Providing a person with HIV infection engages with specialist care and achieves sustained HIV suppression with antiretroviral therapy (ART), morbidity is greatly reduced, life expectancy approaches near normal and the chance of onward transmission of HIV is significantly decreased.   During 2013, an estimated 1212 people with diagnosed HIV in Australia were not engaged in care.
Poor retention in care predicts poorer survival with HIV infection. A retrospective analysis of HIV positive outpatients in Europe found those who missed visits within the first year after initiating ART had more than twice the rate of long-term mortality, compared with those who attended all scheduled appointments (2.3 deaths per 100 person-years for patients who missed visits vs 1.0 death per 100 person-years p = 0.02 for those who didn't).
Disengagement can happen at any point in the continuum of care but the time of diagnosis represents a particular time of danger.
Failure to engage with (or remain) in care is multidimensional and multifactorial (Table 2).
|Table 2: Failure to engage: patient characteristics |