Bibliographic Info
GuidelineUpdated recommendations on service delivery for the treatment and care of people living with HIV
Year of Publication2021
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended in favor
Strong
Certainty of evidence
Low
HIV programmes should implement interventions to trace people who have disengaged from care and provide support for re-engagement
Notes and Remarks
- 1.Support for re-engagement in care can include interventions directed towards patients, such as peer- or provider outreach and navigation back to care, as well as toward health-care providers and health facilities, through systems to alert health-care providers that patients have disengaged. The nature of interventions could include reminders (such as phone calls or text messages), economic interventions (such as financial incentives or conditional cash transfers), case management or policy interventions, with steps taken to ensure complete confidentiality. Programme- or facility-level confidential client contact details should be kept up to date to ensure successful tracing if and when required. When tracing people who are
- 2.The criteria for tracing and recall should consider those who are seven or more calendar days late for a scheduled appointment. Although efforts should be made to trace everyone who has missed appointments and/or has abnormal laboratory test results, the following groups should be given priority: (1) people initiating treatment in the past six months with advanced HIV disease, (2) people with abnormal laboratory test results, (3) people not initiating treatment and (4) people overdue for clinical consultations or laboratory tests. not engaged in care is being considered, adequately assessing risks to vulnerable and key populations is critical. For example, women are subject to increased levels of both intimate partner and gender-based violence in the context of HIV, and appropriate training of healthcare providers is therefore essential (101). Client-reported reasons are critical to understanding both general and local reasons for failures of retention; these patient-reported reasons are far more predictive than sociodemographic factors such as age and sex (102).
- 3.A non-judgemental approach is essential to supporting people to return to care; this requires reducing system barriers and improving interpersonal communication by developing the capacity of health-care providers. The Welcome Back service established by Médecins Sans Frontières and the Department of Health of South Africa provides a strong example of such an approach that combines medical and psychosocial support for people who have disengaged from care