Evidence-Based Interventions for Improved HIV Care Engagement & Retention: Preliminary Implications for the Holloway Community Program

• Aanya Gupta, Neuroscience, Duke University

• Wayne Duffus, Holloway Community Program, ChristianaCare

In recent decades, human immunodeficiency virus (HIV) has become increasingly more manageable due to advances in antiretroviral therapy (ART). However, patient disengagement remains a major barrier to effective medical treatment. Care engagement (participation in care) and retention (continued engagement over time) are crucial in reducing mortality and transmission as well as maintaining viral suppression in HIV patients. To combat disengagement patterns, community HIV programs play crucial roles by supporting patients’ long-term involvement. Before implementing interventions to improve any deficient engagement rates, it is pivotal to understand which factors present themselves as the biggest barriers preventing patients from receiving proper, continuous care. ChristianaCare’s Holloway Community Program provides multidisciplinary services to support approximately sixty-five percent of HIV-positive Delaware residents. The Holloway Program defines care engagement as having at least one laboratory test or clinical visit every six months over a three-year period following linkage to care. Although no universal definition for retention or engagement is observed, studies show that patients consistently reach criteria for disengagement across the various definitions used by HIV programs. Dr. Wayne Duffus, an infectious disease specialist within the Holloway Program, conducted analyses that evaluated structural, demographic, and clinical factors associated with patterns of HIV care engagement and retention, highlighting loss-to-follow-up (LTFU) patients. Monitoring these patterns helped identify predictors of disengagement and opportunities for interventions to enhance care. To support at-risk populations in overcoming barriers that limit optimal engagement, this study evaluates evidence-based interventions working towards improved retention—specifically those that address the barriers identified by the Holloway Program. This paper synthesizes evidence from a structured literature review to qualitatively dissect barriers to care engagement and retention while summarizing effective interventions that help improve outcomes. Ideally, preliminary findings will assist in the development of an evidence-based framework that can be implemented in community HIV programs including the Holloway Program.