A research framework to support re-engagement and continuous engagement in HIV care

Globally, in 2024, 87% of all people living with HIV knew their HIV status, and among people aware of their status and on treatment, 94% were virally suppressed. As progress is being made to reach the UNAIDS 95-95-95 targets, one of the key public health challenges for HIV lies in optimising continuity of care and effectively re-engaging people out of care. Across settings, up to 40-50% of individuals diagnosed with HIV are disengaged from HIV care. Delaying or discontinuing HIV treatment can negatively affect health outcomes at the individual level, including increasing viraemia and mortality, and increases the risk for ongoing HIV transmission at the community level. In addition to the scarcity of HIV research focusing on continuous retention and re-engagement, there are also methodological gaps interfering with our ability to better understand and intervene. This Viewpoint emphasises the importance of more nuanced distinctions of concepts related to disengagement and re-engagement, balancing data harmonisation with flexibility to facilitate evidence generation and collaboration, and identifying and testing re-engagement interventions. Developing a global research agenda, along with methodological guidance, would assist in moving synergistically and intentionally towards a comprehensive approach to re-engagement.