Supporting long-term engagement in HIV clinical care: Learning from the COVID-19 pandemic

SHIELD is a London-based study of engagement in HIV clinical care during and after the COVID-19 pandemic. We document the characteristics of service users who either re-engaged or disengaged with HIV care, together with reflections of HIV clinical service-providers to inform recommendations that address care retention for the long term.

Using an exploratory mixed methods approach, service-users aged ≥18 years who re-engaged (1 March 2020-31 August 2020) or disengaged from clinical care (no contact with service 1 March 2020-28 February 2021) at 8 London HIV services were identified by retrospective records review. Demographics and clinical data were summarized descriptively. For people who re-engaged, follow-up data were collected at 24 months and in those who disengaged, at a single timepoint (1 March 2023). Semi-structured interviews with clinic staff were analysed thematically.

There were 122 people disengaged and 89 re-engaged. In those who re-engaged, a 24-month follow-up showed 71.3% on antiretrovirals, 63.6% virally suppressed and 67.9% had a future clinician appointment booked. For people who disengaged, by 1 March 2023, 21% were on antiretrovirals and 27% had a future appointment booked. Interviews with 11 service providers explored COVID-19's impact on clinical services, multilevel interactions that influenced engagement, and approaches to re-engaging people.

We found that COVID-19 exposed existing vulnerabilities deterring access to HIV clinical care, as well as being itself an additional factor. For some people, the pandemic provided an opportunity to re-engage. We recommend that retention in care is prioritized in policy and financially, that clinical services provide holistic person-centred care, and improve ways to identify those who leave care.