Community-led interventions to re-engage people living with HIV into care in Pakistan.

Background: By 2021, Pakistan had an estimated 210 000 people living with HIV (PLHIV), and 27% of those initiated into treatment in 2020 had disengaged from care within one year.

Aim: We assessed the effectiveness of an intervention to re-engage PLHIV lost to follow-up into care in Pakistan.

Methods: Between September 2020 and May 2021, the Association of People Living with HIV (APLHIV) implemented a search and rescue intervention for PLHIV lost to follow-up in 2 large treatment centres in Pakistan. The centre staff reviewed records to identify those not in care for > 6 months and from September 2020 to May 2021, the APLHIV tracked them through telephone calls and home visits to re-engage them into care. We used SAS version 9.4 to analyse the data and univariate logistic regression to identify factors associated with disengagement and becoming untraceable.

Results: Among the 4184 PLHIV registered (74% male), 36% (1517) (83.9% male, 15.4% female, 0.7% transgender) had disengaged from care. APLHIV members tracked 696 (46%) of them; 295 (42%) were deceased and 325 (47%) were re-engaged into care. Reasons for disengagement were long distance from the ART centre or lack of resources (45%), injecting drug use (19%), adverse effects of antiretroviral therapy (9%), disinformation (9%), no male family member to accompany them to treatment centre after the death of husband (3%), and no reason given (15%). Injecting drug users and males were more likely to be lost to follow-up, and males were more likely to be untraceable.

Conclusion: This community-led intervention successfully re-engaged many PLHIV into care. The community-led re-engagement intervention should be upscaled to reduce loss to care and follow-up in Pakistan, especially among injecting drug users and male PLHIV.