antiretroviral therapy in low- and middle-income countries: systematic review and meta-analysis 2008–2013. J Acquir Immune Defic Syndr. 2015;69(1):98–108.

    Article  CAS  Google Scholar 

  13. Phillips TK, Orrell C, Brittain K, Zerbe A, Abrams EJ, Myer L. Measuring retention in HIV care: the impact of data sources and definitions using routine data. AIDS. 2020;34(5):749–59.

    Article  Google Scholar 

  14. Owusu KK, Adu-Gyamfi R, Ahmed Z. Strategies to improve linkage to hiv care in urban areas of Sub-Saharan Africa: a systematic review. HIV/AIDS—Res Palliat Care. 2019;11:321–32.

    Article  Google Scholar 

  15. Risher KA, Kapoor S, Moji A, Gabriela D, Skarbinski J, Doyle K, et al. Challenges in the evaluation of interventions to improve engagement along the HIV care continuum in the United States : a systematic review. AIDS Behav. 2017;21(7):2101–23.

    Article  Google Scholar 

  16. Higa D, Crepaz N, Mullins M. Identifying best practices for increasing linkage to, retention, and re-engagement in HIV medical care: findings from a systematic review, 1996–2004. AIDS Behav. 2015;20(5):951–66.

    Article  Google Scholar 

  17. UNAIDS. 2025 AIDS targets [Internet]. 2020. Available from: Accessed 15 Feb 2021.

  18. Covidence. Better systematic management [Internet]. Melbourne. 2020. Available from: Accessed 15 Feb 2021.

  19. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Available from: Accessed 15 Feb 2021.

  20. Farrah K, Young K, Tunis MC, Zhao L. Risk of bias tools in systematic reviews of health interventions: an analysis of PROSPERO-registered protocols. Syst Rev. 2019;8(1):280.

    Article  Google Scholar 

  21. Abrams-Downey A, Joseph C, Lindner R, Rodriguez G, Huprikar S, Sigel K, et al. 569 pre-retained: early intervention for HIV patients at high risk of becoming un-Retained. Open Forum Infect Dis. 2018.

    Article  PubMed Central  Google Scholar 

  22. Bove J, Golden MR, Dhanireddy S, Harrington RD, Dombrowski JC. Outcomes of a clinic-based, surveillance-informed intervention to relink patients to HIV care. J Acquir Immune Defic Syndr. 2015;70(3):262–8.

    Article  Google Scholar 

  23. Hart-Malloy R, Brown S, Bogucki K, Tesoriero J. Implementing data-to-care initiatives for HIV in New York state: assessing the value of community health centers identifying persons out of care for health department follow-up. AIDS Care. 2018;30(3):391–6.

    Article  Google Scholar 

  24. Sachdev D, Kohn R, Antunez E, O’Neil M, Phillip S, Scheer S, et al. Re-linkage and navigation outcomes of sexuallyactive not-in-care people living with HIV identified through a municipal STD clinic and partner services. STD Prev Conf. 2016;43(10):S224.

    Google Scholar 

  25. Sharp J, Angert C, Mcconnell T, Wortley P, Pennisi E, Roland L, et al. Health information exchange: a novel re-linkage intervention in an urban health system. Open forum Infect Dis. 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Teklu AM, Yirdaw KD. ART experienced patients for tackling attrition from HIV care: a multi-site cohort study. Ethiop Med J. 2016;54(4):197–205.

    PubMed  Google Scholar 

  27. Udeagu C, Huang J, Eason L, Pickett L. Health department-HIV clinic integration of data and human resources to re-engage out of care HIV-positive persons into clinical care in a New York City locale. AIDS Care. 2019;31(11):1420–6.

    Article  CAS  Google Scholar 

  28. Magnus M, Herwehe J, Gruber D, Wilbright W, Shepard E, Abrams A, et al. Improved HIV-related outcomes associated with implementation of a novel public health information exchange. Int J Med Inform. 2012.

    Article  PubMed  Google Scholar 

  29. Kremer J, Barrios R, Moore D, Salters K, Lepik K, Wang L, et al. Evaluation of an antiretroviral therapy (ART) interruption alert and referral system in British Columbia (BC), Canada. Sex Transm Infect. 2019;95((Kremer J, Barrios R, Moore D, Salters K, Lepik K, Wang L, Slakov K, Li J) BC Centre for Excellence in HIV/AIDS, Vancouver, Canada PG-A168):A168

  30. Sileo KM, Fielding-Miller R, Dworkin SL, Fleming PJ. A scoping review on the role of masculine norms in men’s engagement in the HIV care continuum in sub-Saharan Africa. AIDS Care. 2019;31(11):1435–46.

    Article  PubMed  Google Scholar 

  31. Geter A, Sutton MY, Hubbard McCree D. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005–2016. AIDS Care. 2018;30(4):409–16.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ramadhani HO, Ndembi N, Nowak RG, Ononaku U, Gwamna J, Orazulike I, et al. Individual and network factors associated with HIV care continuum outcomes among Nigerian MSM accessing health care services. J Acquir Immune Defic Syndr. 2018;79(1):E7-16.

    Article  Google Scholar 

  33. Chi BH, Yiannoutsos CT, Westfall AO, Newman JE, Zhou J, Cesar C, et al. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. PLoS Med. 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Shepherd BE, Blevins M, Vaz LME, Moon TD, Kipp AM, José E, et al. Impact of definitions of loss to follow-up on estimates of retention, disease progression, and mortality: application to an HIV program in Mozambique. Am J Epidemiol. 2013;178(5):819–28.

    Article  Google Scholar 

  35. PEPFAR. Monitoring, Evaluation, and Reporting Indicator Reference Guide (MER 2.5) [Internet]. 2020. Available from: Accessed 5 Jan 2021.

  36. World Health Organization Africa. HIV/AIDS [Internet]. [cited 2020 Dec 23]. Available from: WHO African Region is,HIV in the African Region

  37. Castelnuovo B, Kiragga A, Afayo V, Ncube M, Orama R, Magero S, et al. Implementation of provider-based electronic medical records and improvement of the quality of data in a large HIV program in Sub-Saharan Africa. PLoS ONE. 2012;7(12):1–8.

    Article  Google Scholar 

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We thank Tyler New for editing the manuscript.

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Authors and Affiliations



NB, MCL and KAS designed the study. EL conducted the search strategy. NB and MCL independently assessed records for eligibility and extracted the data. NB and MCL wrote the initial draft of the manuscript. All authors critically reviewed and revised the drafts and approved the final version for publication.

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Correspondence to Natalia Blanco.

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Blanco, N., Lavoie, MC.C., Koech, E. et al. Re-Engagement into HIV Care: A Systematic Review. AIDS Behav 26, 132–146 (2022).

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  • HIV
  • Out-of-care
  • Re-engagement into care
  • ART re-initiation